Tuesday, August 23, 2011

Role of psychology after a sports injury...

With injuries hitting the Wales rugby camp, we tracked down Sport Wales’ Dr Joy Bringer to discover what role sports psychology can play in rehabilitation...
Joy is a Sport Psychologist, working full-time with elite athletes and coaches at Sport Wales in Cardiff. She is a Chartered Psychologist and is accredited to the High Performance Sport level with the British Association of Sport and Exercise Sciences.
In her role, she has travelled to the Athens and Beijing Paralympic Games supporting British athletes., and has been appointed as the Lead Sport Psychologist for ParalympicsGB for London2012. She has also been an integral member of Team Wales at the 2006 and 2010 Commonwealth Games.
How traumatic can it be to have an injury?

If the injury is career threatening, it can have a massive impact. Often you find athletes whose whole identity is sport. If that is suddenly taken away from them, it can be devastating.

That’s why we recommend a life balance in which studies, career or hobbies also play a part. So when things aren’t going so smoothly in sport, there are other things to focus on. And that’s true for anything – not just sport. If you’re 100% devoted to your job and you get made redundant, it’s understandably a huge blow. For those that have other interests, it is easier to adapt and move forward.

It all really depends on how serious an injury it is and the perception of the injury. If you have the confidence and belief that you will come back from the injury, it’s more likely that your recovery will be quicker. So confidence is vital!

What sort of issues crop up after suffering an injury?

·         The loss of confidence – questions pop up like, “am I going to get back to where I was before?”, “Are my competitors getting ahead of me?” “Will I be as good as I could have been?” “Am I going to recover in time?”

·         The fear of losing out on your dreams. If you’re moving towards the Olympics for example, there is the fear of not being selected and that may have been something you’ve been dreaming about and working towards since you were a child.

·         The fear of re-injury, especially in similar situations.

·         The feeling of isolation. Teams can be like a tight knit family. If you get injured and you’re not able to train or compete, you can be taken away from that and leave you feeling like you’re missing out.

·         Lack of motivation – if you’re constantly getting setbacks, and there may well be setbacks within the rehabilation programme, you can feel that you’re never going to make it happen and then you it’s easy to lose motivation and think “ why bother?”

How can psychologists play a part in overcoming these issues?

By working closely with the rest of the support team – coaches, physio, nutritionist, strength and conditioning coach, psychologists can help athlete set realistic and appropriate goals. If your focus is just on getting back to where you were pre-injury – that can be a too distant goal. It’s important to give yourself credit for little improvements you make every day.

We can also help an athlete stay in touch with the rest of the team so they don’t suffer from that feeling of isolation.

Psychologists can also help athletes believe in the rehab programme as well as the athlete’s ability to successfully complete it.

How do these issues impact on physical recovery?

We know that chronic stress can impact on physical recovery. Your body doesn’t heal as quickly. If you’re lacking motivation, that can then result in you not sticking to the rehab programme and you won’t see as much progress.

Stress can also result in emotional eating or maybe drinking which leads to weight gain and not eating the right things. So you’re not helping the body to heal itself.

If an athlete has a fear of re-injury, they may change their techniques to protect the injury. This may also result in tension around those muscles and can actually increase the risk of re-injury. But it does depend on the individual and the injury.

What happens psychologically if an athlete misses a major competition?

It really depends on what the competition means to the athlete and how the athlete interprets that. If they (and their support team) can keep it in perspective and believe that it’s not the end of the world – then it is not so devastating. It is a normal response to feel depressed, angry, frustrated, to consider retirement – or it can make an athlete more determined than ever!

How can you help an athlete focus on recovery and rehabilitation? What sort of things will you suggest and put in place?

We look at goal-setting that fits in with the rehab programme so we work closely with strength & conditioning, physio and so on.

We work on Emotional Coping and Problem Focused Coping– In terms of Emotional Coping, we  often deal in stress management, the responses to stress – helping an athlete to reevaluate the situation in a way that is going to help, not hinder them.

Relaxation strategies are also important –we can explore what helps them relax and encourage them to do what they enjoy – going to the cinema, listen to music etc – whatever it is that puts the athlete in a better mood.

Breathing techniques and progressive muscle relaxation are also useful techniques – we can help teach the body to notice the difference between tension and relaxation. This can help an athlete to actively relax.

We use a lot of imagery with the athletes – if they’re feeling stressed, they can imagine a relaxing, safe place. Imagery is also used to motivate – if you imagine yourself fully fit and back competing again, it can have incredible results.

Steve Backley is a perfect example. Three months out before the 1996 Olympics, he’d been on crutches for six weeks. He used visualisation techniques. So he imagined himself throwing a javelin and throwing a personal best.

He won the silver medal and says: “It proved to me how powerful a tool the mind is and how the body just follows it. That's what I like about the championships, it's not only about the physical tests. There are 8, 10 guys, certainly in javelin, capable of throwing the distance necessary to win, but it's the one who handles the pressures of a major championship better than the others who will win.”

We talk to athletes at Sport Wales about those that have had successful comeback stories so they know that it is possible.

Imagery is also a good way to maintain technique. There was a famous study involving a group of rugby players and a group of ballerinas. When the rugby players watched the ballerinas on TV, there was no significant change in their brain activity. But when the rugby players watched a video of other elite rugby players, it activated the parts of the brain that scientist think are related to those same movements.

When an athlete gets injured, it is common to become overly worried about being in the same situation that they were in when they got injured. If an athlete can watch themselves successfully perform the movements in which they sustained the injury, this can also help lessen the fear of re-injury. Basically, it helps to remind the athlete that they have performed the movement many times without injury, and it increases the belief that they will be able to perform the movement again successfully, without injury.

What should family and close friends do? Do they play a part?

There are many, many research studies that show that family and friends are really important to making a successful comeback.  In psychology we call this social support.

It’s important to find out from the athlete how you can best support them. For one athlete, phoning them five times a day might be exactly what they need – for another, it might stress an athlete out.

And remember to support the athlete not just the week after injury – the support might be needed more than ever three months, six months or nine months later.