The Injured Athlete:
Getting Back: in the Saddle, on the Slopes, on the Field, on the Track (You Get
The Idea!): A talk presented at the Vail Summit Orthopedics CATA conference, Edwards Colorado, November 17, 2012
Take a moment to imagine the following: You've been playing your sport as far
back as you can remember. You’ve built strength, and endurance and you’ve
perfected your technique. Your entire life revolves around practice,
performance and competition. You love your sport. It’s who you are! It’s the
most important part of your life and your identity. Its how you spend your time and what you’ve
built your plans and dreams around.
Then the unimaginable happens. Suddenly you're injured and you can’t
play.
For a serious athlete the physical pain of an injury is only
one VERY small part of the suffering experienced as a result of that injury.
The severity and impact of the emotional pain and the temporary or permanent
loss of your sport can far exceed any physical discomfort from the physical
injury. Emotional suffering must be addressed for rehabilitation to be
successful. Coaches, trainers and rehab professionals who are sensitive to
these issues facilitate the rehab process. Professionals and loved ones who
don’t recognize the importance of emotional issues in recovery can further
traumatize the injured athlete and may compromise the healing process.
To better understand what happens psychologically when an
athlete is kept out of action because of an injury, it's important to consider
three major roles that sports play in the life of a serious athlete.
• Sports
fulfill multiple needs for athletes
• The
injured athlete experiences multiple losses:
• Sense
of identity / role / teammate
• Loss
of physical health / invincibility
• Loss
of Independence
• Sense
of alienation and isolation
• Loss
of recognition / esteem
• Loss
of major way they spend time
• Loss
of constructive outlet for stress
• Sports
fulfill multiple needs for athletes
Identity – For serious athletes the sport is their
life. They’ve invested years of time, energy and pain. It's how they see
themselves and how others see them.
Self-esteem - For most dedicated athletes, sports
provide ongoing positive reinforcement and feedback. The enjoyment and
self-satisfaction that come from mastering new skills, overcoming new
challenges and progressively growing stronger and better is a central source of
self-esteem. The recognition of your accomplishments by friends, family and
members of the community feed the athlete’s sense of joy and accomplishment. A well-played
game, race or match feels fantastic and provides tangible evidence that the
athlete’s hard work has paid off.
Stress-managment - Physical exertion is a great
stress reliever. When people have no physical outlets they tend to internalize
their stress, often leading to headaches, GI complaints or other physical
symptoms. Many athletes find that their involvement in sports also provides an
escape from family, school or relationship problems. Participation in sports is
also a healthy way for athletes to manage frustration and anger.
Normal Reactions to
Injury may include: Initial denial / minimizing - Grief and mourning - Sadness - Anger - Questioning - Frustration- Loneliness- Helplessness - Disillusionment - Boredom - Anxiety - Fear
Worrisome Reactions to Injury
• Prolonged
denial of the injury itself, injury severity and / or response to recovery or
limitations
• Obsession
with return to play
• Extreme
guilt
• Rebelliousness
• Impatience
and Irritability
• Rapid
mood swings
• Hopelessness
• Suicidal
Ideation
• Apathy
• Panic
Attacks
• Depression
• PTSD
• Aggression
and Raging
Depression: What to Watch For: Low
self-esteem - Sadness - Irritability - Hopelessness -Tearfulness - Indecisiveness - Difficulty Concentrating - Guilt - Lack of Motivation - Agitation/anxiety - Loss of sex-drive - Suicidal thoughts - Loss of interest - Lack of Energy - Unexplained Aches and Pains - Disturbed sleep or appetite - slowed speech or movement - Social withdrawal - impaired school or work performance
Negative thoughts often accompany depression: Why
me? - It’s not fair - Why now? - If only… - But now I can’t / won't - I’ve worked too hard for this to happen to me! - I’ve let everybody down - Nobody cares - Nobody understands - Nobody can help me - I can’t handle this - It will never get better - I’m being punished for my sins - I’m a loser - It’s
hopeless - I
can’t take it anymore - Everyone
would be better off without me - I’m
a burden -The
future holds nothing. - What
now?
Depression in
Athletes after Injury: Statistics
– Over
half become depressed
– 10-15%
seriously depressed
– 80
% experience symptoms of depression
– Suicide
is rare
– Time
frame determined by physical recovery time frame
– Highly
treatable with psychotherapy
PTSD
• Intense
memories, dreams, nightmares
• Uncontrollable
strong feelings
• Flashbacks
• Avoidance
• Pushing
people away
• Negative
thoughts
• Hyper-arousal
and agitation
• Concentration
problems
• Sleep
disturbance
• Fear
of re-injury
Substance Abuse
Issues in Athletes Recovering From Injury
Alcohol abuse
Illicit drug abuse
Prescription drug abuse: easy for professionals, coaches and trainers to be complicit in prescription drug abuse or even encourage it. Must challenge the athlete about abuse
Alcohol abuse
Illicit drug abuse
Prescription drug abuse: easy for professionals, coaches and trainers to be complicit in prescription drug abuse or even encourage it. Must challenge the athlete about abuse
Psychotherapy can be
highly effective in helping people cope with injuries, overcome depression
or PTSD from their injuries and recover more quickly and completely from their
injuries. Of course, psychotherapy is
very cost-effective too. A course of
psychotherapy to assist an athlete in recovering from injury will often cost
less than a single MRI.
