1. Mental Skills for Injury
Rehabilitation
1
Brennen Salmon, Psychology of Injury
The University of Tennessee, Spring 2015

2.
2
T HE UNIVERSITY OF TENNESSEE
Spor t Psychology & Motor Behavior
MentalSkillsforInjuryRehabilitation
Spring 2015
Brennen Salmon
B.S. Psychology
The University of Georgia
Master’s Candidate
Sport Psychology & Motor Behavior
The University of Tennessee
404-610-8504
bsalmon1@vols.utk.edu

3. Table of Contents
3
Sara Erdner: Lion Chaser 4
Sara’s Path to a Comeback 7
Introduction to Mental Skills 8
Maintaining Motivation 9
Goal Setting for Motivation 10
Self-Talk for Motivation 20
Sustaining Focusing 24
Relaxation for Focus 25
Imagery for Focus 30
References 35

4.
4
Sara ERdner:
Lion Chaser
“Benaiah the son of Jehoiad was a man of Kabzeel with strength of heart. He had done powerful
things…And he went down and killed a lion in a hole while the snow was falling.”
- 2 Samuel 23:20
In 2 Samuel, Benaiah leaped into a pit and took down a
ferocious lion. In a situation where most people would flee,
Benaiah chose instead to pursue. Benaiah’s courage in the face
of death earned him favor with David, the King of Israel. As a
result, Benaiah eventually became the chief of Israel’s army.
While the average person will never come face-to-face
with a fully grown lion, the obstacles in our lives present us
with the same choice that Benaiah had to make: fight or flight.
What we do not realize is that, often times, our biggest
obstacles are also our biggest opportunities. We can choose to
run from our obstacles and miss the opportunities that come
with them, or we can choose to face our obstacles head-on and
find out what opportunities await us.
In order to become a triathlete, Sara Erdner has taken
down a few “lions” of her own. Sara’s first career lion was
actually deciding to compete in triathlons. Sara has been participating in sports all of her life
- doing everything from softball and volleyball to basketball and intramural flag football. In
2013 she wanted to try something new. Sara exercised with women who competed in
triathlons, and she joined them in their training sessions. Initially, Sara doubted her ability
to complete a triathlon despite her athleticism and history of competing in sports. She
eventually made the decision to compete in a triathlon, and she was able to finish - first lion
slain. In the two years since becoming a triathlete, the list of lions Sara has defeated
continues to grow and includes: becoming a swimmer, completing a 66-mile bike ride,
finishing an Olympic race (a 1.2 mile swim, a 25 mile bike, and a 6.2 mile run), finishing first
in a race, and completing as many as ten races.

5. At the end of the 2014 racing season, Sara encountered the next lion in her path. During the
off-season, Sara began to increase the amount of strength training that she participated in.
Sara’s sister-in-law asked Sara to run a half-marathon with her, and Sara agreed to. As Sara
began training for the half-marathon, her body was unable to sustain the distances she was
running with the additional muscle mass that she had obtained through her strength training.
Throughout her training, bones in her foot began to degenerate. One day she ran six miles
and did not realize she was injured until the next morning. The bottom of her foot was very
tender and she hadn’t felt a pain like it before. The stress that her running and training
regimen placed on her foot had caused the Sesamoid bone in her big toe to fracture. After
seeing no improvement over the next three weeks, Sara had surgery on her foot, which
included having bunions removed.
Initially after her surgery, Sara was not overly concerned with the injury and the
recovery process. She was working on her thesis at the time so she used the recovery as an
opportunity to get it finished instead of exercising or lifting weights. One evening she was
going through her yoga routine, and she was able to see a clear difference in the muscular
structure of her calfs. It was at this point that Sara had an emotional breakdown because she
realized the extent of her injury. Sara deeply identified with her athleticism and the strength
of her body. Perceiving herself as weak caused Sara to go through a mourning process during
the early stages of her injury.
It was at this point that Sara had to make the decision one has to make with all of life’s
lions: fight or flight. Overcome or give in. Sara identified with the story of Benaiah in 2
Samuel. She recognized that her injury was a lion on her path to excellence in sport and in
life, and this lion needed to be taken out. Instead of seeing her injury as a obstacle, she began
to see it as an opportunity. Her injury was an opportunity to be a better student, an
opportunity to develop her identity, an opportunity to become stronger, and an opportunity
for spiritual growth. Sara knew that God’s plan for her is bigger than any injury, so she
decided to live by faith and overcome this temporary setback. With this in mind, Sara used
positive self-talk to embrace and nurture her injured leg. She even gave her injured leg a
name - Benaiah.
Sara began seeing a physical therapist early in the recovery process. She developed an
outstanding relationship with her physical therapist whose empathy and light-hearted nature
was critical to Sara’s rehabilitation. In addition to her physical therapist, Sara received great
support from her friends, her family, and even her boss at work. It was difficult for Sara to ask
people for help when she could not do things or get places on her own. Despite the difficulty
of asking for help, Sara understood that asking for help developed her character. Sara said she
learned that, “You cannot be someone’s helper unless you are humble enough to ask them for
help.”
5

