Psychology of Injury - The Coaches guide

This article aims to highlight crucial skills that coaches can be aware of regarding the psychology of players whilst returning from injury. Injuries are a fact of life for a sports person. It is highly unlikely for a player of any sport to complete a career without sustaining some form of injury.

Current research highlights that many coaches and management appear to have a physiological process in place to cope with the injury situation within a team environment. This is normally in the form of a physio department or strength and conditioning specialists. An area which appears to be slightly less favoured by coaches, managers, and directors at present, is the sport psychology aspect of injuries.

This article will highlight the potential problems which occur when injury and return from injury is not dealt with psychologically. The secondary aim of the article is to provide coaches with information on how to recognise any potential problems with players and how to manage them accordingly with support and welfare techniques.

Current research shows that there is a direct link between stress within sport and athletic injuries. Stressful athletic situations are contributors to injury, depending on the athlete and how threatened they perceive the situation to be. The stressful athletic situations can be out of the coaches and players hands at times, such as a final of a competition or “away day” changing rooms. The important areas for the coach to think about is the effect which they can have on many more stressful situations. Stressful situations which the coach can control are pre-competition atmosphere, poor performance management and team selection to name few.

An example of this is highlighted below;

The team coach does not like to select his team until an hour before kick-off. Fringe players are constantly under stress for the entire weekly training sessions, because they do not know if they will be playing until last minute every week. This could have a negative effect on the injuries of players whilst training. If the coach decided to be open and honest with the players and names the team 2 days prior to the competition, then the apprehension and stress levels of the group could reduce which in turn hopefully would reduce the chances of injury occurring.

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USING SCALES FOR SUCCESS

The use of scales as a tool to measure fatigue within sport has become more and more common. These are normally in the form of Rate of Perceived Exertion (RPE), recovery stress scales or hassle and uplift scales. The RPE scale is a tool which management and coaches can use to assess the fatigue of the players or athletes. The scale can be used in various ways, but two of the common ways to use it are to evaluate the intensity of a particular training session or secondly to assess the fatigue of the individual athletes/players on a daily basis. This is normally completed in the morning, prior to training.

The scales, if used correctly can indicate to coaches the level of fatigue the team as a whole are experiencing. This will enable the coaching sessions to be tailored and manipulated to suit the players and to prevent the chances of injury. Stress and stress responses of players can fluctuate and change on a daily basis. The RPE is an assessment which can be completed very quickly and will indicate the potential stress levels of the players. A recent study was carried out using 22 professional football players. The study highlighted that there was a direct correlation between higher levels of perceived fatigue and the risk of becoming injured. Furthermore, using another scale, results showed that higher levels of hassle surrounding players were associated with an increased risk of becoming injured.

The results from the above studies show that there is a need for coaches to use scales to assess the levels of fatigue and stress which their players are experiencing. The use of the scales could potentially reduce the injuries which are caused by unnecessary training sessions which are very intense at the wrong times of the week or season. Using this application in your future coaching practice could potentially save you that crucial injury at the crucial point in the season.

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Emotional Responses to Stress

Digging deeper into the emotional responses to stress. The relationship between negative emotions from injury and heightened risk of re-occurrence, is an area worth highlighting. Increased emotional reactivity is related too decreased activity in parts of the brain were attention is processed.

This decrease in attentional capacity might increase the risk of injury as the brain is too busy thinking about negative stressful thoughts as oppose to what the body is trying to do whilst training.

Imagine a computer with hundreds of infected files loaded on it. The computer is not capable of operating effectively as it is dealing with too much information at once, this causes the computer to crash. This is like the brain dealing with negative thoughts which increases the likelihood of injury.

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Social Support for Players

Social support to the players can be provided by numerous of people surrounding the club.