Psychotherapy
techniques to assist athletes in recovery from injury
• Supportive
listening
• Cognitive-restructuring
• Coping
skills training
• Problem
solving and planning
• Self-management
• Relaxation
skills
• Communication
skills
• Mood
regulation
• Visualization
and hypnosis to facilitate recovery and return to play
Advice for the Athlete Recovering From Injury
Advice for the Athlete Recovering From Injury
• Accept
your feelings
• Learn
about your injury
• Learn
about your treatment
• Be
an active participant in your care
• Take
responsibility
• Set
achievable goals
• Maintain
a positive attitude
• Follow
treatment recommendations
• Self
monitor
• Work
hard within guidelines
• Practice
patience, with yourself and with your body
• Seek
and accept social support
Social Support after Injury Can:
• Maintain
a connection with the team during rehabilitation and recovery
• Help
with treatment
• Help
with daily tasks
• Make
the athlete comfortable asking for help
• Provide
education and answers
• Offer
empathic listening and opportunity to vent
• Be
encouraging
• Provide
a positive opportunity for distraction / fun / pleasure
Suggestions For Recovering Athletes
• Bring
a list of questions to your doctor’s appointment or therapy sessions
• Participate
with your team in non-active ways
• Have
friends / team mates / coaches check in with you
• Schedule
activities with friends
• Plan
ahead and ask for help if you will have mobility issues
• Get
assistance with transportation needs
Set Appropriate Goals
• Injury
can be another training challenge
– Focus
on recovery rather than performance
• Maintain
motivation
• Focus
on small incremental improvement
• Work
closely with therapist or doctor
• Obey
doctor’s orders about pace of rehab
• Accept
injury and know your limits
• Maintain
fitness while injured
• Knowing
what to expect can facilitate sense of control and agency
How can medical professionals facilitate recovery in injured athletes?
• Build
trust and rapport with the injured athlete
• Listen
to concerns and provide honest answers
• Assess
and monitor the athlete’s emotional state
• Educate
the athlete about the injury
• Identify
misinformation
• Involve
the athlete’s family, coach and trainer
• Prepare
the athlete and coach for the recovery process
• Encourage
the development and use of coping skills
• Recognize
return to play issues
• Screen
for depression and other mental health concerns
• Refer
to a psychologist with expertise in sports psychology and / or rehabilitation
psychology if needed
How can Trainers and Coaches Facilitate Recovery?
• Be
empathic and caring
• Build
up the athlete’s self-esteem
• Discourage
self pity
• Take
an interest in the recovery process
• Encourage
realistic goals
• Offer
general encouragement and emotional support
• Listen
to the athletes concerns and feelings
• Encourage
optimistic ways of thinking and discourage pessimism
• Discourage
maladaptive ways of thinking such as “no pain-no gain” or “suck it up”
• Monitor
athlete for depression, substance abuse or other mental health problems
• Encourage
acceptance of help from a psychologist if indicated
• Encourage
patience and realistic expectations
How can Trainers and Coaches Facilitate Recovery?
Reach
out to the athlete, do not wait for him to reach out to you
– If
the athlete is in the hospital, visit, bring greetings from the team
– Participate
in family conference if invited
– Visit
at home during recovery
– Accompany
to physical therapy if appropriate
Keep
the athlete involved with the team
– Keep
athlete in touch with team activities and issues
– Give
the inured athlete achievable team related tasks
– Have
the injured athlete participate in team activities in non-injurious ways
– When
appropriate expect the athlete to participate in practice (with modifications)
Do not allow social isolation and withdrawal
– If necessary assign team mates to check up on or provide practical help
Make the athlete accountable for participation in rehab
– If necessary assign team mates to check up on or provide practical help
Make the athlete accountable for participation in rehab
Participate
in return to play issues and decisions
Encourage athlete to maintain fitness during rehabilitation
Encourage athlete to maintain fitness during rehabilitation
How can Trainers and
Coaches Facilitate Recovery?
Gently help the athlete get in touch with other areas of
personal strength, creativity, interests and ways to participate in their sport
in new ways if they are faced with a long-term recovery or permanent disability
I hope you help the athletes you work with fulfill their
dreams. I hope some of the information
I’ve shared today will help you do that even better than you might have
imagined.
I will end
with another quote from the same person who’s quote introduced this talk.
Wise words for
recovering athletes:
“Speak quietly to yourself and promise there will be better
days. Whisper gently to yourself and provide assurance that you really are
extending your best effort. Console your bruised and tender spirit with
reminders of many other successes. Offer comfort in practical and tangible ways
— as if you were encouraging your dearest friend. Recognize that on certain
days, the greatest grace is that the day is over and you get to close your
eyes. Tomorrow comes more brightly.”
*** Mary Anne
Radmacher:
I hope in your work you help athletes have tomorrows that
come more brightly.
That is the most precious gift you have to give. Thank you for your attention and may your
tomorrow burn more brightly too.
Twitter: @drjsquyres
Facebook: JillSquyresPhD
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Text copyright 2012 by Jill Squyres, PhD. All Rights Reserved