1. Thesis Submitted In Partial Fulfillment
Of the Requirements for the Degree of
Masters of Communication
Quincy University
December, 2015
Athletes and the Willingness to Play
Through Pain and Injury and the
Culture Affects Their Decision Making
Process
By: Mitchell Leppke
Quincy University

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Abstract
There is a culture among athletes that have been created, one of toughness, respect and a sense of
duty to play through pain and injury. Looking into the specifics of this culture, the different
variables that may affect the athlete’s decision-making progress such teammates, coaches and
their families to find why they are putting themselves in harm’s way. To better understand what
the athlete is willing to put them through, one must also understand the specifics of one of the
most dangerous injuries in athletics, concussions, to get a sense of what the athlete is willing to
risk by continuing to compete through competition. Finding that the athlete is willing to sacrifice
long-term health, it was found that the athlete themselves are the ones they believe they are being
influenced by.There is a culture among athletes that has been created, one of toughness, respect
and a sense of duty to play through pain and injury. Looking into the specifics of this culture, the
different variables that may affect the athlete’s decision making progress such teammates,
coaches and their families to find why they are putting themselves in harm’s way. To better
understand what the athlete is willing to put themselves through, one must also understand the
specifics of one of the most dangerous injuries in athletics, concussions, to get a sense of what
the athlete is willing to risk by continuing to compete through competition. Finding that the
athlete is willing to sacrifice long term health, it was found that the athlete themselves are the
ones they believe they are being influenced by.

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Table of Contents
Abstract…………………………………………………………………………………….Page 1
Introduction………………………………………………………………………………...Page 2
Athletic Culture and the Variables that Affect It Athletics Cultuee…………..………..Page 4
Athletes and Team Cultural Influences………………………………….……….Page 5
Family Influence on the Athlete………………………………………….……….Page 7
Coaches Influence on the Athlete…………………………………………..……..Page 8
Specific Injury in Athletic Culture………………………………………………..……..Page 11
Concussion Symptoms…………………………………...……………………….Page 12
Second Impact Syndrome……………………………………………………......Page 13
Concussion Rates in Athletes…………………………………………………….Page 13
Acknowledged Risk……………………………...……………………………….Page 14
Hypothesis………………………………………………………………………………...Page 16
Method…………………………………………………………………………………….Page 16
Results……………………………………………………………………………………..Page 20
Continued Results……………………………………………………………...…Page 22
Concussion Results…...…………………………………………………………..Page 24
Discussion…………………………………………………………………………………Page 24
Conclusion…………………………………………………………………………….......Page 27
References …………………………………………………………………………..…….Page 29

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Athletes and the Willingness to Play through Injury and the Culture Created By Themselves,
Coaches, Teammates and Athletic Trainers
Introduction
To be successful in athletics, there are traits that are taught and driven into the mind of
athletes from when they begin their careers in youth leagues all the way into the professional
ranks if they are lucky enough to reach that level of competition. The same traits that drive
coaches, they also drive players as well. Among those being hard working, confidence, loyalty,
competitiveness, physical health, a “we not me” philosophy, etc, all found in a survey conducted
by a professor at Olivet Nazarene University in 2010 (Holstein, 2010). Athletes thrive on being
on the field, any injury that take them off the field they run the risk of losing their job. For many
athletes, playing sports are. If they are unable to perform, there is someone who is equally as
talented, if not better, waiting in the wings to take advantage of the opportunity to get on the
field. There are similar things going on in the lesser ranks as well, high school athletes are
competing in hopes of receiving a college scholarship. Losing the ability to perform raises the
risk of losing the ability to receive the rewards that can benefit athletes, from a paycheck and
athletic scholarship all the way to the popularity and adrenaline rush, athletes are driven to stay
on the field, sometimes at all costs. As a result of wanting to stay on the field, the last mentioned
trait, mental toughness, has come under fire. Being tough, being able to perform outside of the
comfort level and playing through pain and injury are a few examples of what mental toughness
has come to mean in the sports world. The question has been raised, are athletics creating a
culture where athletes are willing to risk their own health, both short and long term, in order to
stay on the field? Keeping the athlete safe and healthy during competition and post careers is one
of the most important ideals that athletics must continue to evaluate and make progress in.

