Sport Transition Experiences Due to Spinal Cord Injury

Abstract

This study aimed to explore athletes’ experiences of transitioning out of sport following spinal cord injury (SCI). Using a multiple-case study design, three former nondisabled competitive athletes participated in one-on-one semi-structured interviews. The participants’ interview responses were informed by quantitative measure data collected prior to the interviews using the Athletic Identity Measurement Scale, the Social Support Questionnaire-6, and the Satisfaction with Life Scale. The thematic analysis of the interviews revealed that participants experienced a range of cognitive, emotional, social, and behavioral influences during the transition process. These influences contributed to outcome-related appraisals of post-SCI transition. Balanced self-identity, adaptive sport participation, and peer-mentor relationships were common factors influencing athletes’ transition with spinal cord injury. The results partially support the conceptual model of adaptation to career transition and extend it to account for athletes’ experiences following SCI. The results also benefit rehabilitation professionals and athletes with spinal cord injury by providing insight into psychosocial factors and resources that may influence the transition experience.

1. Introduction

Spinal cord injury (SCI) is an impairment that often leads to a permanent, acquired disability, affecting movement, sensation, and bodily functions [1]. These impairments can lead to conditions such as paraplegia and quadriplegia. Understanding the impact of SCI on athletes is crucial, as injuries sustained in sport and recreational activities are a significant contributor to the etiology of SCI [2]. For example, in North America and Western Europe, such injuries account for approximately 9% of SCIs; in Central Europe, about 13%; and in Southern Sub-Saharan Africa, around 5% [3]. Athletes with spinal cord injury are likely to experience a variety of associated physical (e.g., neuropathic pain, spasticity, autonomic dysreflexia, bladder and bowel dysfunction; [1]), psychological (e.g., depression, anxiety, post-traumatic stress disorder; [4]), and social (e.g., disconnectedness and perceived isolation; [5]) consequences. They may also experience loss of the ability to participate in valued activities and loss of independence in daily living [1]. Additionally, having an acquired disability presents many challenges for athletes with spinal cord injury, impacting their psychological, social, and financial well-being through barriers like inaccessibility, employment discrimination, and social stigma [6]. As a result, athletes with spinal cord injury must make significant adjustments to their daily lives to support their well-being and successful adaptation. A review by Zike et al. [7] identified numerous psychosocial factors (e.g., self-identity, sport involvement, social support, narratives) that shape how athletes adapt to SCI. Understanding how these factors impact athletes’ adaptation to the challenges of living with SCI is vital to fostering resilience and promoting overall well-being.

For athletes with spinal cord injury, the adaptation process can be further complicated by the unique nature of athletic retirement and its associated challenges. Most athletes experience athletic retirement much earlier in life than individuals retiring from non-athletic careers; therefore, athletes often need to adjust to new roles in life beyond sport. Athletes experiencing athletic retirement due to SCI may not be fully prepared to find new roles to replace those lost upon exiting nondisabled sport. Research indicates that athletes who are less prepared for retirement or lack a backup plan have greater difficulty transitioning out of their sport careers [8]. Additionally, athletes develop a unique connection to their bodies, enabling them to function as performative tools for career success in athletics. When SCI occurs, athletes whose lives revolve around the performance of their bodies may experience significant disruption to the sense of unity between their bodies and selves, leading to further challenges in adaptation [9]. Given SCI’s potential for significant physical and psychosocial impact on individuals and the unique challenges of athletic retirement, understanding the sport career transition process of athletes with spinal cord injury is important. Such knowledge can be instrumental in helping athletes with spinal cord injury better cope with their injuries and adapt to life beyond sport.

Sport-career retirement is typically described as a process (rather than a single event) of significant change and transition in an athlete’s life [10,11]. The process involves a psychological adjustment phase that varies in success [12], depending on how an individual interprets and responds to sport- and non-sport-related factors during their transition. The quality of this transition is influenced by the presence or absence of these factors and how they interact [13]. Pre-retirement planning, social support, cognitive coping strategies, a balanced self-identity, financial stability, and control over the decision to leave sport have each been found to contribute to ease of adjustment to transition and feelings of subjective well-being [13,14,15,16,17,18,19,20]. High, exclusive athletic identity and loss of self and social identity during the transition have been found to be indicative of vulnerability to career transition difficulties and maladaptive psychosocial responses [13,14,16,20,21].

