Staying Positive With an Injury

Introduction   

How can you maintain motivation and a positive mental state when recovering from a season-ending injury? The pathway to recovery is full of disappointment, frustration, and helplessness. However, there are ways you can cope with these feelings through post-injury interventions. This can lead to personal strength, [the] discovery of new possibilities, and a new appreciation for life (Vann et al., 2019). Every athlete is different, so making sure you customize training for the athletes can make them feel more valued and improve their healing process (Gould et al., 1997). By focusing on both psychological support and physical therapy, athletes can navigate the struggles that come along with a season-ending injury. 

Review of the Literature 

Dealing with an athlete with a season-or career-ending injury is never easy. Believe it or not, there are things the caregiver or the athlete facing hardships can do to help cope with the injury. A lot of times, the athlete will feel total defeat, get easily discouraged, and often get depressed. To help an athlete going through tough times, it is very important to “educate and inform" the athlete about their situation; being very honest is a must so the athlete can have trust in you (Gould et al., 1997). Every athlete is going to need very different and specific treatment depending on the severity of their injury and the location of the injury. Coaches need to understand injuries and recovery for athletes to know when it is appropriate to progress or hold back an athlete. Several athletes felt it would be helpful if sports medicine providers worked more closely with coaches to facilitate a shared understanding between medical providers, coaches, and injured athletes as to the athlete's capabilities and limitations during the recovery process (Gould et al., 1997). 

Moore et al. (2021) researched student athletes’ perspectives and psychological responses to a career- or season-ending injury in a college sport. Ten Division One athletes who were on a scholarship for athletics at Ball State University and experienced a season- or career-ending injury were picked for this study. Researchers used a descriptive phenomenological approach during this study and found four common themes, with two sub-themes relating to their injuries. These include physical and emotional stress, resistance to resiliency, the importance of relationships with others, and appreciation and cultivation of new possibilities outside of sports (Moore et al., 2021).  

The other two sub-themes included anxiety and fear. This information provided researchers with insight into behavioral health professionals and their responses to injuries. Not only is there a physical injury, but athletes also have the psychological challenges they face after a serious injury. Some of these psychological challenges included depression, anxiety, and suicidal ideation. Some of the main questions asked during these interviews included talking about their collegiate playing experience and then describing the injury that ended their athletic season or career (Moore et al., 2021). Some information was learned from these interviews, where eight out of the ten participants shared a common fear of the unknown surrounding injuries, stating things like rehab is taking too long, doctors don’t know what they are doing or talking about, fear of this injury happening again, and reliving trauma. Some of the things that were found to benefit athletes during these times were coaches who kept them close with the team, friends, and family who never left their side, athletic trainers who guided them through the recovery process, and even a finding of religion to help guide them (Moore et al., 2021). 

Sometimes it’s more than just the injury. It could be the pressure the athlete feels from their teammates, coaches, family, and friends putting fear into the injured athlete, making them feel like they must get back and play so they can stay in the lineup, in shape, sharp, and in condition. Podlog and Eklund (2009) found that time pressures, internal pressures, and constraints to be ready for particular competitions influenced their ability to create realistic goals and, in turn, their perceptions of success. These findings suggest the importance of minimizing external pressures to return to sport to facilitate realistic post-injury goals and expectations about when, where, and how well athletes are expected to perform following injury recovery. Fostering perceptions of competence, autonomy, and relatedness may increase the likelihood that athletes view themselves as successful in returning to sport following injury (Podlog & Eklund, 2009).  

Another study took twenty-one athletes, both male and female, from the United States ski team, all of whom had season- or career-ending injuries. These athletes were also at the top of the skill chain, all performing in the Olympics. High stress and hard training were given to these individuals. In this study, researchers wanted to focus more on the benefits or growth individuals experienced from their injuries, unlike other studies that only focused on the negative outcomes (Udry et al., 1997). Researchers used a qualitative methodology approach to the interviews, which is an interview-style more suited to the richness and complexity of an individual’s experiences. The interview took 60 to 90 minutes (about 1 and a half hours).  

After all the interviews were completed, researchers got together and found four common themes among these athletes: injury-relevant information, processing and awareness, emotional upheaval and reactive behavior, and positive outlook and coping attempts. 76.2% were emotionally agitated, angry, panicked, or worried (Udry et al., 1997). The information was then shortened to find four general themes of benefits among the athletes: personal growth, psychologically based performance enhancements, and physical technical development. In fact, 81% of the athletes had a positive outlook on their injury, and twenty out of the twenty-one athletes reported one or more benefits from the injury (Udry et al., 1997). Some of these benefits included more confidence, more maturity, and even non-skiing benefits.  

