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December 28, 2011 • Sports Medicine & Nutrition

Mentally coping with debilitating sports injuries

Being sidelined affects the mind just as much as the injured body part

By Lindsey Wilson, Owner And Lead Presenter, Positive Performance Consulting, Seattle, Washington

It’s truly a marvel of modern science that we have so many different ways to reduce injuries, minimize their effect, speed up recovery, rehabilitate after trauma and generally allow an athlete to compete with injuries that, even a decade ago, would have kept them on the sidelines.

sports-injuryIn my own collegiate years, I used a variety of contraptions I’d never heard of before: a bone-growth stimulating machine, high-powered ultrasound, an automatic pressurized ankle boot, and a pocket-sized electric stimulation machine. I had customized orthotics, mouth guards, braces and one very confusing shoulder sling … custom made, of course.

Physically, I was more than taken care of, and I have no doubt that each one of those elaborate and costly contraptions helped me a great deal. I’m grateful for that. But psychologically, I had few resources to turn to when I was injured.
Teammates, coaches and trainers all helped as they could, but basically I was on my own to adjust to being on the sideline. No one helped me deal specifically with the loss of identity, no one talked to me about the importance of a positive, productive attitude as it applied to my rehabilitation. And unfortunately, this is the norm.

Injuries mentally haunt athletes 

I spoke recently with a friend who seriously injured her knee in college. As a basketball player, she’d seen countless teammates with knee injuries. It wasn’t a complete surprise then, when after a particularly nasty fall during practice, the doctor told her that she would need reconstructive surgery. And then another. And then another.

She was a tough player and knew that rehab would be painful and slow, and it would require a good deal of mental discipline. She was prepared for that. What she wasn’t prepared for was the psychological impact of the injury, much of which still haunts her 10 years later.

She still mourns that she couldn’t finish out her college career as she had envisioned it, and had to choose the pursuit of walking normally at 50 years old over the professional career she could have had. Today, she still is fearful in physical activities and she still remembers that harrowing experience of losing her identity so abruptly with no one to turn to. No one talked to her about that loss. No one walked her through some coping exercises. No one helped her through this life-altering, traumatic experience.

This isn’t a sob story – my friend has a wonderful life and is happily adjusted to life after basketball. But she can’t run, she can’t jump, she can’t do all sorts of fairly basic exercises and most likely needs a knee replacement down the road. And it all happened in a millisecond. If that isn’t a traumatic experience that requires some sort of psychological assistance, I don’t know what is.

Psychological effects similar to war vets

You might think this example is an anomaly. It isn’t. According to (Weiss & Troxel, 1986 as cited in Smith, 1990) Johnston and Carroll (2000), injured athletes disclosed greater negative affect, lower self-esteem and higher levels of depression and anxiety than non-injured athletes.

Injured athletes express some of the common reactions seen in trauma victims outlined by the United States Department of Veterans Affairs, including: fear, anxiety, avoidance, anger, irritability, grief and depression (Foa, 2005). Injured athletes often go through a grief cycle similar to terminally ill patients.

Statistics aside, one doesn’t need a research study to tell you how devastating an injury is for an athlete. My friend compared it to going 180 mph every day for your whole adult life down to 2 mph. She rightfully asked why we have post-traumatic counseling for so many other deserving situations, but fail to provide this for athletes who suddenly go from healthy to hobbled in a second. It wreaks havoc on more than just the body.

So what do injuries do to an athlete’s psyche? And just as important, what can we do to minimize this?

Specific damage to the psyche

There are some obvious psychological issues with injuries everyone identifies with: the disappointment of not being able to play, the frustration of seeing your teammates do things that your body simply can’t, and the difficulty in staying positive when you are on the sidelines, temporary or not. But, there are more specific issues elite athletes face when injured.

• Loss of identity. Most high-level athletes have been identified as such. They’ve been known (often times for the majority of their lives) as a “football player,” “rower,” “runner,” etc. Regardless of what sport, how much playing time they received or how well they did, these athletes have devoted the better part of their lives to their sport. When it’s taken away abruptly, it’s a substantial and painful void in their life.

• Fear. This is from not being able to play at the same level, of being re-injured, of losing playing time or becoming unimportant to the team. Some athletes fear who they will be without their sport, or worry about how people will treat them when they aren’t winning games for their team. Suddenly, they feel powerless and fear takes over in a big and overwhelming way.

• Increased stress due to chemical changes. It’s no surprise that many athletes have depended on sports as their emotional outlet. Many of them find that despite the intensity of focus, practice is actually a huge release for them. It may be the one place in their life that they can be happy, angry, sad, funny, spontaneous or aggressive, all in the space of a few hours. By the end of practice they usually feel tired, yet better mentally.

They’ve also adjusted to having endorphins, to the adrenaline high of competition and to burning off stress hormones such as cortisol. There is a chemical adjustment when you go from working out several hours a day to doing whatever restrictive and often painful movements the injury allows.