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Starting with the culture of athletics and how the athlete portrays injuries, what influences their
decision-making progress, from themselves, their teammates, their coaches as well as athletic
trainers.
Athletic Culture and the Variables that Affect It Athletics Culture
The culture of athletics has greatly changed the way the institutions at all levels have viewed
them as a part of the education experience. Many schools not only shell out millions of dollars to
give students the privilege of participating in athletics but will give them class credit towards
their degree as well. Groucho Marx, an actor in the late 1930’s once joked in the film
Horsefeathers that a school could not afford both a college and a stadium and that they would
start tearing down the college tomorrow (Beyer, 2000). While this was said jokingly in a movie,
it has never seemed more relevant than it does today. Sports have become synonymous with not
only being big business, but a part of the American culture and educational experience. The
stature that athletics has risen to as a part of the American Culture is outstanding. In 2014, the
Southeastern Conference created the “SEC Network” a partnership with ESPN and CBS worth
an estimated $400 million (Glass, 2014). In 2011, a record 7.6 million high school students
participated in high school athletics across the United States (Koebler, 2011). Many young
student athletes look at athletics as a way to help get their education paid for, according to the
NCAA, during the 2013 academic school year there were 460,000 student-athletes at NCAA
institutions. Of the 460,000 athletes, roughly 53% and 56% of those who participated in athletics
at Division 1 and Division II levels respectively received some type of athletic scholarship aid.
At the Division III level, 75% of student athletes received some form of an academic grant or
need-based grant as these schools are not allowed to provide athletic scholarship (NCAA, 2014).
Despite the big business that athletics have become, the goals of the NCAA and its three

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branches remains committed that intercollegiate athletics play a supporting role in the mission of
higher education by developing the sense of community as well as strengthening the identity of
its member institutions (NCAA, 2014.) Looking specifically at the perspective from the athletes,
this section will analyze why athletes participate in sports, what influences their decision making
progress in regards to injury and the other variables that are a part of their athletic experience
such as their teammates as well as their coaches and the athletic training staff.
Athletes and Team Cultural Influences
Athletics have in a sense become a rite of passage in the American culture, with
participation at an all-time high, the athletics world has become one of the most exposed and
influential parts of young people’s lives. As a result, the culture that the athletes themselves have
created as well as the culture created by their teammates has directly changed. Research across
the field of sports psychology has found that there are significant group differences in how
athletes prioritize achievement motives, team affiliation and even social recognition created by
participating in athletics (Kolt, 1999). To better understand the psychological meaning of sports
and its influence on the mind, one must look to a study conducted by University of Portland
student Andrew M. Guest. Guest looked at two vastly different soccer teams, one being a private
University in the Midwest of the United States made mostly of middle to upper-class white
males. The other being a government sponsored University from the sub-Saharan city of Malawi
in Africa, one of the most notoriously poor communities in the entire world. The conductor of
the study based his findings on participant observation, knowing that each team was close in
terms of education and class status, the major variable in the two clearly was the cultures that
they came from. Both teams had similar age groups, through a series of interviews conducted by

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the leader of the study, found that neither team had players who spoke of continuing their careers
professionally, but to be successful businessmen, doctors, or other various trades.
These teams showed a vastly different reason for competing in athletics, as suggested by
the differences in the class standing. As suggested by Guest, he rationalized through his
interviews with the American team that they participated in sports all for similar reasons, all
relating directly to the Western meaning of sport due to the distinctive and broad ideals that
became a trend throughout his interviews. Individually he found that the athletes all played for
similar reasons which relate to the American dream, or ones individual measure of success. In
the Cultural Meaning Systems D’Anrade writes that, “Americans think that if one has ability,
and if, because of competition or one’s own strong drive, one works hard at achieving high
goals, one will reach an outstanding level of accomplishment. And when one reaches this level
one will be recognized as a success, which brings prestige and self-satisfaction (D’Anrade,
1984).” Furthermore, Guest points out that unlike most countries around the globe, the United
States integrates sports into formal education from an early age through what he calls a “nearly
professional” system of college athletics (Guest, 2007). These cultural understandings of what
Western sport means, a competitive, efficient, learning the intrinsic values of competition, team
building and educational practice help us understand what could possibly the key to
understanding the reasoning behind the athlete and their individual willingness to play through
pain and injury.

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Family Influence on the Athlete
The influence family has on the development of children and how they are raised has widely
been published as young minds are particularly impressionable, especially by those whom they
are dependent on. The question to answer now becomes how families are influencing their young
athletes during their athletic careers. Parents have a front row seat to be the most influential part
of young athletes development, as many are not only their parents, but also fit into the role of
coach, chauffer, financier, spectator and even cheerleader (Weiss, 2004). Parents have been
found to adjust their own personal beliefs and behaviors as a result of their children’s own
characteristics. Parents begin exposing their children to athletics in a variety of fashions, such as
buying toys and sports equipment, signing them up for sport specific lessons, taking them to
sporting events and putting them into age-specific teams and leagues. Weiss found that parents
influence the motivation of young athletes by providing different levels of encouragement to
participate in athletics. It was not shocking that Weiss found that punishment of the child in any
capacity related to athletic performance made it less likely that child would participate in
athletics in the future. However, it was less clear whether positive reinforcement increases the
child’s motivation to participate in athletics. Weiss found that the parental influence was not as
much as it was their individual beliefs or values but a much larger social context. For example,
the education, income, employment status, number of children in the family and neighborhood
resources were much more influential in the parent’s ability to influence their children to play
athletics rather than their own core values.
For families who were well off financially, or lived in a good neighborhood, it is much
easier for them to find the resources for their children rather than a family who lives in a
disadvantaged area or economic situation (Weiss, 2004). As far as the core values influencing

