# HL 260 | Chapter 20 - Psychology of Athletic Injury

**Channel:** Derek Marr
**Source:** https://www.youtube.com/watch?v=SNx4PYBRvCs
**Transcript page:** https://www.withtranscript.ai/video/SNx4PYBRvCs

## Chapters

- 0:01 — Introduction to Athletic Injury Psychology
- 4:46 — Causes and Stress Effects on Injury
- 16:50 — Concussions and Return-to-Play Concerns
- 24:32 — Emotional Reactions to Injury
- 32:49 — Rehabilitation Support and Recovery Strategies

## Transcript

**[0:01]:** hi this is dr derek maher here and we're going to continue going over the information that is covered in the foundations of sport and exercise psychology textbook uh this video is going to be on chapter 20 and that's going to be the psychology of athletic injuries and we are really going to look at what the athlete or the exerciser who is injured is going through uh we're going to explore some theoretical frameworks for kind of describing that process and understanding what stage that person may be in and then we're going to ultimately look at effective ways to aid in the rehabilitation process this is something that unfortunately you are likely to deal with in whatever capacity you have within sport and exercise especially within athletics i always say that if we are truly doing our job we are pushing people to that edge we're experiencing what our physiological limitations are and unfortunately at times athletes

**[0:57]:** push a little bit too far or have circumstances in which they become injured ultimately what we want to be able to do is we want to be able to allow the physiological rehabilitation to be the limiting factor for return to play and if we are able to provide specific sports uh uh psychology uh interventions if we are able to help that mental training so that we can have that occur athletes exercisers will get back to doing what they love quicker it's really painful to watch someone who may physically be capable of returning to play experiencing maybe anxiety or fear or maybe just not even adhering to their uh uh rehabilitation uh training because they think that it's unlikely or doubtful or are down about their situation or circumstances so with that said um i have as always a bunch of slides to go through there's so much good information in the book uh but i'm

**[1:52]:** gonna briefly touch on some of the main points main topics and if you have any questions feel free to give me a call shoot me an email uh have a text i'm happy to talk at length about this topic and this is one that is also close to me as i recently had been contacted by ub rehabilitation and an orthopedic surgeon within the marquette area because they were looking at connecting their rehab patients with individuals like myself who provide mental training programs so that their athletes can ultimately come back sooner and have a better adherence to the rehabilitation process so i am currently working with people right now and be working with a lot more in the future and developing better strategies for how to meet this population and how to have them uh not just come back but come back better than where they were to really be able to continue back on that

**[2:47]:** journey that they had prior to that injury so when we look at some of the physiological factors right here some of these numbers are staggering staggering right here you know when we look at americans about 8.6 million have injuries related to sports or recreation a year in children's 5 through 14 2.78 million injuries that result in going to the emergency room these are a lot of people that are getting hurt going out there and playing sports and involving in uh recreation or exercise um when we start looking at uh some of these other data from sweden 75 of elite soccer players sustained an injury sometime during this season so three out of every four most people sustain an injury at some point during just one season so this is extremely common another thing and this is where i work a lot with that orthopedic surgeon is this recognition that unfortunately many people that have an

**[3:44]:** acl tear do not come back from it well not most people about a third of those people um and honestly this may be a little bit different what i the orthopedic surgeon shared with me is the national average is 60 60 of individuals that suffer an acl injury do not return to sport or return to play and that's disappointing and for some of them they're physiologically capable of coming back it's amazing what our doctors can do nowadays it's amazing what our medical system can do how they can go and graft a piece of your quad and go and have that uh repair that acl that was injured wow unbelievable so can we work with these clients can we work with these athletes to be able to mentally come back from this and there's a lot that goes into that much of it is adapting the skills that we've been talking about in this class to

**[4:34]:** this unique population but it's really important that we are providing them the mental performance care that is needed so that they are able to come back from these injuries the first thing is what's an injury i said the

