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.

References

Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3^rd

      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.