My undergraduate degree is in Sports Therapy and I have worked for 3 different rugby clubs. I have a strong understanding of the physical/physiological healing process so it makes sense for me to specialise in providing psychological support/intervention for athletes that have become injured. I think the dual qualification that I have can be an asset and something that I feel the athlete would consider beneficial to their healing journey both physically and psychologically. However, it would be remiss of me not to recognise the fact that I could focus more on the physical healing then the psychological healing so I will need to recognise that I must put in place appropriate checks to ensure that I am focusing on the correct aspect for the athlete.
I did have a female rugby player client who was in the Harlequinns Academy who had an injury, Grade 1 ATFL (anterior tibiofibular ligament) injury. The hospital gave her a boot but no aftercare advice. I saw this client 2 weeks after the initial injury where I was told she had the boot on for 2 weeks, would not take it off and cannot walk without it. At the end of the first session, I got the client to walk back to the car without the boot. I learnt very quickly, that for this client, it was going to be a psychological battle, not a physical one. I realised the educational information I was giving to the client would form a fair proportion of the treatment time and I needed to be clear and concise as to the clinical reasoning I am giving her these exercises, what they will achieve and why it is important. This psychological handholding helped build trust and rapport and engagement with the rehabilitation programme. I saw this client for 8 weeks whereupon I cleared her to start light contact. She was happy with that as she needed to go to the Harlequinns Academy. She wasn’t the only client that needed psychological support but she needed a lot more than the others. She lost her confidence in her limb and fearful of re-injury, which are normal responses to having an injury.
Indrioadottir et al., (2015) conducted a regressional cross-sectional study that identified 8.4% of individuals dropped out of sport due to injury and that 51% of individuals who participate in organised sport seek medical assistance. Those participating in 6 hour or more of organised sport have a fivefold increased risk of seeking medical assistance and that young athletes with sporting injuries can be a cause of drop out (Indrioadottir et al., 2015). Clarsen et al., (2012) identified from 142 athletes monitored weekly for 40 weeks that 36% of athletes had health issues and 15% of athletes had significant issues leading to moderate or severe decrement to sport performance and/or participation. Overuse injuries represented 49% compared to illnesses (36%) and acute injuries (13%). In fact, one study went further to identify psychological predictors of injury in elite athletes and identified 5 mood categories (anger, confusion, fatigue, tension and depression) associated with orthopaedic incidents with each category accounting for 6%-7% each. Psychosocial stressors can affect injury occurrence but there are other influential factors post-injury that affect injury response and recovery such as athletic identity, self-esteem, coach, parent and teammates (Nippert and Smith, 2008).
The general consensus is that sociocultural and psychology do have an impact on high-intensity athletes’ sport injury risk, response, and recovery, and that ongoing efforts in psychological research and professional practise are required to safeguard athletes’ physical and mental health as well as to promote performance excellence and career longevity (Wiese-Bjornstal, 2010).
Regardless of the differing figures from the above studies, which can be accounted for in their differing methodologies, sporting injuries are an every-day risk for athletes. The focus for athletes is this perpetual cycle of improving their performance whilst disregarding their body’s warning system that they are reaching their physiological limit. Injury can occur through a one-off incident or as overtraining and likewise if psychologically they are pre-occupied, that can lead to injury as well.
Recovering from a physical injury is not linear, neither is the psychological journey. Being able to work with an athlete to respond in a healthy way to their injury, engage fully with the rehabilitation programme whilst addressing any fears on re-injury and also equally as important, is preventative behaviours to avoid new or further injuries need to be addressed. Sporting injuries should not be considered, in my opinion, as reactive intervention but being able to provide a proactive psychological intervention and coping strategies might minimise the risk of injuries.
The evidence above shows the incidence of risk is real and frequent and that again and a fair proportion of my potential client base will be injured athletes. Therefore, commercially, not compromising on my psychological care, it makes sense to educate myself further on sports injuries to become a specialist in this discipline. I do feel that being cross qualified in this discipline will be advantageous as I can speak to the medical team and understand what they are saying and potentially act as a conduit with the athlete, with the consideration outlined as above. I also feel that there may be a natural progression of career transitions due to termination of their career due to injury and the psychological stressors that maybe induced in regards to athletic identity, fear (of what their next step will be) etc.
References
Clarsen, B., Rønsen, O., Myklebust, G., Flørenes, T. W., & Bahr, R. (2013). The Oslo Sports Trauma Research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. British Journal of Sports Medicine, 48(9), 754–760. https://doi.org/10.1136/bjsports-2012-092087
Galambos, S. A. (2005). Psychological predictors of injury among elite athletes * COMMENTARY. British Journal of Sports Medicine, 39(6), 351–354. https://doi.org/10.1136/bjsm.2005.018440
Indriðadóttir, M. H., Sveinsson, Þ., Magnússon, K. Þ., Arngrímsson, S. Á., & Jóhannsson, E. (2015). [Prevalence of sport injuries, sport participation and drop out due to injury in young adults]. Laeknabladid, 101(10), 451–456. https://doi.org/10.17992/lbl.2015.10.45
Nippert, A. H., & Smith, A. M. (2008). Psychologic Stress Related to Injury and Impact on Sport Performance. Physical Medicine and Rehabilitation Clinics of North America, 19(2), 399–418. https://doi.org/10.1016/j.pmr.2007.12.003
Wiese-Bjornstal, D. M. (2010). Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement. Scandinavian Journal of Medicine & Science in Sports, 20(2), 103–111. https://doi.org/10.1111/j.1600-0838.2010.01195.x