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young athletes in relation to athletics, Weiss summarized the following facts from his studies. He
found that the higher the parental pressure was in regard to the expectations of the young athlete,
it led to several negative outcomes for the child such as stress, anxiety, and even burnout (Weiss,
2004). This can be attributed to the child’s fear of letting their parents down. As far as the
relation to families, Weiss did not have any specific research regarding the two, but he did find
that an over-involvement form parents has contributed to a negative emotional connotation
between the athlete and their sport, which led to athlete burnout (Weiss, 2004). Perhaps it can be
inferred that if an athlete has developed a negative association with their parents relationship to
their athletic career, they are more likely to miss time from injury as a result of the burnout and
enjoy the time away from the anxiety created through the relationship with their parents.
Coaches Influences on the Athlete
All athletes across the country have been exposed to a variety of different people, not
only their friends and family, but their coaches. Coaches across all sports have a different set of
values and belief system that helps mold the minds of young athletes by exposing them to
challenges and in the mind of the coach are developing a whole person while developing a great
athlete as well. A study done by Lindsey Blom of Ball State University looks closely at this
relationship between player and coach. Before looking further into her study, it is important to
note that nearly 60% of all literature on coaching science has taken place within the last twenty
years, and 20% of that literature has been specifically on the coach and athlete relationship
(Gilbert & Trudel, 2004). Coaches occupy a very specific space in the lives of athletes, their
influence has been found not only in the playing field, but the traits they are asking their athletes
to play with are carrying into the everyday lives of the athlete as well (Jones, Armour, Potrac,
2003). Research has also shown that young athletes who believed that their coaches gave them

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positive feedback and those athletes that found the perceptions of the coach’s behavior to be
encouraging had a better sense of motivation and confidence which was in line with having a
positive performance in their given sport (Black, Weiss, 1992. Allen, Howe, 1998). Blom’s study
looks directly at the coach/athlete, athlete/coach relationship and how the two intertwine with
each other. Using the Sport Interpersonal Relationship Questionnaire, (SIRQ), Blom used one of
the three questions created by Wylleman, De Knop, Vanden Auweele, Sloore and De Marelear
(1995) the SIRQ-AC, which as expected, focuses directly on the athlete coach relationship. The
questionnaire was composed of eighty questions, the first forty focusing the athlete towards the
coach relationship, while the last forty questions flip the direction of the relationship and look
towards the coach’s relationship with the athlete. Each set of questions was derived to closely
examine the relationship between the two and how they perceive the relationship. The athlete to
coach category included subjects such as having a closed attitude, acceptance and assertiveness.
On the other hand, the coach to athlete relationship questions looked criticizing, caring and
permissiveness behavioral questions. Focusing on two different hypotheses,
Blom developed in making her survey so that it may be beneficial to the coaches and the
athletes. First, she states that it was hypothesized that players with coaches received the “PASS
IT Back” Program, Progress and Success through Interaction Training and Feedback (Mallet &
Cole, 2006) would report a substantial improvement in their own socio-emotional behaviors such
as having closed attitudes, acceptance, assertiveness, caring, etc… while her control group would
show no changes. Secondly, as a result of these changes made by the coaches, it was
hypothesized that athletes in the education group and those affected by coaches in the “Pass IT
Back” program would have a significant increase of their perception of their own personal
enjoyment, satisfaction of their experience, improved self-confidence as well as in increased

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inter-team bond over the testing period while the control group would not experience any change
(Blom, 2010). After the survey was conducted, coaches were given the results and individually
interviewed and read the results of their survey. Coaches found the results of the survey to be
very helpful, several coaches made noted comments to take several different approaches to
reaching their players. Several coaches as a result of the survey even added a self-monitoring
form to their repertoire to give their players, as it becomes a great way for them to be self-aware
of their coaching behaviors.
Summarizing the coach’s reactions to the survey as well as the newly implemented self-
monitoring sheets, it was found that the information provided by the survey was very helpful to
developing a better relationship with their teams and with their athletes on an individual basis
(Blom, 2010) as it gave them a tool on how to work to improve their coaching and the athlete
experience. Using the Mallet and Cole three step model which was developed in 2006, which is a
series of questions and interviews between both coaches and players (Mallet & Cote, 2006) a
significant increase in not only the coaches improved self-awareness, but the athletes showed a
higher sense of self confidence, bonding within a team atmosphere as well as noticing increases
in their own coaches own social behaviors. While there is no single model to truly measure what
is effective coaching, it is clear that the relationship between coaches and athletes is directly
intertwined. The connection between how athletes perceive their coaches are clear as well is the
influence that coaches have on not only athlete’s performance, but their own personal wellbeing
as well.