**[4:46]:** word a number of times right here it's a trauma to the body or it's parts that results in at least temporary but sometimes permanent physical disability or inhibition of motor functions this may involve participating while still feeling pain so the attention is needed uh due to the pain there's a loss or change in the function um and the decision process takes place of whether to compete or not to compete or whether to participate or not to participate and that's one of those you know debated topics within sport you know at what point should you remove yourself from the participation when are you and i've had so many coaches tell me you know what's the difference between being hurt and being injured you know it hurt is you have pain but you can play through it injury is that you can't play through it anymore that's one conceptualization of it but it's a difficult continuum to

**[5:33]:** navigate and where do you need to allow your body to physically recover and where can you push through and that's what we see as well one of the results of more injuries is that we have that mentality and i've seen it as well athletes that care a lot push and push and push and push and then next thing you know whoa they have that big injury right there so some causes of this athletic injury physical factors so muscle imbalance i mean collisions as well acute injuries uh you know we have big fast strong athletes and we are amazing within the world of strength and conditioning at getting these athletes bigger faster and stronger and then what does that make that makes the impacts more forceful that makes uh the likelihood that maybe our skeletal system or musculoskeletal system cannot handle that impact anymore also things like over training uh again i talk a lot about

**[6:22]:** motivation and there's some coaches out there that take this information are amazing at motivating but sometimes what we can do is motivate people to push and push and push and push and push more than what their body can handle i mean we don't emphasize rest and recovery i oftentimes talk about the motivation that we put forth the uh the for physical training also needs to be put forth in our rest and recovery so we need to be recognized where we need that and then be as diligent with our rest and recovery as we are within our training social factors all right so things like perceptions of performers for playing with pain and injury you know there's some people that will go and say i'm never injured i just play through it i play through i play through it and maybe that's the culture that they live in maybe that's the pressures that they're receiving from

**[7:02]:** coaches or parents or athletic trainers or other people around them and if that exists that could lead to more severe injuries psychological factors we have personal dispositions towards that all right i mean gosh i see it right now my one my one boy i mean he's two years old and he whoo he's got disposition towards really playing through or i mean it's truly playing at this point if he's doing something that he maybe knows we aren't necessarily supporting or pushing him towards you know jumping off we have some like they're called nuggets they're like big couch cushions he'll jump off and we'll say hey i don't think you should do that buddy i think you might get hurt and then he takes a hard fall he will not cry he'll play through it because i think he knows that he wasn't supposed to be doing it he was getting to do it and he didn't

**[7:49]:** want to get injured because he knows in the future we won't let him do that again so some dispositions like what i think my son may have is to play through these things also there's other things that are going to influence this as well things like stress and we'll talk an awful lot about stresses influence and injury and illness in the future here and how it if it's not under control can lead to increases in that let's see here as well um i basically already said this stress injury relationship as i promised all right athletes with higher levels of life stress experience more injuries than those with lower levels of life stress it's interesting one of the um individuals that i was able to work with at the university of missouri dr brian mann he's now down at uh miami on the academic sides of things but i remember when he was uh working within

**[8:34]:** the athletic department as a strength and conditioning coach and he also had a phd so he had this recognition that wait a second there's an awful awful awful lot of these athletes on the football team that seem to be having increased rates of injury and illness during these high stress periods of the semester what's a high stress period of the semester midterms and finals so what he did is he obtained the injury reports from the athletic trainers and the medical professionals within our teams and he looked at it and sure enough what his study found was when there was a midterm time so the midpoint of the semester or the finals time there was an increase in the uh reported injuries or illnesses hmm it's almost like stress influences this i remember anecdotally an application of this when i was at baylor i'm working with the world coach of the year coach clyde hart and

**[9:25]:** i'm a grad assistant i remember seeing him at track practice and i was like hey coach what's the team got today and he goes and says warming up and going home i came from a culture and an athletic program that was very successful but it was very much like push through it i can remember ncaa has rules about no formal practices during finals week and our coaches were the ones that were posting the workouts and it was like yeah you're not supposed to but you need to get this in it was on like the team captains to like hold people accountable basically for showing up and it was probably against the rules but coaches would ask well who came to the practices who's doing the workouts um interesting right there i thought that no way would one of the best programs in the world have their athletes

