Thursday, September 30, 2010

Addressing the Emotional Impact of Injuries

An injury can affect a player more than just physically. And often the mental or emotional setbacks that a player faces can impact their physical rehabilitation. It’s efficacious to consider more than just the player’s physical needs when determining the best rehabilitation program.

A volleyball player is undergoing a 6-8 week rehabilitation after anterior cruciate ligament (ACL) surgery. As the player’s athletic trainer, I need to come up with a rehabilitation plan that addresses both her physical and mental/emotional injuries.

Wilson, Peper, and Schmidt (as cited in Gill & Williams, 2008) noted two types of strategies that can help me address the player’s needs: external strategies to avoid distraction and internal strategies to stay centered. External strategies such as mental imagery would be effective at the beginning of treatment in this case as the player may have some mobility issues and be unable to perform many physical tasks yet. Internal strategies such as biofeedback would complement the mental imagery by helping the player focus on the mind-body connection. It would also help the player deal with future stress during rehabilitation by training the player to recognize how negative thoughts and emotions are affecting them physically. As the treatment progresses, additional strategies can be employed. Another external strategy that might prove useful is dress rehearsal. By slowly introducing elements that the player associates with volleyball such as a uniform, it allows the player to re-acclimate themselves with the game. An internal strategy that can also help later in the rehabilitation is turning failure into success. It is inevitable that the player will have failures along the way. If the player imagines a success right after a failure, it can help lessen the mental and emotional impact of the failure.

How do we put these strategies into practice? First, it’s important to meet with the player to determine what their specific mental and emotional needs are. Morrey, Stuart, Smith, & Wiese-Bjornstal (1999) found that in particular after ACL surgery, anger, frustration, and boredom contribute to overall mood disturbance. These would be the major emotional issues that the player faces, but it’s also important to recognize the player’s unique needs. The player may also have some ideas as to which strategies will work for them. If a player has experience with mental imagery and has used it with success in the past, then the strategy may be particularly helpful with rehabilitation. Likewise, if the player has used biofeedback in the past with limited usefulness, it may be necessary to explore other options.

Next, we can start with visualizing success using mental imagery. Having the player develop positive thinking with regards to rehabilitation allows them to combat the negative emotions that they are likely feeling. In combination with biofeedback, the player can learn to notice how their body reacts to the negative feelings and use mental imagery to relax. If helpful, positive self-talk can be incorporated. Perhaps the player can develop their own mantra to help them re-focus on their success. This forms the foundation for the rehabilitation by giving the player healthy ways of dealing emotionally and physically with possible setbacks and failures.

Acknowledging that there will be failures can help the player have realistic expectations for recovery. Teaching the player to immediately visualize a success after a failure can help them stay focused on the task at hand without getting too discouraged. Practicing this technique before the player even picks up a volleyball may help in making it a more automatic reaction to failure. Likewise, having the player acclimate by wearing their uniform or putting on their favorite game-day shoes allows them to deal with whatever emotions they are feeling in a slow and steady way.

Injuries are multi-faceted and can have complex outcomes. Cognitive skills can form the foundation of the rehabilitation by helping the individual recognize the link between what they feel and how well they perform physically. Learning to use strategies such as biofeedback and turning failure into success can help players deal with inevitable setbacks, both mental and physical. By working with the individual player to set personalized goals and realistic expectations, athletic trainers can ensure a successful rehabilitation.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd
      Ed.). Champaign, IL: Human Kinetics.

Morrey, M. A., Stuart, M. J., Smith, A. M., & Wiese-Bjornstal, D. M. (1999). A 
     longitudinal examination of athletes’emotional and cognitive responses to anterior
     cruciate ligament  injury. Clinical Journal of Sport Medicine, 9, 63–69.

Tuesday, September 28, 2010

A positive performance on the field is determined by more than just a player’s skill. Players can be affected by things as varied as their mood and their perceived abilities. Coaches play an active role in not only determining what may be affecting a player but also finding ways of helping the player to solve the issue.
Chris has been playing soccer for two years and has the potential to be a great player. However, she appears to have self-esteem issues both in practice and in games. Chris gives up easily and often appears unhappy. Her parents wanted her to play soccer in order to improve her self-esteem, but they are concerned that soccer is not having the desired effect. As Chris’s coach, I can utilize strategies to improve her skills and her self-confidence.
Since Chris has potential but often shies away from challenges, she needs help improving her self-efficacy. Gill & Williams (2008) made note of six primary types of information that impact efficacy expectations: performance accomplishments, vicarious experiences, emotional and physiological states, verbal persuasion, and imaginal experiences. They also noted that performance accomplishments have the most powerful effects on self-efficacy.
So how do we apply this concept to Chris’s unique situation? First, we need to increase the number of tasks that Chris accomplishes successfully. To do that, she and I need to set realistic and achievable goals for her during practice and games. It may even be helpful to set short-term goals that can be achieved in a single practice session to allow Chris a sense of accomplishment during each practice. These accomplishments set up a foundation for Chris to build her self-efficacy upon.
Asking members of the team to demonstrate a particular skill for the group that they do well can help Chris (as well as her teammates) to improve her skills. The players may offer their own tips on how they mastered the skill or how they approach completing the skill. Chris may also benefit from being partnered with another teammate to practice her skills or from some additional time working on skills with me.
To help Chris feel more supported, I would encourage the entire team to give positive feedback and encouragement to every member of the team during practice and games. Hearing her teammates cheering her on and having them compliment the things she does well can help Chris to feel more confident in her skills as she progresses.
At the end of each practice, I can go over some of the healthy habits the teams should have both for practice and games. I can stress the importance of good nutrition and being well-hydrated as well as getting enough sleep. Helping Chris (and the team) to understand the link between good health and a positive performance will help her see how feeling better physically will make her a better player.
Chris and I can work on imagining positive outcomes when she attempts something. If she can focus on visualizing herself completing a task successfully, she is more likely to succeed when she attempts it.  And as Vargas-Tonsing & Bartholomew (2006) found that emotional pleas before a game increased the self-efficacy of the team, I’ll also focus on motivating the team before each game as a way of improving Chris’s (and her teammates’) self-efficacy.
Chris has voluntarily continued playing soccer for the last two years, so it’s obvious that she enjoys the sport. Her tendency to give up easily and be unhappy during games may mean that she simply hasn’t been given the encouragement and support that she needs to become confident in her skills. By employing the strategies above, I can help Chris develop her self-efficacy and she can start to really enjoy playing soccer.

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd
      Ed.). Champaign, IL: Human Kinetics.

Vargas-Tonsing, T. M., & Bartholomew, J. B. (2006). An exploratory study of the effects of pregame
     speeches on team efficacy beliefs. Journal of Applied Social Psychology, 36, 918-933.