One way to understand the sport-career transition process is through the conceptual model of adaptation to retirement among athletes [22] (hereafter referred to as the conceptual model). The conceptual model aims to explain how different factors and resources related to retirement adaptation may interact and determine the overall success of the transition process. The model comprises five interdependent stages [23]. Stage one outlines the reasons for sport-career retirement: age, deselection, injury, and free choice. Stage two lists factors related to the adaptation to sport-career retirement (e.g., developmental contributors, self-identity, perceptions of control, and social identity). The third stage outlines available resources for retirement (e.g., coping skills, social support, and pre-retirement planning). The model assumes that the quality or success of the sport-career retirement process depends on bidirectional interactions among the factors listed in stages 1–3; depending on the athlete’s responses, the outcome (stage four) can be either a healthy career transition or a retirement crisis. Examples of retirement crises include evidence of depression, substance abuse, and family/social problems [24]. Stage five consists of a range of cognitive-affective-behavioral and social intervention strategies professionals can implement to assist athletes experiencing sport-career transition difficulties. Support for the conceptual model has been found among former professional and college athletes who retired from sport [15,16,17,18,20].

Although reviews [13,25] have identified many studies focusing on sport-career retirement, research on the retirement of disabled athletes remains scarce [26,27,28,29]. Furthermore, little research has explored the retirement process from a sports career due to SCI [30,31,32], and no published studies have used the conceptual model to examine the retirement process specifically in athletes with spinal cord injury. Therefore, the purpose of this study was to explore athletes’ experiences of transitioning out of sport following SCI. More specifically, by using a multiple case study design, the study aimed to:

• Identify and analyze patterns in transitions out of sport following SCI.
• Examine the relationships among factors related to adaptation to transition, available resources, and the quality of adaptation to athletic retirement.
• Explore individual experiences of transitioning out of sport following a SCI to better understand how context affects complex SCI adaptation outcomes.

2. Materials and Methods

2.1. Design

This study employed a mixed-methods multiple-case study design. As defined by Yin [33], the case study research method is “an empirical inquiry that investigates a contemporary phenomenon within its real-life context; when the boundaries between phenomenon and context are not clearly evident; and in which multiple sources of evidence are used” (p. 23). This study is underpinned by an interpretivist approach (subjectivism) that involves constructing an understanding of shared social meanings and processes as perceived from different perspectives on a phenomenon, and by an ontological belief in socially constructed multiple realities (relativism). A multiple-case study design was deemed appropriate to meet the study’s aims, as this approach enabled the first author to explore a complex process of transition across varied contexts, examine similarities and differences within and between cases, and test the conceptual model across several examples of SCI [34]. Quantitative data were collected using valid and reliable measures prior to qualitative semi-structured interviews. The quantitative measure scores, which were not pooled across cases, were provided to individual participants during the semi-structured interview. The purpose of the quantitative measure scores was to prompt discussion of complex topics, inform participants’ responses to qualitative questions, and better contextualize the qualitative findings [35,36].

2.2. Author Positionality

The first author is a disabled, white, cisgender male. He has a personal history of SCI, having acquired a physical disability (quadriplegia) in late adolescence as a result of an ice hockey accident. At the time of the research, the first author was a novice researcher who brought an insider perspective of the disability experience to the study. This personal familiarity with participants’ experiences could impact all parts of the research process [37]. By having a visible disability, the first author, in acting as the interviewer, was likely treated as an insider by the research participants, thus possibly enhancing familiarity, trust, and rapport. It may have also contributed to both increased sharing and omission due to the participants’ assumed pre-interview understanding of information.

The insider perspective may have also influenced the first author’s analysis and meaning-making of participants’ accounts, potentially introducing bias and conferring additional insight and empathy. The first author’s understanding of disability is guided by the social-relational model [38] while acknowledging its shortcomings (e.g., overtly negative conceptualization of disability). Consistent with the model, the author considers disability a product of society’s micro- and macro-level attitudinal and physical constraints on top of the effects of impairment. The first author’s understanding and personal experiences are believed to have enhanced the research process, including conceptualization, data collection, data analysis, and drawing conclusions.

The second and third authors are both nondisabled, white, cisgender females with expertise in quantitative and qualitative research in sport psychology, including the psychology of injury.

2.3. Participants

Participants were included if they (a) were at least 18 years of age, (b) acquired a disability as a result of SCI, (c) participated in competitive organized sport at the time of injury, and (d) were at least two years removed from the date of injury. Participants were excluded if they (a) did not speak English, (b) sustained a SCI prior to 14 years of age, (c) had a pre-existing diagnosed disability prior to SCI, or (d) sustained a SCI more than 15 years ago.

