Mind for sport part one

Participation in sport incurs an inherent risk of sports injury. It has been estimated that 29.7 million sports injuries occur each year in the UK (Nicholl, Coleman and Williams, 1995). Traditionally, the study and treatment of sports injury has focused on physical aspects of injury. More recently however, the psychological aspects of sport injury have also been considered. As such, interest in applying psychological interventions alongside physical interventions during sports injury rehabilitation has grown.

The links between sports injury and psychology

Research has demonstrated that the occurrence of a sports injury can lead to the several negative psychological reactions including feelings of frustration, stress, anxiety, depression, anger, confusion, low self-esteem, isolation, fear, guilt and loss (Grantio Jr, 2001; Johnston and Carroll, 1998; Newcomer and Perna, 2001; Tracey, 2003). Such negative reactions can potentially impact on rehabilitation behaviour (such as adherence to a rehabilitation programme) and outcome. Therefore, sport psychology intervention aimed at addressing these negative emotions may potentially benefit the injured athlete.

Athletes will respond in different ways to an injury. One might perceive an injury as a disaster while the other athlete could perceive it as an opportunity to take a break from training. How an athlete responds greatly depends on their cognitive appraisal (subjective interpretation) of their injury, this can influenced by personal factors (such as personality, previous injury experiences) and situational factors (social influences, stage of season). The sports therapist has the capacity to influence an athlete’s cognitive appraisal of their injury by their own response. Trying to frame positively is important.

Sports psychology interventions

Research examining the benefits of sport psychology intervention during sports injury rehabilitation has identified that it can lead to many positive outcomes including:

The development of a more positive attitude;
Increased rehabilitation adherence
Heightened concentration;
Increased self-efficacy/confidence;
Improved motivation;
Faster recovery;
Increased mental toughness;
Enhanced sense of control; and
Greater psychological well-being.

(Armatas et al, 2007; Beneka et al, 2007; Driediger, Hall and Callow, 2006; Gilbourne and Taylor, 1998; Quinn and Fallon, 2000; Rock and Jones, 2002).

These benefits are clearly attractive to the athlete; the next step is to consider what sport psychology interventions can produce and how they can be applied. The five key sport psychology techniques that have been shown to benefit injured athletes are social support, imagery, positive self-talk, goal-setting and relaxation:

Due to regular and close contact a sports therapist has with the athlete, they can be a key source of social support. Simply by talking and listening to the athlete, t is possible to help make them feel better and more positive. When talking to an athlete, it can be beneficial to ask them about the emotional and psychological aspects of their injury as well as the standard physical aspects. This will help them to come to terms with their feelings and also help to develop a more holistic approach to treatment.

Some of the negative consequences of injury such as loss of identity and loneliness occur because contact is lost with team-mates/coaches when injured. Those who work in a sports team environment could help to alleviate this by encouraging the maintenance of contact by, for example, scheduling rehabilitation sessions alongside usual team practice sessions.

(ii) Imagery

Imagery can be defined as the process of “using all the senses to recreate or create an experience in the mind” (Vealey and Greenleaf, 2006; p307). In sport, athletes often appear to run through a performance in their mind before executing it, for example a high jumper before a jump. This is an example of imagery, and it provides the athlete the opportunity to mentally practice a challenging skill before they physically execute it, which may potentially help improve sport performance and physiological functioning. Imagery can be used during sports injury rehabilitation in many different ways, including:

Skill practice – those who are injured to the extent that they are unable to physically practice their sports skills can mentally practice, in order to minimise loss of skill that naturally occurs in the absence of physical performance. This involves the athlete imaging physically undertaking sports skills, such as hurdling.

The more real this imagery is, the more effective it tends to be, so athletes should be encouraged use all of their sense when recreating the execution of that specific skill in their mind, imagining what they would see, hear and smell. Although imagery of skill practice will vary from athlete to athlete depending on their sport, experience and injury, in general athletes should mentally practice the key technical skills from their sport at least three times per week.

Relaxation – imagery of being in relaxing place (lying on a bench) can be used as a stress management or anxiety control strategy. This type of imagery works due to two main mechanisms: first, it distracts the athlete from source of their stress/anxiety; second, it helps to reduce any physical symptoms of stress/anxiety such as muscle tension.

Pain management – when undertaking a painful treatment, it is encouraged to undertake imagery, such as relaxation, can help to distract from the pain. Also, imagery of placing an ice pack on an injured area may help more directly with pain management, as it helps to recreate the sensation of cold in the affected area.

Healing imagery – there is some evidence to suggest that imaging the injured tissues healing can speed up the healing process. The exact mechanism of how healing imagery works is unclear, but it has been suggested that this type of imagery can increase blood flow to the injured area, thus potentially enhancing healing. Healing imagery can be anatomically correct, which can be enhanced by showing the athlete anatomical pictures of the injured body part; or representative, such as imagery armies of healing blood cells entering the injured area to fight the injured tissues with weapons.