Emotional support can be given in the forms of:

. Esteem – Boosting the athlete’s confidence, Sense of competence or self-esteem

. Listening – Actively listening whilst refraining from advice or judgement

. Emotional support – Providing impartial assistance during difficult times

. Emotional challenge – Challenging the athlete to do their upmost to overcome obstacles to goal achievement

. Share social reality – Verifying an athlete’s perception of the situation, providing a sense of normalisation

The question can be asked about who provides social support to the athletes. The answer is family and friends who are well suited for emotional and listening support. Team mates and coaches are well suited for technical appreciation and technical challenges. Sports medicine team members can work with the athletes on a daily basis to provide emotional and motivational support.

Ways in which this can be implemented is dependent on the stage of the rehabilitation.

Injury support groups, one on one consultations, and peer modelling (involvement with an athlete who has experienced similar problem ie. Ben Atiga pictured below) are few ways in which this can be implemented. The coaching staff can improve their skills if they have awareness of these social support interventions.

Returning from Injury

The returning process from injury involves many feelings for the player. Using the chart below, as a coach you can highlight the areas which you can influence the most.

The most influence as a coach lies within the decision-making process. The coach can positively or negatively influence a player’s pace at which they return back to competing. If the coach places too much pressure on the player, then the player may still be injured or have a higher chance of re-injury.

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“I'm a little bit nervous actually. I've been out a year and I don't think the nerves are about other people. I think my nerves are more about making sure the knee doesn't blow up now that I've gotten this far".

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“I have a fear of re-injury mainly because I had a few recurrences and I hurt it a few times. So, when I'm training now, I'm always thinking about it and if it feels uncomfortable, I think maybe something is going to happen".

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Psychological factors surrounding return to sport post injury

As a coach or manager of a sporting team, the welfare of the player needs to be one of the highest priorities. This becomes even more relevant when the player is returning from injury. Previous research has shown that positivity surrounding an injured player directly links to a higher success rate of return to play and return to play at the same level as pre - injury.

The emotional feelings of the player need to be addressed whilst injured to increase the chances of a successful return. Fear is one of the emotions which is highly recommended to be monitored. Fear remains a prominent emotion at the time athletes are actually returning to sport. Fear is also a common reason given by athletes for not returning to sport.

Athletes and sports people need to feel they are in control of their injury and their return to sport. It has been suggested within studies that the athlete needs to feel they are supported by the coaching staff and management.

Reducing the athlete’s perception of external pressures on return to sport, by involving them in the identification of a date as a target to return to play can give the player a realistic goal to aim for. This technique may promote a sense of ownership for the athlete and give them focus throughout the injury process.

On the flip side to this approach, negative attitudes towards players injuries has found to be predictive to not returning to sport. As a coach, if a negative outlook towards rehabilitation and injury is portrayed then this could stretch the recovery process for the players. Taking the time to understand the players within the club, and the rehabilitation process they are going through could reduce the players apprehension and increase the positive support the player feels, which in turn could speed up the recovery process.

Knowing your players mentally and physically could be key to unlocking their potential. Working with elite athletes can bring more problems with regards to psychology of injury. External pressures such as pay, keeping the spot in the team and fear

of letting the team down may lead to premature return from injury.

Prematurely returning from injury prior to being psychologically ready has been shown to subsequently increase the chances of re-injury.

Once the player has returned from injury, it Is highly important that the coach is aware of the players demeanour and personality. If the player appears to be withdrawn and is struggling to compete at the same level as pre-injury, then this can lead to some psychological issues. If the coach can highlight this to sports psychology clinicians as early as possible then interventions to help the player can be put in place quicker.

How the above information can be applied to the day to day routine as a coach is the key to success when trying to implement the best return from injury strategies. It appears from previous research that the coach must be open and honest with the players whilst injured. The coach needs to communicate effectively with the player and discuss the timelines which are expected by the club, coaches and rehab experts for the player to return from injury. Once this is completed the player will have a goal to aim for.

