Psychological Challenges of injury, rehabilitation and return to play
Watching several sports this weekend I was reminded of the number of injuries that occur, such as Jason Roy’s unfortunate calf injury for the England Cricket team whilst playing against the South African team. While many of these injuries experienced are relatively minor and have short recovery times other injuries are more significant and require extended periods of rehabilitation and recovery. Understanding the psychological impact of the injury, the rehabilitation process, and the challenges faced in returning to play post injury are crucial if we are going to best help athletes recover and move on from injuries.
The first thing to think about is the psychological response to injury. There are a few theories that seek to outline what this process looks like, but the severity of the injury, the trauma experienced in becoming injured, and the debilitating nature of the injury are all important factors. Post-event traumatic flashbacks are not uncommon and something that athletes need to be helped to cope with.
Once the severity of the injury has been determined, diagnosis has taken place, and a plan of rehabilitation has been outlined there is then the psychological challenges related to this process of recovery. However, in some cases there is the challenge of surgery to overcome before recovery can start for real. In recent years I have spent a fair amount of time with both athletes and military personnel discussing what will happen post-surgery, what pain might be experienced, the impact upon normal functioning (living your life normally), and the expert recommended recovery time post-surgery. In my experience athletes always think they are the exception in terms of recovery timescales and think they can ‘get back’ sooner. This view can be problematic as unrealistic timescales and perceptions of targets can be a significant contributor to rehabilitation stress and frustration. The view that recovery should be a linear upward line is also a problem in this regard. Often, athletes must be protected from their own optimism to ensure their expectations are realistic, great if they recover quicker, but this should not be the expected timescale.
With any major injury there is also a period of adjustment that is required to come to terms with the ‘new normal’ and physical and psychological reality that emerges during the recovery process. Many athletes talk about ‘getting back’ to where they were before the injury, this is simply not possible. The body heals, but it is different to before, often the body can feel different and there might be different sensations felt when moving, athletes need to understand and accept and embrace this new normal to be able to sufficiently recover.
Finally, there is an assumption that once someone has recovered physically, they have recovered, but that is often not the case. Their skill levels can take time to recover, also their confidence in their ability to return can be impacted which can again result in increased levels of stress and anxiety around return to practice and competition, all of which can both impact upon their ability to perform, and potentially increase the likelihood of re-injury. Sport and performance psychologists can help through this process either working directly with athletes or supporting the rehabilitation specialists guiding the athlete through their rehabilitation programme.