Gabriela Mateo

Getting back: How to overcome psychological factors affecting athletes’ return to sport after injury Ana Gabriela Mateo Volkart s- Word count: 2087 Getting back: How to overcome psychological factors affecting athletes’ return to sport after ACL injury A. Gabriela Mateo Volkart and maintains a positive outlook on his recovery. ABSTRACT Background A significant amount of athletes from a variety of sports suffer anterior cruciate ligament (ACL) injury. After they undergo surgery to reconstruct the knee they follow physical therapy. Only two out of three patients return to the activity or sport they were practicing. Although physically they recover knee mobility and stability, there are a series of psychological factors that play a role in this abstinence. Fear of reinjury, lack of confidence, little or no social support seem to be emotions that athletes deal with when recovering from injury. Research Question What psychological methods can help athletes return to sports after ACL injury? Aim Explore solutions to psychological factors preventing athletes’ return to their practice after ACL reconstruction. There is sufficient literature to overview different methods and find which ones are suitable. Previous research has used varied intervention methodologies that are evaluated with the aim of building a base for coaches, trainers and athletes. Having a list of the available techniques for the psychological recovery of an injury is important to complement the already efficient and widely researched physical aspect of rehabilitation. ACL offers a common ground since it is a very frequent incident but the purpose is to offer these solutions to any and all athletes undergoing the recovery of an injury. Nine months later, Rubio is back with the Timberwolves, providing NBA fans and other athletes just one of many examples of how important positivity is when recovering from an injury. Anterior cruciate ligament (ACL) tears are one of the most common knee injuries in athletes from a wide variety of sports. In the United States alone, approximately 300,000 reconstructions of the knee take place (Czuppon, 2014). Return to sport numbers are concerning, only two out of three individuals are able to achieve their level before injury and less than half get back to competitive level again (Ardern, 2012). Although most athletes that undergo surgery recover INTRODUCTION through therapy, it seems like it is only physical. On March 9th of 2012, in a heated basketball Through testing of knee stability and other match between Minnesota Timberwolves and Los objective measurements they are capable of Angeles knee completing physical tasks but there seems to be unexpectedly twists as he is trying to defend, in psychological factors affecting the willingness to the last few seconds of the game, a shoot from all play again (Arden, 2012). Lakers, Ricky Rubio’s star Kobe Bryant. This famous incident results in During rehabilitation, 13% of athletes a tore anterior cruciate ligament, one of the most experience fear while 40% experience it once common knee injuries in athletes, not only in reincorporated into competition (Crossman, 1995, basketball, but a wide variety of sports. Rubio as cited in Arden, 2012). On the other hand, spends the last month of the season watching, another study finds the difference between disappointed but committed to rehabilitation. As recreational and competitive athletes. The latter his physical abilities improve, he also engages seem to experience greater mood disturbances once they receive medical clearance. Anger, Anterior cruciate ligament injuries are a frustration and boredom seem to be the emotions common ground for many athletes, and we aim to that contribute to this mood change (Morrey, find overarching ideas, particularly solutions. To 1999). guarantee return to sport, it is important to treat Fear is an important psychological factor or each individual separately. In the long run, we the main negative emotion that prevents athletes hope that coaches, athletes and therapists will from returning to sport. Reviews of extensive benefit from having available techniques to be literature from various sports list fear and other used in order to help the psychological aspect of similar emotions as one of the main causes recovery. preventing athletes from return to sport. Fear of reinjury, lack of confidence, fear of losing a DISCUSSION position or scholarship, self doubt, little or no Desensitization social support are the collection of factors that Suinn (2005) neatly presents an intervention seems to be coincidental for many athletes strategy for stress management, with a particular (Podlog, 2007). case of a skier facing anxiety after a knee injury. The purpose of this paper is to gather the His idea is based on removal of external cues that different methods used to overcome fear and trigger anxiety or stress. In the case of this these other psychological burdens and assess athlete, desensitization therapy was used. Her fear which ones can be applicable to ACL patients and was so severe to the point that any cue related to possibly other athletes as well. The literature skiing triggered anxiety. To dissocate the cues, dealing with return to sport seems to focus on the she was told to find the tallest tree as to distract amount and type of emotional and physical her. The approach temporarily reduced the build processes athletes deal with but it is few authors up of stress. The athlete was able to overcome her that suggests tangible and concrete solutions. fear and reincorporate hersef to her skiing Even if there are proposals, few have been practice. applied to practice and it is important to know management, this technique applied to sports how to implement them. Because it is such a injury was useful for this particular case. Although his focus is stress frequent casualty, it is necessary to evaluate the In another situation, (Rotella, 1983, as cited possible therapies to guarantee return to sport. by Podlog, 2007), systematic desensitization, a Nonethelss, it should be kept in mind that the technique that can help ameliorate a specific fear, psychological issues behind an injury should be is applied. Through use of imagery and treated case by case. relaxation, the athlete’s anxiety provoking thought is dissociated. The basketball player who had this intervention was able to play again after to continue his participation in a five-a-side getting over her fear of reinjury. Despite the fact football once a week. Every week the work was that the amount of trials is undefined and that the gradated and became slightly more challenging. case studies are limited, this method has been Slow but steady, the player, after three years of shown to improve performance. In ACL patients, working with this method, returns to first class this could mean that desensitizing focusing on the rugby. moment of injury could help overcome the fear injury in the shoulder, if applied to ACL, it that is triggerred by the memory of the incident. It should focus on routines aimed at lower limb is also possible that it is another memory or event rehabilitation. Emphasis should be given to the that causes fear, which would then imply a need muscles around the knee but complemented with for psychological exploration. Once identified, exercises from the desired sport. As it is a holistic Rotella’s systematic desensitization can be approach, it should slowly and gradually build an applied. athlete’s assimilation back into play. Successive approximation Goal setting and confidence Cox et. al (2002) utilize a method titled Several