Guidelines for Using Sport

IAM W. FQWB, BPE, BWD SAMDV GOIRDQM, PhB Department of Human Movement The University of Western Australia

ESEARCH WITH sport/ athletic trainers, athletic therapists, and sport physiotherapists has

revealed that, during rehabili- tation, athletes exhibit a number of dysfunctional emotional and behavioral responses that in- fluence the effectiveness of their treatment (Ford & Gordon, 1997; Gordon et al., 1991; Larson et al., 1996).

Furthermore, these sport- injury rehabilitation personnel have signaled a desire to learn more about the psychology of injury and to participate in edu- cational programs aimed at in- creasing awareness of and compe- tence in the use of psychological strategies that facilitate a more holistic recovery.

In response to this, we offer the following guidelines. They are designed to both assist the development of appropriate training programs and improve the theoretical knowledge and applied practice of sport psy- chology on the part of athletic therapists.

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Mental Skills Injured athletes can apply the same mental skills they are trained to use to enhance sport performance and cope with com- petitive stress. Good mental or

psychological skills enhance per- formance in the treatment room. Outlined below are brief descrip- tions of mental skills identified by trainers and therapists that facili- tate recovery from sport injury.

Further information about psychological interventions for athletic injury can be found in Brewer (1998), Gordon et al. (1998), Grove and Gordon (1995), Heil(1993), and Pargman (1993). Additionally relevant texts on ap- plied sport psychology include Williams (1998).

Goal Setting. Athletic thera- pists should help injured athletes set specific, positive, realistic, process-oriented goals for both home and clinic. Goal setting, as a motivational and organizational tool, allows athletes to translate commitment into specific and relevant actions (Ford et al., 1993; Gilbourne, 1996). Consequently, it can speed recovery and improve compliance from injured athletes (Ievleva & Orlick, 1991).

Comrnunication/Counseling Skills. What athletic therapists

0 1998 Human Kinetics May 1998 Athletic Therapy Today 41

actually say and how they say it can significantly affect an athlete's response to injury and approach to recovery. Clear, controlled com- munication at all stages of treat- ment is needed (Wiese-Bjornstal & Smith, 1993). By effectively communicating with their pa- tients, athletic therapists can en- gender positive action, thoughts, and feelings about rehabilitation through trust, education, and instruction.

Athletic therapists should be empathic and reassuring; they should provide honest, realistic information in comprehensible language. Active listening in par- ticular is a relatively simple skill that athletic therapists can learn and apply to promote commu- nication with injured athletes (Grove & Gordon, 1995).

Confdence/Assertiveness Train- ing. Injury casts doubt, uncer- tainty, and fear in an athlete's mind and can erode his or her confidence. By appreciating and understanding techniques that build self-confidence, athletic therapists can ensure that injured athletes approach their recovery and return to sport as a challenge and a test of their capabilities rather than inabilities.

Athletic therapists can en- courage injured athletes to develop a positive self-image through successful experience during recovery by using goal- setting, positive self-talk (e.g., affirmations), imagery, and role- modeling (Williams, 1993).

Arousal ControllAnxiety Man- agement. Athletes often experience anxiety both in responding to in- jury and during the recovery pro- *

cess. Worry and concern can have a detrimental effect on rehabil- itation performance. Therefore athletic therapists should help

athletes learn to control their emo- tional state in order to optimize performance.

Incorporating cognitive tech- niques such as relaxation, imag- ery, and positive self-talk in the recovery program can promote appropriate arousal levels and manage the anxiety experienced. Athletic therapists should encour- age athletes to focus on what they can control, and should also en- sure that athletes maintain some involvement in their sport (Will- iams, 1993).

Other Relevant Mental Skills. Additional skills that athletic therapists could teach injured athletes to use include the fol- lowing:

Their close liaison with athletes gives athletic therapists an excel- lent opportunity to educate and counsel them on potential prob- lem areas encountered during re- habilitation. For example, they should inform their athletes on the nature of the injury and the realistic prospects for recovery and return to sport.

