Psychological Response to Injury

Psychological Response to Injury

Sports medicine health professionals need to be sensitive to the cognitive, emotional and behavioural responses to injury  to help athlete work through the stress or grief of the affects of the injury. The consequences of injury to an elite/top level athlete may be profound. Most athletes will have appropriate and adequate psychological responses to injury, some will not and need further help. The response will vary with severity/acuteness of injury and personality characteristics of athlete. Awareness of the psychological response will help clinicians interact in a more positive way with the injured athlete.

Injured athletes have been shown to be more frustrated, depressed, bored, tense, hostile, unsure, tired and confused than a non-injured control group and the author felt that physiotherapists had considerable potential to influence the athletes moods during the rehabilitation period.

Injuries to athletes do have cognitive, emotional and behavioural effects that can impact on rehabilitation.
Weiss & Troxel (1986) – 4 stages of response to injury:
1) What happened?
• what actually were the events that happened
• the athlete is inquisitive about the injury
2) What does the athlete think about what happened?
the athletes cognitive appraisal of what happened  has impact on athletes ability to cope/deal with it
the appraisal may be positive or negative, which will influence progress to next stage  may need to use a sports psychologist to influence more accurate cognitive appraisal of injury
3) How the athlete feels about what happened.
• the emotional response to the injury which may manifest as anxiety, worry/concern and physiological arousal  may need to use a sports psychologist to help control emotional response
4) What do athletes do about what happened?
the behavioural consequences of the physical and psychological responses  influences adherence to rehabilitation plan

Specific emotions that athletes have can be similar to the grief response. Hodge (1990) – the grief response following injury can be due to the psychological trauma to athletes goals and dreams being ‘shattered’ by injury  trigger an emotional response similar to that of the death of a loved one:

Phase 1: Shock:
• immediate reaction  sudden shock like state  emotions include anger, disbelief, and denial of the injury
Phase 2: Preoccupation:
• involves an intense preoccupation with the injury  emotions include depression, isolation, guilt and bargaining behaviours
Phase 3: Reorganisation:
• athlete fully accepts injury  renewed interest in sport and rehabilitation

A number of mediating factors can affect the impact, duration and intensity of the different stages of the psychological responses to injury. Sanderson (1981) suggests that personality factors play a role. The dimensions of introversion/extraversion could be important. Extraverts tend to be impatient and have a higher pain tolerance whereas introverts tend to be more guarded, indecisive and apprehensive. The athletes coping resources, previous stress history and social support may also mediate the psychological responses. The responses of individuals will vary from those who ‘take it in their stride’ to those who will need intervention of a sports psychologist.

Guidelines for athletes adapting to a sports injury :
1) Respond positively to the incapacities, pain and weakness from the injury:
• inform coach immediately
• denial of injury is dysfunctional to rehabilitation
2) Adapt promptly to the stresses of the treatment procedures:
• accept that hospitals, treatments rooms, braces and devices, rehabilitation timetables will be unsettling and difficult at first
• adjustment, however, does occur with time
3) Place trust in health professionals and encourage communication:
• diminished trust in professionals in unfamiliar settings can be anticipated and is normal
• athletes often feel vulnerable when dependent on others
4) Maintain an emotional balance:
• avoid self blame and/or guilt (past events)
• focus on rehabilitation and recovery (present events)
5) Maintain a healthy self-image:
• forced inactivity and non-participation is extremely frustrating – few will fully comprehend this emotional challenge
• keep a healthy and positive perspective on life – the loss of mastery, competence and participation is only temporary
• preserve relationships with team-mate, coaches, family and friends
• avoid alienating or isolating yourself from associates who may find dealing with your injury difficult
6) Look forward positively to an uncertain future:
• surgery and advanced rehabilitation techniques can both raise hopes and destroy hopes of a full recovery
• always be enthusiastic and positive about full activity and an active life
7) Accept the limitations and restrictions imposed by the injury and adjust lifestyle and goals accordingly:
• focus on what you can do – not on what you can’t do – learn to accept physical realities
• keep moving forward in life – looking back with regret is a waste of time.