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Specific Injury in Athletic Culture
As the different variables that athletes are exposed to throughout their athletic careers and
how their relationship affects their careers, it is time to look at a specific injury, in this case,
concussions. A very dangerous injury, it is one that has come to the forefront of athletic trainer’s
attention and has become a mainstay in the national media as well. Looking at the specifics of
this injury will help create a greater understanding of what athletes have been willing to put
themselves at risk. To better understand the culture, one must understand what the athlete is
willing to put themselves through in order to remain on the field of competition. The Center for
Disease Control and Prevention describes concussions as a traumatic brain injury or TBI. Caused
by a bump, blow, or jolt to the head or body a concussion can change the way the brain normally
works (Concussion, 2012). When a concussion occurs, the brain and head have moved rapidly
back and forth, causing the brain to bounce and twist in the skull, damaging brain cells and
causing chemical changes. This injury can come from something as simple as bumping your
head in your kitchen, to whiplash in a car accident or from hitting your head on the court or field
during competition. According to a neuropsychologist, at the University of Denver, it was found
that a concussion occurs at roughly 95 G’s (Most, 2010). A “G” is a unit of measurement that is
equal to the force of being pulled by gravity (University of Denver, 2010). Therefore, in most
cases someone who has suffered a concussion has had their brain become subject to forces
equivalent to 95 times of gravity’s pull. Again, to better understand why athletes are willing to
put their bodies through to stay in the game, one must be aware of the risk they are putting upon
themselves and the injuries they are subjecting themselves too. In this case, having a better
understanding of concussions and the risks that are associated with them will create a more
thorough development of the idea of playing through injury.

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Concussion Symptoms
As previously stated, a concussion is a Traumatic Brain Injury (TBI), is when the brain
and head is moved rapidly back and forth, causing the brain to bounce around or twist inside the
skull, stretching and damaging the brain cells and also creating chemical changes inside the
brain. The brain works incredibly hard to maintain a delicate balance with the chemicals that are
part of what control our behaviors and reactions. Inside the skull, the brain is surrounded by
spinal fluid that protects it from the skull as well as small bumps and jolts it may sustain
throughout the course of day to day activity. When the brain is jolted around and damage is done
to the spinal fluid, the chemical compound is altered and can cause damage to the
neurotransmitters, chemicals that send messages to other parts of the body (Hospitals, n.d.).
These chemical changes can cause the brain to become more sensitive to any increased stress or
injury until it is fully healed and are the main cause for the physical side effect of concussions
(Mild, 2015). Some common symptoms that occur immediately after the injury include the
following, headaches with a feeling of pressure in the head, a temporary loss of consciousness,
dizziness or the effect of “seeing stars” , ringing in the ears, vomiting, slurred speech and fatigue.
There are also symptoms that are longer term as a result of the injury, not occurring for hours or
days after the injury. They are concentration and memory complaints, irritability and personality
changes, sensitivity to light and noise, changes in sleep patterns, depression and changes in tastes
and smells.

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Second Impact Syndrome
Concussions are usually not life threatening, but if not treated correctly the victim is at
risk for Second Impact Syndrome, where a person gets a second concussion before the first has
fully healed. The brain is at a higher risk following the original injury, and a minimal amount of
force can cause irreversible damage. The brain has an innate ability to control the amount of
blood that is allowed to it when it is damaged it can result in increased cerebral blood volume
which causes brainstem herniation and death. There are also symptoms of SIS, the victim may
not lose consciousness, but appear stunned, if they are still standing after the initial impact, they
will collapse within minutes. Following the collapse, the condition worsens rapidly, they will go
unconscious, lose control of eye movement, have dilated pupils, are at a high risk of coma,
respiratory failure, and death. CPR and standard emergency medical care must be provided
immediately if the victim has any chance of surviving (Ziegler, n.d.). Athletes can go from being
a star to being disabled and be taken care of by their family members, such as the case of a
former Idaho four-sport high school athlete, Kort Breckenridge. He hid the remaining effects
from his first concussion, got hit during a game, and his life changed forever. After waking from
a two-week induced coma by doctors, he was able to faintly recognize his own family members.
Despite still being on the road to a full recovery, says he still would choose to play football, but
wishes that he had been smarter about how he handled his situation (KnowConcussion, n.d.).
Concussion Rates in Athletics
Looking into concussions at all levels of play, ClearedToPlay.org reported the following
statistics in 2014. In the year 2010, there were 120 sports-related deaths among the youth of the
United States and roughly 8,000 youth are treated per day in the emergency rooms of local

