Self-Determination Theory and Injury-Mitigating Health Behaviours and Outcomes in Physically Demanding Performance Settings: A Systematic Review
DOI:
https://doi.org/10.64255/gxg6e451Keywords:
Motivational Regulation, Self-determination theory, musculoskeletal injuries, injury mitigation, high-performance settingAbstract
Introduction: Musculoskeletal injuries (MSKIs) are prevalent across physically demanding performance environments, including competitive sport and high-demand occupations, impacting health, performance and organisational operations. Self-Determination Theory (SDT) can be applied within these contexts to understand how motivational regulation impacts protective behaviours and injury risk. However, SDT research and its constructs in relation to injury-related processes and outcomes have not been consolidated to inform interventions. Therefore, this systematic review investigated associations between SDT motivational constructs and injury-mitigating health behaviours and outcomes in physically demanding performance settings.
Methods: A search of five electronic databases identified studies published between 1985 and 2026 involving participants (≥16 years) in sport or occupational performance contexts. This yielded 10,838 studies, with 26 studies meeting the inclusion criteria across sporting, military, police and firefighter settings.
Results: Autonomous motivation and psychological need satisfaction were associated with greater engagement in injury-mitigating health behaviours and protective practices, with more limited evidence for lower injury risk and improved rehabilitation outcomes. Models through which these mechanisms might occur are presented. Evidence is presented suggesting individuals may internalise health-directed goals despite external demands, allowing autonomous and controlled motivations to coexist. We therefore hypothesise a contextual extension of the SDT process model in which positive agentic engagement may support the translation of internalised health behaviours into effective injury mitigation.
Conclusion: Although the evidence base was limited by predominantly self-reported, cross-sectional designs, restricting causal inference, this review provides a foundation for future longitudinal research and the development of theory-informed injury mitigation interventions in physically demanding performance settings.
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Additional Files
- Supplementary File 1 - PRISMA Checklist
- Supplementary File 2 - Behavioural Risk Factor Classification Framework
- Supplementary File 3 - Inclusion/Exclusion Criteria
- Supplementary File 4 - Search String
- Supplementary File 5 - List of Excluded Studies with Reasons
- Supplementary File 6 - Study Characteristics of Included Studies
- Supplementary File 7 - The Mixed-Method Appraisal Tool (MMAT)
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