6. Sara’s perspective, determination, and support system propelled her into an effective
rehabilitation. Sara described her rehabilitation adherence as “100 percent. Maybe even more
than necessary.” Sara went to the gym daily and always attended her physical therapy
appointments. Sara had a confidence and belief in physical therapy. She knew that adhering
to physical therapy religiously would get her back to her pre-injury form. In order to make her
rehabilitation exercises part of her daily routine, Sara did additional exercises at home while
reading or while watching television. Additionally, Sara will be able to swim before she will be
able to run. Sara described swimming as her weakest leg of a triathlon. She plans on using her
injury as an opportunity to become a better swimmer. When she returns to pre-injury form,
Sara will be an even better triathlete because she was able to see the opportunity to become a
better swimmer during her recovery.
In a follow-up interview with Sara, she displays a lot of confidence in her foot and in
her recovery. Sara is currently ahead of schedule in her recovery. She is completely out of her
walking boot so she is re-learning to walk. Sara is really working toward regaining strength
and flexibility in her calf, ankle, and foot. She has employed affirmations to aid in her
recovery. When describing her foot, Sara says, “My foot feels strong. It is strong.” Looking
ahead, Sara is excited about returning to competition. Sara’s first big test in her return to
sport will be a 30-mile bike ride at the end of April. This bike ride will allow Sara to know that
she is close to being “back”. Throughout rehabilitation, Sara has been motivated to return to
sport by her internal drive to be successful and excel at anything she does. She wants to come
back from her injury and come back stronger. When she does, Sara will be in a new age
bracket for triathlons. Typically, the older age brackets present stiffer competition. Sara wants
to prove that she can compete at a new age level.
Sara is in the midst of a struggle with the largest lion she has faced as a triathlete. She
is winning the battle, and she is going to win the battle. Throughout her life, Sara will be able
to look back on this obstacle and see the opportunity that she was given to grow athletically,
personally, and spiritually. She will have the confidence to face other lions in her life as well.
The reality of life is that it is full of lions - obstacles - that we can choose to flee from or fight
off. Sara has already shown that she is a fighter - a lion chaser.
6
“It’s our past problems that prepare us for
future opportunities. So someday we may be
as grateful for the bad things as the good
things because the bad things helped
prepare us for the good things.”
- Mark Batterson

7. Note: The remainder of this casebooks will specifically address and instruct Sara concerning
the various mental skills and strategies that are presented.
7
SAra’s path to a comeback
According to Khampoff, Thomae and Hamson-Utley (2013), there are three
phases that an athlete typically goes through during the injury recovery. Phase
one considers the athlete’s reaction and experience during the initial injury.
Phase two considers the athlete’s reaction and experience during
rehabilitation. Phase three considers the athlete’s reaction and experience
when returning to his or her sport. The second, and most lengthy, phase of the
stages of rehabilitation is typically characterized by the physical factors of
strength, balance and mobility and the psychological factors of motivation and
hardiness (Hamson-Utley, 2010).
Currently, Sara is in the later stages of the second phase. Sara is working to
regain all of the strength and flexibility in her foot. She is learning to walk
again and looking to make progress in her mobility. Physical therapy is still a
primary aspect of her rehabilitation and she continues to stay committed to the
various exercises prescribed by her physical therapist. This stage can be
lengthy and challenging for athletes, so it will be critical that she maintain her
motivation and focus.

8. 8
Mental Skills for
injury rehabilitation
Although sport injuries are typically perceived as physical in nature, there is
also a considerable mental component to injury. Mental skills training can
equip you with a sense of control in a circumstance filled with uncertainty.
Mental skills and strategies allow you to be an active agent in your recovery
and leads to greater motivation and adherence to your rehabilitation regimen
(Flint, 1998). Mental skills training can help you efficiently recover physically,
in addition to preparing you to perform at a high level in your return to sport.
Sara, throughout the rest of this casebook, I am going to provide you with
relevant mental skills and strategies which will assist you in your recovery from
injury and your return to sport. Injury rehabilitation can be a long and
formidable process, however, I know that you are more than up to the task!
Thus, the two mental skills that we will be cultivating throughout this casebook
are motivation and focus. My hope is that this casebook will equip you to
return to sport physically and mentally stronger than you were before. Take
advantage of the resources in this casebook, and enjoy the process of becoming
a better - and healthier - athlete!

