by Dr. Pete Temple
When athletes get injured they embark on an unwanted journey. It is a challenging journey that involves much more than healing bones, tendons or tissues. It involves the mind just as much as the body. If you question the validity of this statement, just ask any athlete who has experienced a serious injury. By helping injured athletes understand the road in front of them – knowing what to expect and how to navigate some of the twists and turns – we can help them arrive at their desired destination (the court, the field, the pool) more quickly and better prepared.
There is an understandable focus on the physical aspects of an athletic injury. Injuries need to be diagnosed and healed and that’s the work of doctors, trainers and physical therapists. These professionals do a good job of helping injured athletes know what to expect from the perspective of their disciplines. They help athletes by telling them what’s happened (the diagnosis), what they’ll have to do (the treatment plan) and when they may be able to return to play (the prognosis).
It has been my experience that injured athletes are often ill-prepared, if not left completely in the dark, when it comes to the emotional and psychological aspects of injury and recovery. Helping athletes (and parents and coaches) understand what to expect, and what they can do to facilitate their rehabilitation will help them recover more quickly and more fully. It will also lesson the secondary trauma, the psychological hit, that comes with injury. This secondary trauma, if not accounted for, can be as challenging as the injury itself. It can complicate the rehabilitation process and impact performance after the athlete has returned to play.
Understanding the Psychological Impact of Injury
If we want to help injured athletes through the recovery process from a psychological and emotional perspective, we have to understand the way injuries can affect them. Serious athletes have a lot of themselves invested in their sport(s). They spend countless hours honing their skills and conditioning their bodies. In the process, sport becomes central to their existence and begins providing a number of constructive benefits to the athlete. An injury disrupts this part of their life and creates a number of losses that we need to understand. These losses may include:
- A loss of identity (“I’m an athlete”)
- A loss of role (“I’m an important part of a team”)
- A loss of a significant source of self-esteem
- A loss of a healthy coping mechanism (at a time when they need it most)
- A loss of social connectedness or belonging/li>
- A loss of structure (“What do I do now”)
- A loss of confidence
- A loss of a goal (or dream)
As you can see, the sense of loss – real or perceived – can be profound for some athletes. It is daunting, and a little scary, to think that this might be the road that lies ahead for the injured athlete. It is tempting to not look at something that is scary. Maybe, we hope, it will go away. This is a challenge that must be faced head on, so let’s look at how we can help athletes do this.
Helping the Injured Athlete Psychologically and Emotionally
The advantage of understanding the psychological/emotional impact of injury on athletes is that we can use that to help them. Here are some suggestions that can be helpful and facilitate a successful return to play.
- Encourage the athlete to express their feelings related to the injury. Be sad. Be angry. Talk about fear. These feelings are normal, but you can’t stay stuck in them. It is easier to work through them if you acknowledge them.
- Encourage the athlete to be realistic. Failing to accept the injury or insisting that it isn’t as bad as thought may seem brave, but it is actually an obstacle in the recovery process and can lead to additional injury.
- Encourage the athlete to refocus. Determine what the course of action will be and set specific and realistic goals. Remain focused in the present (not the “what if’s” of the past) and on the things that are within their control.
- Encourage the athlete to maintain a positive attitude. PMA isn’t a sports cliché, it is a scientifically proven variable that can speed recovery and minimize physical pain. Getting down or frustrated will happen, but do not get stuck in negativity.
- Encourage the athlete to continue to like an athlete. Attack your recovery like you’ve attacked and defeated numerous challenges over the course of your athletic career. Set an outcome goal (e.g. return to play), identify process goals (e.g., what you need to do) and get after it. You’re still an athlete.
- Encourage the athlete to continue to act like an athlete. Practice your sport. That’s right, practice your sport. If you can’t run, but can still shoot free throws, shoot free throws. If arm trouble has you shut down, you can still think about what pitch you would throw each hitter. Mental Imagery is another way to see yourself executing skills physically strong and pain free in your Mind’s Eye.
- Encourage the athlete to know and use their support system. Help them identify the people in their life that will want to be there for them – parents, teammates, coaches, trainers, neighbors, etc. The bigger and broader the list, the better. Generating this list will help the athlete realize that they are not alone and make it more likely that they will reach out.
- Encourage the athlete to be patient and trust his “team.” The “recovery team” is made up of many people – parents, doctors, trainers and coaches. Make sure there is good communication between these individuals and that everyone is on the same page as much as possible. Injured athletes get impatient and discouraged. Knowing that everyone is working together will keep them positive and improve compliance with treatment.
