Psychology of Injury

A range of negative emotions, principally shock, disbelief, anger, frustration and depression, have been reported by athletes following severe injury. Over time these negative emotions are replaced by optimism and focus as the athlete concentrates on the rehabilitation. The quicker an athlete becomes disengaged from these negative emotions the sooner they can become focused on the physical rehabilitation. As such early acceptance of the severity of the injury can result in a speedier and more efficient return to previous physical fitness levels. Without going into great detail, academic research has attempted to understand the psychological processes experienced by using both stage models (Kübler-Ross, 1969; Pedersen, 1986) and cognitive appraisal models (Brewer, 1994; Wiese-Bjornstal, Smith, Shaffer & Morrey, 1998). Because of the loss of health, sense of purpose, and self-identity initial research suggested the response to athletic injury was similar to the grief responses of terminally ill patients. Kübler-Ross’ (1969) grief model involves five stages (Denial; Bargaining; Anger; Depression; and Acceptance) passed through sequentially. While Wiese-Bjornstal et al. (1998) presented an integrated model of the psychological response to sports injury, which illustrated the multitude of cyclical factors involved in development of cognitive appraisal and adjustment to being injured. Specifically, personal factors (i.e., age; level of competition) and situational factors (i.e., injury severity; timing of injury, availability of medical support) interact to influence the athlete’s appraisal of injury, which influences emotional, behavioural, and cognitive responses.

However, from a practical perspective we know that dealing with the psychological components of injury is equally important as the physical rehabilitation. To make this simpler we have broken down the best approaches for managing the mental processes into three stages: 1) Pre and Post Surgery; 2) Physical Rehabilitation; and 3) Return to Competition.

1) Pre and Post Surgery - Prior to surgical intervention feelings of depression and anxiety are predominant, and those working with injured athletes should encourage the adoption of problem focused coping strategies. Specifically, medical providers can reduce the stress of athletes by providing them with a detailed overview of the surgical procedure and the subsequent rehabilitation program. Knowledge of the process allows the injured athlete more control over the rehabilitation and assists with preparation for surgery. Early acceptance of the injury post-surgery facilitates the recovery by providing a greater focus on the rehabilitation goals; while establishing new goals to compensate for the removal of sport performance goals should be encouraged.

2) Physical Rehabilitation - During the physical rehabilitation athletes should be guided to become personally involved with the rehabilitation process. Developing some autonomy and control over the process is essential. Research suggests that increased personal control during rehabilitation promotes more adaptive coping response, and increases persistence and adherence. Athlete confidence can be developed by seeing improvements in physical ability and by achieving short term goals.

3) Return to Competition - Fear of re-injury has been commonly reported by athletes returning to competition following ACL injury, however more recently research suggests greater fears relate to a lack of physical fitness and performance. As such physical competence can be increased by ensuring athletes successfully complete clinical and sport specific tests. It is recommended that a psychological skills training program, concentrating on confidence development, should be integrated with the physical rehabilitation program. Coaches, medical staff, and the returning athlete should all be involved in the design of specific, realistic goals aimed at returning the athlete to previous performance levels. The use of goals within the return to competition allows the athlete to concentrate on other factors and reduce concentration on the injured body part; while the achievement of these goals can increase competence and self-confidence.

Some General Tips to Follow:
  • Get a good understanding of your injury and the rehabilitation process
  • Re-set your goals, setting a number of short-term objectives
  • Take ownership of your rehabilitation
  • Build confidence by identifying the small improvements you make
  • Stay involved with your sport / team / club as much as possible (but take a complete break away if it starts to get too much)
  • Work with a coach / medical provider / sport psychologist to set specific targets for return