2.4. Procedure

Participants were recruited through purposive, convenience sampling [39]. Participants were self-selected for the study through voluntary referral after receiving the recruitment letter from the University of Michigan Spinal Cord Injury Model System (UMSCIMS). Participants were informed about the study’s aims, the benefits and risks of participation, and their right to withdraw without reason. Upon giving consent, participants provided background information about demographics, injury, and sport participation. Participants then completed the quantitative measures (approximately 15 min) and returned them to the first author via email. The first author scored the quantitative measures. The first author conducted a single one-on-one interview with each participant through video call software (e.g., Skype, FaceTime). The interviews ranged from 35 to 60 min, with an average interview time of 47 min. At the start of the interview, each participant was given their final scores from the quantitative measures. These scores were used to prompt participants to reflect on specific constructs (e.g., athletic identity, life satisfaction, and social support), which were further elaborated in the interviews. Each interview was audio-recorded. Participants were debriefed following the completion of the interview process. This included a simple review of the study rationale and purpose, and asking for and answering participants’ questions.

2.5. Quantitative Measures

The following three quantitative measures were selected because they assess constructs that are key to understanding the transition process as represented by the conceptual model.

2.5.1. Athletic Identity Measurement Scale

The Athletic Identity Measurement Scale (AIMS; [40]) assesses the degree to which an individual identifies with the role of an athlete. The AIMS contains 10 items, and participants respond to each item using a 7-point Likert-type scale (1 = strongly agree; 7 = strongly disagree), with total scores ranging from 10 to 70 (lower scores are associated with a stronger athletic identity). The internal consistency of the AIMS items over 14 days was reported to have a Cronbach’s alpha of 0.93 and a test–retest reliability of 0.89. An analysis by Tasiemski and Brewer [41] supported the unidimensionality and internal consistency of the AIMS inventory among people with spinal cord injury. The original scale (AIMS) and a retrospective version of the AIMS (AIMS-r) were used in this study. The retrospective version was identical to the original scale, with the exception that the frame of reference for participant responses was immediately preceding the occurrence of SCI, and items were adapted to the past tense (e.g., the item “I have many goals related to sport” became “I had many goals related to sport”). Previous studies have used the AIMS retrospectively [42] and specifically with retired athletes [21].

2.5.2. Social Support Questionnaire-6

The Social Support Questionnaire-6 (SSQ-6; [43]) aims to measure athletes’ available social support resources and their satisfaction with that support. The SSQ-6 contains six items assessing two dimensions: (a) the number of available sources of social support an individual has and (b) the level of satisfaction with the overall support that is available to them. The first dimension (SSQ-N) asks the participant to list all the people they know whom they can rely on for support in the various ways described. The SSQ-N dimension is scored by adding the total number of people for each item (max = 54) and dividing the sum by six. The second dimension (SSQ-S) uses a 6-point Likert scale (1 = very dissatisfied; 6 = very satisfied). The SSQ-S dimension is scored by adding the total satisfaction scores for each item (max = 36) and dividing by six. The SSQ-6 has demonstrated adequate internal reliability (consistency score range 0.93 to 0.96; [43]).

2.5.3. Satisfaction with Life Scale

The 5-item Satisfaction with Life Scale (SWLS; [44]) measures aspects of subjective well-being, including life satisfaction as a cognitive-judgmental process. The SWLS contains five items, and participants respond to each item using a 7-point Likert-type scale (1 = strongly disagree; 7 = strongly agree), with total scores ranging from 5 to 35. The SWLS has shown strong internal reliability and moderate temporal stability. Diener et al. [44] reported an alpha coefficient of 0.87 for the SWLS and a test–retest stability coefficient of 0.82.

2.6. Semi-Structured Interview Guide

This study adopted a theory/empirical evidence-guided research approach to instrument construction to ensure the interview would purposefully capture what is already known about the topic [45]. The development of the semi-structured interview guide (see Appendix A) was informed by the literature on sport career transition, including the conceptual model [22], and relevant constructs. To obtain a more comprehensive understanding of the transition experience, questions were designed to be open-ended and flexible and elicit participant responses that bring up additional, unexpected insights that current theory/empirical evidence may not account for. Semi-structured interviews are standardized to some degree, which preserves a degree of comparability across interviews [46]. The interview guide was used to initiate flexible discussion toward the direction of the participant’s choosing. Questions were divided into five sections: (a) the events preceding and immediately following their injury (e.g., What were your immediate concerns/worries when your SCI occurred?), (b) psychosocial factors (e.g., Did you experience any significant social changes when withdrawing from participation in nondisabled sport?) and available resources related to adjustment to career transition (e.g., What coping strategies did you utilize?), (c) how individuals perceived the quality of adjustment to career transition (e.g., Given your experience, how would you describe a healthy sport-career transition after SCI?), (d) methods of intervention used during career transition distress (e.g., Did you experience any difficulties while moving from nondisabled sport participation to your current role?), and (e) well-being (e.g., What did you need after your sports career ended to give your life meaning and satisfaction?). Participants were asked three questions about how their quantitative measure scores capture their transition experience (e.g., How do your AIMS scores illustrate how you identify as an athlete both pre- and post-career transition/spinal cord injury?). Before each question related to the quantitative measure scores, participants were briefed on the meaning of their scores according to the respective measure scoring criteria.

