Psychological Aspects Psychological Aspects of Sports Injury and of Sports Injury and

RehabRehab

Mrs. MarrMrs. MarrSports Med ISports Med I

ObjectivesObjectives1. Define stress and the three physiological stages that occur in response to a

stressor. 2. Explain the psychological stages of a loss. 3. Describe different psychological factors that may predispose an athlete to injury. 4. Discuss the predictors of injury and interventions5. Discuss how athletes might respond psychologically to an injury.6. Discuss different reactions to a serious injury/illness and how to appropriately

respond to them. 7. Describe the progressive reactions to injury, dependent on the length of

rehabilitation Describe the progression of an athlete returning to sports after a serious injury/illness.

8. Identify the stressors in the athlete’s life.9. Discuss the concept of buffers for stress management.10. Explain Jacobson's Progressive Relaxation Method and systematic desensitization

and how it may be used to reduce stressors from competition anxiety.11. Discuss the importance of goal setting as a means of making the injured athlete

compliant in the rehabilitative program.12. Identify the various considerations for the coach in managing the psychological

impact of injury.13. Describe the decision-making process for returning the injured athlete to

competition.

KEY TERMINOLOGYKEY TERMINOLOGYalarm­­Creates the fight or flight response.anxiety­- One of the most common mental and emotional stress

producers, it is reflected by a non-descript fear, a sense of apprehension, and restlessness.exhaustion - Caused by chronic stress and leads to disease.

psychophysiological­- Involving the mind and body.psychosomatic - A psychosomatic illness originates in the

mind, though its symptoms manifest in the body and are quite real.

resistance - Stage in which the body prepares itself to cope with the stressor.

staleness - Burnout, overreaching, overwork, or overtraining.stress­- The positive and negative forces that can disrupt the

body's equilibrium.

The Foundation of a “Sports The Foundation of a “Sports Medicine of the Mind” Medicine of the Mind”

• The Psychological Process• The Recovery Timeline• The Way to Failed Rehabilitation• The Way to Recovery• The Aspects of a Remarkable

Recovery

The Athlete’s Psychological The Athlete’s Psychological Response to InjuryResponse to Injury

• Athletes do not all respond to injury in the same manner.

• Generally there are three reactive phases:– Reaction to injury– Reaction to rehabilitation– Reaction to return

Objective: Discuss how athletes might respond psychologically to an injury

Psychological Process and Psychological Process and Recovery TimelineRecovery Timeline

Elizabeth Kubler-Ross (1969) On Death and Dying Her stage theory has been applied to athletic injury, however research has failed to demonstrate that injured athletes move in a predictable fashion through a series of stages on route to recovery

The Athlete’s Psychological The Athlete’s Psychological Response to InjuryResponse to Injury

Objective: Describe the progressive reactions to injury, dependent on the length of rehabilitation.

Short (< 4 weeks) shock impatience eagerness relief optimism anticipation

Long (>4 weeks) fear loss of vigor acknowledgementanger irrational thoughts

alienation

Chronic (recurring) anger dependence or independence, confident or skeptical frustration apprehension

Termination (career ending) isolation loss of athletic identity closure and renewal grief process

Length of Rehab Reaction to injury Reaction to rehab Reaction to return

The Affective Cycle of InjuryThe Affective Cycle of Injury• Distress (e.g. anxiety and depression)• Denial (unacknowledged distress)• Determined Coping (vigorous,

proactive, goal driven)

The goal is to help the athlete to progress from distress and denial to determined coping

Predictors of InjuryPredictors of InjuryThe­Injury­Prone­AthleteThe­Injury­Prone­Athlete

• Why are they more at risk for injury?

• Stress and Risk of Injury– Positive stressors vs. negative stressors

• Advantages and Disadvantages

Objective: Discuss the predictors of injury and interventions.

The Way to Failed RehabilitationThe Way to Failed Rehabilitation

• Denial– Functional when it protects the athlete

from being overwhelmed by negative emotions

– Problematic when failure to recognize the severity of the injury results in low level of motivation for rehabilitation.

• Pain Pain – Pain is a “whole brain experience” derived from a summation of inputs from multiple brain centers including those that serve emotion and memory

• FearFear – A type of competitive anxiety related to injury risk. – Fear can contribute to a respect for dangerous

conditions and limit reckless behavior or undermine concentration and interfere with skill execution.