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hospitals for sports-related injuries. Surprisingly, female soccer athletes suffer an astounding
40% more concussions than males, an average of 29,000 per year. Continuing along the lines of
female sports, female basketball players suffer an incredible 13,000 concussions per year, 240%
more than male basketball players. Athletes who participate in football and suffer a concussion,
there are 15.8% of athletes lose consciousness and will return to action during the same day. The
most disturbing piece of information publicized by CleardToPlay.Org states that only 42% of
high schools have access to athletic training services. The same study, conducted in 2011,
showed that of high schools with at least one certified athletic trainer that of the entirety of
injuries reported, concussions accounted for 15% of those injuries (Statistics, 2013).
Acknowledged Risk
Every player who steps onto the field of competition is acknowledging the risk of injury.
Sports require the body to move violently, and some require a high rate of contact, such as
football. With the National Football League’s popularity being at an all-high, it is home to some
of the biggest, fastest, and strongest athletes in the world who are more than willing to risk their
bodies for gridiron glory.
The National Football League is at risk of losing several billions of dollars in lawsuits
from former players for how organizations handled concussions during their career. Jim
McMahon, the quarterback on the 1985 Super Bowl Champion Chicago Bears is battling the
early onset of dementia, a progressive decline in cognitive function due to conditions that have
affected the brain (Dementia, 2008). The Chicago Tribune quoted McMahon in saying, “My
memory is pretty much gone, I walk in a room and forget why I walked in there. I'm going
through some studies right now and I am going to do a brain scan. It's unfortunate what the game

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does to you.” That quote is enough to make you wonder why people continue to put themselves
at risk. The NFL has even amended rules to attempt to make the game safer by fining and
suspending players for hits that affect the head. Despite his condition, McMahon was quick to
defend the same game that has ruined his life that he loved and played for so long. Compared to
the current procedures in evaluating head injuries, McMahon said “Back then, all they did was
tape an aspirin to your helmet and go back in.” and he is currently listed on a class action law
suit against the league for negligence on how his concussions he suffered during his playing days
were treated.
There are even cases of retired players who have killed themselves from depression from
multiple concussions, in their suicide notes they have even requested that their brains be donated
to science, so that the long-term effects of concussions may be studied. James Harrison, a former
NFL Defensive player of the year, and current Pittsburg Steeler outside linebacker reported
recently to ESPN that he estimates that he has fought concussion-like symptoms in the “double-
digits” throughout his career. Harrison and roughly one hundred other NFL players added a layer
of CRT padding to his helmet, a material made of military grade Kevlar. Since adding this, he
claims to not have seen any spots or momentary blackouts during games anymore. While other
players worried about the added three to four ounces of weight to their bodies, Harrison said that
“To protect my head I’d take a pound more (Associated Press, 2008).” Harrison, who is known
as the one of the fiercest hitters in the NFL and has received fines for some of those hits, is
becoming a shining example for the league on keeping their athletes safe on the field while
maintaining an exciting brand and product to put on the field every fall.

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Hypothesis
Looking at the aforementioned information, my question before beginning this project
was “What is truly affecting the athlete’s decision-making progress when deciding to play
through injury?” As a result, I had to look at the different variables they are exposed to and study
how they are affected by said variables and the psychology of those relationships. Hypothesizing
that “If an athlete suffers an injury, then they will be willing to play through pain and injury on
their own personal beliefs rather than be influenced by the different variables they are exposed
to.” Further investigating this matter was of utmost importance.
Method
Participants
To best find the information needed to look into my hypothesis, I ultimately decided I
needed to look a very large scope of athletes to gather as much specific information to athletes,
in general, rather than narrow it down to a specific sport or age group. With the intent of finding
having a minimum of 100 participants in my survey, 125 total participated and answered a
minimum of one question. The target audience for the desired information was any current or
former athlete, both men and women who are over the age of 18 were allowed to participate in
the survey and participated on their own recognizance. Respondent ages and sexes are
represented below in Table M-1.