9. The key to successfully navigating the windy roads of rehabilitation is
motivating yourself to keep driving! Sustaining a positive and healthy
engagement in the recovery process will determine the quality of your
motivation (Duda and Treasure, 2013). When you believe that you have the
resources to meet the demands of the task at hand, you will feel and act more
motivated (Ryan and Deci, 2002). Two relevant strategies for maintaining your
motivation are goal setting and self-talk. The next section will provide you with
goal setting and self-talk resources to assist you in meeting the demands of
rehabilitation and return to sport.
9
Maintaining motivation

10. Goal setting is the primary motivational mechanism
to influence the degree of effort in striving toward a
goal (Evans and Hardy, 2002). The main intent of
goal setting should be to identify objectives for the
rehabilitation process that allow you to return back
to pre-injury form both mentally and physically
(Arvinen-Barrow and Hemmings, 2013). Goals can
also help you manage your time as the semester
comes to a close. The increased utilization of goals
leads to an increase in motivation, which leads to
increased adherence to your rehabilitation regimen.
As a result, the rehabilitation process becomes more
manageable, and the healing process is aided.
Taylor and Taylor (1997), identified three types of goals that are specific to injury
rehabilitation:
1. Psychological - psychological goals assist with issues associated with motivation,
self-confidence, focus, stress, and anxiety.
2. Physical - physical goals give a clear direction for physical aspects of recovery.
3. Performance-related - performance-related goals identify potential areas of
improvement for various aspects of successful rehabilitation (e.g., rehabilitation
exercises)
Taylor and Taylor (1997), have also identified four different levels of goals that can be
used to successfully achieve psychological, physical, and performance-related goals:
1. Recovery – associated with the final level of recovery (long-term goals).
2. Stage - consists of specific objectives for each of the different stages of
rehabilitation (medium-term goals) - in your case phase two.
3. Daily - daily objectives and targets for each rehabilitation session (short-term
goals).
4. Lifestyle - goals related to any lifestyle choices that can influence the quality of
your recovery. For example, sleep, diet, alcohol and drug use, relationships, work,
school, and commitments.
10
Maintaining motivation:
Goal Setting

11. A great way to begin the process of setting goals for rehabilitation is
rehabilitation profiling. Rehabilitation profiling allows you to assess both the
personal and psychological factors that influence the quality of your
rehabilitation and your recovery (Taylor and Taylor, 1997). By completing a
rehabilitation profile, you will create an awareness of your personal and
psychological needs so you cater your rehabilitation goals around those needs.
In addition to having an understanding of the factors that can help and hinder
the rehabilitation process, completing a rehabilitation profile can give you a
belief that you control your destiny and your recovery.
In order to complete the rehabilitation profile, it is important to understand
each of the personal (Table 1.1) and physical factors (Table 1.2) that can impact
your rehabilitation. Once you have an understanding of each factor, you can rate
(on a scale from 0 to 10) how important each factor is to your rehabilitation and
recovery.
After determining the importance of each factor, take a colored pen, pencil,
marker, or crayon (whichever makes you happiest!) and fill in the personal
profile (Figure 1.1) and physical profile (Figure 1.2) from inside to outside based
upon the score that you gave each factor. For example:
11
rehabilitation profiling
for goal setting

12.
12
Rehabilitation profile:
Definition of Personal factors
Table 1.1 Rehabilitation profiling: definition of personal factors
Source: Adapted from Taylor and Taylor, 1997

13.
13
Rehabilitation profile:
Personal factors
Table 1.1 Rehabilitation profiling: personal profile
Source: Adapted from Taylor and Taylor, 1997

14.
14
Rehabilitation profile:
Definition of Physical factors
Table 1.2 Rehabilitation profiling: definition of physical factors
Source: Adapted from Taylor and Taylor, 1997

15.
15
Rehabilitation profile:
Physical factors
Table 1.1 Rehabilitation profiling: physical profile
Source: Adapted from Taylor and Taylor, 1997