**[10:10]:** not work out hard because of something like academics well guess what he followed it up and explained exactly what's on the slide he goes and says as i kind of laugh and i go no really what is it he goes warming up and going home he goes baylor's a really good academic school he goes they are under an awful lot of stress during midterms week so if i go and i push him hard on the track this week what what's up happening week from now two weeks from now they're injured or ill and he goes so it's not worth it so what we do we get them out here we warm them up we have them uh loosen up a little bit run off a little bit of that stress and then we send them home and he said tell them to go do well on their exams whoa world coach of the year doing

**[10:49]:** that recognizing that there's these stresses outside of the sport that these individuals are participating in and that if you manage that effectively we reduce things like injury and illness same thing that football studies showed uh from brian mann and interesting he said that the reviewers actually kicked back asked for a little bit more detail and so he broke it out based off of starters or players that were expected to play significant uh amounts of the game um and then uh bench players and then those that are redshirted and that he found that those that had the expectation of playing and playing a lot had even higher rates than those that were like redshirted and not even gonna go to the competition so it shows that that stress of playing during a midterm or finals week does go into correlate with that injury or illness rate so there's a lot that goes into it but this

**[11:42]:** slide does a nice job of breaking it down so really what we have is that potentially stressful situation and then we're going to have the athletes that are going to have this perceived threat they're going to have their stress response that can lead to things like attentional distraction which then may increase some of those acute injuries also muscle tension and when we're tightening up right there it's harder for us to absorb a hit it maybe leads to more force in some unusual angles that then causes other injuries but ultimately that's what ends up leading to the injury we have those things like our personal personality factors our coping resources our history of stressors but hopefully what we can do is also use psychological skills interventions effectively to reduce some of this stress to reduce some of this anxiety to hopefully make it so we can get through these stressful times and we have less rates

**[12:28]:** of injury or illness so athletes at high risk of being injured had fewer uh injuries after stress management training interventions this stuff works the greatest stress sources for an injured athlete were not the physical aspect but the uh psychological one so after the injury occurs things like fear of re-injury or maybe man my goals are no longer capable of being completed this year i'm injured i physically can't compete in my sport so those goals that i had for this year not gonna happen so now i have to reshift those things research shows that teaching stress management techniques may help athletes and exercisers perform more effectively and may reduce rates of injury and illness but overall this relationship it's very very complex alright so individuals with low self-esteem that are pessimistic they have higher levels of trait anxiety and have low mental toughness this may lead to more injuries so what we want to do is

**[13:30]:** we want to address this we want to help facilitate things like optimism we want to build things like not just self-esteem but self-confidence we want to reduce anxiety when we start looking at those two things that are going to play into it the attentional and muscle tension potential disruptions and muscle tension potential disruption stress disrupts an athlete's attention by reducing their peripheral attention so you can't see the field as much we talked about that a little bit within concentration and then also we'll increase our distractions which then could cause us to in that momentary lapse of our attention engage in injury um an example that would give for this would be um not being able to recognize where you're at on the field and you're a wide receiver on a crossing pattern and because of that you don't prepare yourself to take the hit from the safety when the ball's thrown and next thing you

**[14:22]:** know it results in an injury increased muscle testing is a high stress can cause muscle tension and coordination interferences as well as more of fatigue muscle uh inefficiency reduced flexibility and poor motor coordination as well so also what we do and we'll hear people man you look tight you look tight before this that's a real thing you're actually tightening up because your body's stressed so being able to uh be aware of that and reduce that will hopefully result in better performance and decrease in a likelihood of injury there's also some other explanations for this relationship things like the overemphasis of being tough so pushing through those injuries playing while injured which then uh result in more severe injuries that's part of it and it's a tough line to ride and i'll talk about that in some of my other teachings where i know as a coach as a mental performance consultant i emphasize uh this