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TABLE M-1
GENDER – 122 Respondents
Male – 47 (38.52%)
Female – 74 (60.66%)
Prefer not to Disclose – 1 (.82%)
AGE – 122 Respondents
18-22 - 28 – (22.95%)
23-30 – 38 – (31.15%)
31-40 – 25 (20.49%)
41-50 – 12 (9.84%)
51+ - 19 (15.575)
A minimum competition level was established as well, they had to have participated in
was high school or club sports equivalent. This minimum level of the sport was chosen based off
teenagers beginning to make their own decisions yet while being highly impressionable by the
variables they are exposed to. 122 respondents indicated the highest level of competition they
participated in, the distribution of level of competition can be found in table M-2 below.
Table M-2
Participant Highest Level of Competition – 122 Respondents
High School – 45 – (36.89%)
College – 74 – (60.66%)
Professional – 3 – (2.46%)
One hundred and twenty five people participated in the survey during the duration of research
period and answered a minimum of one question to have registered as an anonymous participant.

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Method
Gathering information came in the form of a twenty-six question survey distributed on
two social media websites over a two-week long period. Facebook via sharing of the link as well
as Reddit, an online community with various forums specific to one’s own interests, these
websites provided a very quick and efficient way of the survey getting to a large number of
people in my selected target audience. Containing a variety of multiple choice questions as well
as open-ended questions, it was my intention to get very specific information regarding the
athletes and their thought process, as well as allow them to give their own personal feelings and
feedback to some of the different topics that the survey covers. Questions sought feedback based
on their relationships with the different variables they are exposed to, their thought processes
when dealing with an injury, injury specifics as well as their current status as to playing through
pain and injury. This target audience being very general as well as the questions posed to those
who participated in the survey allowed me to gain a better understanding of what the “athlete”
feels regarding their decision-making process to play through pain and injury by not limiting
myself to a single sport. Multiple choice questions with closed answers allowed me to seek very
specific information, respondents had to choose an answer that was as close to their own
personal experiences as possible.
EX - Did you play through an injury while participating in athletics?
YES
NO
Prefer not to disclose.

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Open ended questions allowed participants to give personal feedback regarding to their
experiences and relationships, giving specifics examples or reasoning to the questions they were
asked.
EX – If you suffered an injury, please respond to the following question, if not, please
skip until the next questions. What do you believe influenced you to play through your
injury?
This model allowed me to very thorough, exploring different types of sports and looking
defining the thought process of the athlete as a whole and understanding why they play through
pain and injury.
Procedure
Beginning the data collection process began by creating my survey and then seeking
permission from the Quincy University Institutional Review Board for permission to conduct my
survey by explaining the information I was seeking to learn, letting them review my survey as
well as my intended method of distribution. Once permission from the IRB was granted, I
distributed my survey via the online social media platforms of Facebook as well as the online
forum based community of Reddit. The survey remained live from July 6, 2015, until July 13,
2015. In that time, 125 people participated in the research. When posting the survey, the
instructions were simply that you must be 18 or older and have competed in a minimum of high
school athletics or club sport equivalent.

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Results
As previously mentioned, there were 125 anonymous participants who responded to a
minimum of one question in the survey. The gender demographic came together with 74 women,
47 men and 1 participant who preferred not to disclose said information (Table M-1). The mean
age of participants fell in the 23-30-year-old age group, with a total of 38 participants in this age
group it was also the largest participant group in the survey, the age distribution chart can be
found in Table M-1 as well. The high majority of participants, 74 of 122 respondents (60.66%)
indicated that the highest level of competition they participated in was college athletics.
Participants were required to indicate what sport they played, if they indicated more than one
sport, the first sport listed was chosen in order to keep data clear (Table R-1).
Table R-1
Type of Sport – 120 Respondents
Team Sport – 101 (84.16%)
Individual Sport – 19 (15.83%)
** Participants indicated a wide variety of sports, for the purpose of this research, the definitions
of each type of sport will be as follows as sports such as tennis, wrestling and golf carry a team
concept.
-Team Sport – Any sport where there are multiple people competing on the same field of
play and the win/loss record may not be tagged to any individual person but the team as a
whole.
- Individual Sport – Any sport where an individual competitor can compete in
competition without their teammates or is solely based on the result of the individual
competitor.

