Psychological Effects of Injury and Evaluating an Effective Rehabilitation for Athletes

Injuries in sport is an evitable risk that is associated with its participation, most notably the physical injuries that result from the action in game. A general notion amongst most athletes suggests that returning to play as soon as possible is the right course of action, because of a preexisting stereotype that challenges their competitive nature and willingness to sacrifice for the team. This sentiment is also reflected in current professional sports media outlets, that constantly reports an estimated recovery period of an injured athlete and the importance of their return to their respective teams and sport. There has been a considerable amount of criticism for athletes who choose to rehabilitate longer which causes many to question their devotion to the game, mental toughness, and if their contractual salary is proportional to their diminished value. But, a major factor in injury rehabilitation that is sometimes overlooked is the psychological aspect of an injury. Because of their competitive mindset, some athletes rush their rehabilitation and do not place an importance on their psychological readiness to return to action, causing it to affect their performance and also their daily life. The psychological effects that can result from an injury can range depending on the severity of the injury and an athletes’ mental approach. The rehabilitation process is crucial period for an athlete to recover both mentally and physically, and this paper will explore effective approaches in mental rehabilitation post injury, in order for the athlete to achieve an efficient level of readiness and perform to the best of their abilities.

Understanding the Psyche of an Athlete

In order to understand how an athlete would react to an injury and rehabilitation, it is important to first establish the mental psyche of an athlete. It is widely recognized in the sports world that athletes must exude a level of mental toughness in order to achieve a certain degree of success in their respective sport. Researchers Tristan Coulter, Clifford Mallett, and Jefferson Singer define mental toughness in their article “A Three-Domain Personality Analysis of a Mentally Tough Athlete”, stating that mental toughness is “…regularly performing to high levels, despite incidents of challenge, pressure, or adversity” (Coulter, Mallet, & Jefferson, 2018). These levels of challenge, pressure, or adversity is very prevalent in a rehabilitation scenario where an athlete must endure long arduous sessions that tests both their mental and physical boundaries. The concept of how mentally tough an individual is, is difficult to quantify through data and has often been misconstrued with the idea that is simply ignoring any mental easiness that an individual may be experiencing, which is far from the truth. In congruence with the proper focus of a rehabilitation program, the mental toughness of an athlete could help determine the manner in which he or she responds to an injury. Coulter’s article further analyzes the psyche of an athlete named Wade (confidential alias) during the injury rehabilitation, in which it states “[Wade] employs positive reframing to view his injury in more helpful terms. Congruent with his positive outlook, Wade spoke about the potential benefits of his injury…” (Coulter, Mallet, & Jefferson, 2018). By being able to cope with the psychological stress of rehabilitation and providing a positive mindset on the situation, an athlete such as Wade is capable of persevering through his injury and preparing himself both mentally and physically to return to action. The severity of psychological effects of injuries do vary from case to case, which warrants the discussion of the athletes who do experience the psychological effects of injury more significantly. The process of injury and returning to action, can produce a tremendous level of stress on any individual, and their level of self-efficacy can come into question. An athletes’ reaction to the injury can be very indicative of their ability to perform to the highest of their ability post-injury. In a study titled “The Relation Between Self-Efficacy, Injury, and Fear of Injury Among Elite Athletes” by McCaffrey, Mrazik, Klassen, the data collected in the case study of 365 CFL players found that “…players who sustained more injuries throughout the season had significantly less self-efficacy to avoid future injuries” (McCraffrey et al., 2014). These findings suggest that an athlete’s approach to their sport is altered because of the psychological effect of an injury, which can be attributed to a level of anxiety and mental unreadiness that was not resolved within the rehabilitation process. Often, in order for an athlete to overcome the mental block and achieve the desired comfortability of playing, there is a level of confidence that they must reestablish within themselves and in their body. Researchers Dale Forsdyke, Andy Smith, Michelle Jones, and Adam Gledhill explore this topic in their study, in which they state “Developing confidence in the injury body part and in the ability to perform to a satisfactory standard may act as a ‘buffer’ from injury-related anxiety and fear” (Forsdyke et al., 2016). One can surmise that the rehabilitation process for an athlete is a multi-dimensional process that involves several factors such as the level of confidence, mental toughness, along with the incorporation of both physical and mental preparation. Athletes who experience difficulty in rehabilitation can result in further setbacks that could potentially affect his or her ability to play and even function on a daily basis. A study that tested this relationship between stress and performance titled “Relationships Between Hoffman Reflex Parameters, Trait Stress, and Athletic Performance” essentially supported the correlation between performance and stress levels stating that, “First a high trait stress might lead to decreased athletic performance. Therefore, psychological rehabilitation can be useful as an adjunct program to enhance athletic performance of some athletes” (Bagheri, et al., 2018). The psyche of an athlete is an essential component in their ability to perform in competition, and an increased level of stress without the proper outlet to manage it could expose them to harmful effects in their ability to function. Athletes are often labeled with a preconceived notion that they are capable of overcoming any mental obstacles that result from their injuries, but it is evident that without the proper course of action, personal development and assessment, resolving the issue will become increasingly more difficult. 

