What are we trying to prevent?
Sport can be high impact and high risk and injuries are sometimes inevitable. Some people don’t cope when they get an injury that puts them out for more than a couple weeks leading to poor recovery outcomes and re-injury, or performance slumps. Others people who usually show great resilience may not cope due to specific circumstances (missing the grand final, just before trials). When an injury threatens to put an athlete out for the season or even for good, increased stress raises the risk to their psychological health, physical recovery and wellbeing. Injuries can have devastating consequences, not only for one’s sport career, but also one’s emotional health, relationships and self-esteem.
Athlete Crisis Equals Stress
Our mental state has a significant effect on our motivation and physical wellbeing, including injury recovery. We usually think of the damage to the body and pain when we discuss injury but for any serious athlete a serious injury can represent a Critical Life Event, or crisis. A serious injury can significantly affect an athlete’s mind and emotional wellbeing in the short term because of the stress it causes. There can be significant psychological effects of the interruption or end of an athlete’s career by injury because so much time, effort, focus and social contact revolve around one’s sport. Too much exposure to stress reduces the bodies capacity to heal and slows recovery time. If this initial psychological stress and disturbance isn’t recognised and managed, longer term mental health issues can arise.
Athlete Crisis and Mental Health
The initial psychological distress from a sport injury can resemble symptoms of three Psychological Disorders. This is not to say that injured athletes experiencing mild symptoms suffer from these disorders. Injured athletes may not show symptoms or may range in what symptoms they display but understanding the basics of all three can be important when coping with injury or supporting an injured athlete. The three conditions worth understanding are Shock & Trauma, Grief & Loss and Adjustment Disorder (transitional stress). If someone is showing significant signs of traumatic stress, grief and loss and/or transitional stress it is important they seek support by talking to a GP and/or a psychologist.
Shock & Traumatic Stress
Immediately after a serious injury or life threatening situations humans can go into shock. The physical signs of shock are low blood pressure, rapid heart rate, nausea, weakness. The psychological signs of shock are confusion, emotional detachment, muteness, disorientation, memory loss and unresponsiveness. If an athlete goes into shock immediately after injury, it is more likely they will experience traumatic stress symptoms and future fear or anxiety when taking similar risks.
Traumatic stress can effect athletes after injuries involving shock or severe pain. Traumatic stress also has both physical and psychological symptoms. The physical signs of traumatic stress are excessive alertness to signs of danger, energy swings, being easily startled, fatigue, disturbed sleep and general aches and pains. The Psychological effects of traumatic stress are, Intrusive thoughts, memories and dreams of the event, poor concentration and memory, confusion, avoidance of reminders of the event, social withdrawal, loss of interest, emotional numbness, low mood, guilt, irritability, anger and anxiety. Prolonged traumatic stress can increase one’s risk of developing depression and other mental and physical health issues.
Grief & Loss
Understanding the five stages of grief and loss, introduced in 1969 by Elisabeth Kübler-Ross, in a study of people’s response to death and grieving, provides valuable insight into what athletes can go through when they are faced with serious injury. Injury can mean loss of one’s sporting identity (temporary or long term depending on the injury). This loss can feel like grieving the loss of someone close to you. It is important for athletes to know that it is natural to go through these stages. If someone gets stuck in a stage for too long, support may be helpful to move on.
- Denial and isolation– Denial protects us when emotions and shock are too great for our coping resources. We resist and withdraw from anyone or anything that makes us face the facts, leading to isolation.
- Anger– Once denial wears off, it is common to become angry, as a way of deflecting emotional pain. It’s easier to turn our attention outward for the pain we find ourselves in. It may be an irrational response, but it is very human. This anger can lead to guilt quickly.
- Bargaining– Once the reality of the injury has sunk in, we feel helpless and grasp at any possible, even impossible, idea of how we can salvage or reverse the loss. We repeatedly imagine how it could have been different in our minds.
- Depression– When bargaining fails reality really kicks in leading to sadness and concern about the changes and uncertainty we face. This depression is defined by the “letting go” process (your season goal, events, your riding time at training).