2.7. Research Quality

The authors engaged in strategies to enhance and ensure study quality. The first author engaged in reflexivity and critical self-reflection regarding potential biases or predispositions they may bring to the study [47]. The first author maintained an open dialogue with the second author throughout the research process in regular reflexive meetings to evaluate the progress to date and check for potential bias. In data analysis, the first and second authors discussed themes constructed from each case. The second author acted as a critical friend [48] during data analysis, encouraging reflection upon analytical explanations and interpretations and challenging the construction of knowledge to ensure themes were coherent and constructed from the data rather than driven by the conceptual model.

2.8. Analyses

All quantitative measures were scored according to their respective scoring guidelines. The interviews were transcribed verbatim, and participants were given pseudonyms. As is typical in multiple case studies, a within-case analysis was conducted to “provide a detailed description of each case and themes within the case” [49] (p. 101). Data analysis was guided by a combined deductive and inductive-thematic approach [50,51]. This process involved using deductive coding for established areas while remaining open to any new information and potentially unexpected insights. First, the participant transcripts were combed through and coded for meaning. This approach meant codes and patterns recognized within the data were constructed into themes that became categories of analysis. This process involved carefully reading and re-reading participant responses before identifying important and meaningful codes. Shared meanings interpreted across individual codes were located and grouped into patterns of data. These constructed patterns came to characterize coherent, consistent, and distinctive themes [51]. Thematic analysis is an iterative process. Previous stages were revisited before proceeding further. Within-case analysis of each case was followed by a thematic analysis across the cases [49]. The established intra-case themes were subjected to inductive cross-case analysis. The integrated data suggested broader categories of analysis that cut across cases.

3. Results

Participants were males who acquired an SCI and subsequently transitioned out of nondisabled competitive sport (N = 3 Caucasian males; M_age = 27.3 years; M_{age at injury} = 23.3 years). At the time of the injury, all participants were at least 18 years of age and had acquired an SCI within 2 to 6 years before study participation. Participants are referred to by the pseudonyms of Andrew, Brad, and Chris. Andrew and Brad were injured while competing in a sport, while Chris sustained the SCI outside of sport participation. All had completed at least a high school level of education at the time of SCI. Both Andrew and Brad now identify as paraplegic. Chris now identifies as quadriplegic.

3.1. Quantitative Measure Scores

Quantitative measure scores are presented in Table 1. For the AIMS [40], the scores reported by Andrew, Brad, and Chris suggest that, from retrospectively pre-injury to the time of the interview, there was no change, a somewhat negligible decrease, and a small decrease in athletic identity, respectively. For the SSQ-6 [43], the scores reported by Andrew, Brad, and Chris suggest that all participants were satisfied with their average number of sources of social support. For the SWLS [44], the scores reported by Andrew, Brad, and Chris indicate satisfaction with life, extreme satisfaction with life, and satisfaction with life, respectively.

Table 1. Quantitative Measure Scores.

Participant	AIMS	AIMS-r	SSQ-N	SSQ-S	SWLS
Andrew	31	31	3.83	5.50	28
Brad	28	24	5.33	5.83	31
Chris	68	57	9	6	26

Note: AIMS = Athletic Identity Measurement Scale, AIMS-r = retrospective version of the Athletic Identity Measurement Scale, SSQ-N = number of available sources of social support, SSQ-S = level of satisfaction with overall support available to them, SWLS = Satisfaction with Life Scale.

3.2. Qualitative Findings

What follows is a narrative of the themes constructed from the interviews with Andrew, Brad, and Chris.

3.2.1. Change

The transition narratives of Andrew, Brad, and Chris were characterized by change, which took two forms: adaptive changes and career changes.

Adaptive changes refer to the cognitive, affective, and behavioral responses to injury and the participants’ coping responses to physical impairment. The sudden, unexpected nature of the change in circumstances initiated by SCI was difficult for the participants to deal with. Brad stated that, because he was “blindsided” by the change, it took a long time “for some things to really sink in.” Chris had just ended his sports career, graduated from high school, and was preparing for college. He felt that managing each of these transitions and the suddenness of it all was tough. He acknowledged that having more time to adjust and regaining more independence could have made for an easier transition. Brad felt that he struggled with managing his emotions and communicating his feelings: “I think I just kind of internalized a lot and rather than talking about them or letting myself express them, I kind of just packed it all in and shut it up tight.” He said, “I didn’t have any other way that I knew of to deal with it.” While Brad found it difficult to deal effectively with emotional discomfort, he also explained that his willingness to “put myself out there and not be embarrassed if I fell… you know, I didn’t get embarrassed easily” allowed him to cope with social situations in which his disability was salient.