Post-Injury Psychological Effects

An athletes’ reaction to injury can drastically affect their mental well-being outside of the sport which often translates to a hindered ability to function daily and an imbalanced emotional state. Sports injuries have been shown to cause depressive symptoms in athletes which is elaborated upon in Palisch and Merritt’s article, “Depressive Symptoms in the Young Athlete after injury: Recommendations for Research”. The article states that “A traumatic injury, particularly one that limits or ends sports participation, may trigger a new mental or emotional concern or exacerbate an existing mental health condition in a young athlete” (Palisch & Merritt, 2018). Considering the potential psychological effects that an injury may induce upon a young athlete, the emotional nature in which an athlete responds to an injury should be a primary concern during the rehabilitation process. These potential mental or emotional concerns that may result from an injury is alarming because of its capability to develop further if not treated in an effective manner. Symptoms of depression and other mental illnesses may manifest due to an athletes’ inability to participate in their sport, which Palisch and Merrit expands upon further in their work stating that “Along with identity loss, for many athletes, sports participation is an escape and provides a healthy coping mechanism for emotions and stress. When this avenue of stress release is taken from the athlete’s life, he or she may not know how to cope…” (Palisch & Merritt, 2018). This inability to cope with the stressors in an individual’s life adds to the mental distress that an athlete may experience, which only hinders the rehabilitation process. The culmination of stress and the pressure to return to action is what often causes athletes to return to action prematurely which could affect their mental approach to the game and ability to perform at the same level before their injury. In a study conducted by Margot Putukian titled “The psychological response to injury in student athletes: a narrative review with a focus on mental health”, the statistics show that “In a retrospective study of Division I football players, 33% of injured athletes reported high levels of depressive symptoms…depressed athletes and those under ‘stress’ are at an increased risk for injury and athletic performance is often impacted by emotional or mental health factors” (Putukian, 2016). Considering how vital sport could be to athletes in regards to their stress coping mechanisms and their identity as an individual (Palisch & Merritt, 2018), it is very important to note that this notion is reflected in the data stated above. The reported 33% of Divison I football players highlights the strong correlation between the mental effects of a physical injury, which raises the concern as to how far an injury can truly set an individual’s overall health back. Because injured athletes are susceptible to experiencing depression-like symptoms during the stages of rehabilitation, this can also affect their levels of self-confidence and their willingness to even return to the game. Putukian provides a case example of this issue in his article in which he states:

Kenny McKinley played as a wide receiver professionally for the Denver Broncos Football team. He was found dead of a self-inflicted gunshot wound in September of 2010 . after growing despondent after a knee injury…[he] had made statements about being unsure what he would do without football and reportedly sharing thoughts that he should kill himself. (Putukian, 2016).

Unfortunately, this is only one of the numerous cases of injury-related depression that has been recorded throughout the years, which speaks to the drastic level that some athletes are willing to take to relieve their depressive state of mind. As mentioned previously, the increased level of stressors that an individual may experience after an injury could be a lasting effect that has the potential to carry through in the future, which could result in cases such as Kenny McKinley. The data found in longitudinal study titled “Psychological Distress following Injury in a Large Cohort of Thai Adults” supports this notion of the lasting psychological effects in which the researchers state, “Those that were previously injured were more likely to report psychological distress compared to those who did not report an injury in 2009- 8.8% of people injured in 2009 reported high distress in 2013, compared to 6.2% of those with no injury” (Tran et al., 2016) It is evident that physical injuries have a dramatic impact in the overall psyche of an individual and considering the high frequency of an injury in sports, proper protocol must be taken in order to address these mental health concerns that may come as a result. Without the proper mediation, these post-injury effects such as a loss of an identity, lack of stress coping, and depression like symptoms can develop even further, which could ultimately prove to be detrimental to an individual’s life.

Mental Health in Sports

The stigma that surrounds mental health is still a present issue within the sports world and its effects on athletes is evident in their approach and perception of rehabilitation. The concept of mental toughness has often steered athletes from allocating the proper time to recover mentally because of the stereotypes associated with mental illnesses. Mental toughness is often misconstrued with the notion that ignoring emotional struggles is what constitutes a mental strong individual, which has led to counterproductive and self-destructive behaviors. Putukian elaborates on the struggle that athletes may endure when seeking care, stating that “Athletes may be at greater risk for mental health issues in that they are less likely to seek treatment, may be afraid to reveal symptoms, may see seeking counselling as a sign of weakness, are accustomed to working through pain…” (Putukian, 2016). The rehabilitation process provides athletes with the opportunity to both physically and mentally recover from the trauma suffered from their injury, and for them to feel insecure about pursuing the proper mental help is preventing them from truly rehabilitating. The very nature of sports contributes to this stigma, because of the mentality that any form of weakness is an advantage to your opponent, so naturally many athletes repress any emotional distraught and force themselves to compete. A notable case example of an athlete who publicized his battles with his mental illness is the NBA player, Kevin Love, who wrote a memoir to the Player’s Tribune detailing his experience and struggle to seek out the proper help. Love stated “Call it a stigma or call it fear or insecurity- you can call it a number of things – but what I was worried about wasn’t just my own inner struggles but how difficult it was to talk about them. I didn’t want people to perceive me as somehow less reliable teammate…” (Love, 2018). Considering how difficult it is for athletes to speak on any mental blocks they are experiencing, one can surmise that the stress of rehabilitation and returning to competition for the benefit of the team could prevent an athlete from investing the correct amount of time in mentally preparing themselves to return. The stigmas and stereotype that go against an athlete’s nature as a competitor needs to be acknowledged when constructing an effective rehabilitation program. As evident with Kevin Love along with the countless number of athletes who experience struggles with their mental health, addressing the importance of mental health is a key component in reducing the mental illness stigmas which allow athletes to feel more comfortable in seeking the proper rehabilitation.