**[15:19]:** at times i go and say hey you know what is it hurting yeah well then you're doing it right but there is a point in which we need to know our body we need to trust ourselves and say hey i think i'm on a fine line right here i might not be able to sustain this i might be on the edge of having a big injury and that's where you do need to rest and recover so it's such a difficult construct to be able to teach especially the younger athletes about when to push when to rest when you can play through this when you should give your body some time um so it's important to and in my theory have really good communication that's the most important thing can you communicate what you're going through as an athlete to someone like a coach athletic trainer mental uh performance consultant um medical professional and be able

**[16:04]:** to differentiate between when i need to push when i need to rest there's also some things like hey if you're injured you're worthless and i a great coach i worked with at one point i remember an athlete sharing though that you know when i was healthy coach would respond to my text messages instantly coach would call me coach would want my opinion on stuff the moment that i was injured in a good be out for a few weeks i didn't hear anything from coach and i really felt bad you know self-esteem took a hit right there i'm only good if i'm able to uh uh be on the field and that's hard and that happens a lot of times and then what we do then is we keep pushing through things because we feel if you're injured you're worthless um also there could be norms of the team you know we start really preaching these

**[16:50]:** things winners never quit and quitters never win so we oftentimes within our culture really push push push this idea and it may be counterproductive at some points so a little bit about the physiological components of the uh athletic injury stress um there's actually um some different types of hormones that are released so there's a chemical process within the body related to stress and then this can also impair some of the immune cells and then that makes it harder for us to recover um prolonged stress as well uh can decrease the actions of insulin-like growth hormones that are critical to that rehabilitation process and the rebuilding process of those damaged tissues and also stress can cause sleep disturbances and oftentimes what we really need to be able to do we need to rest and recover we need to sleep well while we're injured so if we're having that stress then that impairs that process this could

**[17:48]:** be a huge topic right here it's embedded in this chapter we'll touch on a little bit we've already touched on a little bit as well but concussions um concussions is something that is getting mainstream media attention because of some of the science behind it what we're finding is that there's long lasting effects of concussions especially concussions that are not recovered from so if we if an athlete suffers a concussion goes back out and plays through that they can further damage themselves and it's really scary some of the things that are coming out especially within nfl um and when we see some of the mental illness that it may be attributed to the changes in the brain chemistry as a result of concussions and repeated concussions this is something that we need to be very very aware of because guess what nine percent of high school and eight percent of college athletes um injuries are concussions

**[18:40]:** concussions are very common i've had concussions um and i'm in largely non-contact sports heck i had a concussion a really bad one one in which i was throwing up had to go to the hospital um from slipping and falling in a bathroom when i was coaching and i mean i was absolutely out of it and it scared me it made me really realize how important this topic is because some things that i took for granted usage of words simple math so one thing that i would do in my job as a distance coach is often times calculate splits and be able to tell athletes on the fly while they're running what their paces were so for a rough example right here in real simple math if i was working with an athlete that was a miler and they were a four minute miler that's 60 second laps so one thing that i'd be able to

**[19:28]:** do is while they were coming through the second lap i'd be able to go and simply say hey two minutes you're on four minute pace now this is really simple it's much harder when it's some you know obscure number like you know their uh goal is to run 437 for a mile all right that may be uh was a all-conference performance for a d2 runner um a female and that's a little bit more complex but four minutes two minutes at the half you get what i'm saying right there i could predict what it was going to be after this concussion i would sit there and i'd look at the watch i just couldn't make sense of it and the athlete would be running they'd expect me within like a second to spit out what their pace was and i'd be like uh uh and i'd have to pull up my calculator on my phone and

**[20:12]:** actually do the math on it it was unbelievable how that resulted for not just like a day but weeks months before i truly felt like i could do that and also my language i would be stopping and searching for words at times trying to finish my thoughts so it's really scary the long lasting effects of these types of injuries so concussion is a complex pathophysical process affecting the brain uh induced by biomechanical forces a concussion may be caused by either a direct or indirect blow to the head face or neck or even elsewhere on the body when the pulse is transmitted to the head some of the signs and symptoms all right headaches dizziness fatigue drowsiness uh that mental fogginess that i was talking about also some things like sadness all right vomiting like i've experienced before as well trouble falling asleep numbing numbness or tingling also sleep disturbance as well so there's a lot

