by Corinna Daye MAT, LAT/ATC
Key Points:
Are you truly ready for return to sports after injury?
What are the risks for not being mentally prepared?
What are the signs to look for?
What are the Techniques to work through mental hurdles and put them into play?
One moment you are in the game, giving it the best go you can. Then, in a moment it all comes to a halt due to a game ending injury. The next moments to follow are all wrapped around the injury, how bad is it, how long will this take, is surgery needed, how much rehabilitation will I need, and can this happen again? So often athletes will give their best efforts into recovery so that they can return to the field of play. As a Certified and Licensed Athletic Trainer, I have personally witnessed the 100% effort into rehab and the 75% effort into rehab.
The difference between these two types of athletes is what I call “the point of realization.” The point of realization is the moment an athlete struggles mentally after injury of knowing they are not superhuman and can be seriously injured. During this point it is common to see an aversion to returning to the field of play. Not all athletes will be open about their fears of returning to play after injury (RTPAI). As part of the Sports Medicine team, Athletic Trainers are tasked with the duty of ensuring that an athlete is ready, both mentally and physically to return to participation.
Are you truly ready for return to sports after injury?
Have you ever stopped and asked yourself this question? All rehabilitation has been followed and completed, everything feels solid, finally getting the green light to return fully, but the “what ifs” start entering your head. Being ready to enter the field of play is not just about being physically able, it includes mentally able. An athlete can be ranked at the top of the elite status, but if they are not mentally ready elite performance will never be witnessed on the field. Here are a few questions to ask yourself or have your athlete ask themselves following RTPAI:
Have I successfully completed all my rehabilitation?
Structurally is everything solid?
Have you seen your updated x-rays and MRI results?
Have you kept up with workouts as best you could?
Do you trust your recovered area?
Do you trust your Sports Medicine Providers?
Do you trust yourself?
Does the thought “what if this happens again” constantly run through your mind?
If faced with the same exact scenario that lead to the injury, would that produce anxiousness or confidence?
When you physically step on the field do you feel anxious or confident?
What are the risks for not being mentally prepared?
Some risks for not being mentally prepared to return to the field of play would/could be:
Reinjury
Anxiety/ Stress Response
New or Worse Injury
Feeling of letting the team down
Inability to protect a teammate during a tackle
These are just some examples of risks that could happen if one is not mentally ready to return to active sports.
What are the signs to look for?
Signs/Symptoms can include, but not limited to:
Withdrawn social interaction
Sweating, shallow rapid breathing (not from activity, but just standing watching and thinking about activity)
Constant negative self-talk
Ditching out of a drill that resembles injury scenario
Increased heart rate when thinking of activity
Claustrophobia
Lack of interest in returning
Prolonging Rehabilitation (when not needed)
These signs/symptoms can be experienced solely or as a pairing. One important mental health aspect to keep an eye out for is depression. Depression can be hidden and presented as a player being happy and smiling at practice, but behind the scenes presenting with harmful self-talk and thoughts. Key things to spot with depression is noticing their social engagement and how they talk about themselves. Listen to what the athlete says and how they say it. By simply listening to the athlete can tell you a lot about where they are mentally. If you suspect the athlete may be experiencing depression, let them know you are available to talk to and encourage them to talk with a Licensed and Certified Counselor/Therapist. Let your athlete know that experiencing these signs/symptoms is completely normal and it is okay to seek out help.
What are some techniques to work through the mental hurdles and put them into play?
Breathing Techniques
When you feel the field/performance anxiety rising breathe. Inhale through your nose for 5 slow counts, then exhale slowly through your mouth for 8 slow counts. Do this process 5-8 times.
You can also try the above breathing technique with the addition of your hands, as you take the inhale start with hands by your navel, palms facing up; as you inhale allow your hands to slowly follow-up to your chest for the same count speed. Then as you exhale turn your palms facing down and slowly push them back down for the same count as the exhale.
These are best used when one is feeling anxious/claustrophobic. Allow the athlete to pull themselves out of the drill/field of play to complete this technique. Give them space and a quite location to go over these, if they need assistance have the Athletic Trainer or Coach stay with them until they have calmed their anxiety/claustrophobia. If needed refer out to a mental health specialist or physician for further evaluation.
Grounding Techniques
List 5 truths of the situation
List 5 things you can physically touch
List 3 things you can feel
List 3 things you can see
List 3 things you can smell
These are best used when one is feeling anxious. Allow the athlete to pull themselves out of the drill/field of play to complete this technique. Give them space and a quite location to go over these, if they need assistance have the Athletic Trainer or Coach stay with them until they have calmed their anxiety. If needed refer out to a mental health specialist or physician for further evaluation.
Positive Self-Talk
Replace “I can’t” with “I can” and “I will”
State 3-5 things you like about yourself
Imagine how you would like to perform and how you would like to be seen
Saying the word “Stop” out loud when you find your mind going over all the negative
Remind yourself of what you learned and not your mistakes
These are best used before the athlete reaches the practice/playing field. While this method can still be used on the playing field it is more effective if they have already written these out before they are needed. The athlete may need to repeat this method several times a day until it becomes second nature to them. If needed refer out to a mental health specialist or physician for further evaluation.
Trusting the Injured Site
This is mostly accomplished through rehabilitation, however as a Certified Athletic Trainer I can take you through on field drills slowly, building up your trust level of your injury.
This can be accomplished with agility drills, position specific drills, and scenario-based drills.
These are usually done in the Athletic Training Room, practice field, or in a clinic. This type of technique needs to be completed under the supervision of a Sports Medicine Professional, to ensure the health and safety of the athlete. If needed refer out to a mental health specialist or physician for further evaluation.
*Consult with your Athletic Trainer before returning to your sport. If you do not have a regular Athletic Trainer please check out the Innovate AT website to find one in your state that can best help to ensure you are on the right page for return. If you are, we can refer/recommend mental health specialists that can best assist you with mental preparedness for returning to sports. These bullet points are based upon experiences I have personally witnessed and seen to be effective. If you have any questions or concerns, please let one of our Innovate ATs know so we can best assist you with your situation/issue. *
Check out more types of breathing techniques here:
For more ways to help mentally prepare an athlete for return to sports after injury:
https://www.psychologytoday.com/intl/blog/compassion-matters/201211/risks-the-mental-health-athletes
Source - statistical data on how negative emotions effect joint responses:
Yong Woo An, Lobacz, A. D., Baumeister, J., Rose, W. C., Higginson, J. S., Rosen, J., & Swanik, C. “Buz.” (2019). Negative Emotion and Joint-Stiffness Regulation Strategies After Anterior Cruciate Ligament Injury. Journal of Athletic Training (Allen Press), 54(12), 1269–1279.