Throughout the rehab process it is recommended that the management employ specialists in sports psychology to monitor the mindset of the players and assess the positivity surrounding them. Routine screenings are recommended to do this and confidence building strategies have been a tool which has previous evidence of success. As previously highlighted, fear is one of the biggest limiters for a player returning from injury. If this can be highlighted as early as possible by the coaching staff, then the intervention to correct this can be applied.

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Professional players reaching out

Ben Atiga, Former NZ Rugby player

Ben Atiga was propelled into the spotlight of New Zealand rugby at the age of 20. He quickly started experiencing mental health problems such as anxiety and depression. These symptoms forced him to retire early. He later returned to rugby but due to injury he retired once again. Ben now has started helping other rugby players to cope with mental health issues and encourages coaches to engage with their players to help with these problems.

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Grant Hall, QPR Footballer

Professional footballer Grant Hall suffered from debilitating knee conditions. He was sidelined for 18 months and explained how he “bottled everything up for months” he later admitted he needed help and he’s not ashamed to say it. It’s an experience that has given him a sense of perspective.

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Billy Vuinipola, England Rugby Player

Billy only played 167 minutes of international rugby in the 2018 & 2019 international seasons. The enforced absence has taught him a few life lessons. He has experienced lows he never wants to experience again. “Its tough mentally to always go into that dark place”

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5 GRIEF STAGES OF AN INJURY

Injury to an athlete is a form of loss to the individual. This loss can either be enhanced or reduced depending on the individual circumstances of the athlete. When an injury occurs more often than not, they will complete the grief response cycle (Pictured Below left) in some way shape or form. Sometimes an injury cannot come at a worse time for a sports person.

For example, a football player suffering a 3-month Injury in the final warm up game to a world cup. On the reverse of this situation a player may have a reduced feeling of grief if injury occurs if they are playing with the worse form since they joined the club. Sometimes the player may not even spend time in all of the stages of grief, especially if the injury is justifying bad form.

As a coach, having a brief insight into the grief response model will help to determine how the players may be feeling in the club and how to avoid any negative energy passed onto the remaining players. The order of the 5 stages will not always be moved through in descending order. The stages may even be passes through back and forth on numerous occasions.

Stage One

The denial stage is the initial step on the grief response model. It is common for the player to deny the severity of the injury or down play the pain experienced.

Stage Two

The anger stage is often taken out on the people closest to the athlete, such as their family members, partners or closest team mates. This is a stage which a coach needs to be aware of as the player could sometimes be showing signs of anger and aggression purely because of the disappointment of not been able to help their team succeed.

Stage Three

The bargaining stage can either be with the athlete themselves or the coaching staff. The player could sometimes be begging the coach to keep them on for another season, even though deep down they know their body is not capable of holding out for another one. This is the same as when the athlete sustains an injury during a match, and they are immediately bargaining with themselves to try and carry on playing.

Stage Four

The depression stage is an area of great importance for the coaching staff to keep an eye on. If a player Is the Centre of attention and all of a sudden, all of that is taken from underneath them due to a serious injury. The likely hood of a player experiencing some form of depressive symptoms is high. If the coach feels that the player is not being themselves then a referral to a sports psychology professional will be needed.

Stage Five

The final stage of the model is the acceptance phase. This occurs when the athlete realises that it is not the end of the world and everything is going to be ok. Within this phase there is also the reorganisation element. It is important for the athlete to take ownership of the injury and also have specific goals to reach. This will hopefully reduce the chances of the athlete slipping back down the phases into depression or anger.

The application of this happens on a daily basis with injured sports players. It is highly recommended that a coach has an understanding of this model to guide and help the players where they can.

Previous research has highlighted that the main areas which appear to be experienced whilst injured are anger, depression and acceptance. If the coach and psychology specialists can provide coping strategies for anger and depression, then the chances of reaching acceptance is far greater.

Jordan Kerman BSc (Hons), MSc (Hons), BBCO Performance Director.