**[21:06]:** of things that are very serious um and that are sometimes not immediately recognized you know sleep disturbances may not be recognized until a couple days after when you say man i'm just not sleeping well so a little bit about the research and this is evolving very rapidly there's a lot of money that's being put into this topic so when an athlete is suspected of a sports related concussion he should immediately be removed from play and not returned until he's cleared by a licensed health care provider we've seen even in high school sports now there's these return to play protocols and you need to go to a doctor nurse practitioner a licensed healthcare provider not just your athletic trainer but someone outside of the sport to be able to get that clearance that second impact syndrome is what we are becoming increasingly aware of an athlete experience a concussion does not completely recover and then gets

**[21:55]:** a second concussion this often results in catastrophic consequence and permanent brain injury interesting here females compared to males are at greater risk of concussion comparable sports now football skews this a little bit uh hockey also is a little bit more male dominated at this point but one thing that we see soccer you know beloved by both males and females but there's a large female following within this that's one of the sports where we see a lot of brain injuries heck we're using our heads many times for a header that is absolutely providing biomechanical force that could result in that especially that when you hit a competitor as well that can definitely cause a concussion but even hand the ball could so multiple concussions in a short period of time equals long-term impairments and that's what's really scary the treatment for concussions rest first and foremost rest all right hey academic accommodations as well i can

**[22:48]:** remember being an instructor or professor at one of my previous institutions and it was there was a professor that did great great research um in concussion she was looking at uh blood markers to be able to better uh understand the length of the recovery process and i had a student athlete come up to me after they had taken an exam didn't talk about the exam but when asked me hey do you know where so-and-so's office is i said yeah it's down the hall it goes okay yeah i'm going to do that concussion testing with him and i knew that the research she was doing you had to have had a concussion to go and do her study and they got compensated for it so the kid was really pumped he was getting like 100 bucks i was like um wait wait did did you have a concussion yeah i had one the other day i

**[23:38]:** said oh i said uh why didn't you let me know he goes oh i i didn't i i figured it wouldn't be a big deal well the athlete that actually the student had actually not even completed the exam turned it in incomplete and scored terribly on this i knew the background that they probably were having some residual effects of this concussion so guess what if you have a concussion go talk to the athletic trainers talk to individuals about getting extended time maybe postponing some of those exams if possible you're not making an excuse it's really that it does impact you substantially in your ability to perform on things like academic tests um also some other things as well like cbt could be an effective treatment as well medication in some situations as well most symptoms for 80 to 85 uh a percent of concussions are resolved in your back a baseline in about 7 to

**[24:32]:** 14 days all right but in some cases it could last even longer so a little bit about the response to all injuries this isn't concussions but this is all of them this is the way i was taught this comes from uh actually work on death and dying and adopting that framework to the athletic population because as they explained to me and it makes some sense um in a way when you're injured a part of your personality we talked about that way back i think chapter three was personality we talked about that inner core and you identify as an athlete and that's part of what you do when you're injured it's almost like that part of your personality is dying and that's very difficult you go through this grief response now some newer work suggests maybe this framework isn't flexible enough um to be able to account for all situations and i agree with that so

**[25:20]:** there's some more general theories that we'll talk about after this but i used to spend a lot of time teaching this i now kind of boil it down a little bit i still think it overall makes sense first denial we see this with athletes often you have that injury you see them on the field and they try to get up from it they try to just walk it off i'm not injured i'm okay and then you'll see them stumble for a couple and then fall back down to the ground and the trainer has to come out all right i've seen this with endurance athletes quite a bit i'm not hurt it's shin splints it's shin splints and shin splints and then during a workout or a race they end up snapping their tibular fibula and it's like whoa they broke the bone i gotta athletes break their femurs actually it's oh no it's a muscle