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Looking at my hypothesis, “If an athlete suffers an injury, then they will be willing to
play through pain and injury on their own personal beliefs rather than be influenced by the
different variables they are exposed to,” the collected research shows that my intuition was
correct. An astounding 117 of 122 participants s reported that they played through pain and
injury while participating in athletics. When further pressed and asked, “Why do you believe you
played through pain and injury?” the results came as follows in table R-2.
Table R-2
What Influenced Athletes to Play Through Pain and Injury (115 Total Votes)
Individual values and goals – 70 (60.87%)
Family – 6 (5.2%)
Coaches – 15 (13.04%)
Athletic Training Staff – 0 (0%)
Team – 21 (18.26%)
No Injury – 1 – (.8%)
Did not Play through their Injury (1.73%)
When answering the open-ended question, athletes gave their first initial thoughts on
what they believed influenced them the most in regards to playing through pain and injury. To
categorize these thoughts and to put them into the table, I divided their thoughts and put them
into the categories seen in Table R-2. More often than not, athletes mentioned their own self-
determination, pride, and own toughness before anything else. Anything athletes mentioned such
as a “fear of losing my starting spot, playing time” or anything that their coaches directly were
able to influence was put into the coach’s category. When mentioning they felt influenced by
their teammates and families, the athlete often pointed out a close connection with one or the
other and how they did not want to disappoint that specific aspect of their athletic experience by
not playing. If an athlete mentioned more than one of the categories, the first mentioned category

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was chosen. The high majority of athletes felt that they were the ones who influenced themselves
to play through pain and injury, as stated by the hypothesis.
Continued Results (Level 2)
Some of the more interesting results came from the athlete’s perception of the different
variables they are exposed to. Athletic trainers a tool provided for the athletes that helps keep
them healthy, improves recovery time and even to reduce the risk of injury by seeking treatment
for various ailments, even for simply just being sore. When looking at what athletes experienced
with this tool meant to be beneficial to them, the responses were very interesting.
Table CR-1
Please Identity anything you experienced while working with the athletic trainers (choose
all that apply). (106 participants, 181 total votes)
I sought out help when injured – 73
The athletic trainers wanted to keep me out of participation longer then I was willing to miss. - 38
My teammates had not healed quickly from injury and I did not want to risk missing time. – 5
I sat out at the discretion of the athletic training staff – 30
The athletic training staff forced me to play – 0
I took pain killers as a result of seeking treatment – 15
I did not seek help when injured out of fear of what I would have been told. - 20
Table CR-1 shows that athletes are willing to seek help when injured, however there is a
disconnect when it comes to what the feedback provided by the athletic trainers means for the
future of the athlete. Athletes perhaps are seeing that the time period given to them by the
athletic trainers as a personal challenge to get back on the field before they are ready, and
continually putting themselves in harm’s way. When asked if athletes would be willing to play
through pain and injury again, they responded in the following matter as seen in table CR-2.

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Table CR-2
Would you be willing to play through pain and injury again?
Indicate Why or Why Not – 112 Respondents
Yes – 72 (64.28%)
No – 29 (25.89%)
Uncertain – 11 (9.8%)
Despite the suffering that pain and injury has caused, the majority of athletes are still
willing to play through pain and injury again. Many of the athletes who indicate yes still
indicated their own personal values and beliefs and that playing sports is its own reward for the
suffering they are willing to put their bodies through. Many athletes who said “No” on several
occasions mentioned the advances of modern medicine and knowledge of injuries being more
readily available to athletes today than it was 15-30 years ago. Athletes in their eyes now have a
plethora of medical information to make smart decisions when it comes to the long-term health
of their bodies. Athletes who were uncertain indicated that their decision depended on the
situation and added different variables to the question and to see if they were leaning towards
playing or sitting with an injury nearly impossible to distinguish. Clearly athletes are willing to
sacrifice their bodies for their sport, there is a feeling that what they put their bodies through is
worth it and will be rewarded in one form or another for what they are willing to do in order to
stay in the field of competition. Participants answered this as such after nearly 70 of 118 voters,
just fewer than 60%, indicated that they are still suffering from side effects as a result of their
injuries suffered in athletics.

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Concussion Results
Athletes and their concussion history did not provide an insight into their understanding
of the injury as much as I intended it to do so. This came as a result of the survey and data
collected as a result of poor questioning, not necessarily as a result of a data provided by the
athletes. Just over 33% of 121 respondents indicated that they suffered a concussion while
participating in athletics. A fairly high number, it shows that this injury is highly prevalent
among athletics and needs not only continue to be researched by scientists, but the athlete must
continue to be educated about the injury. Of those who indicated they had a concussion, thirteen
people participate in playing through their injury, six believe they are still suffering from the hit
to their head, sixteen people suffered multiple concussions and eleven were not aware that they
had a concussion at the time they received the injury. It is clear that our athletes must become
more informed about what the finer details about what a concussion is, the side effects of the
injury and how to treat it, there still is athletes who are playing or suffering from this injury and
perhaps it could have been prevented or treated properly.
Discussion
My research shows that athletes are making their own decisions to play through pain and
injury more so based their own beliefs and values rather than be affected by the different
variables they are exposed to in their niche culture. Teammates and coaches did not factor into
the athletes decision-making process to play through pain and injury as one might tend to think it
does. Fitting into the “Decision Theory” which is concerned with the choices of individuals
rather than groups or interactions of peoples whose decisions affect each other (Hannson, 1994),