All the participants described experiencing a drastic disruption in their physical capabilities as well as bodily obstacles they have had to learn to manage due to impairment (e.g., bowel and bladder incontinence, spasticity, and pressure sore susceptibility). Andrew detailed how his health was initially severely affected by pressure sores, which significantly limited his activity involvement. Chris stated that his loss of functioning and the resulting loss of independence led to a necessary reliance on others for tasks of daily living, “like getting up in the morning and going to bed at night.” To compensate for his loss of physical capabilities, Andrew said he needed to plan more for activities, focusing on only a couple of tasks or activities at a time. He also described how he gradually developed his independence to swim without using his lower body:

Just getting comfortable, you know, getting out of my chair and into the pool and comfortable with doing the swim without using my legs and getting comfortable getting out of the pool. And then doing that all on my own to where I wouldn’t need a lift to get me in and out.

Career changes detail the impact of injury on career pursuits and the adjustments participants made to continue these pursuits. All the participants indicated that returning to school or work to continue their career pursuits was a major concern. Brad desperately did not want to give up dental school, so he resolved “to do everything and anything I needed to do in order to still become a successful dentist.” He decided not to take time off from school to focus on rehabilitation. Instead, he resolved to engross himself in schoolwork:

I think not taking a year off was a coping method for me. Because I was so crazy busy to make up… probably that second part of the semester of dental school during the hardest semester that I didn’t have time to think about anything else other than schoolwork. And I think it was just a really good thing for me to do.

Similarly, Chris directed his focus toward getting back to school:

It was my main goal and sort of thing keeping me focused. And also sort of like functioned as a coping mechanism. And so, in terms of transitioning through another occupation, it was really just trying to get back to school as the best way to start all of those processes over again.

Given their loss of physical functioning, the participants did not know whether they could return to the roles they occupied before injury. Brad stated that he was fortunate to have access to adaptive technology provided by his school and workplace, allowing him to continue pursuing a dental career. Andrew had to pivot to an alternative role due to his loss of functioning. However, he gained comfort from the assurances of his employer that his work would remain largely unaffected upon his return. Once he ascertained what he was capable of, he was comforted knowing, “I’d be able to get the job training and get back to work, and I had full use of my arms and hands… So, I knew I wasn’t in that bad shape relative to what it could have been.”

To compensate for his impairment, Brad stated that he had to change how he approached his work; he had to be better, more conscientious, and more efficient than his peers. In the end, he stated that securing a residency was a “huge” achievement for him and that it had a positive emotional impact on him.

3.2.2. Significance of Sport

Sport was significant in the lives of Andrew, Brad, and Chris. Both Andrew and Brad believed that sports involvement was a necessary feature and positive influence in their lives. This belief influenced their subsequent participation in adaptive sports. When asked how their AIMS scores (i.e., Andrew [AIMS = 31, AIMS-r = 31], Brad [AIMS = 28, AIMS-r = 24]) illustrate their athletic identity, both Andrew and Brad explained that it was indicative of how important sport was to them. However, they also believed their scores illustrated the balance they maintain between sport and other life roles. Brad said that he now has more roles and responsibilities outside of sports that compete with the athlete role: “I never had the thought of giving up sports totally to strictly practice dentistry. I always knew it was going to have to be a balance between the two in my life.” After his injury, he accepted that he would not be able to return to nondisabled sport, but he was nonetheless eager to return to sport.

When asked how his AIMS scores (i.e., Chris [AIMS = 68, AIMS-r = 57]) illustrate his athletic identity, Chris explained that while he participated in high school sports for leisure, fitness, and social reasons, he never primarily identified as an athlete. Chris explained that he identified more as a student than an athlete, prioritizing academics over athletics. He did not see the loss of sport as relevant to his transition because he did not believe he would pursue professional or college athletics. More relevant to his concerns was his inability to freely participate in, and the inaccessibility of, leisure or fitness opportunities: “I always assumed I would stay active, like in outdoor sports and things. I guess it changed because I realized that some of those things wouldn’t be as much of an option.” He explained his dissatisfaction with his physical activity options: “The only activity I do physically is like FES [Functional Electronic Stimulation] bike, which is great for staying in shape, and I appreciate it for that, but it’s not exactly fun.” Chris’s perception of his inability to freely participate in sports and other activities may be due to the lack of sports and physical activity opportunities provided to disabled people. These perceived restrictions may result from negative experiences with structural disablism (e.g., inaccessible environment and equipment). He felt that his inability to participate in physical activity freely led to his essentially nonexistent identification with the athlete role post-injury. That said, Chris indicated that he missed the camaraderie, collaboration, and fitness aspects of sports. While Andrew stated that he still had social opportunities that allowed him to stay involved with his former rugby team as a spectator, he also lamented the loss of experiences as a player that allowed him to feel camaraderie and relish in team achievements: “I’m not in the locker room and having all that level of camaraderie I guess… that was cool seeing that stuff [His former team won two championships] happen, but I missed out on it… as the experiences as a player.”