Effective communication will not only ensure that the athlete is aware of what is occurring at all stages of rehabilitation but will also provide candid explanations on some of the phenomena out- lined below. Of course, as alluded to in previous research, the ath- letic therapist's level of involve- ment will influence which of these skills is most applicable.

GriefResponse. Following their injury, athletes may experience a sequence of predictable psycho- logical reactions that are charac- teristic of the grief response (Kubler-Ross, 1969). This in- cludes: disbelief, denial, and isolation; anger; bargaining; de- pression; and, acceptance or res- ignation.

Once athletes become re- signed to the limitations imposed by their injury, they can begin to focus on what needs to be done to facilitate recovery. At this point they become actively involved in their rehabilitation. Athletic therapists should try to hasten the acceptance/resignation stage while also acknowledging the emotional and behavioral chal- lenges the athlete will likely ex- perience.

Because injury threatens an athlete's physical, social, and emotional well-being, it is im- portant that athletic therapists be

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May 1998 Athletic: nerapy Today

aware of the influence of cogni- tive, emotional, and behavioral reactions to pain and injury.

To provide the best care for injured athletes, athletic therapists must understand the psychol- ogical processes involved during recovery and use appropriate strategies to deal with these pro- cesses. Relevant strategies would include cognitive restructuring; peer modeling; shaping behavior through positive reinforcement; social support; and skills such as goal-setting, relaxation, and imagery.

Athletic therapists can learn to observe and act on behavioral symptoms in response to injury and either attend to these reac- tions themselves or refer the athlete immediately to other appropriate professionals such as a physician or a psychologist.

Long-term Injury and Perma- nent Disability. The problems and challenges presented by long- term injury and permanent dis- ability can also be addressed. In particular, how an athlete adjusts from being an able-bodied athlete to one with a disability depends on his or her own attitude and beliefs as well as on the support and direction offered by the treat- ment providers.

How athletes cope with such a transition is a function of their identity with sport, their per- ceptions of self-worth, and their expectations for the future (Henschen & Shelley, 1993). Athletic therapists need to under- stand this and provide appro- priate support and encourage- ment.

Malingering. Malingering athletes present a difficult and potentially disruptive situation for athletic therapists. One prob- lem lies in establishing whether

May 1998

the athlete is actually malingering, which is almost impossible to know for sure. However, it is important to be able to identify certain characteristics and their

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cant behavioral problems can be curbed.

Through an understanding of the malingering process, athletic therapists can be involved in both diagnosis and treat- ment, which can ensure that athletes recover effectively and effi- ciently (Rotella et al., 1993).

Overdoing Reha- bilitation. Pressure from self and others-teammates, Social Support. Social support coach, family-to return to com- is an important coping resource petition can often lead athletes to following injury. Therefore, an- overdo their prescribed rehab ex- other important area of training ercises. While pressure can create should be an applied understand- motivation to work hard at reha- ing of social support based inter- bilitation, it can also lead to treat- ventions. Ford and Gordon (1993) ment setbacks and possible have presented a number of sup- reinjury. Athletic therapists can portive behaviors identified by guard against over-compliance sport physiotherapists as both by getting athletes to understand important and practicable, and that rehabilitationu is which athletic therapists can better than "more rehabilitationu adopt to help athletes reach full (Heil, 1993). recovery.

Self-Presentation Style. Injured athletes may sometimes have dif- ficulty gaining the support they need and want during rehab be- cause of their own behavior.

Athletic therapists need to in- form athletes that a "balanced" self-presentation style-whereby the athlete both discloses the dis- tress he or she is experiencing and acknowledges self-responsi- bility for rehab-is more likely to induce the support required for effective recovery. To do this, athletic therapists need to under- stand the self-presentation dilemma and appropriate inter- ventions (Silver et al., 1990).

Remember.. . Athletes' adaptation to injury and their emotional and behav- ioral responses require not only observance and understanding by athletic therapists, but also action. Knowledge and practical application of psychological skills on the part of athletic thera- pists needs to be promoted and encouraged. Indeed, effective treatment on the part of all mem- bers of the sports medicine team requires attention to the psych- ology of injury.