16. Now that you have an idea of what personal and physical factors will influence
your rehabilitation and recovery, you get to begin the process of developing the
goals you want to achieve moving forward! When setting goals, it is important to
follow a few guidelines to make them as effective as possible (Gould, 2013):
1. Goals should be specific - outline exactly what you want to achieve. It is
better to have your goals be explicit rather than general.
2. Goals should be measurable - goals should be measurable numerically or
by observable behaviors that allow you to assess the degree to which your
goals were attained.
3. Goals should be attainable - make sure that you have the resources
available to attain your goals.
4. Goals should be realistic - goals should be realistic based upon your past
experiences/successes and your current capabilities.
5. Goals should be time-bound - you should have a target date for
accomplishing your goals.
6. Goals should be stated in a positive manner - identify the behaviors you
want to display rather than the behaviors you do not want to display.
7. Set both short-term and long-term goals - seeing success in your short-
term goals will motivate you to continue working toward your long-term
goal.
8. Goals should be somewhat flexible - it is better to focus on the degree to
which you have attained your goal. Settling for nothing less than absolute
attainment of your goal can result in feelings of failure (Arvinen-Barrow and
Hemmings, 2013).
9. Monitor goals throughout rehabilitation - take the time to reflect on and
evaluate your goals as you recover. It can give you an understanding and an
appreciation for your progress which will lead to greater effort and
motivation (Arvinen-Barrow and Hemmings, 2013).
16
goal setting guidelines

17. The next few pages will provide you with tools for outlining and keeping
track of the goals you want to achieve during rehabilitation.
The Goal Staircase (Gould, 2013) is a great visual tool that you can use to
remind yourself of the importance of using short-terms goals (for
example, comfortably riding on a stationary bike) as stepping stones
toward achieving your long-term goal (for example, completing your 30-
mile bike race). The first step should assess your current ability with the
following three or four steps specifying what short-term goals you need to
achieve to reach the top step - your long-term goal. Fill in your goal
underneath each step then post the staircase somewhere visible or bring it
with you to physical therapy. Let the Goal Staircase motivate you to a full
recovery!
17
Goal setting Activities
Present Ability
Short-Term
Goal 1
Short-Term
Goal 2
Short-Term
Goal 3
Short-Term
Goal 4
Long-Term
Goal

18. An alternative to the Goal Staircase is a traditional goal recording worksheet.
Feel free to write down any long-term recovery goals you may have along with
some short-term daily goals (physical, psychological, or performance) that you
can accomplish to reach your long-term goal!
18
Goal setting Activities

19. Once you have recorded your long-term and short-term goals for your
rehabilitation, you can go through this checklist to ensure that your goals are
equipping you for long-term motivation and a successful recovery!
19
Goal setting Activities

20. The thoughts and things that you say to yourself during your rehabilitation and
recovery influence your emotions, behaviors, and recovery outcomes (Wiese-
Bjornstal, Smith, Shaffer and Morrey, 1998). With this in mind, it is important
to interrupt or change the negative thoughts that you have during rehabilitation,
in addition to utilizing and fostering positive thoughts that you have during
rehabilitation. The positive thoughts and self-talk create positive emotions that
are associated with enhanced quality of rehabilitation (Udry, Gould, Brides, and
Beck, 1997).
According to Hardy (2006), self-talk is:
1. verbalizations or statements addressed to the self
2. multidimensional in nature
3. has interpretive elements associated with the content of statements
employed
4. is dynamic
5. has intersectional and/or motivational functions for the athlete
Sara, for your stage of rehabilitation it will be beneficial to focus on the more
motivational function of rehabilitation. Motivational self-talk is suggested to be
more effective for the execution of strength and endurance-based tasks because
it can increase effort, enhance confidence, and/or create positive emotions (Tod
et al., 2011). As you regain strength in your foot and aim for participating in the
endurance task of bike-riding, motivational self-talk should be a valuable
resource for you.
20
maintaining motivation:
Self-talk

21. Motivational self-talk has been categorized into three primary, and more
specific, motivational functions (Hardy et al., 2001):
1. Arousal - this function of motivational self-talk is used to psych up, relax,
and control arousal. Motivational arousal self-talk allows you to control your
arousal in a way that best suits your needs during rehabilitation. Maybe you
are having a tough time motivating yourself to start an exercise, use self-talk
to psych yourself up and get yourself in the right mindset. Maybe you are
struggling with trying a new exercise or are attempting to get back into sport
and anxiety is setting in. Use motivational arousal self-talk to relax yourself
and lower your arousal levels.
2. M a s t e r y - t h i s f u n c t i o n o f
motivational self-talk is used for
mental toughness, focus of attention,
confidence, and mental preparation.
Mastery self-talk can be used to cope
with difficult situations. In the
rehabilitation setting, motivational
mastery self-talk can help you push
through the pain or exhaustion of an
exercise or the conditioning that takes
place as you ease yourself back into
sport.
3. Drive - this function of motivational self-talk is used for goal achievement
and maintaining or increasing drive and effort. On the days when the
rehabilitation process is taking its toll on your psyche and you start to doubt
your commitment to rehabilitation, utilize motivational drive self-talk.
Motivational drive self-talk encourages you and increases your motivation
and your effort levels.
21
maintaining motivation:
motivational Self-talk