Approaches to Effective Rehabilitation

Rehabilitation for an athlete can pose new levels of difficulties and stress that they could be experiencing for the first times in their careers. It is important to acknowledge the importance of this period and understand that every case is different therefore different recovery lengths could come as a result. Maintaining a balanced focus in both the mental and physical progression is key to achieving a well-rounded rehabilitation. A study done by Lynne Johnston and Douglas Carroll titled “The Psychological Impact of Injury: Effects of Prior Sport and Exercise Involvement” echoes this sentiment when Johnston and Douglas state, “In line with previous research, injury had discernible emotional effects, and the negative emotional impact of injury diminished over the course of rehabilitation” (Johnston & Douglas, 2000). Being able to assess the mental state of the athlete during the recovery process is important procedure that needs to be taken into account. Athletes have the inclination to return to action prematurely, but it is imperative that they devote the required amount of time in order to resolve any unresolved anxiety or confidence problems that they could be experiencing post-injury. As stated in Johnston and Douglas’ work, the negative emotional effects of an injury lessened through the duration of rehabilitation which speaks to the importance in allocating the right amount of time and not rushing the process. In a separate study conducted by ED Porter and GC Dover, titled “Pain Severity, Pain Interference and Athlete Fear Avoidance Are Related to Acute Injury Rehabilitation Time in Athletes”, it was found that “…our data suggests that baseline pain, athlete fear avoidance, and function are related to return to competition time…which could predict rehabilitation times in athletes” (Porter and Dover, 2017). This supports the notion that the duration of rehabilitation is dependent upon the mental readiness of the athlete, therefore placing a level of importance in the mental health aspect of rehabilitation. Along with the appropriate rehabilitation time, it is necessary for the rehabilitation program to address any mental issues that an athlete may be experiencing during the process. In a team physician consensus statement titled “Psychological Issues Related to Illness and Injury in Athletes and the Team Physician” (2017), it states that “It is essential that the team physician understand emotional responses will accompany athletic illness and injury…recognize psychological factors play a key role in illness and injury treatment and rehabilitation” (2017). The psychological effects of an injury can range depending on the severity of the injury and the athletes’ reaction to that injury. There is a multitude of issues that can come as a result such as depression, substance addiction, lessened self-confidence, and an increased level of stress with no outlet to cope. It is critical that the rehabilitation program places a focus on these problems should they arise, by providing suggestions and guidelines for the athlete in order to combat these problems. Ivarsson and his team of researchers provided some recommendations in their article stating,

Athletes should, therefore, work with stress management techniques to decrease the level of negative affective responses during the rehabilitation process, which in previous research has been related to successful rehabilitation outcomes…it is important to design an environment that decreases negative affective responses and maximizes the rehabilitation adherence (Ivarsson et al.,2017).

The rehabilitation process should incorporate a level of mental and personal development for the athlete, that could be facilitated by providing them ways to deal with the stress of their injury and learning to communicate any concerns they may be experiencing, with no fear of being judged. By instilling a positive and optimistic outlook, it can help reduce any doubts or anxiety that may occur through the recovery process. The psychological impact of an injury can ultimately determine the athlete’s ability to fully function both a mental and physical level, which highlights the significance of a productive rehabilitation program. It is crucial to incorporate mental assessments throughout the duration of the recovery period, in order to track the progress and mental readiness of an athlete.

Conclusion

The injury and rehabilitation process in the sports world has always been synonymous with the physical aspect of recovery. As evident through data and personal accounts of athletes, the psychological impact that injury can have is significant and can have life altering effects depending on its severity. Stigmas and stereotypes surrounding mental health have caused many athletes to ignore the mental aspect of rehabilitation in order to expedite the physical rehabilitation and return to competition. Many athletes have labeled mental struggles as a weakness due to these stereotypes, which goes against their competitive nature causing them to not value the importance of mental health. This has proven to be an unhealthy habit, which has shown to change the athlete’s approach to the game and has hindered their ability to compete at their highest potential. The repression of these psychological effects after an injury, has even led to the development of harmful mental illnesses which can prove to be fatal if not dealt with. Addressing these concerns during the rehabilitation process is essential to reacquiring the same level of confidence, comfortability, and self-efficacy that an athlete had prior to the injury. By investing the proper time and focus to become mentally ready to return to action, it will help facilitate an efficient and balanced recovery.

Works Cited

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