“Serious athletes come in two varieties: those who have been injured, and those who have not been injured yet” (Brown, 2005)
While this is probably a very grim way to start this post, it is unfortunately fairly close to the truth. As Jamie was describing in this blog post, cycling crashes happen all the time and this is similar in other endurance sports. In a sense, you are bound to get yourself an injury if you perform in a sport over a longer period of time. And if the injury is bad enough, this will mean having to take time off training for an extended period of time and to enter rehabilitation. For you to be able to recover completely back to the performance level you had before the injury, this rehabilitation process needs to be effective. A variety of research in the past years has shown that psychological factors can influence the rehabilitation process and its effectiveness (Arvinen-Barrow & Walker, 2013).
One of these key psychological factors is the impact injuries can have on mental wellbeing. For example, when you have been training for a while, possibly preparing for an event, an injury can cross out all those plans from one day to another, potentially destroying some dreams. Such reduced mental wellbeing can come with worries or even anger about the rehabilitation process, negative thoughts about the sport and a loss of motivation (Annear et al., 2019). All these effects can not only influence mental wellbeing, but also how successful the rehabilitation process is; for instance, anxiety around the return to sport and a loss of motivation can lead you to break the rehabilitation plan that was set up and thereby draw out the injury recovery process.
While an injury poses the risk for all these effects, it should also be pointed out here that this is not guaranteed. The kind of effects an injury has very much depends on how you as the athlete interpret the situation (Arvinen-Barrow & Walker, 2013). In some cases, athletes have reported positive effects of injuries such as personal growth and improved connections to their loved ones because the rehabilitation gave them some time to themselves. Essentially, even if you do get an injury, this does not have to mean the end of the world. Next to committing to the rehabilitation program, you can also use this time to focus on some other aspects of your life like you friends and family, new hobbies and your job or studies.
During that time, you might also want to focus on building some mental skills training that can help you with the injury recovery process. Such psychological injury interventions have become more popular over the past years as they have been shown to facilitate less pain interference, lower disability, and higher quality of life during rehabilitation (Alschuler & Alberts, 2020). In the past, 72% of athletes who used mental skills during their injury rehabilitation perceived to have a faster recovery (Arvinen-Barrow et al., 2015). The risk for reinjury is also greater if a rehabilitation program does not address the psychological aspects of injury recovery (Mahoney & Hanrahan, 2011). Take-away: working on some mental skills during rehabilitation can be very beneficial to you by not only helping you with returning to your sport faster but also return in a better mental state.
This brings us to the question of what kind of mental skills can be the most beneficial during injury rehabilitation. Before we get into this, please have a read through Jamie’s blog post on regaining confidence after a cycling crash as well. His post very much relates to some aspects that are covered here as well. The following are just an introduction to some of the most beneficial skills for injury rehabilitation. You might want to seek out some further resources if you are interested in these.
1 Goal setting. Everyone has heard about goal setting, maybe you have even read about it. Essentially, goal setting can help you manage the potentially negative emotions that are connected to the injury or even facilitate having some positive emotions around it (Santi & Pietrantoni, 2015). Employing effective goal setting can also help with the pain management during rehabilitation and help to return faster to your pre-injured state by motivating you to stick with the rehabilitation plan (Rose et al., 2019). As Jamie also discussed in his post, goal setting can improve your confidence about returning back to your sport. To make goal setting effective, it is important to choose specific goals that are not necessarily focused on outcomes (injury recovery), but rather on what you can do to get there. So, for example, if your physio gives you specific exercises to do, then you could create a goal of:
“I will perform the exercises at least once in the morning and once in the evening for each day of the week”.
You should discuss these goals with your physio or medical professional to figure out what frequency is the most appropriate here. The idea (based on Weinberg, 2009) is to make these goals specific (what are you doing), measurable (how often are you doing them), achievable and realistic (which is why you should discuss them with your physio) and time bound (for how long you are sticking to this goal; for rehabilitation, this would probably be the duration of your rehabilitation). At the start of your rehabilitation, you might want to focus more on goals around the rehabilitation program. Towards the end of the rehabilitation, you should focus more on the return to the sport and your goals should reflect that.