22. Sara, throughout the duration of your rehabilitation, make use of motivational
self-talk to keep yourself focused on your end goal of becoming the healthiest,
strongest, and best athlete you can be! Below are a few examples of each
function of motivational self-talk. Modify these or even change them completely
so that the words and phrases you say to yourself have as big an impact and
motivational effect as possible!
22
Examples of motivational
self-talk
Motivational Arousal Self-talk:
“Come on! You can do this!”
“Stay relaxed. Breathe deeply
and slowly.”
Motivational Mastery Self-talk:
“My foot is strong like a
mountain. I am ready!”
Motivational Drive Self-talk:
“Keep pushing! Only 2 more
minutes!”

23. Another self-talk strategy you can use to increase your motivation is
affirmations. According to Williams, Zinsser, and Bunker (2013), affirmations
are statements that reflect positive attitudes or thoughts about oneself. They are
statements of what you want, phrased as if you already had it. In order for an
affirmation to be effective, they need to be realistic and vivid. Affirmations
should also be in the present-tense and avoid perfectionist statements that
include words like “always” or “never”. Some examples of affirmations that you
can use are: “My foot is powerful! I will conquer this exercise!” or “I am a
healthy and strong triathlete!”
Affirmations activity:
Write down two or three personal affirmations regarding your rehabilitation,
recovery, and return to sport. Say these affirmations to yourself until you believe
them. Additionally, you can post your affirmations in easily visible places that
you are frequently nearby. You can also write them down on an index card and
carry it around. Look at the index card as many times as you need to throughout
the day in order to instill confidence in yourself and motivate yourself to
continue rehabilitating with purpose!
1. ____________________________________________________.
2. ____________________________________________________.
3. ____________________________________________________.
23
maintaining motivation:
self-talk (AfFirmations)

24. When you you are fully focused or concentrating, you are able to selectively
attend to appropriate environmental or internal cues, while blocking out
irrelevant or distracting stimuli (Willaims, Nideffer, Wilson, and Sagal, 2013).
Focusing enables you to completely engage in whatever activity you are
participating in. For you, that could mean fully engaging in your strength and
flexibility exercises, your conditioning exercises, or even having a complete
awareness of how you are walking. In the next section of this casebook,
information and strategies regarding imagery and relaxation will equip you to
sustain your focus throughout the rest of your rehabilitation and recovery.
24
Sustaining Focus

25. Flint (1998) divides relaxation into two categories: physical and mental.
Physical relaxation is typically used to relieve the body of physical tension, while
mental relaxation is used to relax and focus the mind, which will relax the body.
Using relaxation techniques can reduce symptoms of stress and anxiety by
focusing your attention to the task at hand, which will increase blood flow to
your foot and aid in the healing process (Walker and Heaney, 2013; Taylor and
Taylor, 1997).
The two relaxation techniques I want to introduce you to for the purpose of
sustaining your focus during rehabilitation are: centering and mindfulness.
1. Centering is a conscious process used to adjust weight about your center of
mass so you feel centered and in control (Williams, Nideffer, Wilson and
Sagal, 2013).
2. Mindfulness is a mental state resulting from voluntarily focusing your
attention on your present experience in its sensorial, mental, cognitive and
emotional aspects, in a non-judgmental way (Cottraux, 2007).
25
sustaining focus:
Relaxation

26. Centering is all about focusing your attention on the task at hand. The primary
means of centering is by focusing your attention from your head to your center
of gravity which will give you a sense of control, stability, and relaxation. With
practice, centering provides you with a means of relaxing almost instantly.
When you become skilled at centering, a deep breath is all it takes to enter into a
relaxed mindset so that you can focus your full attention on what needs to be
done and how you are going to do it (Walker and Heaney, 2013).
You can also pair cue words with your centering exercises. For example, if you
want to feel “loose” or “strong” while running, biking, or swimming, you can
repeat those words to yourself while you are going through a centering exercise.
Choose words that describe how you want to feel or how you want to behave
while rehabilitating your foot or conditioning for your first bike race. With
practice, similar to a deep breath, cue words used during centering exercises can
also result in almost automatic relaxation and focus (Williams, Nideffer, Wilson,
and Sagal, 2013).
26
sustaining focus:
relaxation (centering)