The Role of the Coach
It is an obvious statement to say a coach plays an important role in the lives of their athletes. Not only does he/she and their staff prepare the athlete to compete, but they also play a very important role emotionally in the athlete’s life. They are the head of their “athletic family” and are looked to for guidance, inspiration, and a healthy sense of self worth. With good coaches these things occur organically within the context of their practices and interactions. Athletes need healthy relationships with their coach to maximize their potential.
When an athlete experiences a serious injury that will result in them missing significant time, they often say the hardest part is feeling disconnected from the team. A coach who understands this can do some simple things to keep his/her athlete feeling like a vital part of the team. In addressing this important emotional aspect of their recovery, the coach can play a vital role in helping them return to play. Here are some suggestions for coaches.
- Remain connected to the athlete. Make sure it is clear to them that the connection you feel with them is to a person, not just a. Demonstrate empathy towards your injured athlete. Tell them that you understand how hard this is on them and make it clear that you will help them through it.
- Continue to be a “Coach.” Do what you’ve always done for your athletes. Encourage and inspire the injured athlete. Make sure they know that you believe they will return strong and make a significant contribution to the team. Athletes rise to the level of their coach’s expectations.
- Give the injured athlete a role on the team. This is very important because one of the most common reasons injured athletes become depressed is because they feel they aren’t making a contribution to the team. There are lots of ways to do this. Some examples might include: seeking out their opinion from a players perspective, involving them to some extent in the game planning, letting them help scout opponents, involving them as assistants in practices.
- Make sure the injured athlete remains connected to their teammates. Don’t let them isolate themselves. Make it clear that they are still a member of the team and are expected to be at all team functions. Giving them a role will help with this tremendously. This is also a responsibility that can be shared with team captains.
- Formally check in with your injured athlete from time to time. This is another opportunity to make sure they know you care about them even if they aren’t suiting up for games. Check in on their physical emotional status. Let them know that you understand how difficult it is to be out of action.
- When and where appropriate, expect the injured athlete to practice. This allows you to treat them like a member of the team and an athlete, two important aspects of their identity. If they cannot physically participate in any way, encourage them to use Mental Imagery to work on their skills, or to take “mental reps” during practice when their teammates are doing drills. Encourage them to be an active spectator during games and watch and think like they would if they were playing. If the injury is only partially limiting, have the athlete work on aspects of their game that they can still work on (for example, an athlete with a foot injury may still be able to work on shooting or throwing).
The Role of Parents
When you’re the parent of an athlete you wear a lot of hats. You’re the trainer, the dietician, the head cheerleader, sports psychologist… you get the idea. When your son or daughter gets hurt, what they want and need most of all is “mom” and “dad.” The good news is that you’ve been in training for this important roll since the first “owie” and scraped knee. Here are some things you can do to help your injured child get through the difficult challenge of being injured.
- Demonstrate loving empathy. Your child is hurting physically and emotionally. They need their parents. Let them know that you understand what they’re going through. Employ the parenting fundamentals – tell them you love them, give them physical affection and tell them it will be okay.
- Promise them that you will be on this journey with them. The road in front of an injured athlete can be a long one. Let them know that they will have your support and assistance throughout their recovery. Try to learn as much as you can about their injury and rehabilitation so they can see you as a knowledgeable advocate.
- Be realistically optimistic. Remain positive at all times. Your injured athlete will go through their ups and downs, but they need consistent optimism from you. However, be careful not to set them up for disappointment. If the doctor has said 3 months, it doesn’t help them to suggest that they might be able to do it in six weeks. Instead, encourage your athlete to focus on the treatment plan and their process (what they need to do that is within their control). If their hard work and positive approach speeds up their recovery, it’s a victory and confidence booster.
- Keep an eye out for signs that might indicate you’re injured athlete is starting to struggle emotionally. Ups and downs, moodiness, frustration and anger are normal and to be expected. However, these states should be transient and somewhat responsive (you should be able to help your athlete work through these states). If your athlete appears “stuck” in a bad place you may need to contact a qualified professional who understands athletes. Some signs to be on the lookout for would include; (1) persistent feelings of intense anger or sadness; (2) denial related to the seriousness of the injury (“It’s not that bad,” “The doctors are wrong,” “I’m playing in the next game”); (3) Disengagement from activities and/or withdrawal from friends and teammates; (4) sudden non-compliance with treatment; (5) suspicions of maladaptive coping mechanisms (e.g., substance abuse).
When an athlete gets hurt, we tend to think about the injury and the athlete from a physical perspective – What did they hurt? How will they treat it? How long will the rehab take? As is often the case with athletic performance, this (“physical only”) way of thinking about injury neglects the importance of the mental aspect. By helping athletes, coaches and parents understand what to expect and what they can do from a psychological and emotional perspective, we can give the injured athlete some additional tools that will help them accomplish their goal of returning to the sport they love physically and mentally strong.