The Psychology of Sport Injury and Rehabilitation

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In general, the perspectives have strong cognitive and motivational components, which is not surprising given the effort and persistence that adherence to sport injury rehabilitation programs can require. Although psychological readiness to return to sport is a concept that is still being defined, it has not been completely atheoretical.

Podlog and his colleagues e. Over the past quarter-century, a sizable body of research on the topic has accumulated. The primary foci of scientific studies have varied over time, but pain, cognition, emotion, behavior, and readiness to return to sport have all been examined by investigators. Pain is ubiquitous in sport. It not only can signal the occurrence of sport injury and feature in its aftermath, but it also can be a central aspect of sport training and competition.

Reflecting the prominent role of pain in sport, scholars have investigated multiple aspects of the phenomenon in the context of sport. Research has progressed along four main lines of inquiry.

One line of research has examined pain from a sociological perspective, yielding the important finding that sport is a culture in which athletes can be reinforced or even glorified for ignoring, denying, and playing through pain and injury e. Pain, therefore, appears to be a socially charged psychological response to sport injury that athletes may be discouraged from expressing, even to those responsible for treating the conditions that precipitated it Safai, ; Walk, A second line of research has compared athletes and nonathletes on laboratory measures of pain tolerance and pain threshold.

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The relevance of these findings for pain in response to sport injury, however, is not clear. A third line of research has focused on assessing the prevalence and identifying anthropometric, biomechanical, strength, training, and, in rare cases, psychological predictors of pain in athletes. Many of the studies in this area of inquiry have examined pain in particular parts or regions of the body experienced by athletes participating in sports in which such pain is likely.

Overall, the findings in this area of research attest to the ubiquity of pain in sport, but they do not have clear implications for understanding pain as a psychological response to injury because many of the participants who reported experiencing pain were not necessarily injured per se and, even when injured, may have been training as much as those who were not injured Dahlquist et al. The fourth main line of research has explored pain experienced by athletes after anterior cruciate ligament ACL reconstruction. In addition to examining associations of factors such as surgical procedures Beck et al.

Pain intensity is higher for adolescents than adults at 24 hours postsurgery Tripp et al. Pain intensity is positively associated with anxiety at 24 hours postsurgery Tripp et al. In general, research in this line of inquiry is more concentrated on pain as a psychological response than that in the other three lines, but the narrow focus on a single type of injury and approach to treatment limits its generalizability.

Thus, although the four lines of research have been informative, limitations with each of them preclude a thorough understanding of pain responses to sport injury.

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As noted in the general section on theoretical perspectives, the integrated model of psychological response to sport injury Wiese-Bjornstal et al. Cognitive responses beyond the primary appraisals of the injury can be grouped into three potentially overlapping categories of cognitive content i. Given that sport injury is the kind of event that elicits the psychological responses addressed in this article, it is logical to expect the cognitive content of athletes with injuries to reflect their experiences and pertain at least partially to the injuries themselves.

Later, after the immediate impact of injury has passed, athletes have shown a propensity for experiencing more positively tinged cognitive content, reporting perceptions of benefits they have accrued as a result of their injuries e. Consequently, it is reasonable to expect that injury might have an impact on self-related cognitive content.

Substantial changes in self-definition, which reflects how athletes think about themselves, have been reported by athletes with severe injuries Vergeer, In taking an active role to deal with the adverse physical and psychological effects of injury, athletes have reported that they sometimes initiate cognitive coping strategies. It appears that the cognitive strategies deployed by athletes are at least in part influenced by the specific qualities of the injury-related stressors e. The literature suggests that, in addition to affecting cognitive content, sport injury has an adverse effect on cognitive processes such as attention, memory, processing speed, and reaction time Moser, The largest share of research on the psychological consequences of sport injury has been devoted to emotional responses.

Findings from an abundance of qualitative and quantitative studies have converged to produce a rich description of how athletes respond emotionally to injury and identify a variety of personal, situational, cognitive, and behavioral factors associated with those responses.

From a descriptive standpoint, athletes have tended to use a variety of negative terms e. Although common, reports of negative emotions are not inevitable and may fluctuate widely over the course of the rehabilitation Bianco et al. In addition to the large body of research that has provided a thorough description of emotional responses to sport injury, numerous studies have investigated potential predictors of such responses. As proposed in the integrated model of psychological response to sport injury Wiese-Bjornstal et al.

Regarding personal factors, positive associations have been obtained between postinjury emotional disturbance and pain Brewer et al. With respect to situational factors, the variable most consistently associated with postinjury emotional responses is the amount of time that has passed since occurrence of the injury. Because pain, cognition, and emotion can be readily concealed from view, behavior is undeniably the most overt psychological response to sport injury.

Further, even though the behavior of athletes may reflect or be a manifestation of their experience of pain, cognitive, or emotional responses to injury, it is behavioral responses that have the greatest potential to affect the rehabilitation process.

The Psychology of Sports Injury and Rehabilitation

Some of the behaviors that athletes have reported themselves as engaging in after injury can be interpreted as attempts to cope with the challenges of the situation. The behavioral response to sport injury that has garnered the most attention from investigators is adherence to rehabilitation.