Prior sports experiences were invaluable to the participants. Andrew said that a sports training mentality helped him cope with rehabilitation difficulties: “You look at all the training that goes into just sport in general, and that’s a really easy transition from the training for sports and training for rehabilitation and physical therapy.” Brad believed that his effortful participation in a demanding sport benefited him by preparing him to handle the rigors of transition: “I think I was used to needing to put in work to get in… to get out results.” Chris, too, expressed that the strong work ethic he developed through sport was a valuable tool in therapy and activities of daily living.

3.2.3. Adaptive Sports Community

The adaptive sports community theme is characterized by how the resources provided to participants and the pursuit of fulfilling athletic opportunities affected their adaptation to SCI. Brad talked about his initial concern about losing the valued sports activities he had been involved in. However, he explained that his introduction to the disability community helped assuage those fears. Andrew and Brad discussed members of the disability community who facilitated their entry into adaptive sports through offered advice and guidance. Andrew indicated that the rehabilitation hospital he enrolled in provided information regarding adaptive sports opportunities and loaned him adaptive equipment. A friend of Brad’s dad, who was involved in adaptive sports, helped Brad get involved by teaching and socializing with him. Brad described the benefits he experienced from interacting with the disability community.

I met so many people through the adaptive community. And I started to branch out a little bit more and travel more. There are a lot of good opportunities that go to different adaptive programs or take advantage of different opportunities.

Chris did connect with people with similar SCI experiences. He talked with them about how they adapted to life with acquired SCI, but he expressed that none of these people had experiences that reflected his own. He felt that connecting with those who had experienced the multiple transitions that he had would have helped facilitate his transition.

Andrew believed that the realization that his nondisabled sports career was over allowed him to begin looking forward to other athletic pursuits. The knowledge Andrew gained through his work as a special education teacher also uniquely prepared him to find new opportunities. He knew he still had access to several activities (e.g., triathlons, hand-cycling, swimming). Brad viewed adaptive sports as a refreshing experience he was ready to participate in. He explained that the difficulty he felt adjusting to adaptive sports was in “swallowing your pride” to enjoy the competitive level of adaptive sports. Andrew and Brad believed that achievement in adaptive sports helped them adjust to their transition.

3.2.4. Social Support

Social support was a theme in the transition narratives of Andrew, Brad, and Chris. The participants identified several outlets for support (e.g., friends, family, caregivers, and counselors). When asked how their SSQ-6 scores reflected their social support, the participants suggested that their scores (i.e., Andrew [SSQ-N = 3.83], Brad [SSQ-N = 5.33], Chris [SSQ-N = 9]) indicated that they had many strong supportive relationships. Andrew interpreted these scores as an indication of the number of places he could turn to for help: “I know I’ve got a lot of support; you know from friends and family, you know, around the world really—.” Brad thought it indicated how many individuals he felt comfortable confiding in. Chris believed he was fortunate to have the relationships he did. He shared that not only did he develop an entirely new set of friends, but his relationships with close friends deepened. He described his reliance on these friendships; “talking with them about everything” was emphasized. Chris stated that understanding he still had deep, meaningful relationships with friends was helpful post-injury.

Brad expressed that he had a “really good group of friends” who helped him succeed in “getting better” and getting involved in activities. He described how his friends helped him feel normal by interacting with him in the same manner as they had before the injury, acting as if nothing had changed. He felt that their efforts helped him adjust: “It was huge in my recovery when you have everyone around you being positive and hanging out and making you feel normal or making the situation feel normal. It’s a lot easier to get used to things.” Andrew, too, believed his friends’ involvement in his activities (e.g., group training sessions, cycling, and swimming) had a positive effect on him, satisfying his need to be part of a group.

Andrew and Brad also emphasized the support they received from their mothers. Brad described his mother as his “rock,” offering advice and a listening ear, and Andrew felt that his mother was his biggest source of support. Chris similarly expressed that his support from family and close friends was his greatest resource, aiding with medical assistance, future planning, and fundraising. In contrast to his mother, Brad described his father’s devastation and self-blame for Brad’s injury, which he found difficult to handle emotionally. In addition, the difficulties of a poor romantic relationship post-injury were described as having a decidedly negative influence on him emotionally. Despite these emotional challenges, Brad said he felt pressure to stay positive for others. He believed that his positive outlook did help him post-injury. Andrew felt the weight of others’ concerns as well. He struggled with feeling like others, particularly family members, were concerned about him. He ended up utilizing this attention and concern from his social network as positive motivation for rehabilitation.

