Mental rehab

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Hannah Winter examines the psychological consequences of injury and outlines strategies athletes can use to cope more effectively

Despite the best efforts of athletes and coaches, injuries are unfortunately commonplace in sport. Athletes often concern themselves mostly with the physical aspects of rehabilitation. However, athletes will often report a number of negative psychological consequences when injured.

What’s more, while an athlete may be physically ready to return to sport and competition after injury, we know that this is not the same as being psychologically ready. With this in mind, effective injury rehabilitation and a successful re-entry into athletics after an injury requires a focus on both the physical and psychological factors.

Psychological responses to injury

People respond to injuries in various ways. Athletes understandably can be incredibly upset and frustrated when sidelined. There is often a lot of uncertainty, for example, in understanding how long an injury will take to recover from, how it will impact sporting ambitions or whether it will be career-ending.

For some, having an injury is therefore incredibly debilitating and is viewed as a disaster. Depression, frustration, stress, anxiety, anger, rehabilitation compliance problems, poor concentration and exercise addiction are some of the emotions and behaviours injured athletes report.

For some, responses can be clinically significant. In one study, 24% of coaches said they had referred an athlete for counselling following an injury.

In contrast, some people when injured react more positively. For them, an injury is seen as a challenge to overcome, an opportunity to demonstrate courage or even as a relief to have a break from training.

Developing effective ways of coping with injury setbacks is therefore important to help navigate what can be a difficult time.

A culture of risk

It can be a challenge for injured athletes to express how they are truly feeling about an injury. Certain beliefs concerning accomplished athletes and successful injury rehabilitation are often drilled in by coaches, parents and media to an injured athlete.

For example:

» Demonstrate mental toughness and give 110%: this can lead athletes to over-train and risk further injury and/or return to sport too quickly after an injury.

» Play through pain: this can make it hard for athletes to understand what pain should be ignored and what should be treated more seriously.

» A focus only on performance: this can make athletes only feel valued as performers and encourage injured athletes to ignore both the precautions needed for a full recovery and what’s needed to enhance their wellbeing.

Coaches, parents and sporting organisations therefore have a role to play in determining what is in the best interest of the injured athlete to help them reach their full potential and be mindful that those previously-mentioned beliefs may exist within the injured athlete.

Coping strategies

If you are faced with an injury, employing strategies to help you cope with the psychological impact may therefore be just as important for your recovery as the physical rehabilitation.

A response to an injury is very individual and it is important to work out what strategies are beneficial for you. As with any new skill acquisition, these techniques can take time to put into practice and lead to desired outcomes.

Here are some examples of evidence-based coping strategies that have been found to be effective in managing the psychological challenges that can come with injury:

1. Educate yourself: research shows that people who take time to really understand their injury cope better. Talk to your doctor, physiotherapist or surgeon and learn about your injury and the rehabilitation process. This can help you become more engaged in your recovery and it can help you feel more empowered in the process.

2. What’s in your control: be really clear about what is in your control versus what’s outside with regard to your injury and recovery. Write them down and place the list somewhere visible. Then each day focus on what is in your control.

3. Talk about it: don’t go through an injury alone. Social support is often critical in the rehabilitation process, particularly with severe injuries. Find a friend, family member or team-mate to listen to your concerns and provide emotional support when needed. This is often most effective if the person you are talking to understands your sport. Coaches can also set up injury support groups to enable injured athletes to have a safe space to talk openly about their injury experience.

Photo by Sport England

4. Don’t isolate yourself: staying involved with your sport can, for some, be helpful. For others, however, it can have a negative impact on their emotional state. If you think it would be helpful for you, you can look for ways that you could be involved in your sport, for example, by coaching or mentoring other athletes.

5. Find a mentor: research has shown that, if your recovery is going to take a long time, finding a peer mentor – someone who has successfully recovered from a similar injury – can be helpful.

6. Focus on the long term: with an injury, it can be very tempting to push through pain or go back to training too quickly. However, it is important to focus on your long-term objectives and not the short-term fear of losing fitness.

7. Set realistic goals: be flexible with your goal for recovery. Depending on the nature of your injury, understand that rehabilitation can at times be slow and have setbacks. Once you’re ready to return to sport, set new and realistic goals to avoid disappointment. It may not, at least initially, be possible for you to compete at the level you did previously.

8. Track your progress: keep a daily or weekly diary on your rehabilitation progress. Writing in a diary each day about the current state of your injury can help see the progress you are making recovery-wise. This can be particularly helpful if you are out of your sport for a long time.

9. Mix up your rehabilitation: physiotherapy exercises may be needed for a long time. Completing the same routine for weeks or months on end can be boring. Mixing up rehabilitation choices can improve motivation and adherence.

10. Consider the positives: ask yourself whether there are any positives to have arisen from the injury. For example, have you been able to come back stronger than before? Have you been able to work on a weakness? Or perhaps you were able to spend more time with your friends and family. Become clear on any positives and write these down.

11. Positive self-talk: think about your inner dialogue and whether you are having helpful or unhelpful thoughts about your injury and recovery. Negative self-talk can be self-defeating and prevent rehabilitation adherence. Look for ways to develop your inner dialogue to be self-enhancing.

12. Practise relaxation strategies: breathing techniques can help manage any anxiety and frustration throughout the injury process. One example is box-breathing: breathe in for a count of four, hold for a count of four, breathe out for a count of four and hold for a count of four; repeat five times.

There is no doubt that injuries can be incredibly frustrating, leading to a loss of identity and confidence. However, when approached correctly, psychological adjustment can be healthier and an athlete may more readily return to higher levels of performance.

Understanding what coping strategies work for you is important. Even if you are not currently injured, formulating a clear plan on how you would respond to an injury should one arise can help minimise confusion when such a time comes.

Lastly, it is important to note that, for some, professional support may be helpful if the psychological consequences are severe, particularly if they have suffered a career-ending injury.

» Hannah Winter is a sport and exercise psychology consultant. Go to hannahwinter.co for more information and contact details

» This article was first published in the April 11 edition of AW magazine. For more on the topic, see the April 4 edition of AW

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