Transcript Document 7360678

Psychological Aspects of
Sport Injury Rehabilitation
Presentation to the Sport Injury Special Interest
Group – Singapore General Hospital
13 March 2002
By Daniel Smith, Ph.D.
Physical Education and Sport Science
National Institute of Education
Nanyang Technological University
The Foundation of a “Sports
Medicine of the Mind”
 The
Psychological Process
 The Recovery Timeline
 The Way to Failed Rehabilitation
 The Way to Recovery
 The Aspects of a Remarkable Recovery
Psychological Process and
Recovery Timeline
Elizabeth Kubler-Ross (1969) On Death and Dying
Her stage theory has been applied to athletic
injury, however research has failed to demonstrate
that injured athletes move in a predictable fashion
through a series of stages on route to recovery
(Brewer, 1994)
The Affective Cycle of Injury

Distress (e.g. anxiety and depression)
 Denial (unacknowledged distress)
 Determined Coping (vigorous, proactive,
goal driven)
The goal is to help the athlete to
progress from distress and denial to
determined coping
The Way to Failed Rehabilitation

Denial – Functional when it protects the athlete
from being overwhelmed by negative emotions,
Problematic when failure to recognize the
severity of the injury results in low level of
motivation for rehabilitation.

Pain – Pain is a “whole brain experience”
derived from a summation of inputs from
multiple brain centers including those that
serve emotion and memory (Merskey,1986).
Catastrophizing contributes to heightened
pain (Sullivan et al., 2000).
Cognitive Restructuring is necessary
(attention diversion, rational emotive
therapy, stress inoculation training).

Fear – A type of competitive anxiety related to
injury risk. Fear can contribute to a respect
for dangerous conditions and limit reckless
behavior or undermine concentration and
interfere with skill execution.
Fear of re-injury was common in those
rehabilitating severe knee injuries, with the
fear inhibiting the recovery process in some
cases (Mainwaring, 1999).
Cognitive restructuring needed.

Culpability – When complications arise in
rehabilitation, culpability may be directed to
treatment providers (who may in turn, redirect
blame to the athlete for failing to recover as
anticipated). If the athlete assumes
responsibility for injury, feelings of guilt may
follow, especially if he or she feels the team or
significant others have been let down.
Attributing recovery to personal control
(internal attributions) has been associated with
greater rehabilitation adherence.
The Way to Recovery

Education – About 50% of injured athletes felt
their physicians were impersonal and did not
provide enough information about their injury
(Macchi & Crossman, 1996).
Goal-Setting – 5 Guidelines
1. Help develop management skills that are
transferable between rehabilitation situations.
2. Help athletes establish rehabilitation schedules.
3. Provide opportunities for self-evaluation and
recording.
4. Involve athletes in decision making.
5. Ensure individual progress is self-referenced.


1.
2.
3.
4.
Social Support
Athletes expect, but do not receive, sufficient social
support and information from sports medicine
professionals (Mainwaring, 1999).
Athletes lives are often intertwined with sport, with
injury separating them from their teammates and
coaches, thus they feel isolated.
Connections with other injured athletes, particularly
those with similar injuries seems to be helpful
(Granito, 2001).
Emotional support was especially important when the
rehab process was slow, setbacks were experienced, or
other life demands placed additional pressure on the
athlete (Evans et al., 2000).

1.
2.
Mental Training
Imagery – Rehabilitation that includes
imagery yields more effective healing than
physical rehabilitation alone (numerous
references). It represents a natural transfer of
sport skills to rehab.
Relaxation – Conditioned Relaxation. When
an athlete learn stress management
techniques, the threat of injury becomes less.
The Aspects of a Remarkable Recovery
The Quest for Competitive Excellence in
Rehabilitation is built on:
Heightened body awareness – Follows from
quality rehabilitation that enhances fitness and
a refined sense of biomechanics.
 Enhanced pain assessment – Develops out of a
keener sense of pain awareness and a more
informed decision making ability relative to
pain per se and injury.

Psychological Momentum – Injury boosts
negative emotion, demanding a corresponding
increase in positive affect to maintain emotion
balance. Maintaining positive affect as negative
emotions diminish with recovery creates
positive psychological momentum.
 Revaluing of Sport – When injury deprives the
athlete of the opportunity to compete, it may
have a paradoxical benefit – calling to mind all
the good things that sport brings.

A Complete Sports Medicine
Program Includes a
“Sports Medicine of the Mind”