3.2.5. Quality of Adaptation

All participants perceived the quality of their adaptation to be “very” (Andrew), “pretty” (Brad), or “really” (Chris) good. Andrew based his evaluation on regaining athletic and career pursuits, satisfaction with athletic challenges, and achieving these benchmarks in two years. He felt the amount of time provided to him to focus solely on rehabilitation, without the pressure to return to work, helped him to adjust. Chris also pointed toward career benchmarks, such as graduation from college, when evaluating his adaptation to SCI. Chris’ initial concerns were how the injury would affect his ability to go to college, his relationships and friendships, and his ability to lead an active and fulfilling life. He believed that recognizing what he derived satisfaction from and focusing on those things (e.g., school, relationships) was an important part of his adjustment. Brad took great satisfaction in his ability to graduate at the same time as his peers, get back to being physically active, and develop romantic relationships. Brad explained, “You know, you’re successful going through these things. It feels good to get back.”

When asked how their SWLS scores (i.e., Andrew [SWLS = 28], Brad [SWLS = 31], Chris [SWLS = 26]) reflected their satisfaction with life, all participants explained that the scores indicated happiness or contentment with their current place in life. Brad explained that he would not change much about his life. He believed his transition made him a better person and gave him a new perspective that he cherishes. Brad and Chris thought their social support was a significant positive factor in their lives. Andrew and Brad indicated that a positive romantic relationship would help improve their lives. Andrew perceived that he could improve his life by getting comfortable with his work and sports roles. Chris believed there is always room for improvement. He still sees his transition as an ongoing process.

4. Discussion

The current findings revealed a range of cognitive, emotional, social, and behavioral influences on participants’ transition experiences, highlighting the multidimensional nature of the transition process and the potential for sport psychology practitioners and other helping/rehabilitation professions to support athletes who experience an SCI. The most prominent cognitive appraisal used to evaluate the transition process was the extent of adjustment to career or athletic goals. The most common emotional responses included fear of retained function. Identified social factors that lead to negative emotional coping were a parent’s anguish and poor romantic relationships. In contrast, positive factors included shared experiences, guidance from the disability community, and peer and family support. Prominent behavioral influences included a sports work ethic in rehabilitation, continued health management, regaining independence, a focus on career pursuits, and adaptive sports involvement.

This study’s results support stages 2–4 of the conceptual model [22]. Factors outlined in Stage 2, Factors related to adaptation to career transition (i.e., developmental experiences, self-identity, social identity, and tertiary factors), and Stage 3, Available resources (i.e., coping strategies, pre-retirement planning, social support), were found to be prevalent in the participants’ experiences of transitioning out of sport due to SCI. The participants also appraised their quality of adaptation (Stage 4) to career transition as “good,” which appeared to be a consequence of detected interrelationships between the factors from Stages 2 and 3 [22]. Signs of a healthy career transition were indicated to be the ability to return and achieve success in career pursuits, strong social support, independence, and satisfying sports and physical activity pursuits. Athletes who experience an SCI should evaluate how well they address these areas in their transition to determine what resources they need and which coping strategies to implement.

The results of this study also extend the conceptual model to reflect athletes’ experiences after SCI. Factors related to adaptation to retirement (i.e., Stage 2 in the conceptual model) observed in this study (e.g., physical impairment, occupational development, and sport and physical activity opportunities) are not components explicitly outlined in the conceptual model. Similarly, available resources (i.e., Stage 3 in the conceptual model) do not account for the needs of athletes with spinal cord injury, such as adaptive technology. Additionally, the conceptual model fails to account for the individual’s cognitive appraisal and emotional response to sport-career retirement, as well as barriers to adaptation (e.g., unpredictability). The authors encourage researchers to investigate this phenomenon using alternative transition models, such as the integrated career change and transition framework [52], which may prove more useful for capturing the transition experience in this population.

The current study supports existing research on the role of balanced self-identity, adaptive sport participation, and peer mentor relationships in career transitions out of sport following injury. The development of a balanced self-identity has been found to affect successful career transition, whereas high athletic identity is linked to transition difficulty [17,53]. This study’s findings support this; Andrew and Brad discussed how they maintained balance among their life roles and how their pre-injury career pursuits outside of sport became a source of satisfaction after their injury. These participants reported little to no change in their athletic identity scores following SCI, maintaining a moderately strong athletic identity. They indicated that they had satisfying opportunities for adaptive sport and physical activity. Practitioners can encourage athletes to develop fulfilling pursuits outside of sport and help them understand how their athletic skills can transfer to other non-sport pursuits to foster a balanced self-identity.