– Fear of re-injury is common in those rehabilitating severe knee injuries, with the fear inhibiting the recovery process in some cases

Cognitive­restructuring­needed

• CulpabilityCulpability – When complications arise in rehabilitation, culpability may be directed to treatment providers (who­may­in­turn,­redirect­blame­to­the­athlete­for­failing­to­recover­as­anticipated).­

• If the athlete assumes responsibility for injury- feelings of guilt may follow, especially if he or she feels the team or significant others have been let down

• Attributing recovery to personal control (internal attributions) has been associated with greater rehabilitation adherence.

The Way to RecoveryThe Way to Recovery

Education –Education – About 50% of injured athletes felt their physicians were impersonal and did not provide enough information about their injury

Goal-Setting – 5 GuidelinesGoal-Setting – 5 Guidelines1. Help develop management skills that are

transferable between rehabilitation situations.

2. Help athletes establish rehabilitation schedules.

3. Provide opportunities for self-evaluation and recording.

4. Involve athletes in decision making.5. Ensure individual progress is self-

referenced.

Goal Setting as a Motivator to Goal Setting as a Motivator to ComplianceCompliance

Nine factor to incorporate into goal setting for the athlete

1. Set specific goals2. Use positive versus negative language3. Goals should be challenging but realistic4. Set a reasonable timetable5. Integrate short-,medium, and long-term goals6. Link outcome to process7. Internalize goals8. Monitor and evaluate goals9. Link sport goals to life goals

Objective: Discuss the importance of goal setting as a means of making the injured athlete compliant in the rehabilitative program.

Social Support Social Support 1. Athletes expect, but do not receive, sufficient

social support and information from sports medicine professionals

2. Athletes lives are often intertwined with sport, with injury separating them from their teammates and coaches, thus they feel isolated.

3. Connections with other injured athletes, particularly those with similar injuries seems to be helpful

4. Emotional support was especially important when the rehab process was slow, setbacks were experienced, or other life demands placed additional pressure on the athlete

Mental TrainingMental Training1.1. ImageryImagery – Rehabilitation that includes

imagery yields more effective healing than physical rehabilitation alone (numerous references). It represents a natural transfer of sport skills to rehab.

2.2. Relaxation Relaxation – Conditioned Relaxation. When an athlete learn stress management techniques, the threat of injury becomes less.

Interventions for Stress Interventions for Stress ReductionReduction

• Intervention Methods– Who can help?

• Counseling centers• Sport psychologist• Grief support groups

– Buffers• Progressive Relaxation Techniques• Imagery

Objective: Discuss the concept of buffers for stress management.

The Aspects of a The Aspects of a Remarkable Remarkable RecoveryRecoveryThe­Quest­for­Competitive­Excellence­in­

Rehabilitation­is­built­on:

• Heightened body awarenessHeightened body awareness – Follows from quality rehabilitation that enhances fitness and a refined sense of biomechanics.

• Enhanced pain assessmentEnhanced pain assessment – Develops out of a keener sense of pain awareness and a more informed decision making ability relative to pain per se and injury.

• Psychological Momentum – Injury boosts negative emotion, demanding a corresponding increase in positive affect to maintain emotion balance. Maintaining positive affect as negative emotions diminish with recovery creates positive psychological momentum.

• Revaluing of Sport – When injury deprives the athlete of the opportunity to compete, it may have a paradoxical benefit – calling to mind all the good things that sport brings.

Considerations for the Coach in Managing the Considerations for the Coach in Managing the Psychological Impact of InjuryPsychological Impact of Injury

Checklist Establish a rapport and a sense of genuine concern and caring

for the athlete. Earn the athlete’s trust. Establish good open communication with the athlete. Take a personal interest in athletes before an injury occurs. Be a good listener. Look the athlete in the eye with genuine interest and use good

body language. Don’t neglect or ignore the injured athlete. Facilitate continuing social support by teammates. Provide as much information about his or her injury as

possible. Make sure the athlete is included in the decision making

process.

Objective: Identify the various considerations for the coach in managing the psychological impact of injury.

Return to CompetitionReturn to CompetitionGuidelinesGuidelines

• When should the athlete return to competition?– List some factors

Objective: Describe the decision making process for returning the injured athlete in competition.

A Complete Sports A Complete Sports Medicine Program Medicine Program

Includes Includes “Sports Medicine of the “Sports Medicine of the

Mind”Mind”