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Boys Lacrosse player Cameron Wright '18 Cradling the lacrosse ball
"From Pain to Performance: The Psychology of Injury"

January Performance Theme:

"From Pain to Performance: The Psychology of Injury"

This month's blog focuses on the mental side of injury rehabilitation, with a specific emphasis on returning to practice and competition. 

What does the research tell us?

  • An athlete's readiness to return is primarily a result of psychological factors such as fear of re-injury, anxiety, and confidence in performing well (Forsdyke, Smith, Jones, & Gledhill, 2015).
  • The primary mental skills training athletes use during injury rehabilitation are goal setting, mental imagery, and positive self-talk (Arvinen-Barrow, Clement, Hamson-Utley, Zakrajsek, Lee, Kamphoff, Lintunen, Hemmings, & Martin, 2015)  
  • Certain factors have been found to negatively impact return to play after injury, such as:
    • Fear of re-injury and high trait anxiety (Covassin, Beidler, Ostrowski, & Wallace, 2015)
    • Negative cognitive appraisals and emotional responses (Clement, Arvinen-Barrow, & Fetty, 2015)
    • Feelings of loss, lower self-esteem, frustration and anger (Tracey, 2010)
  • Factors that positively influence return to play after injury include:
    • Positive social support from coaches, athletic trainers, and friends (Yang, Peek-Asa, Lowe, Heiden, & Foster, 2010)
    • High self-efficacy and adherence to a goal setting program throughout rehab (Wierike, van der Sluis, van den Akker-Scheek, Elferink-Gemser, & Visscher, 2012)
    • Constructive communication and interaction with others (i.e., team, coaches), strong self-belief, and ability to set reasonable goals (Johnson, Ivarsson, Karlsson, Hagglund, Walden, & Bjoresson, 2016).

"In my experience..." An anecdotal account 

The following is an interview with a senior DI tennis player who finished the 2017 season ranked in the top 50 nationally. In the last match of the season, she was experiencing shoulder pain that would eventually require surgery. She has since made a full recovery and is returning to competition this spring. This is an account of how she has handled the past year and her advice for others:

What was your reaction when you found out that you would miss part of the season?

I was pretty upset, to say the least. Because I had a great year I was invited to join a collegiate travel team that would play several professional events. That was out the window after the injury. It was frustrating to finally be playing well and then have a major setback like this. Plus, I feared I might not be able to return to that level of play, which was also letting my teammates down. I had the physical pain to deal with, but also the emotional and mental pain to work through.

How did you handle setbacks during the recovery process?

At first, I did not handle setbacks very well, especially because we decided to hold off on surgery to see if my shoulder would heal with therapy. I went several weeks believing that I would only miss the summer, only to find out in August that I would need surgery anyway. That was really tough, going from thinking I was getting close to returning to realizing I would miss another few months. Eventually, I just made a decision to put all my effort and energy into the new plan and accept my situation. I just needed to realize that I can only control certain parts of what I was going through and it was up to me to turn my attention to those aspects - no one would do it for me. Once I shifted my mindset I was able to handle the little setbacks much better. 

Now that you have returned to competition, what are your primary challenges?

Number one is confidence. I doubt myself a lot when I am on the court, especially when things are not going my way. I overthink my serve since that was where the pain started last year. Even though I know my shoulder is strong, I still think about it too much, which hurts me during competition. I am also struggling with being positive and managing high expectations. I left off on such a high last year and I keep comparing myself to that player. As a result, I get frustrated more easily, but I am working on it. I'm working on changing my thought process and focusing more on process-oriented goals and objectives. 

What advice do you have for injured athletes?

1) Take the time to educate yourself on your injury and what it will take to get back to competition. Ask plenty of questions. Each person and injury is unique and their rehab is a journey with bumps along the way. Simply knowing what to expect helped me manage my expectations and when I might be able to do more.  

2) Once you know what to expect, take the time to set personal goals. Most of these goals should be day-to-day or week-to-week. Of course, you want to get back to playing, but cut it up into smaller bites so you can strive for the little successes.

3) Use this time wisely and work on other skills. I always knew that the mental part of my game was important but I never really devoted the time to work on those aspects. With my injury, I had plenty of time. I was able to watch videos of my matches and figure out my tendencies and where I was breaking down. I also attended coaches' meetings and spent more time looking at the game from the outside looking in. This helped me so much and gave me a new perspective that is helping me now that I am back on the court.

Road to Recovery

In this video from The Players Tribune, Isaiah Thomas discusses his rehab from a hip injury, along with the challenges he has faced during the recovery process. 

Luke Walton Article

This article highlights a number of topics such as 1) how coaches can include injured players in the process, 2) using mindfulness and meditation as a training tool, 3) handling expectations and distractions. 

Performance Challenge

Close the "GAP": Set Your Goal Achievement Pathway

Having a clearly defined goal achievement pathway (GAP) is important as you get closer to returning to practice and competition. Goal setting can help manage your expectations, limit distractions, and direct your energy and effort towards a future action. Follow these principles as you think about your GAP:

1. Write them down and keep them with you.

2. Think of specific and relevant performance/process goals. 

3. Use positive/neutral language (Leave out "don't").

4. Seek out your coaches' thoughts on appropriate goals.

5. Smaller goals should progress to a larger goal.

Here is one example of a GAP and performance journal combination.