Athletic Therapy Today 43

Brewer, B.W. (1998). Theoretical, empirical, and applied issues in the psychology of sport injury [special issue]. Journal of Applied Sport Psychology, lO(1).

Ford, I.W., & Gordon, S. (1993). Social support and athletic injury: The perspective of sport physiotherapists. Australian Journal of Sci- ence and Medicine in Sport, 25(1), 17-25.

Ford, I.W., & Gordon, S. (1997). Perspectives of sport physiotherapists on the frequency and significance of psychological factors in professional practice: Implications for curriculum design in professional train- ing. Australian Jo&nal i f science and Medi- cine in Sport, 29(2), 34-40.

Ford, I.W., Gordon, S., & Horsley, C. (1993). Providing social support for injured ath- letes: The perspective of elite coaches. Sports Coach, 16(4), 12-18.

Gilboume, D. (1996). Goal-setfing during injury rehabilitation. In T. Reilly (Ed.), Science and soccer (pp. 185-200). London: E & FN Spon.

Gordon, S., Milios, D., & Grove, J.R. (1991). Psychological adjustment to sport injur- ies: ImpIications for therapists, athletes, coaches and family members. Sports Coach, 14(2), 40-44.

Gordon, S.,Potter,M., &Ford,I.W. (1998). Toward a psychoeducational curriculum for training

sport-injury rehabilitation personnel. Jouml $Applied Sport Psychology, 10,140-156.

Grove, J.R., & Gordon, A.M.D. (1995). The psychological aspects of injury in sport. In J. Bloomfield, P.A. Fricker, & K.D. Fitch (Eds.), Textbook of science and medicine in sport (2nd ed.) (pp. 194-205). Melbourne: Blackwell Scientific.

Neil, J. (Ed.) (1993). Psychology of sport injury. Champaign, IL: Human Kinetics.

Henschen, K.P., & Shelley, G.A. (1993). Coun- seling athletes with permanent disabilities. In D. Pargrnan (Ed.), Psychological bases of sport injuries (pp. 251-263). Morgantown, WV: Fitness Information Technology.

Ievleva, L., & Orlick, T. (1991). Mental links to enhanced healing: An exploratory study. The Sport Psychologist, 5,25-40.

Kubler-Ross, E. (1969). On death and dying. Lon- don: Tavistock.

Larson, G.A., Starkey, C., & Zaichowsky, L.D. (1996). Psychological aspects of athletic in- juries as perceived by athletic trainers. The Sport Psychologist, 10,37-47.

Pargman, D. (Ed.) (1993). Psychological bases of sport injuries. Morgantown, WV: Fitness Information Technology.

Rotella, R.J., Ogilvie, B.C., & Perrin, D.H. (1993). The malingering athlete: Psycho- logical considerations. In D. Pargman (Ed.), Psychological bases of sport injuries

(pp. 85-98). Morgantown, WV: Fitness In- formation Technology.

Silver, R.C., Wortman, C.B., &Crofton, C. (1990). In B.R. Sarason, I.G. Sarason & G.R. Pierce (Eds.), Social support: A n interactional view (pp. 397-426). New York: Wiley & Sons.

Wiese-Bjomstal, D.M., & Smith, A.M. (1993). Counseling strategies for enhanced recovery of injured athletes within a team approach. In D. Pargman (Ed.), Psychological bases of sport injuries (pp. 149-182). Morgantown, WV: Fitness Infor- mation Technology.

Williams, J.M. (Ed.) (1998). Applied sport psy- chology: Personal growth to peak perform- ance. London: ~ a y f i e l d .

Ian W. Ford is a counselor with the Athlete Career and Education Program at the Western Australian Institute of Sport. He is com- pleting doctoral studies at The University of Westem Australia.

Sandy Gordon is a senior lecturer in sport and exercise psychology in the Department of Human Movement at The University of West- ern Australia. He has been researching the - psychological aspects of sport injury since 1983.

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44 Athletic Therapy Today May 1998