27. The following is an exercise adapted from Harwood (1998) that you can use to
develop the relaxation technique of centering:
27
sustaining focus:
relaxation (centering)
❖ Stand with your feet shoulder-width apart and bend your
knees slightly.
❖ Relax your neck, arms and shoulder muscles.
❖ Direct your thoughts inwards to check and alter your
muscle tension and breathing, by focusing on the
abdominal muscles and how they expand as you breath
in. Try to feel the heaviness in your muscles.
❖ Take a slow, deep breath (from the diaphragm), trying to
limit the movement of the chest cavity.
❖ Concentrate on your breathing and the heaviness of your
muscles, clearing the mind of all irrelevant thoughts, and
say ‘relax’.
❖ Now focus your attention on the rehabilitation activity
and what you need to do to perform it.

28. Mindfulness is a distinct form of awareness or attention that uses breathing
methods, guided imagery, and other practices to relax the body and mind and to
help reduce stress (Walker and Heaney, 2013). Mindfulness allows you to stay
focused on the present moment which is critical to producing the most
beneficial rehabilitation and performance outcomes. Mindfulness during
rehabilitation can help draw your attention to your various rehabilitation
activities and promote the correct execution of physical movements (Mahoney
and Hanrahan, 2011). Additionally, mindfulness allows you to objectively
address any negative thoughts (boredom, frustration, anxiety, etc.) you may
have during rehabilitation. You can mentally draw back, recognize these
thoughts for what they are (just thoughts, not realities), and continue focusing
on the task at hand.
28
sustaining focus:
relaxation (mindfulness)

29. The following is an exercise adapted from Williams, Nideffer, Wilson and Sagal
(2013) that you can use to develop the relaxation technique of mindfulness and
stay focused during your rehabilitation and return to sport activities:
29
sustaining focus:
relaxation (mindfulness)
❖ Sit quietly.
❖ Close your eyes.
❖ Begin breathing deeply in through your nose and out
through your mouth.
❖ Breathe in slowly for four seconds and then breathe out
slowly for eight seconds.
❖ See how long you can focus on a single thought.
❖ Become aware and mindful of your mission for today.
❖ What do you need to do to during this next rehabilitation
exercise? How do you want to feel? Lock in on the task at
hand.
❖ When you feel ready, become aware of your environment
and bring yourself back.
❖ With your mindful state and focus, begin your
rehabilitation exercise.

30. Imagery is an activity which involves creating a clear mental picture of the
athletic situations, which can mean the environment, the performance, the
conditions, the people, the emotions and senses. In the injury setting of sport,
you can use imagery to create images of: the healing process, the injured body
part fully healed and restored to desirable levels of functioning, the
rehabilitation setting, successfully completing rehabilitation exercises, dealing
with pain and any emotions associated with the injury and recovery process
(Arvinen-Barrow, Clement and Hemmings, 2013).
This section of the casebook will guide you through how to make the most out of
your imagery sessions, in addition to describing three types of imagery that will
help you stay focused on your rehabilitation and recovery. The three types of
imagery that will be discussed are: healing imagery, rehabilitation process
imagery, and performance imagery.
30
sustaining focus:
Imagery

31. Now that you have an idea of some of the uses of imagery during injury
rehabilitation, you get to begin the process of using imagery yourself! When
utilizing imagery, it is important to follow these guidelines to make your images
as effective as possible (Vealey and Forlenza, 2013; Taylor and Taylor, 1997):
1. Imagery should be a polysensory experience. When using imagery, you
should incorporate as many of your five senses as possible to recreate a prior
experience or create a desired experience. You can also include your
kinesthetic sense (which involves the sensation of your body in motion) and
the emotions that you felt or want to feel (e.g., confident, relaxed, focused,
determined).
2. Related to imagery being polysensory is images being vivid. Vividness refers
to your ability to see the image clearly and with detail. The more senses and
feelings you can include in your images, the more vivid they will become.
3. As you practice imagery, your images should also be more controllable which
means imaging exactly what you intend to and being able to manipulate
those images as you please. The controllability of your imagery will take
time, however you will find that you have more control with practice and
patience.
4. Your images can also be from an internal perspective (the images are from
your point of view) or from an external perspective (you are seeing yourself
from an outsider’s point of view). Both perspectives are effective methods of
using imagery so use whichever perspective is most natural and helpful for
you!
5. When imaging, reproduce or create an entire experience. Use all of the
physical and the psychological aspects of the injury rehabilitation process.
6. Use imagery when you are in a relaxed state. When your body is relaxed and
your mind is calm, you will have the best physical and emotional experience.
7. Use imagery to facilitate physical and emotional wellbeing and feeling good.
31
sustaining focus:
Imagery