2 Relaxation techniques. One of the issues during rehabilitation tends to be muscle tightness that develops from the injury. Relaxation techniques can help you release that tension and thereby overall help with pain management (Concannon & Pringle, 2012). Depending on the technique, they can also help you calm your mind and alleviate some stress and anxiety. If you are more after physical relaxation, you would probably go for techniques like progressive muscle relaxation (PMR) or breathing techniques. In PMR, you are tensing your muscles actively (but just lightly) and then releasing the tensions (Ganz, 2018). This can alleviate some tensions you didn’t even know you were holding (you would use this on the body parts that are not injured!). There is a link to a PMR session at the end of this section that basically talks you through all your muscles groups. Mental relaxations are a little different since they focus more on relaxing the mind. So, if you are suffering from some anxiety or stress around the injury, this would probably be quite useful. Again, there is a link at the end of this section for an example. However, be aware that it can take some time and searching to find the right resource for you personally. Some people don’t enjoy PMR or mental relaxation and that is absolutely fine, just keep looking for a resource that you like and want to continue using. The point here is to have these techniques help you, not to make it feel like a chore. Generally speaking, for rehabilitation, you might want to focus on physical relaxation at the start of the rehabilitation process to manage pain. Once you feel more of a need to mental relaxation because you are getting stressed about the rehabilitation, you might want to turn towards more mental relaxation.
Mental Relaxation: https://www.youtube.com/watch?v=krKXXmnLQ80
3 Mental Imagery. Mental imagery is probably one of the most used skills in psychological interventions in sport, but also a very tricky one to get good at. During mental imagery, you are essentially trying to picture a scenario as vividly as possible. This means, getting all your senses involved. Typically, athletes use this to picture themselves successfully performing a skill such as starting a race, but this can also be used during injury rehabilitation. The idea here is that imagery can help athletes cope with their injuries and the acceptance of the injury (Santi & Piertrantoni, 2015). It can help you manage emotions like anxiety as well as the pain connected to the injury. Through imagery, you can also increase your motivation, so you are more inclined to stick to your rehabilitation program. Now learning how to use imagery can be quite tricky, so don’t get discouraged if you don’t feel like you are getting it right at first try. For the beginning of rehabilitation, you might want to stick to healing imagery where you visualize the injured body part healing, which can help you stay motivated. You can also use imagery that distracts you like imagining yourself on a beach to help with pain management. Using these types of imagery early on also gives you some practice with developing a vivid image and getting your different senses involved. Further along the rehabilitation process, you might want to use images in which you perform the exercises the physio gave you. Later, when you are about to return to your sport, you could use imagery where you imagine yourself performing in your sport (e.g., racing) again.
4 Self-talk. Self-talk is a fairly simple concept; the idea here is that you literally talk to yourself (whether that is out loud or in your head is up to you). This technique has been shown to be associated with better quality of the rehabilitation and help athletes to deal with negative thoughts that can interfere with the rehabilitation program. It generally aims to help you with a more positive interpretation of the injury and the rehabilitation process (Podlog et al., 2011). If you struggle with anxiety something like “Calm” could be useful, but if you have more an issue with motivation “Stick to it” might be more appropriate. Again, tailoring this to where you are at in the rehabilitation is best for this to work. For instance, right after the injury, you might want to focus more on your ability to manage the pain successfully e.g. “I can cope”. Later you should shift your focus more to keeping up your motivation and managing potential anxiety or doubts (again, read Jamie’s post on confidence, he has some nice additions to this).
Conclusion. Hopefully, this post has given you some insight as to why considering psychological aspects during injury rehabilitation is an important factor for injury recovery. Again, this is just a selection of skills that have been shown to be the most useful for injury rehabilitation. Looking for more resources on how to practice these is highly recommended. One of these resources could be the workshops that are coming up in a couple of weeks (June, 2021), during which we will focus on some of the techniques discussed here. So, have a look out for those!
Written by Hanna, photos and proofread by Dipam
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