Psychological Aspects of Sports Injury and Rehab

1. Psychological Aspects of Sports Injury and Rehab Mrs. Dobbins Sports Med I

2. Objectives • Define stress and the three physiological stages that occur in response to a stressor. • Explain the psychological stages of a loss. • Describe different psychological factors that may predispose an athlete to injury. • Discuss the predictors of injury and interventions • Discuss how athletes might respond psychologically to an injury. • Discuss different reactions to a serious injury/illness and how to appropriately respond to them. • 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. • Identify the stressors in the athlete’s life. • Discuss the concept of buffers for stress management. • Explain Jacobson's Progressive Relaxation Method and systematic desensitization and how it may be used to reduce stressors from competition anxiety. • Discuss the importance of goal setting as a means of making the injured athlete compliant in the rehabilitative program. • Identify the various considerations for the coach in managing the psychological impact of injury. • Describe the decision-making process for returning the injured athlete to competition.

3. KEY TERMINOLOGY alarm­Creates 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.

4. The Foundation of a “Sports 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

5. The Athlete’s Psychological Response 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

6. Psychological Process and Recovery 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

7. Length of Rehab Reaction to injury Reaction to rehab Reaction to return Short (< 4 weeks) shock impatience eagerness relief optimism anticipation Long (>4 weeks) fear loss of vigor acknowledgement anger 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 The Athlete’s Psychological Response to Injury Objective: Describe the progressive reactions to injury, dependent on the length of rehabilitation.

8. The 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

9. Predictors of InjuryThe Injury Prone Athlete • 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.

10. The 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.

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

12. Fear– 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 Cognitive restructuring needed

13. Culpability– When complications arise in rehabilitation, culpability may be directed to treatment providers (who may in turn, redirect blame to the athlete for failing to recover as anticipated). • 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.

14. The Way to Recovery Education – About 50% of injured athletes felt their physicians were impersonal and did not provide enough information about their injury

15. Goal-Setting – 5 Guidelines • Help develop management skills that are transferable between rehabilitation situations. • Help athletes establish rehabilitation schedules. • Provide opportunities for self-evaluation and recording. • Involve athletes in decision making. • Ensure individual progress is self-referenced.

16. Goal Setting as a Motivator to Compliance Nine factor to incorporate into goal setting for the athlete • Set specific goals • Use positive versus negative language • Goals should be challenging but realistic • Set a reasonable timetable • Integrate short-,medium, and long-term goals • Link outcome to process • Internalize goals • Monitor and evaluate goals • 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.

17. Social Support • Athletes expect, but do not receive, sufficient social support and information from sports medicine professionals • Athletes lives are often intertwined with sport, with injury separating them from their teammates and coaches, thus they feel isolated. • Connections with other injured athletes, particularly those with similar injuries seems to be helpful • Emotional support was especially important when the rehab process was slow, setbacks were experienced, or other life demands placed additional pressure on the athlete

18. Mental Training • Imagery – Rehabilitation that includes imagery yields more effective healing than physical rehabilitation alone (numerous references). It represents a natural transfer of sport skills to rehab. • Relaxation – Conditioned Relaxation. When an athlete learn stress management techniques, the threat of injury becomes less.

19. Interventions for Stress Reduction • 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.

20. The Aspects of a Remarkable RecoveryThe Quest for Competitive Excellence in Rehabilitation is built on: • Heightened body awareness – Follows from quality rehabilitation that enhances fitness and a refined sense of biomechanics. • Enhanced 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.

21. 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.

22. Considerations for the Coach in Managing the Psychological 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.

23. Return to CompetitionGuidelines • When should the athlete return to competition? • List some factors Objective: Describe the decision making process for returning the injured athlete in competition.

24. A Complete Sports Medicine Program Includes “Sports Medicine of the Mind”