32. The three types of imagery that would be most beneficial to sustain your focus
throughout the rest of your rehabilitation are rehabilitation process imagery,
healing imagery, and performance imagery. Process and Healing imagery can
help you remain mindful of the rehabilitation process and focus on gaining
flexibility and strength in your ankle, calf, and shin. Additionally, as you prepare
to compete in your first bike race since injuring your foot, it would be beneficial
to utilize performance imagery as well!
1. Rehabilitation Process Imagery - rehabilitation process imagery equips
you to create images of the many aspects of the rehabilitation process that
you typically experience. For example, completing exercises, adhering to the
rehabilitation program, overcoming setbacks and obstacles, maintaining a
positive attitude, and staying focused (Heil, 1993; Ievleva and Orlick, 1991;
Wiese et al., 1991).
2. Healing Imagery - healing imagery
refers to images in which the athlete will
see the injured body part healing. In order
for healing imagery to be effective, you
need to have a complete understanding of
the injury and you must be able to create a
picture of the injured area (Taylor and
Taylor, 1997). Be sure to ask your
orthopedic surgeon for more information
about the sesamoid fracture, where your
foot is currently at physically, and what it
should look like when it is fully healed so
that you can utilize healing imagery!
3. Performance Imagery - performance imagery entails mentally rehearsing
sport-specific skills during rehabilitation (Walsh, 2005). You can imagine
yourself participating in all three legs of a triathlon - successfully and
strongly swimming, biking, and running on your fully healed foot. For your
upcoming bike race take the time to image yourself completing the race and
the emotions and feelings you want to have before, during, and after the bike
race.
32
sustaining focus:
Imagery

33. In a study done by Cressman and Dawson (2011), athletes claimed that healing
imagery encouraged more concentration toward and awareness of their injury.
This led to improved adherence, focus, motivation and positivity during
rehabilitation. The following is an imagery script adapted from the Cressman
and Dawson (2011) study that you can use to stay focused on actively
rehabilitating your foot and returning to sport:
Note: Be sure to follow the guidelines for imagery on page 31! Be patient and
practice about 10-15 minutes a day!
33
sustaining focus:
Imagery
❖ Shift all of your attention toward your injury, it is the only thing on
your mind now.
❖ Feel the tightness and resistance in your leg and foot releasing.
❖ Feel the tension around your injury releasing, your foot is becoming
relaxed.
❖ See your lower leg, it is weakened but is ready for recovery.
❖ See the muscles in your lower leg and foot, see any loss of muscle mass.
❖ Feel the blood in your arteries pumping toward the injury, it is
bringing new food and oxygen to your lower leg and foot.
❖ See the fresh blood circulating around the injury, strengthening the
bone and muscles in your lower leg and foot.
❖ See new, strong, and indestructible muscle tissues coming to together
and growing in your lower leg and foot.
❖ See the muscles coming together to make a strong, unbreakable band
that is ready to run.

34. Sara, thank you so much for taking the time out of your semester to be
interviewed and allowing me to be a part of your recovery! It has been a great
opportunity for me to grow as a student and as an sport psychology consultant. I
hope that this casebook is as beneficial to you as it has been to me. Please stay in
touch and let me know how the rest of the recovery process goes. Keep chasing
those lions!
Best,
Brennen
34
Thank you, Sara!

35. Arvinen-Barrow, M., Clement D., & Hemmings, B. (2013). Imagery in sport injury
rehabilitation In M. Arvinen-Barrow & N. Walker (ed.), The psychology of sport injury
and rehabilitation (pp. 71-85). New York, NY: Routledge.
Arvinen-Barrow, M. & Hemmings, B. (2013). Goal setting in sport injury rehabilitation In M.
Arvinen-Barrow & N. Walker (ed.), The psychology of sport injury and rehabilitation
(pp. 56-70). New York, NY: Routledge.
Cottraux, J. (2007). Therapie Cognitive et Emotions: La troiseme vague [Cognitive Therapy
and Emotions: The third wave]. Paris: Elsevier Masson.
Cressman, J. M. & Dawson, K. A. (2011). Evaluation of the use of healing imagery in athletic
injury rehabilitation. Journal of Imagery Research in Sport and Physical Activity, 6(1).
Duda, J. L., & Treasure, D. C. (2013). The motivational climate, athlete motivation, and
implications for the quality of sport engagement In J.M. Williams & V. Krane (7th ed.),
Applied sport psychology: Personal growth to peak performance (pp. 57-77). New
York, NY: McGraw-Hill.
Evans, L. & Hardy, L. (2002). Injury rehabilitation: A goal setting intervention study. Research
Quarterly for Exercise and Sport, 73, 310-319.
Flint, F. A. (1998). Integrating sport psychology and sport medicine in research: The dilemmas.
Journal of Applied Sport Psychology, 10, 83-102.
35
Resources

