PCL4- Psychosocial factors

PSYCHOLOGICAL REACTIONS ACCOMPANYING ATHLETIC INJURY

EMOTION

-Athletes can be expected to experience a variety of emotional responses upon being injured.

- Athletes may experience feelings of separation, loneliness, guilt and a loss of identity and independence, because they feel that they are no longer vitally contributing to the team and that they are reliant upon others in the rehabilitative process

-The athlete may also experience withdrawal symptoms if they must stop exercising which include depression, increased irritability, decay of personal relationships, anxiety, insomnia, fatigue, and muscle tension

-Emotions such as depression, anger, fear, tension, disgust, anxiety, and panic have been shown to create psychophysiological reactions that contribute to and exacerbate the pain of the injury

-Therefore the emotions experienced by the athlete may further add to the injury

-Problematic emotional reactions occur when symptoms do not resolve or worsen over time, or the severity of the symptoms seems excessive relative to other injured athletes

-Depression is an especially significant warning sign.

- It magnifies other emotional responses and impacts recovery from injury.

PROBLEMATIC EMOTIONAL REACTIONS (EXAMPLES)
Persistent Symptoms	Worsening Symptoms	Excessive Symptoms
• Alterations of appetite • Sleep disturbance • Irritability	• Alterations of appetite into disordered eating • Sadness into depression • Lack of motivation into apathy • Disengagement into alienation	• Pain behaviors • Excessive anger or rage • Frequent crying or emotional outbursts • Substance abuse

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Stress

-If an athlete is injured, stress and anxiety can also become an overwhelming problem during the healing process

-Stress causes attentional changes (e.g., narrowing of attention, general distraction, increased self-consciousness) that interfere with an athlete’s performance

-Stress has been shown to cause increased muscle tension and coordination difficulties which increase the athlete’s risk of injury.

-A serious athlete who identifies herself with a certain sport can be devastated by an injury that takes her out of the game.

-She might fear losing her skills, strength, conditioning, and experience of a season

-She might also fear losing her position.

- Additionally, she is unable to exercise as before due to the limitations of her injury.

-Even though she might now have a lot of time on her hands, she might feel great stress

Table 1 SELECTED SIGNS AND SYMPTOMS OF STRESS
Behavioral	Physical	Psychological
• Difficulty sleeping • Lack of focus, overwhelmed • Consistently performs better in practice/training than in competition • Substance abuse	• Feeling ill • Cold, clammy hands • Profuse sweating • Headaches • Increased muscle tension • Altered appetite	• Negative self-talk • Uncontrollable intrusive and negative thoughts or images • Inability to concentrate • Self doubt

As a physician

-A number of factors should be considered when treating injured athletes. These factors include:

• Building trust and rapport with the injured athlete. Injured athletes often experience a range of emotions that make it difficult for athletic care network members to establish rapport and build trust. Listening to the athlete is particularly important, not only to make a medical diagnosis but also to assess and monitor their emotional state.

• Educating the athlete about the injury. Injured athletes must understand and process injury-relevant information, often at a time when they are experiencing emotional upheaval. It is critical that explanations of injuries be presented in terms that the injured athlete can understand. An effective method to assess this understanding is to ask the athlete to provide their interpretation of information given to them.

• Identifying misinformation about the injury. Injured athletes often obtain inaccurate information from a variety of sources (e.g. parents, coaches, teammates, Internet) which may contribute to confusion and emotional upheaval.

• Preparing the athlete and coach (only with athlete’s permission) for the injury recovery process. The injury recovery and rehabilitation process is variable due to characteristics of the injury, treatment provided, presence of complications and psychological issues. Therefore, the athlete and coach should be educated that an injury is best managed on an individualized basis. In addition, coaches should be encouraged to help the injured athlete avoid isolation from the team.

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• Encouraging the use of specific stress coping skills. Injured athletes can experience considerable stress throughout the injury and rehabilitation process. Psychological as well as physical strategies will enhance the recovery process

Coping strategies

1. Set Appropriate Goals

- SMART

- goal setting can become an incredibly important tool to make sure that the athlete continues to focus on making progress.

- goals will now focus on recovery rather than performance

- will help keep athlete motivated

-By monitoring goals, athlete will also be able to notice small improvements in the rehab of their injury.

-they will feel more confident that they are getting better and improving.

2. Visualization Technique

- visualization is an effective way to reduce or eliminate out-of-control feelings of stress and anxiety

-Visualization is about slowing down and picturing yourself in a time and place where you will be relaxed and peaceful.

-Visualization is a very personalized relaxation technique, and the key to success is coming up with images that will work for you.

- The visualization activity that works for you might involve picturing yourself relaxing in a beach or boat, or it might be an image of yourself standing atop the winner's podium after a tough meet

- This strategy can help ward off extreme anxiety and panic attacks.

3. Accept Responsibility for Your Injury

-What this means is that you accept that now you have an injury and you are the only one that can fully determine your outcome.

-By taking responsibility for your recovery process, you will find a greater sense of control and will quickly progress in recovery, rather than dwelling on the past or blaming the injury on an outside factor.

4.Maintain a Positive Attitude

-To heal quickly you need to be committed to overcoming your injury by showing up for your treatments, working hard, and listening and doing what your doctor and/or athletic trainer recommend.

-You also need to monitor what you are thinking and saying to yourself regarding the injury and the rehab process.

- Your self-talk is important.

-Are your thoughts negative and self-defeating?

-To get the most out of your daily rehab, you need to work hard and maintain a positive attitude. Remain focused on what you need to do.