Every athlete will respond to injuries in different ways. Research shows that elite athletes tend to deal with serious injuries better than most because they tend to feel a sense of loss related to their own sport, which then tends to motivate them more to return quicker to their sport. Blame, shame, and guilt are common mechanisms adopted after an injury or trauma (Vann et al., 2019). This tends to lead athletes to cope with drugs, alcohol, and anger, which can lead to depression. Vann et al. (2019) explain why communication with the injured athlete is very important to make them feel that they are not alone and that the injury will get better:

It is important for those working with athletes to understand where athletes are developing the most growth, but also the areas that are less likely to produce growth for athletes. Post-injury interventions can first focus more specifically on the types of growth that may be most likely to occur (personal strength, discovery of new possibilities, and a new appreciation for life) early on to move an athlete away from PTSD and depression risk and later incorporate methods of improving the growth least likely to occur to support the athletes in every possible outlet. (p. 97)

Staying positive for the athlete, all in all, is the most important, distracting them from the injury itself and asking them simple questions about what their goal is to be at their progression-wise next visit. Greater awareness of why PTG (posttraumatic growth) occurs and how to better foster growth outcomes may help promote resilience against future traumas that will occur in the life of an athlete (Vann et al., 2019). 

 Implications for the Practitioner 

The first recommendation is to keep the athlete engaged and stress the importance of a relationship with the athlete. By doing this, the athlete can still feel a part of the team and not get consumed by the feelings of isolation and social stress athletes feel when they endure a season or career-ending injuries. It can be seen that the accommodations provided by coaches and athletic trainers to alter a training routine or engage in the team by sitting on the sidelines were received positively and enhanced the working relationship with the athletes (Moore et al., 2021). When coaches and medical professionals can create an environment where the injured athlete can still be a part of team activities, they have a positive response instead of feeling isolated from their teammates and friends. This leads to a more positive recovery for the athlete, even though they are still in pain, they will have an easier time not being able to participate directly in their sport if there are alternate ways to participate in their sport. 

The second recommendation for coaches and medical professionals would be to manage the injured athletes' expectations when returning to their sport. Having realistic expectations for athletes when they return to sport will help them have a more successful return to their sport. On the other hand, there can be “. . . potentially detrimental effects of setting overly high-performance expectations” (Vann et al., 2019). If the expectations are too high for a returning athlete, this can cause stress and depression when the athlete cannot achieve the goals that are set for them by coaches or by themselves. Coaches or medical professionals should sit down with the returning athlete and establish realistic, achievable goals depending on the fitness of the athlete after recovery from injury. 

The third recommendation is to use the Posttraumatic Growth Inventory (PTGI) to evaluate the athlete's perception of growth. The PTGI is the sum of the scores for the 21 inventory aimed at calculating the posttraumatic growth of the athlete taking the inventory test. The result of collecting this information on all athletes could provide a way to start the conversation about the impact an injury may have on an athlete (Vann et al., 2019). Having this conversation with an athlete as a coach or medical professional can prevent the athlete from developing destructive coping habits because of their season or career-ending injuries. Being able to open a conversation with the athlete based on their PTGI score will show the athlete you care about them as part of the team even though they are unable to participate in the sport. 

Conclusion 

Suffering through a season or career-ending injury is never easy for anyone involved. It takes a lot of time for any athlete to bounce back from something like this. It can cause depression and anxiety for the athlete, especially when watching their teammates perform and knowing they cannot do anything to help. However, by surrounding themselves with the right people and being around coaches and trainers who know what they are doing, athletes can get back to doing what they love in no time. Communication and honesty are key for this, and if the athlete is not clear with their coaches and trainers about what is going on, it can be difficult for them to return when they want to. On the contrary, if the athlete works hard, is patient, and communicates well with all parties involved, they can get back to a normal life quickly. 

References  

Gould, D., Udry, E., Bridges, D., & Beck, L. (1997). How to help elite athletes cope psychologically with season-ending injuries. Athletic Therapy Today, 2(4), 50–53. https://doi.org/10.1123/att.2.4.50

Moore, M. A., Vann, S., & Blake, A. (2021). Learning from the experiences of collegiate athletes living through a season- or career-ending injury. Journal of Amateur Sport, 7(1), 46–63. https://doi.org/10.17161/jas.v7i1.14501

Podlog, L., & Eklund, R. C. (2009). High-level athletes’ perceptions of success in returning to sport following injury. Psychology of Sport and Exercise, 10(5), 535–544. https://doi.org/10.1016/j.psychsport.2009.02.003

Udry, E., Gould, D., Bridges, D., & Beck, L. (1997). Down but not out: Athlete responses to season-ending injuries. Journal of Sport and Exercise Psychology, 19(3), 229–248. https://doi.org/10.1123/jsep.19.3.229

Vann, S. E., Moore, M., Freiburger, K., & Johnson, H. (2019). The end is not the injury: Posttraumatic growth after sport injuries. Journal of Amateur Sport, 4(2), 87–102. https://doi.org/10.17161/jas.v4i2.6705