researchers report on the importance of “succesive approximation” that is based on long term outcome goals during rehabilitation in positive reinforcement. The idea is to create a order to guarantee maintainance of motivation series of training drills in successive steps. The (Evans, 2000). In a recovering athlete, goal small are setting has to have a balance. There has to be a of goal that is achievable as to progress physically reinforcement. The goal is to step by step build a and psychologically, but it can not be too structured routine with a final desired behavior, challenging as to demotivate and cause more which in the athlete’s case is reintegration to the struggle. Similar to Cox, this is done through the sport of preference. implementation of small tasks in training that behavioral rewarded changes positively as implemented a measure Although this example was about an This technique was used to help a rugby help build confidence. This goal flexibility is hard player who had a severe injury that traumatized to achieve since encountering a setback, such as him for over a year. After a serious accident medical results displaying slower recovery or during a game, he is left paralyzed but through inability to perform a determined exercise, can therapy, recovers physical capacities quickly. As cause frustration. Emotional and listening support his psychologist, Cox prescribes him a circuit seems to help in such cases. Coming back to the training involving short exercises from sit-ups to concept of “step by step”, a recovering ACL burpees, swimming, running and encourages him patient has to start with small goals, first walking a given distance, then increasing little by little. which makes sense since it is the period when Typically a physical therapists will guide him or athletes need it the most. There is a tendency to her through these steps, but setting mental goals seek coaches, physicians, athletic trainers and is critical, in the context of building self teammates but still rely on family and friends. assurance. The role athletic trainers play seems to be the Confidence is a very important factor for most important, being the most informative recovering athletes (Evans, 2000). Returning to source. Nonetheless, it is called into question sport relies heavily on developing trust and since some coaches do not have proper confidence on oneself; particularly the injured psychological background or the sufficient body part. In this particular case, a rugby player is preparation to treat athletes. trained to focus on successful experiences Male athletes counted more sources of through verbal persuasion. He is repeatedly told social support than female counterparts. Females about previous times that he has performed well. relied on family and friends as social support Additionally, imagery is used to refer to anxiety- preinjury and sought out more sources after provoking instances, such as being tackled, in injury. This is explained by the fact that females order to dissociate fear or negative thoughts. In tend to seek help more often than males. It would parallel, these methods make the athlete bulid self seem logical to keep gender in mind when assurance. Ideally, he or she is able to providing an athlete support. ACL patients can comfortably visualize the different moves and surely benefit from social support, especially if plays. Improving confidence not only involves the correct type is prescribed (Yang, 2010). the athlete’s willingness to trust him or herself, but also social and emotional support from either CONCLUSION a coach or a psychologist. The aforementioned intervention methods have a common overarching theme that centers on the Social support athlete Yang (2010) cites the vast literature that supports developing a positive outlook. Just like Ricky the importance of social support in injury Rubio’s optimism led him to overcome his ACL recovery. This particular study explores the injury and get back into play, other athletes can different sources of social support and how they follow the same principle. change throughout the recovery process. losing Desensitization, negative associations successive and approximation, Specifically, they find differences between male goal setting, confidence building and social and female as well as post and preinjury. support are the selected methods by which Perceived social support increases after injury, athletes can work through their psychological issues brought by injury. It is surprising to find reports, the database of psychological measures many ways of tackling mental problems given the for injury recovery can be bettered. lesser emphasis it is given in comparison to Limitations to the study not only include the physical recovery. The importance of gathering small amount of methods found, but also the this information lies in the inevitable reality that reliability or applicability of some. Certain rehabilitation is holistic: the body heals parallel to techniques seem very specific and could not have the mind. Addressing an athlete’s emotions is a general application. To reiterate, the use of significant and having a collection of available these methods has to be case by case. A college techniques is useful for coaches, trainers and the rugby player is not motivated by the same issues sports community. an international soccer athlete and will not Although the methods have a common ground, respond to the same training scheme. Their fears recovery should be case by case: each athlete has have different underlying causes and thus require a unique scenario and is to be treated as such. different treatments. Once more, we restate the There has to be careful consideration as to how need the injury occurred, what thoughts trigger fear or personalized care. anxiety, gender, history of other for individualized assessment and injuries, As painful as twisting a knee during play is, motivation as to preference of the sport, and such the most enduring part about incidents like ACL other factors that make up the psychology of the is recovery. Despite the fact that physical therapy athlete. Not all individuals will respond positively gives bodily functions back, it is very important to one type of treatment but others might. to complement the mental and emotional aspect Additionally, it is important to note that a as well. Because injured athletes experience fear, recovery is not complete after the first game. An lack of confidence and other emotionally athlete has to be accompanied some time later to burdening feelings, addressing these is necessary. guarantee full time incorporation. Many of the The few studies presented can ideally offer a psychological aspects and routines that were bulit reference and developed through the methodolgies have to athletles and trainers to be used when facing be followed up and continued. recovery of injury. Further research should not only seek additional methods but also should attemp testing and evaluating the efficiency of each. Having concrete evidence of different cases, in different sports will yield even more usefulness. Through collection and evaluation of observation and for sport psychologists, coaches, References: Ardern, C. L., Taylor, N. F., Feller, J. A. & Webster, K. E. (2012). A systematic review of the psychological factors associated with returning to sport following injury. British Journal of Sports Medicine, 47, 1120-6. Cox, D. (2002). The psychological rehabilitation of a severely injured rugby player. In Cockerill, I. (Ed.), Solutions in Sport Psychology (159-172). 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