• Loss of group. No matter how much a team tries to include an injured player, it’s not the same as being out on the field. Even the last player on the bench who never plays in games at least has the satisfaction of knowing he or she contributed to the good of the team in practice.

An injured player seldom feels that way, no matter how hard they cheer during the game. Injured athletes spend most of their time doing rehab – away from their support group and isolated from the people that know and understand them best.

The repercussions of these issues are difficult to quantify. Some players may have emotional scars that are difficult to see, which may or may not affect them in college or later in life. Some players end up quitting because the fear and lack of confidence erodes the benefits they once received from playing their sport. Still others spiral down into low self-esteem and turn to substance abuse, depression or drop out of school.

Methods of support

As the coach, trainer or athletic director, there are specific steps to take to help your athletes mentally deal with being injured.

• Counseling. Not only do athletes feel pressure to recover from injury unaided, but many athletes view seeking help as a weakness (Shuer, 1997). Only 6.74 percent of injured athletes sought out counseling to cope with the emotions associated with injury, which is consistent with previous findings that athletes are less likely than non-athletes to make use of psychiatric counseling services and “often the psychological distress caused by injury goes untreated.” (Klenk, 2006)

Some of this may be due to athletes not believing a psychologist is able to understand their particular issues as an athlete or, as noted, they think it is perceived as a weakness.

Find someone who has worked with athletes before and encourage your athletes that getting help is a way to work toward health faster and more efficiently.

• Give them a “job.” A huge part of their injury is the athlete’s view that they aren’t able to contribute. They lose self-esteem and feel excluded and powerless.

Everyone wants to feel productive. Give your athletes tasks of video watching, supporting certain players or watching specific things during games or practice.
It often doesn’t matter what the job is and certainly shouldn’t interfere with anything the team is doing, but it goes a long way in keeping your athlete engaged and happy.

• Have a talk. This needs to be a real talk. Tell them you know it’s difficult, it’s lonely and there might be times they want to give up. Let them know you support them and that they are a vital part of the team, regardless of their physical state. Let them know it’s fine to feel down, but it’s not fine to bottle it all up.

• Get them mental training. Visualization, self-hypnosis and breathing exercises help injured athletes on so many levels. It helps them relax despite the constant stress of an injury, and de-stress though they aren’t burning off stress hormones as fast as usual.

It helps them maintain their confidence and keeps a steady belief in themselves until they can get back out on the playing field (this helps with their anxiety, their fears and their confidence). It helps them feel and stay productive, despite their physical limitations.

• Give them this article. Sometimes awareness makes all the difference. By reading this article, they might realize they aren’t alone in their feelings, that they can make sense of the jumble of emotions and they aren’t going crazy, but are going through a very normal grieving process.

Athletic departments invest so much in their athletes. From physical therapy to nutrition to tutoring sessions, athletes have a lot of resources to keep them healthy, eligible and well adjusted. But when they get injured, we need to focus on the total person, not just the injury. Even as we celebrate and encourage the fortitude, strength and discipline of our athletes, we must remember they are young and in need of guidance. We mustn’t fail them when an injury turns their life upside down. It’s up to us to ensure that a broken leg doesn’t result in a broken spirit.


Lindsey Wilson is a former three-time All-Big 12 Conference Player at Iowa State University. She was drafted by the WNBA’s Connecticut Sun and played professionally in Europe and the Middle East for eight years. In addition to her expertise in mental performance training, Wilson is a certified strength and conditioning specialist (NSCA) and a Certified Hypnotist (NGH).

References
Klenk CA. (2006). Psychological response to injury, recovery, and social support: A survey of athletes at an NCAA Division I university. Senior Honors Projects, paper 9.
http://digitalcommons.uri.edu/srhonorsprog/9.

Foa EB, Hembree EA, Riggs D, Rauch S, Franklin M. (n.d.). Common reactions to trauma. Retrieved February 26, 2006, from the National Center for Post Traumatic.

Stress Disorder website: http://www.ncptsd.va.gov/facts/disasters/fs_foa_handout.html.

Weiss MR. (June 2003). Psychological aspects of sport-injury rehabilitation: A developmental perspective. Journal of Athletic Training. 38(2): 172-175.

Shuer ML, Dietrich MS. (February 1997). Psychological effects of chronic injury in elite athletes. Western Journal of Medicine. 166(2): 104-109.


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Eddie Canales

Great article, this is what I deal with,some of the athletes I work with. Unfortunately on a high school level there is very little resources available for athletes who suffer a catastrophic spinal injury. Many people will see and relate to the physical aspect of a spinal injury however very few will know our understand the emotional and psychological part of these injuries. For those athletes that received a lot of accolades and were being recruited to play at the next level, have an especially hard time on the National Day of Signing. Good Job very informative. http://www.gridironheroes.org