- Acceptance– The final stage of grief and loss is the ultimate acceptance of the reality of the injury. Acceptance is not a happy shift, but it is quite different from depression in that it is making peace with the reality that allows us to let go of struggle and move on.
Adjustment Disorder & Transitional Stress
Transitional Stress refers to the high levels of stress we naturally encounter when we are forced to make a large unexpected change in our lives that presents challenges, discomfort and tests our problem solving and coping skills (examples: moving school, parent’s separation). Transitional stress is normal when we are adapting to a new situation like an injury. When we are experiencing transitional stress we experience low levels of the same symptoms as traumatic stress without the panic, flashbacks and more serious symptoms. For some people change is really hard and they can have such high levels of transitional stress that it disrupts daily life or relationships and causes them bigger issues. This is referred to as Adjustment Disorder.
Athlete Crisis Model
The Athlete Crisis Model below illustrates how an injury can cause different psychological stressors described above. Their psychological and physical effects can put unprepared athletes at risk of; slow recovery, re-injury, performance slumps and mental health issues.
The Peak Recovery Mindset Model
Some people are unusually resilient (good at coping with tough times) to injuries and do not experience much psychological stress when faced with adversity. Some people have developed such mental toughness in their lives that, rather than stress, they thrive when challenged with setbacks, allowing their injury to contribute to their success.
Resilience and Mental Toughness are broad concepts that underpin the Peak Recovery Mindset Model. They are things you can learn and develop through training. Factors such as adaptability, acceptance, internal motivation, creativeness, curiosity, emotion regulation, social support, communication skills, ability to stay focused in the present, patience and even having other interests outside sport all contribute to resilience and mental toughness.
Performance Psychology for Injury Recovery
Mental toughness and resilience training in sport psychology aimed at developing peak performance mindset can be transferred into injury recovery to develop a Peak Recovery Mindset. Developing this mindset allows athletes to turn adversity into opportunity and use the negative experience for positive growth. Peak Recovery Mindset also protects injured athletes from the various stressors caused by serious injury and their long term effects on mental health, recovery and performance.
The Peak Recovery Mindset Model described below illustrates how the Athlete Recovery Academy develops Peak Recovery Mindset through four contributing factors (Knowledge, Resilience, Enhancement and Support).
Peak Recovery Mindset Model
A serious injury for an athlete is not as simple as damage to the body and full recovery is not as simple as physical rehabilitation. There is a complex interaction between the brain and body that determines how our thinking, feelings and behaviours effect our physical and performance recovery. The more severe the injury, and the more that a person’s life is influenced by sport and movement at the time of injury, the bigger and longer the resulting psychological and physical response. Knowledge allows preventative planning.
It is valuable to empower athletes soon after serious injury with education on the brain science of injury and potential psychological issues associated with injury. This knowledge helps people normalise their experience and fits it into a scientific model. If an athlete is equip to understand their experiences after an injury they can anticipate the psychological and physical challenges and prepare for them. This knowledge forms a foundation for understanding and developing coping strategies, allowing athletes to connect the dots.
In some cases, an injury can elicit significant mental health concerns such as traumatic stress, grief and loss, transitional stress, depression and anxiety. Knowledge of the signs and symptoms can help identify when support is needed and prevent such conditions effecting one’s lives and sporting careers.
- Empower athletes early with brain science of injury- fit their experience into a scientific model
- Equip to anticipate and prepare for physical and psychological symptoms following injury
- Understand MH signs- Traumatic stress, Grief and loss, Transitional stress
- Normalise their experiences (not crazy, normal human response)
- Injury and recovery are not simply physical – mind plays a role
- Understand how injury effects thinking, feeling and behaviour
- Understand how thinking, feeling and behaviour effect recovery
It is important to empower athletes soon after injury with preventative skills and strategies to manage the potential rollercoaster of negative thoughts and emotions experienced after a crisis. It is possible to re-calibrate or adapt the way we think and feel in response to injury symptoms in ways that promote resilience, wellbeing and growth in the face of adversity.