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athletes tend to focus on themselves when deciding when to play through pain and injury rather
than the entire group.
Limitations
My survey had a variety of limitations that kept me from perhaps obtaining clearer cut
data to prove my hypothesis. For example, the open-ended questions required my interpretation
of participant responses, some responses were more clear cut than others. Interpreting data can
lead to statistical differences that may change the result of the data. Given the opportunity to do
the survey again, I would reduce the amount of open-ended questions and force the athlete to
give very specific and clearly outlined responses that best fit their beliefs and their thought
processes.
The target audience of my research perhaps led to unspecific results as well. While the
athlete as a whole provides an understanding of their thought process, an individual sport may
have provided a more specific answer to why they are willing to play through the pain an injury.
One sports culture may be drastically different then another and create a different atmosphere for
the athlete and affects their decision-making the process as a result.
More limitations of my survey are that it is very one-sided, the athlete themselves are the
ones making the impulse decision. While looking at several different variables, such as the
athlete’s teammates, coaches, and their families, there is no data coming from those three
variables. Perhaps, data from the three variables that were looked into would continue to concur
with the data I collected, or would show something drastically different. In another survey, I
would add teammates, coaches and families of athletes with very specific questions geared
toward gaining their insight on how they believe they influence the athlete as well as how they

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believe from their given relationship with the “athlete” as a whole, how they are influencing their
decision-making process
Implications
As a result of my research, there are different things that I would recommend to the
athletic world and those affected by it. First and foremost, I recommend that the education
athletes receive regarding pain and injury increase significantly, specifically when it comes to
injuries that carry long-term side effects such as concussions, specific ligament tears and specific
conditions that the body develops as result of continuous injury. Making athletes more aware of
the long-term side effects may make them be more cautious, seek more help from athletic
trainers as well as make smarter decisions regarding their health. This could come in a variety of
different formats. For example, this could come in a variety of different platforms such as
doctors meeting with athletes before their season, continued education in the classroom on long-
term effects of injuries, etc…
However, the one method I personally believe would be most effective is to have an
athlete educate the athlete, especially someone that the athlete respects such as a famous athlete,
one who’s information and personal experiences will resonate with the athlete and they can
develop a connection with.Athletes must continue to be educated and make informed decisions
regarding their health, if an athlete comes to the decision to play through injury it is because they
are making very well educated decision, not an emotional reaction.
Coaches, teammates, and families must be educated as well as they have shown that
while they are not the most influential part of the athletes choice to play, they are a part of the
decision-making process. Educating them on how they are influencing their athletes to play,

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perhaps through a series of seminars or educational forums as to how they are influencing their
athlete, how to have the conversation rationally about playing through pain and injury is vital to
the success to eliminate some of the long term effects that playing through injury has caused.
Even more so, coaches and families need to realize that they are in a true power position and not
to let the athlete make any type of decision that they are not mentally prepared to handle.
Coaches, teammates, and families must be educated as well as they have shown that
while they are not the most influential part of the athletes choice to play, they are a part of the
decision-making process. Educating them on how they are influencing their athletes to play,
perhaps through a series of seminars or educational forums as to how they are influencing their
athlete, how to have the conversation rationally about playing through pain and injury is vital to
the success to eliminate some of the long term effects that playing through injury has caused.
Even more so, coaches and families need to realize that they are in a true power position and not
to let the athlete make any type of decision that they are not mentally prepared to handle.
Conclusion
There is a feeling among athletes that they can compete through almost anything, willing
to put their minds and bodies to the test, they are making the decision to play through pain and
injury on their own. Despite what is known about certain injuries and conditions, athletes are
eager to stay on the field and find a way to play. Through several influences, from their coaches,
teammates, and families the athlete has a variety of different variables developing and modeling
them into the people that they are. Coaches work to develop a sense of drive and motivation
while teammates help create a bond and unity. Families give the athlete a sense of pride and self-
worth. Each having a great influencing the type of person an athlete believes themselves to be.

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However, in regards to the athlete playing through pain and injury, the majority of athletes
believe that they themselves are making the decision to continue to play and are not being
influenced by those around them, that the choice to continue to compete is their own. The athlete
has developed a very specific mindset, where they are able to tune out those around them and
find a way to compete. Very few believe that the people who they are exposed to are the ones
who are influencing them to play. Our athletes must continue to be educated and the variables
they are exposed to must continue to change and grow in order to help reduce the risk of long-
term damage to athletes as well as the integrity and sanctity of athletics intact.

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