**[26:02]:** not it's a muscle knot no it isn't it's actually a very substantial um uh injury right there but they're in that denial phase after that anger i share that uh one of my roommates uh punched a hole in the wall once uh because they got the call from the athletic trainer and told them they're gonna be out for a while um that's a natural phase as well that then there's the bargaining and i oftentimes say that in that bargaining phase that's where they either bargain with someone for return to play coach just play me i'm gonna be fine within the concussion protocol i'm fine they don't know what they're talking about i'm fine i pass that test i swear just let me out there let me out there and i swear that i won't put myself in a situation to further hurt myself or maybe you're bargaining a hey athletic trader just you know give

**[26:44]:** me a a a shot give me a painkiller right now i can play through this i can play through this i know i can um it's going to be the state championship and i got us to this point just let me play it's really hard the important thing is that when you're in a leadership role you do not engage in the bargaining process you go and say no we got this diagnosis we're sticking with the recovery for this depression comes out of that it could be clinical depression or just a general sadness it's like oh man i can't play anymore and then hopefully what we can do is get athletes through this process to the acceptance and reorganization so they can accept that they're injured and they can dedicate themselves to overcoming that injury coming back from it this now is a little bit it's very similar but it's more generalized one there's three general

**[27:28]:** categories to the emotional reaction to being injured one injury-relevant information processing to that emotional upheaval and our reactive behaviors as a result of that that'd be like the anger phase that be also some of the depression type phases and then ultimately coming to that positive outlook and coping so being able to work through it be optimistic about your return right there that's where we need to be trained in the mental processes so that we can understand i oftentimes say especially like athletic trainers that feel really bad for them so often they're dealing with these athletes when they're in that emotional upheaval so you have that injury occur and they take it out on that trainer or maybe they take it on their coach and i've worked with coaches and trainers before to say hey listen that anger that's being projected onto you don't take it personally so when they get mad and they say well

**[28:13]:** this wouldn't happen if i had better treatment i didn't get the prehab i needed and then i go out there and get hurt let it just water off your back i also talked the athlete about don't take it out on these other people right here or the coaches well i got this over training injury because the coaches didn't prepare me or you know what i got injured out there on the field because our strength staff didn't get me uh enough muscle to be able to absorb these hits don't worry about it they're just going through that phase i often times work with the athletes who go say sorry as well after they've done that but ultimately we want to help them get through that point so they can get that positive optimistic look at things to come back from it some other things that happen in this process you know we have that loss of

**[28:51]:** that identity we identify as an athlete and then when that's gone or when that's even temporarily removed it's it's hard fear and anxiety oh man i'm working with some people right now they're worried about going back out and doing the activities that they love because they got hurt while doing it the skier right now so you're a downhill skier you get injured downhill skiing you love doing it but now you got fear and anxiety that's real very uh very infrequently do we find ourselves in a negative situation then we go back into that negative situation with this one individual that i'm working with they're going gonna go back to the same ski hill this winter but i talk about how this can be a good part of the process of overcoming this so that you can start working to go back there and complete the run that you did and get through it healthy all

**[29:36]:** right also that lack of confidence confidence builds confidence when we lose our confidence it's really hard to be confident so i work a lot on building confidence knowing that we're going to regain that confidence but also recognizing that it does dip all right i have a die an assessment and guess what ends up happening on that assessment i've not seen it yet where confidence doesn't drop after a injury like an acl injury and then performance decrements as well you know we lose the confidence we miss some practice and then when we're coming back it's not as good what we wanted to do though is set the athlete up so they understand that's a natural part of the process you're not going to be at where you were immediately at uh before the injury so what we want to do though is accept that and work through that not allow that to then further have us

**[30:17]:** withdraw from our sport and then also group processes one thing that's really hard is that you may be a part of the group so oftentimes i give this example so many times athletic trainers are really busy you have the prehab for the athletes getting ready for practice and games and you have that injured athlete and the injured athlete has a really busy schedule especially at the college level or the high school level with classes other extracurriculars things that are going on so you're gonna say hey when can you come in and do your rehab and so often the time that is available to both the athletic trainer says well hey after prehab the team goes down they leave for like three hours and like you physically can't participate right now so can you come in during that time so then what ends up happening that athlete's in the training room instead of out at practice