36. Gould, D. (2013). Goal setting for peak performance In J.M. Williams & V. Krane (7th ed.),
Applied sport psychology: Personal growth to peak performance (pp. 188-206). New
York, NY: McGraw-Hill.
Hamson-Utley, J. J. (2010). Psychology of sport injury: A holistic approach to rehabilitating the
injured athlete. Chinese Journal of Sports Medicine, 29(3), 343-347.
Hardy, J. (2006). Speaking clearly: A critical review of the self-talk literature. Psychology of
Sport & Exercise, 7, 81-97.
Hardy, J., Gammage, K. L., & Hall, C. R. (2001). A descriptive study of athlete self-talk. The
Sport Psychologist, 15, 306-318.
Harwood, C. (1998). Handling Pressure. Leeds: The National Coaching Foundation.
Heil, J. (1993). Mental training in injury management In J. Heil (ed.), Psychology of Sport
Injury. Champaign, IL: Human Kinetics, pp. 151-174.
Ievleva, L. & Orlick, T. (1991). Mental links to enhanced healing: An exploratory study. The
Sport Psychologist, 5, 25-40.
Kamphoff, C. S., Thomas, J. & Hamson-Utley, J. J. (2013) Integrating the psychological and
physiological aspects of sport injury rehabilitation In M. Arvinen-Barrow & N. Walker
(ed.), The psychology of sport injury and rehabilitation (pp. 134-155). New York, NY:
Routledge.
36

37. Mahoney, J. and Hanrahan, S. (2011). A brief educational intervention using acceptance and
commitment therapy: Four injured athletes’ experiences. Journal of Clinical Sport
Psychology, 5, 252-273.
Ryan, R. M., & Deci, E. L. (2007). Active human nature: Self-determination theory and the
promotion and maintenance of sport, exercise and health. In M. S. Haggar and N. L. D.
Chatzisarantis (Eds.), Intrinsic motivation and self-determination in exercise and sport,
(pp. 1-20). Champaign, IL: Human Kinetics.
Taylor, J., & Taylor, S. (1997). Psychological Approaches to Sports Injury Rehabilitation.
Gaithersburg, MD: Aspen.
Tod, D., Hardy, J., & Oliver, E. (2011). Effects of self-talk: A systematic literature review.
Journal of Sport and Exercise Psychology, 33, 666-687.
Udry, E., Gould, D., Bridges, D., & Beck, L. (1997). Down but not out: Athlete responses to
season-ending injuries. Journal of Sport & Exercise Psychology, 19, 229-248.
Vealey, R. S. & Forlenza, S. T. (2013). Understanding and using imagery in sport In J.M.
Williams & V. Krane (7th ed.), Applied sport psychology: Personal growth to peak
performance (pp. 240-273). New York, NY: McGraw-Hill.
Walker, N. & Heaney, C. (2013). Relaxation techniques in sport injury rehabilitation In M.
Arvinen-Barrow & N. Walker (ed.), The psychology of sport injury and rehabilitation
(pp. 86-102). New York, NY: Routledge.
37

38. Walsh, M. (2005) Injury rehabilitation and imagery. In T. Morris, M. Spittle and A. P. Watt
(eds.), Imagery in Sport, Champaign: Human Kinetics, pp. 267-284.
Wiese-Bjornstal, D. M., Smith, A. M., Shaffer, S. M., & Morrey, M. A. (1998). An integrated
model of response to sport injury: Psychological and sociological dynamics. Journal of
Applied Sport Psychology, 10, 46-69.
Wiese, D. M., Weiss, M. R., and Yukelson, D. P. (1991). Sport psychology in the training room:
A survey of athletic trainers, The Sport Psychologist, 5, 15-24.
Williams, J. M., Nideffer, R. M., Wilson, V. E., & Sagal, M. (2013). Concentration and
strategies for controlling it In J.M. Williams & V. Krane (7th ed.), Applied sport
psychology: Personal growth to peak performance (pp. 304-325). New York, NY:
McGraw-Hill.
Williams, J. M., Zinsser, N., & Bunker, L. (2013). Cognitive techniques for building confidence
and enhancing performance In J.M. Williams & V. Krane (7th ed.), Applied sport
psychology: Personal growth to peak performance (pp. 274-303). New York, NY:
McGraw-Hill.
38