Directly after an injury, there are often negative emotions, including fear. During the rehabilitation period, the ‘U-model’ has been described, where emotions are negative from the beginning, become more positive during rehabilitation (when the athlete becomes more confident in their ability to perform and symptoms resolve), and then again turns more negative at the time the athlete begins to get ready for return to sport . These negative emotions usually decrease over time but may prevent a quick return to play.
Self-determination theory suggests that athletes have three basic psychological needs—autonomy (the need to feel ownership of one’s behavior), competence (the need to produce desired outcomes and to experience mastery), and relatedness (the need to feel connected to others). To promote successful return to play, athletes’ basic psychological needs should be satisfied .
Researchers identified barriers and facilitators for physical and psychological recovery after an injury. In order to decrease fear, information about the content and progression of the rehabilitation and expected realistic timelines for sports-specific rehabilitation and a return to sport should be a part of the rehabilitation process . To promote a sense of autonomy, it may help to involve the athlete in the identification of a realistic date for return to play – thereby reducing athletes’ perceptions of external pressure to return to play . Athletes also want to learn strategies to help manage pain and injury risk. Some evidence exists for psychological interventions, such as imagery, relaxation, positive self-talk and cognitive awareness skills to reduce anxiety and fear of injury. These interventions may also promote a sense of competence, although more research in this area is needed [3,4].
Relaxation, imagery and positive self-talk
Relaxation and guided imagery (i.e. breathing techniques and imagining healing and perfect function in the injured body part) were found to improve pain management, increase self-efficacy, manage stress, and reduce re-injury anxiety in athletes . Positive self-talk, or self-encouragement, decreased negative mood disturbances and increased rehabilitation adherence and feelings of positive rehabilitation self-efficacy in patients recovering from ACL reconstruction.
Support and goal setting
Support from important people, such as coaches, friends and physical therapists, and the ability to set realistic and achievable goals will also help the athlete to recover and eliminate debilitating fear [3,4]. Counseling provides a source of emotional and social support, thereby positively influencing rehabilitation program adherence in athletes recovering from ACL reconstruction. Goal setting was associated with increased motivation, exercise compliance, and rehabilitation awareness along with increasing positive feelings of self-efficacy.
Return to play
Although none of the intervention studies described above specifically examined return to play, positive psychological factors (e.g. motivation, confidence and low fear of re-injury) have been associated with a greater likelihood of returning to the preinjury level of participation and returning to sport more quickly . Return to play requires a multidisciplinary approach and frequent communication between doctors, physical therapist, psychologists, coaches and athlete.
- Morrey MA, Stuart MJ, Smith AM, Wiese-Bjornstal DM. A longitudinal examination of athletes’ emotional and cognitive responses to anterior cruciate ligament injury. Clin J Sport Med. 1999;9(2):63-69. doi:10.1097/00042752-199904000-00004
- Ardern CL, Taylor NF, Feller JA, Webster KE. A systematic review of the psychological factors associated with returning to sport following injury. Br J Sports Med. 2013;47(17):1120-1126. doi:10.1136/bjsports-2012-091203
- Kvist J, Silbernagel KG. Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport. Phys Ther. 2022;102(2):pzab272. doi:10.1093/ptj/pzab272
- Gennarelli SM, Brown SM, Mulcahey MK. Psychosocial interventions help facilitate recovery following musculoskeletal sports injuries: a systematic review. Phys Sportsmed. 2020;48(4):370-377. doi:10.1080/00913847.2020.1744486