How Psychosocial Factors Influence Athletes' Recovery and Rehabilitation From Injury, Including the Return-To-Play Process
Athletes’ emotional reactions to injury include feelings of loss, denial, frustration, anger, and depression. Positive emotions such as happiness, relief, and excitement have been reported as well. The attainment of rehabilitation goals and the prospect of recovery may engender a host of positive emotional responses throughout the course of rehabilitation. It seems that these responses are influenced by a wide array of personal factors (eg, athletic identity, previous injury experience, injury severity, injury type, current injury status) and situational factors (eg, life stress, social support satisfaction, timing of the injury).
Return from athletic injury can be a lengthy and difficult process. The injured athlete commonly receives care from several providers, including physicians, athletic trainers, physical therapists, and strength and conditioning specialists. At some point in the recovery process, athletes return to strength and conditioning programs and resume sport-specific activities in preparation for return to play. The transition is important for several reasons. First, although the athlete may have recovered in medical terms (ie, improvements in flexibility, range of motion, functional strength, pain, neuromuscular control, inflammation), preparation for competition requires the restoration of strength, power, speed, agility, and endurance at levels exhibited in sport. Such sport-specific training may be beyond what those attending to the athlete’s medical needs are qualified or prepared to provide.1 Returning from injury is a process requiring additional work from the injured athlete to regain competitive ability. Exercise must be prescribed with an emphasis on the fundamental components of the exercise prescription, which progressively incorporates activities and skills displayed in sport. When athletes resume team-based strength and conditioning activities, emphasis should be on generic movements (exercises inherent to most sports, such as closed kinetic chain squats) and sport-specific movements that makes up the complete strength training program for an athlete. Both exercise templates are vital in the recovery process. In contrast to linear improvement, rehabilitation is often a haphazard process with positives and negatives occurring daily. Consequently, athletes usually benefit from input from all providers throughout the process of returning to play. Unfortunately, athletes often pay the price for poorly coordinated recovery plans within the return-to-play process.
Athletes have difficulty coping with the changes that accompany injury. Athletes expressed an inability to cope with injury, activity restriction, long rehabilitation, and feelings of being externally controlled by their injury. Several other researchers have recognized that the lack of daily physical activity can affect an injured athlete psychologically. For instance, athletes are predisposed to neurotic illness when mandatory deprivation of exercise is necessary because of a preoccupation with fitness or sport. Often times an athlete will use physical activity to cope with stress. When athletes are injured and unable to engage in physical activity they may have difficulty dealing with their daily stresses. Smith (1990) states that “the development of neuroses in fitness fanatics deprived of exercise was at least partially because their life stress prior to injury or illness had been managed by physical activity rather than by articulating emotional concerns.” Furthermore, the injury can actually produce additional stress that may induce emotional disturbance. Hardy (1992) suggests that “the major sources of stress that have been reported by sports performers include fear of failure, concerns about social evaluation by others, lack of readiness to perform and loss of internal control over one’s environment.” Separation from the team takes an emotional toll on injury athletes. Athletes enjoy camaraderie among teammates and they rely on each other for support. Consequently, “an injury that even temporarily halts participation causes tear in the fabric of well- being through which uncomfortable or unacceptable feelings may emerge”.
In summary, they need to believe that there overall level of physical conditioning and that their technical and tactical abilities are to the best they can achieve. Finally, injured athletes must have a positive and patient attitude about their progression from the initial training to right the way through to competition. From reviewing literature in the area of sport psychology and injury, it is clear to see that there are many different opinions as to what and why affects a persons psychological state as a result of sustaining injury. There is a need for much further research concerning this topic area and sport psychologists continue to work with injured athletes in order to better to understand what they are going through. This will help athletes to obtain a quicker and more successful recovery with their return from injury.
Smith, A.M., Scott, S. G., & Wiese, D.M. (1990). The psychological effects of sports injuries coping. Sports Medicine, 9(6), 352-369.
Wasley, D., Lox, C.L. (1993, June). Self-esteem and coping responses of athletes with acute versus chronic injuries. Abstract retrieved on February 20, 2006 from PubMed database.
Foa, E.B., Hembree, E.A., Riggs, D., Rauch, S., & Franklin, M. (n.d.). Common reactions to trauma. Retrieved February 26, 2006, from the National Center for Post Traumatic Stress Disorder Web site: http://www.ncptsd.va.gov/facts/disasters/fs_foa_handout.html
Hardy, L. (1992, July). Psychological stress, performance, and injury in sport. Abstract retrieved on February 20, 2006 from PubMed database.