**[30:59]:** they don't know what's happening at practice they aren't around their team they then go to the dining hall afterwards and they're talking to their teammates and the teammates are saying oh man do you see coach oh my gosh you got on so and so and then did you see so-and-so make that play and they're left out of the process and now what they do is they start to withdraw heck competitions all of a sudden a lot of teams have if you are injured you don't travel the competition so now they're at home they're hanging out with their friends that aren't athletes and they start to slide away from the team so it's important that we can with injured athletes find a way to keep them involved in their team if it's athletics or involved in their sport or their group so i know a lot of times when i was working with applied teams we

**[31:42]:** would kind of have the crutch crew it'd be the individuals that have those injuries and they'd be coming around in a sport like track field and they'd be keeping splits or they would be cheering on their teammates during practice and that was a part of the rehab process as well to be able to have them still involved it's a little bit about signs of poor adjustment so when we see this happening maybe we need to refer these individuals on so feeling or confusion uh or anger and confusion obsession about hey when can i get back when can i get back hey we've already told you this could be six months well can i get back sooner how can i get back denial so trying to act like there is no injury there may be repeatedly coming back too soon and re-experiencing that injury or exaggerated bragging about accomplishments that they had done previously also maybe

**[32:27]:** dwelling on minor physical complaints maybe guilt about letting the team down withdrawal from significant others or withdrawal from the team as well if you have that injured athlete and then you start not seeing them come around very much that's a big sign right there that maybe they're adjusting poorly to this rapid mood swings and maybe even statements including no matter what is done recovery will not occur kind of that real pessimism about it so at that

**[32:49]:** point we need to go and get them help now licensed mental health providers and clinical psychologists really need to be consulted for severe depression real big anxiety disorders or debilitative anxiety anxiety however and i'm a proponent of this getting mental performance consultants for just about anyone before this is even recognized so when i'm working with this orthopedic surgeon one thing i've said is i'd love to see all your clients pre-operation to be able to talk to them about the different types of interventions they can engage in to enhance their rehabilitation to enhance their recovery from this to start shaping a more optimistic view towards the surgery and their path coming back from that so that hopefully they don't get too down on themselves so hopefully maybe they don't go into those clinical states so really when we start looking at this though a big holistic approach is really needed um you know psychological factors are

**[33:51]:** playing just as important of a role in the injury recovery heck 90 percent of athletic trainers say that it's very important to treat the psychological aspects of injuries and this is a hole that oftentimes is not filled athletes interestingly do not automatically transfer the psychological skills that they have for performance to injury rehab and that's a lot of times what i'm working on connecting you know an individual have amazing self-talk for their performances but towards their actual um and i call it practice but it's the rehab sessions during the rehab sessions terrible all right they'll be super negative they'll be really down on themselves uh they won't be fired up to be there it's about gaining the awareness and shifting that can we transition these skills or build these skills even further during this rehab process things like goal setting things like self-motivation self-talk these are really important developing optimism really good things that we

**[34:42]:** can do to help this go forward imagery we talked about a few chapters ago research suggests that it really helps with the rehabilitation process so what we want to be able to do is we want to be able to have them maybe observe practices watch game film of themselves and then adapt that to seeing themselves coming back from the injury as well and it really does a lot of great things like facilitates goal setting helps with relaxation controls anxiety helps them motivate themselves as well so some predictors of enhancement and of adherence to sports injury rehabilitation personal attitudes is part of that on your self-motivation mental toughness and can we develop that as well do you have social support as a big one um also what's your practitioner's expectations as well and are you meeting those or are you not that's one of the areas that i'm really working at right now is those that

**[35:33]:** are not cleared after six months have another three months of rehabilitation and oftentimes get really down on themselves and then decreases likelihood that they ever come back from it so can we have them push through that and recognize that even if they miss that six month uh return to play uh mark guess what don't give up on that your body is taking a little bit longer you'll still get there you'll still come back you're not gonna be 40 that don't return you're just going to be one that takes a little bit longer time um other things as well you know in adherence to the the intervention so reinforcement goal setting education of a lot of these different types of constructs and um also just uh that idea of being able um to adhere to the rehabilitation to believe in the treatment uh or have confidence in that treatment and the perceptions of their ability to