After SCI, it is not uncommon for athletes to desire to return to their former lives and a similar physical self [54]. The desire to return to a “restored self” may present identity difficulties during transition, as athletes may struggle to recapture their past selves and the patterns that characterized them. Preoccupation with and failure to measure up to past selves can lead to despondency and exacerbate identity issues [9]. Andrew and Brad’s ability to re-establish aspects of their former selves likely contributed to a smoother career transition. Participants reported that focusing on returning to and succeeding in their careers outside of sport after injury positively affected their transition, acting as an effective coping strategy that promoted healthy adaptation. Research has indicated that returning to occupational engagement can be health-promoting and should be a significant focus of spinal cord injury rehabilitation [55,56]. Practitioners can support individuals by using multiple strategies (e.g., assistive technology, vocational services) to assist their navigation of returning to work and school [57].

Participants attributed their positive assessment of the quality of adaptation to transition in part to their involvement in adaptive sport and physical activity. They believed that sport was a necessary part of their lives and stated that they entered adaptive sports to regain the benefits they felt they had received from nondisabled sports. Adaptive sport has been found to facilitate a sense of normalcy by providing individuals with opportunities to express competence, be included, and be recognized for their similarities rather than their differences [58]. The findings support this, as participants reported that the sense of achievement they gained from participating in adaptive sports helped them transition from nondisabled sport. Andrew, in particular, shared how the adaptive sport activities his friends participated in with him helped him feel included. Additionally, Participation in adaptive sports has been found to offer athletes with spinal cord injury an opportunity to re-establish their identity after injury [59]. The findings seem to support this, as Andrew and Brad’s positive views of their adaptation quality are linked to their involvement in adaptive sport and physical activity, and their moderate scores on the AIMS, both retrospectively and after injury, suggest that participating helped restore their athletic identities and eased psychological distress related to losing nondisabled sport. Based on these findings and existing research indicating that athletes prevented from participating in their favorite sport after SCI may experience psychological distress and lower life satisfaction [41], practitioners are encouraged to raise awareness of adaptive sports opportunities that enable athletes with spinal cord injury to demonstrate competence and regain the benefits they enjoyed in nondisabled sport.

Participants reported that receiving guidance from and sharing experiences with members of the disability community helped facilitate their transition. These findings align with previous research indicating that, among individuals with spinal cord injuries, peer social support increases participation in daily activities and adaptive physical activity [60,61] and enhances adaptation to life changes following injury [62]. Peer-mentor relationships within the adaptive sports community were identified as instrumental in promoting involvement in adaptive sports and in understanding others’ responses to injury. Research has demonstrated the unique and supportive elements of these relationships and their impact on adjustment after SCI [62,63,64]. It is recommended that practitioners foster peer-mentor relationships between individuals with spinal cord injury and those with similar experiences, as having a shared social reality has been shown to be important to disabled athletes [65]. Specifically, promoting these relationships among athletes who have SCI and other disabled athletes is crucial because disabled individuals are the primary social agents facilitating entry into adaptive sports [66].

Limitations

The study has its limitations. The sample consisted exclusively of Caucasian American males; thus, the results may not be transferable to other populations (e.g., women, other races, ethnicities, nationalities). Research has demonstrated differences in reactions to sport-career termination between athletes of different nationalities [14], and racial and gendered differences have been found in the coping styles of athletes with performance stress [67,68]. Capturing the experiences of a more diverse sample of individuals may enhance the applicability of the findings, and by examining the differences in demographic variables (e.g., gender, race, ethnicity, and nationality), practitioners may be able to use that information to provide appropriate support for the athlete. This study used a retrospective design; consequently, the potential for recall bias and the limitations of participant recollection are also concerns [69]. Future research should employ a longitudinal design to examine the dynamic transition process. It is also imperative to note that self-selection may have influenced the type of athletes who participated. It could be that only athletes who had experienced a healthy, positive sport-career transition chose to participate, and those who experienced emotional and/or behavioral difficulties had self-selected out of the study. Researchers are encouraged to purposively sample individuals with diverse levels of adaptation to sport-career transition (i.e., positive or negative outcomes, retirement crisis experiences).

5. Conclusions

To conclude, the findings of this study suggest that the sport-career transition following SCI is a multifaceted process influenced by numerous cognitive, emotional, social, and behavioral factors. In particular, participants’ responses indicated that balanced self-identity, adaptive sport participation, and peer-mentor relationships influenced their sport-career transition experiences. Based on these findings, practitioners are encouraged to introduce individuals with spinal cord injury who are experiencing a sport-career transition to accessible and empowering adaptive sport and physical activity opportunities, peer athletes with shared spinal cord injury experience, and strategies for occupational engagement outside sport. This study has provided insight into the SCI experiences of these men, illustrating some of the complexities of the sport-career transition process. Hopefully, this study will spur future research into sportspeople with spinal cord injury.