​Hannah Winter, Sport and Exercise Psychology Consultant, discusses the psychological impact of injuries

Psychological responses to injury

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People respond to injuries in various ways. Athletes, understandably, can be incredibly upset and frustrated when experiencing an injury. There is often a lot of uncertainty for example in understanding how long an injury will take to recover, how it will impact sporting ambitions or whether it will be career-ending. For some, having an injury is therefore incredibly debilitating and is viewed as a disaster. Depression, frustration, stress, anxiety, anger, rehabilitation compliance problems, poor concentration and exercise addiction are some of the emotions and behaviours injured athletes report. For some, responses can be clinically significant. In one study, a quarter (24%) of coaches said they had referred an athlete for counselling following an injury.

In contrast, some people when injured react more positively. For them, an injury is seen as a challenge to overcome, an opportunity to demonstrate courage or even as a relief to have a break from training. Developing effective ways of coping with injury setbacks is therefore important to help navigate what can be a difficult time.

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A culture of risk

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Sometimes it can be a challenge for injured athletes to express how they are truly feeling about an injury. Certain beliefs concerning accomplished athletes and successful injury rehabilitation are often drilled in by coaches, parents and the media. For example:
 

• Demonstrate mental toughness and give 110 per cent – this can lead athletes to over-train resulting injury risk or return to sport too quickly after an injury;

• Play through pain – this can make it hard for athletes to understand what pain should be ignored and what should be treated more seriously

• A focus only on performance – this can make people only feel valued as performers and encourage injured athletes to ignore both the precautions needed for a full recovery and what’s needed to enhance their wellbeing

 

There is therefore, a role for coaches, parents and sporting organisations to do what is in the best interest of the injured athlete to support them and be mindful that these beliefs may exist within the injured athlete.

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Coping strategies

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If you are faced with an injury, employing strategies to help you cope with the psychological impact may be just as important for your recovery as the physical rehabilitation. A response to an injury is very individual and it is important to work out what strategies are beneficial for you. As with any new skill acquisition, these techniques can take time to put into practice and lead to desired outcomes. Here are some examples of evidence-based coping strategies that have been found to effective in managing the psychological challenges that can come with injury:

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1. Educate yourself: research shows that people who take time to really understand their injury cope better. Talk to your doctor, physiotherapist and/or surgeon and learn about your injury and the rehabilitation process. This can help you become more engaged in your recovery and it can help you to feel more empowered in the process
    

2. What’s in your control? Be really clear about what is in your control versus what is outside of your control with regard to your injury and recovery. Write them out and place the list somewhere visible. Then each day focus on what is in your control
    

3. Talk about it: Don’t go through an injury alone. Social support is often critical in the rehabilitation process, particularly with severe injuries. Find a friend, family member or teammate to listen to your concerns and provide emotional support when needed. This is often most effective if the person you are talking to understands your sport. Coaches can also set up injury support groups to enable injured athletes to have a safe space to talk openly about their injury experience
    

4. Don’t isolate yourself: staying involved with your sport can, for some, be helpful. For others, however, it can have a negative impact on their emotional state. If you think it would be helpful for you, look for ways to be involved in your sport for example by coaching other athletes or mentoring younger players
    

5. Find a mentor: If your recovery is going to take a long time, research has shown finding a peer mentor – someone who has successfully recovered from a similar injury – can be helpful
    

6. Focus on the long-term: With an injury, it can be very tempting to push through pain or go back to training too quickly. However, it is important to focus on your long-term objectives and not the short-term fear of losing fitness
    

7. Set realistic goals: Be flexible with your goal for recovery. Depending on the nature of your injury, understand that rehabilitation can at times be slow and have setbacks. Once you are ready to return to sport, set new and realistic goals to avoid disappointment. It may not, at least initially, be possible for you to compete at the level you were previously
    

8. Track your progress: Keep a daily or weekly diary on your rehabilitation progress. Writing in a diary each day on the current state of your injury can help see the progress you are making in your recovery. This can be particularly helpful if you are out of your sport for a long time
    

9. Mix up your rehabilitation: Physiotherapy exercises may be needed for a long time. Completing the same routine for weeks or months on end can be boring. Mixing up rehabilitation exercises can improve motivation and adherence
    

10. Consider the positives: Consider whether there are any positives to have arisen from the injury. For example, have you been able to come back stronger than before? Have you been able to work on a weakness? Or perhaps you were able to spend more time with your friends and family. Get clear on any positives and write these down
     

11. Positive self-talk: Think about your inner dialogue and whether you are having helpful or unhelpful thoughts about your injury and recovery. Negative self-talk can be self-defeating and prevent rehabilitation adherence. Look for ways to develop your inner dialogue to be self-enhancing
     

12. Practice relaxation strategies: breathing techniques can help manage any anxiety and frustration throughout the injury process. One example is box breathing where you breathe in for a count of four, hold for a count of four, breathe out for a count of four and hold for a count of four. Repeat five times
     

There is no doubt that injuries can be incredibly frustrating, leading to a loss of identity and confidence. However, when approached correctly, psychological adjustment can be healthier, and an individual may more readily return to higher levels of performance. Understanding what coping strategies work for you is important. Even if you are not currently injured, formulating a clear plan on how you would respond to an injury should one arise can help minimise confusion at the time of injury as to what should be done. Lastly, it is important to note that for some professional, support may be helpful if the psychological consequences are severe, particularly if it is a career-ending injury.