Although athletes engage in some of the rehabilitation behaviors in supervised clinical settings, they complete other of the behaviors at home, away from the direct oversight of rehabilitation professionals. Although such behavior is technically nonadherent, it is fundamentally different from failing to complete one or more aspects of a rehabilitation program. Given the potential importance of adherence in achieving desired sport injury rehabilitation outcomes, investigators have attempted to identify factors associated with adherence to sport injury rehabilitation.

With respect to situational factors, findings from multiple investigations have shown that athletes display higher levels of adherence to sport injury rehabilitation programs when they consider themselves as receiving support from others for their rehabilitation Byerly et al. Several cognitive and emotional responses have also been found to predict adherence to sport injury rehabilitation programs across multiple studies. From a cognitive standpoint, athletes have demonstrated higher levels of adherence to rehabilitation when they report believing that their treatment will be effective Brewer, Cornelius, Van Raalte, Petitpas, Sklar et al.

In terms of emotional responses, negative associations have been documented between mood disturbance and sport injury rehabilitation adherence Alzate et al. The lack of a universally accepted definition of psychological readiness to return to sport after injury has not prevented researchers from investigating the topic through two main approaches. One approach involves comparing athletes who return to sport after injury with those who do not return to sport after injury on psychological variables measured during or after rehabilitation.

The other approach involves asking athletes who have returned to sport after injury to describe their experience of returning. The consequences of an absence of psychological readiness to return to sport are not fully understood. Beyond being less likely to return to sport in the first place, athletes who are not psychologically ready to return to sport but do so anyway may be at increased risk for such consequences as injury or reinjury , poor sport performance, and a lower quality sport experience.

Prospective longitudinal research is needed to investigate these possibilities.

The Mind Often Recovers After the Body

Common treatment approaches for pain differ somewhat from those for problematic cognitive, emotional, and behavioral responses, and treatments designed to enhance psychological readiness to return to sport have not been evaluated explicitly. Consequently, interventions to treat pain and improve psychological readiness to return to sport are discussed separately from the other three main types of psychological response and from each other.


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An important aspect of postinjury pain among athletes is that it often can be escaped or reduced by ceasing, reducing, or modifying involvement in activities that produce or exacerbate the pain. For postinjury pain that is especially intense or long-lasting, formal pain management interventions can be initiated.

Such interventions are likely to involve a combination of analgesic medications and physical therapies Kolt, Aspirin, ibuprofen, and paracetamol acetaminophen are the analgesic medications most likely to be recommended, with opioids e. Physical therapies used to treat postinjury pain in athletes include electrophysical agents e.

The lack of research on psychological pain management techniques in sport injury rehabilitation suggests that the techniques are not implemented on a widespread basis in clinical settings. As for postinjury pain, many psychological interventions have been advocated to affect cognitive, emotional, and behavioral responses to sport injury.

As an emerging construct, psychological readiness to return to sport after injury has received minimal attention from researchers attempting to evaluate the effectiveness of interventions designed explicitly to foster psychological readiness in athletes resuming sport participation after injury. Nevertheless, interventions that have produced increases in confidence e. As a fuller understanding of the composition of what it means to be psychologically ready to return to sport emerges, inquiry into the effects of interventions developed to enhance readiness is likely to ensue.

Sport injury can affect athletes both physically and psychologically.

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Pain, cognition, emotion, and behavior are primary areas of psychological functioning affected by injury. Psychological responses to sport injury tend to be strongest in close temporal proximity to injury occurrence and fluctuate over the course of rehabilitation. Psychological readiness to return to sport after injury is an emerging concept that incorporates aspects of cognition, emotion, and behavior, including anxiety, confidence, motivation, and postreturn expectations.

A variety of theoretical perspectives have been used to guide a body of research on psychological responses to sport injury. Relatively few controlled investigations of interventions designed to influence psychological responses to sport injury have been conducted. Abenza, L. Find this resource:. Addison, T. Understanding the psychology of pain in sport. Irish Journal of Psychology , 19 , — Albinson, C. Cognitive appraisals, stress, and coping: Preinjury and postinjury factors influencing psychological adjustment to athletic injury. Journal of Sport Rehabilitation , 12 , — Alzate, R.

The effect of psychological response on recovery of sport injury. Research in Sports Medicine , 12 , 15— Appaneal, R. Measuring postinjury depression among male and female competitive athletes. Journal of Sport and Exercise Psychology , 31 , 60— Ardern, C. A systematic review of the psychological factors associated with returning to sport following injury. British Journal of Sports Medicine , 47 , — Astle, S. The experience of loss in athletes. Journal of Sports Medicine and Physical Fitness , 26 , — Baranoff, J. The roles of acceptance and catastrophizing in rehabilitation following anterior cruciate ligament reconstruction.

Journal of Science and Medicine in Sport , 18 , — Bassett, S. A test of an adherence-enhancing adjunct to physiotherapy steeped in the protection motivation theory.

How Injury Affects Mental Health - Athletes Connected

Physiotherapy Theory and Practice , 27 , — Beck, P. Postoperative pain management after anterior cruciate ligament reconstruction. Journal of Knee Surgery , 17 , 18— Benea, H. Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study.

The Knee , 21 , — Beneka, A.