**[36:20]:** return to play there's really three uh phases to the rehabilitation recovery there's the injury or illness phase where you're hurt where you're injured right there there's that rehabilitation where you're starting that transition back to being to where you were pre-injury and then finally there's that full return to injury phase you know each phase dictates different approaches to the psychological recovery during the injury or illness phase you hope you focus on helping the athlete understand the injury and what to expect from it during the rehabilitation phase you focus on um sustained motivation and adherence to the rehabilitation program goal setting maintaining positive attitudes and then return to full activity you're really uh working on getting back to normal competitive functioning during that injury treatment and rehabilitation education the of the uh injured person on the injury and the process teach coping skills teach uh coming back from setbacks because there's a good chance that at some

**[37:17]:** point maybe you get more pain or maybe you lose some range of motion and although you felt like it was a nice little process there's going to be some backs and forwards backs and forwards to ultimately get there i use the the uh the getting stuck in the snowbank uh uh analogy since uh you know marquette here we're in a cold weather climate so if you've ever been stuck in that snow bank sometimes you gotta rock it back and forth back and forth and you think you're out of it and then you go back a little bit oh you're almost out of it and that's kind of like what it is with the injury process oh let's see here so fostering social support is one of these important parts as well and here's some guidelines for providing it what do you want to build rapport quickly so take that athlete's perspective provide some emotional support

**[38:01]:** but also you gotta be realistic with them about they are injured but you're going to come back from it you want to provide a lot of social support for them so have them tap into significant others their uh re or their medical personnel that they're working with so their surgeons their athletic trainers their physical therapists they're coaches as well um also just people in their lives that are meaningful to them athletes generally turn to coaches and medical professionals for informational support and to family and friends for social support but try to tap into all those as much as possible um guess what there's setbacks and oftentimes that setback ends up happening when there's more stress in the athlete's life so hopefully by providing social support you'll help them get through it and get through it really well there are negative side effects to it so when a support a provider does not have a good

**[38:49]:** relationship or credibility with the athlete or when that support is forced so i say you know find your biggest fan that person that's really going to care for you a lot of times athletes or individuals i'm working with it's maybe a significant other maybe it's a mom or a dad maybe it's a grandma or grandpa but there's going to be someone it's about finding that person and tapping into them um learn from injured athletes by understanding the recommendations for the injured athlete uh that have been made about that in rehabilitation and injury recovery so learn about what they're cleared for and then help them be proud of their accomplishments in that context or in that frame so another thing is we need to ensure that that athlete's psychologically ready to return to play so one uh work with the sports management medicine people and the coaches to make sure that they are ready to go

**[39:38]:** systematically address both physical and psychological factors during the rehabilitation and then you also want to make assessments for the readiness to return so things like confidence expectations motivation and that anxiety related to fear of re-injury so recommendations for other injured athletes accept and positively deal with the situation focus on high quality training use goals all right recommendations for coaches you know foster that coach athlete contact maybe it's not going to be present within the competition or the the training environment so maybe you need to meet with them outside those hours demonstrate empathy and support and don't repeatedly mention the injury and training all right sometimes if we keep on bringing that up it doesn't allow the athlete to get over that so if you keep on asking hey is that hurting how you feeling coming back just let them be all right for me sports medicine personnel educating inform you don't know what you don't

**[40:29]:** know and so a lot of it is educating the athlete about what to expect foster the positive infra interaction and show them that you're individualizing it for them and where they're at and then demonstrate confidence and confidence in what you're doing so that is an awful lot of information i just dumped on you but it's a really important topic to be dealing with i'm happy to share more with you about this topic and unfortunately but fortunately i work with a number of these athletes and i get a lot of satisfaction about helping someone return to doing what they love so hopefully there's more that will be equipped with the skills to be able to best meet this population with that said i look forward to talking to you more about the next chapter take care and let me know if you have any

**[41:13]:** questions