Psychological Aspects of Sport Injury Rehabilitation

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Psychological Aspects of Sport Injury
Rehabilitation

• Presentation to the Sport Injury Special Interest
  Group Singapore General Hospital
• 13 March 2002
• By Daniel Smith, Ph.D.
• Physical Education and Sport Science
• National Institute of Education
• Nanyang Technological University

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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
• Heil 2002

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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 (Brewer, 1994)

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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

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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.

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• Pain Pain is a whole brain experience derived
  from a summation of inputs from multiple brain
  centers including those that serve emotion and
  memory (Merskey,1986).
• Catastrophizing contributes to heightened
  pain (Sullivan et al., 2000).
• Cognitive Restructuring is necessary
  (attention diversion, rational emotive therapy,
  stress inoculation training).

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• 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 was common in those
  rehabilitating severe knee injuries, with the
  fear inhibiting the recovery process in some
  cases (Mainwaring, 1999).
• Cognitive restructuring needed.

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• 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.

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The Way to Recovery

• Education About 50 of injured athletes felt
  their physicians were impersonal and did not
  provide enough information about their injury
  (Macchi Crossman, 1996).

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• 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.

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• Social Support
• Athletes expect, but do not receive, sufficient
  social support and information from sports
  medicine professionals (Mainwaring, 1999).
• 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 (Granito, 2001).
• Emotional support was especially important when
  the rehab process was slow, setbacks were
  experienced, or other life demands placed
  additional pressure on the athlete (Evans et al.,
  2000).

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• 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.

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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.

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• 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.

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A Complete Sports Medicine Program Includes a
Sports Medicine of the Mind