Portal de Periódicos da CAPES

Assisting Injured Athletes With the Return to Sport Transition

2004; Lippincott Williams & Wilkins; Volume: 14; Issue: 5 Linguagem: Inglês

10.1097/00042752-200409000-00001

1536-3724

Leslie Podlog, Robert C. Eklund,

Motivation and Self-Concept in Sports

For many years, coaches, athletic trainers, and medical practitioners have returned injured athletes to the field of play based primarily on the assessment of physical criteria. 1 Sport psychology research, however, reveals that athletes may be physically healed and rehabilitated but not necessarily psychologically prepared to return to competition. Discussing his return from injury, Earvin “Magic” Johnson commented, “But I had lost a lot of confidence during the long layoff. And for a long time after I returned, I still held back. All I could think about was protecting my knee from another injury” (p. 137). 2 As Johnson’s comment suggests, making the transition from rehabilitation to training and competition may not be an easy one for injured athletes. Until recently, the psychologic aspects of returning to sport from injury have unfortunately been largely neglected. Among medical practitioners and clinicians working with injured athletes, knowledge of psychologic return to sport issues may lead to questions or concerns regarding the most effective ways of assisting returning athletes. Research studies have revealed that athletes may have fears related to reinjury, concerns about not performing up to preinjury levels, and difficulties meeting the demands and expectations of coaches and others. 1,3 It has also been noted that athletes may face pressure to return to sport or to meet specific return deadlines. 3 For example, elite Canadian skiers indicated the importance of having “freedom from pressure” in their return to sport (p. 385). 3 According to these skiers, freedom from pressure meant receiving encouragement “to take the time to recover fully,” reassurance “that their positions were not in jeopardy,” and “allowing them to work at their own pace on the return to skiing.” Another frequent finding is that athletes may return to sport because they “fear losing membership in the elite athletic fraternity.” 4 Many injured athletes may have a sense of isolation or alienation from their teammates, their coach, or a particular group of individuals. 5 Finally, evidence demonstrates that athletes may experience difficulties once they return to competition following injury recovery. 1,3 In particular, injured athletes identify negative social comparisons (i.e., losing to someone I used to beat) as a source of stress upon returning to competitive sport. 1 Athletes also report that the combination of high performance expectations and disappointing results contributed to a drop in confidence during their comeback season. 3 Athletes returning from injury may commonly experience concerns and/or difficulties in 3 psychologic areas: competency, autonomy, and relatedness. The finding that returning athletes have fears and concerns about how their body will withstand the demands of sport 1 suggests that competency issues may be highly significant. Athletes may also have concerns about how they will perform once they return to sport. 3 Moreover, knowledge that athletes may receive external pressure to return to sport from injury and that they value freedom from pressure 3 suggests that issues of autonomy may be relevant. Finally, recognition that injured athletes may often feel a sense of alienation from their friends, teammates, and fellow competitors 5 suggests that relational issues may be highly significant. Athletes may fear losing membership in the “elite athletic fraternity,” further suggesting that relatedness issues are of significance for returning athletes. 4 Ryan and Deci’s 6 self-determination theory suggests that all individuals have basic, universal needs for competence, autonomy, and relatedness. Ryan and Deci 6 argue that when the environment meets these needs, individuals are more likely to experience enhanced self-motivation, increased well-being, improved performance, and greater social development. Conversely, when the environment fails to meet these needs or prevents their satisfaction, individuals may function at a nonoptimal level (e.g., increased apathy, alienation, and lethargy). Research across numerous social settings including education, the family, and sport supports this contention. In the area of family and sport, parents and mentors who provide a sense of autonomy and competence have been found to stimulate more intrinsic motivation. 6 From the standpoint of self-determination theory, the success of the athletes’ return to sport may be dependent upon the degree to which the surrounding environment meets the individuals’ 3 basic needs. Given that the needs for competence, autonomy, and relatedness are important among athletes returning from injury, it may be useful for practitioners working with these individuals to target these 3 areas. Based on this logic, the following suggestions are offered to practitioners as a guideline for meeting both the physical and psychologic needs of returning athletes. (1) HELP ESTABLISH REALISTIC EXPECTATIONS Having discussions with athletes about what they hope to achieve and how they expect to perform following their return may be useful for revealing unrealistic goals and expectations. Recognizing that making a return to sport is a gradual process may help athletes avoid creating overly high expectations that in turn lead to frustration and decreased confidence. Expecting too much too soon may often lead to a sense of frustration, reduced confidence, and ultimately poorer performances. 3 Encouraging the athlete to create realistic expectations upon their return is important. (2) DEVELOP SHORT-TERM PROCESS GOALS Encouraging the athlete to focus on short-term process (i.e., task-oriented) goals upon their initial resumption of sport-related training may be a useful way to help athletes build confidence in their physical and mental capabilities. Providing the athlete with as many opportunities as possible to experience success may assist them in avoiding a sense of frustration and decreased confidence should they struggle to return immediately to preinjury form. 7 (3) ASSIST ATHLETES IN OVERCOMING RETURN-TO-SPORT FEARS AND BUILDING CONFIDENCE The 2 most common fears associated with a return to sport appear to be a fear of reinjury and concern over not performing to preinjury levels. Providing athletes with progressive physical challenges that they can successfully meet without physical pain has been demonstrated to enhance their sense of competency regarding their capabilities and their bodies’ ability to remain uninjured. 8 Reassuring athletes that they have met all the physical requirements necessary for their return may help alleviate concerns about reinjury and performance issues. Finally, discussion of return-to-sport fears or concerns can provide an opportunity to dispel irrational beliefs and to get out in the open any issues the athlete might have. 8 (4) PROVIDE ATHLETE ROLE MODELS Putting returning athletes in contact with other athletes who have experienced and overcome similar injuries may be highly beneficial for the returning athletes’ level of confidence. Having models who have come back from a similar injury to follow and discuss concerns with may give athletes a sense that if others can do it, so can they (i.e., “seeing helps believing”). 9 (5) DISCUSS MOTIVATIONS TO RETURN TO SPORT Having a discussion with athletes prior to their return to training and competition about why they are returning may help the practitioner establish which athletes are returning for the wrong reasons (e.g., pressure from a coach or teammate, guilt about missing an important competition the athlete does not feel prepared to compete in). (6) HELP ENSURE THE AUTONOMY OF THE RETURNING ATHLETE Given that athletes may be susceptible to receiving pressure to return to sport (and that they typically want freedom from pressure), medical practitioners may be well positioned to ensure that they have the freedom to return at a time and manner of their own choosing. 3 (7) ENCOURAGE THE CONTINUATION OF SOCIAL RELATIONSHIPS AND CONTACTS Staying involved with the team during the injury rehabilitation may help team sport athletes as they make the transition from injury to training and competition. Injured athletes often miss the social aspect of their sport participation. Staying in contact with the team can provide athletes with a sense of connectedness and provide them with the opportunity to observe, learn, and analyze their sport from the sidelines. 5 Taking in their sport from the perspective of the onlooker may help the athlete come to particular realizations and understandings about keys to successful performance that they can incorporate upon their return. Clinicians working with injured athletes may be ideally positioned to assist these athletes in making the most effective return to sport possible. Existing research and theory suggest that athletes returning to sport from injury will be most prepared if both their physical and psychologic needs are met. The needs for competence, autonomy, and relatedness appear to be central issues for athletes making the transition from rehabilitation to training and competition.