There are three kinds of athletes: those that have been injured, those that are injured, and those that will be injured. To excel in competitions athletes must push themselves to their limits. To train for competitions they must overload their physical systems in order to obtain a training adaptation. It’s at these times that injuries can occur.
It’s been estimated that up to 17 million sport injuries occur each year in the United States. This not only occurs among elite athletes, but among weekend warriors as well. In the 1990s, sport-related emergency room visits increased 33% for persons between 35 and 54 years old and 54% for persons 65 years and older.
It was once thought that sports injuries were not only caused, but also cured, solely by physical processes; the mental aspects of injuries were largely ignored. This was exemplified in the “old school” mentality when athletes were expected to fight through their pain regardless of its source and coaches treated injured athletes as worthless because they were not contributing. These antiquated attitudes, however, began to change in the 1970s when physicians began to recognize that behavioral and psychological factors played a significant role in putting athletes at risk for injury as well as in injury rehabilitation.
Research has demonstrated that increased stress and coping difficulties increase the risk of injury. For example, a study conducted on the University of Washington football team found that only 9% of the players with low life stress experienced injuries compared to 50% of the players with high life stress.
Stress increases the risk of injury in three ways. First, when individuals experience stress they become physically tense. When muscles are tense, coordination and motor speed decrease. If you’ve ever tried to navigate through a mass sprint at the end of a race while maintaining a death grip on your handlebars, you might have first-hand knowledge of how muscle tension can affect coordination.
Secondly, when people feel tense their focus narrows. It’s as if they are looking through a camera with a telephoto lens: They focus only on a few details, but can miss other important things happening around them. If anxiety leads a quarterback to glue his eyes in the middle of the field and he doesn’t notice the outside blitz, he could be in for a very long day.
Thirdly, anxiety can cause a person to have difficulty maintaining their focus. They can become so distracted by their anxiety that they miss something important. This can lead not only to a poor performance, but can also increase the risk of injury.
Psychological factors are also important in the injury recovery process. A 1996 survey revealed that about half of 482 certified athletic trainers believe that every injured athlete suffers negative psychological effects. The most common of these effects were stress and anxiety, anger, non-compliance with treatment, and problems with concentration and attention.
The good news is that this same body of research has clearly shown that athletes can use mental skills to cope with or control these psychological factors. For example, a study with collegiate athletes who were taught relaxation training showed a 52% decrease in injury rates among swimmers and a 33% injury rate decrease among football players. Additionally, several studies have shown that injured athletes who practiced such mental skills as a goal-setting, relaxation training and positive self-talk experienced increases in attention and decreases in stress, subjective pain and recovery time.
Okay, so what does all this data mean? What should you do to minimize your risk of injury and to maximize your recovery after an injury? Here are some tips to consider:
Learn stress management techniques. Strategies to help you relax both physically and mentally can help you cope more effectively with life stress to avoid injury and to decrease anxiety and facilitate recovery after an injury.
Avoid risks when you are stressed. When you are stressed your coordination and concentration suffer, leading you to be more vulnerable to injury. For example, if you’re a cyclist, practicing tricky technical mountain descents at 50 miles an hour right after your heartthrob dumps you is a bad idea!
Know the difference between “good” and “bad” pain. Don’t get the idea that I’m suggesting that you be so careful that you don’t train hard. No one ever performed their best with their mother running along side them screaming, “Be careful! Don’t go so fast! You’ll poke an eye out!” What I am suggesting is that you learn to distinguish the kind of pain that comes with hard training from the pain that tells you something is wrong. This largely comes from experience and paying attention to how your body feels. When in doubt, consult your physician.
Use thought-stopping and thought-replacement. After an injury it’s easy to catastrophize and tell yourself that your season is over or that you will never return to your previous form. These thoughts may not be true, but they definitely will not help you recover. To cope with this, become more aware of what you say to yourself by making a list of your negative self-talk. Then think of a word or image that commands you to stop this type of thinking and use it every time you notice yourself having a negative thought. Next, make a list of more positive and realistic thoughts that you can use in place of the negative ones, such as, “Yes this stinks, but if I stick to it and work hard I can make progress.”
Use imagery. Imagery is a powerful tool, and can be used in two ways during injury rehabilitation. First, you can use imagery to mentally rehearse technical skills and competative strategies. This will improve your muscle memory and strengthen your mental blueprint to keep you sharp while your body heals. Secondly, you can use imagery to facilitate the healing process by imagining such things as diminished the swelling and increasing the blood flow to the injured area. It helps if you have your physician show you a model or picture of your injury. I know, this sounds hokey, but believe it or not research clearly indicates that it works.
Use goal-setting. One of the worst things after an injury is the realization that you can’t do nearly as much as you used to. This can add to your feelings of helplessness and despair. To cope with this, it’s important to establish clear goals for your rehabilitation. Start by thinking of your ultimate dream goal, and then make a list of the things that you need to do that can get you there. Determining realistic short-term goals and strategies to accomplish them will help you feel more confident, in more control, and assist you in complying with the treatment prescribed to you by your physician, physical therapist, or athletic trainer.