Injured athletes can benefit from adopting some modern clinical and sport psychology techniques, proven effective in reducing negative thinking and emotion in many contexts. Targeted injury-specific Cognitive Behavioural Therapy (CBT) and Mindfulness strategies allow athletes to manage thoughts, emotions and attitude during this tough time (ride the wave rather than struggle). This is key to creating opportunities for growth and positive change during recovery.
Without preventative skills and coping strategies to manage thoughts and emotions, waves of injury related negativity can harm confidence, motivation, self-belief, physical recovery and pose a threat to one’s mental health. Moreover, important sport-beliefs and positive thinking styles are linked to performance success. Preservation and defense of them during waves of injury-related negativity is important to achieving full performance recovery.
- Calibrate the mind to prepare for negative thoughts and emotions
- Learn to adapt the way we think and feel in response to injury symptoms
- Adopt from clinical and sport psychology- manage negative thoughts and emotions
- Targeted Cognitive Behavioural Therapy and Mindfulness based strategies
- Promote positivity and opportunities for growth in face of injury experience
- Prevent slumps in motivation, self-belief, confidence and physical recovery
- Reduce chances of more serious mental health issues and performance issues
Mental Skills Training including imagery, goal setting and motivation, used in sport and performance psychology to enhance performance, can be utilized in injury recovery to enhance the physical recovery process.
Mind-body imagery skills can enhance the production, maintenance and strengthening of simple and complex neural pathways from the brain to the body important to movement. Imagery of a movement that an athlete can not achieve yet due to injury activates neurons from the motor cortex that reach muscle groups strengthening these connections. Mind body imagery prevents the ‘use it or lose it’ rule- if we are not using them, these circuits weaken. Mind body imagery can also be used to rehearse complex sport movements to strengthen parallel complex neural circuits for skill execution.
Goal getting is the process of setting and achieving goals. A structured goal getting process and a look at one’s motivational drive in sport act to focus an athlete on the task at hand- improvement in recovery. Confidence and motivation from sport can be transferred into recovery by making things structured and measurable. Applying these skills in parallel with rehabilitation act to compliment and add value to the healing and recovery process.
- Mental skills used to enhance performance (sport psychology) adapted to enhance recovery
- Compliments and adds value to rehabilitation process- enhances physical recovery
- Enhance Rehab: Comprised of Brain-body Imagery, Goal Getting and Motivation
- Mind body imagery can activate, maintain and strengthen neural pathways of movement
- Prevents ‘use it or lose it loss’ phenomenon and helps bridge gap to next stage of recovery
- Goal getting applied to rehab- goal setting to focus and motivate athletes on peak recovery
Encouraging social support is very important to athlete coping and recovery because people naturally withdraw when injured. Peak recovery can not be accomplished alone and depends on the interaction of a multi-disciplinary team. Support comes from both the inner circle and outer circle. The inner circle is our family and friends, while the outer circle is the sports medicine team (doctor, physio, trainer, coach). Feeling supported and believing in both circles support insulates us from the negative effects of injury in practical and emotional ways. But, social support rests on communication skills that some athletes and health practitioners struggle with.
The more engagement and ownership an injured athlete shows in seeking support, the more knowledge and understanding of their injury and recovery they have. Not only does this make them more equip to manage recovery at an elite level, it also helps in reducing stress by resolving uncertainty and increasing the perception of control. Reducing stress enhances recovery at a physiological and psychological level.
- Injured people naturally withdraw- social support is important to recovery for several reasons
- Social support reduces stress, increases wellbeing, improves knowledge and skills, practical
- Inner circle support- family and friends, outer circle- sports and medical team
- Optimal support from outer circle relies on high level communication skills- Barriers may exist
- More engagement with outer circle support leads to ownership of recovery- high quality
- Reduces stress- resolves uncertainty and improves control (stress slows recovery and health)
- Peak recovery can not be accomplished alone, depends on multi-disciplinary team interaction