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Sports Injury Recovery and Return to Play:
Tools for the Practicing Psychologist
Skill Building Session at the
American Psychological
Association Convention
Chicago, Il
2019, August
Heil & Podlog
SUMMARY
Injury is recognized as one of the most debilitating experiences among high-performance individuals
(e.g., athletes, police officers, dancers, and soldiers). Despite a wealth of evidence highlighting the
deleterious ramifications of injury, few sport psychology practitioners are sufficiently skilled to
intervene in this relatively wide-spread challenge in sport and performance environments. This skill-
building session addresses this critical need by building practitioner expertise in implementing
evidence-based treatment strategies for achieving timely recovery and psychological readiness for
return to play. The session is comprised of three main components. First, we articulate a
conceptualization of injury rehabilitation as a form of competitive challenge in which athletes ability
to transfer sport-specific skills to the rehabilitation setting is crucially important for optimizing
effective recovery. The six skills requiring mastery include: 1) understanding injury recovery
processes, 2) pain management, 3) overcoming debilitating thoughts and emotions, 4) cultivating
motivation for rehabilitation exercises, 5) seeking social support, and 6) promoting psychological
readiness to return to play. Second, we briefly discuss Self-Determination Theory (SDT) principles,
which inform the injury treatment strategies. In the third and final component, participants practice
sport-specific, SDT strategies designed to foster the six essential rehabilitation skills outlined above.
The strategies include (but are not limited to): implementing an injury education heuristic,
identifying irrational thinking, use of goal-setting techniques, and practice receiving/delivering
relaxation, imagery, and social support. Use of such strategies can help athletes channel the injury
experience into an opportunity for stress-related growth. The session will include a variety of
pedagogical strategies such as PowerPoint, self-reflection exercises, think-pair-share exercises,
group discussion, and role-play exercises.
Introduction
John Heil (DA)
Les Podlog (Ph.D)
Reflection
In groups of 3, take 3 minutes and discuss…
• What are the critical challenges of sport injury rehabilitation?
• What skills or athlete attributes facilitate effective recovery?
Remarkable Recovery
REMARKABLE RECOVERY
Injury as Learning
Higher Order Factors
• Psychological Momentum
• Body Awareness Heightened
• Pain Assessment Enhanced
• Mental Skills Sharpened
• Sport Revalued Heil (1993); Wadey, Evans, Evans & Mitchell (2011)
PSYCHOLOGICAL MOMENTUM
Negative & Positive Affect Independent
Injury & Emotion
Negative Affect Up w/Injury
Positive Affect Maintained
Negative Affect Down w/Rehab
Balance Shifts to Positive
Determined
Coping
[Hi +/Hi-]
Zone
Flow
[Hi+/Lo-]
Distress
[Lo+/Hi-]
Denial
[Lo+/Lo-]
Heil (2000)
BODY AWARENESS HEIGHTENED
• Motor Genius Ogilvie
• Fine Tuned Fitness
• Biomechanics
Macchi & Crossman (1996) Ballet
Udry et al (1997) Skiers
PAIN ASSESSMENT ENHANCED
• Pain vs Injury
• Finely Tuned Perception
• Decision Making
e.g., Sport-Attention Matrix
MENTAL SKILLS SHARPENED
• Mental Game to Rehab
• Mental Rehearsal as Preparation
Case Study: Morten Anderson
NFL leading scorer; FG Kicker
I made it to the Pro Bowl through mental
preparation and visualization. There was no foot to
ball practice until Sunday afternoons.
Andersen (2013)
SPORT REVALUED
• Self-Actualizing
Maslow (1971)
• Paradoxical
Day-to-Day Grind
Sense of Loss
Eight Rehabilitation Skills
1) Understanding injury recovery processes
2) Pain management
3) Overcome debilitating thoughts and emotions
4) Creating realistic expectations
5) Cultivating motivation for rehabilitation exercises
6) Seeking social support
7) Communicating with treatment team members
8) Psychological readiness to return to play
Podlog, Heil et al. (2014, 2018)
Self-Determination Theory (Deci & Ryan, 1985)
1. Motivation quantity vs. quality
2. Controlled motivation
– external or internal pressures
3. Self-determined motivation
– valued benefits, personal interest
Basic Needs
Fulfillment
High
Quality
Motivation
Positive
Consequences
SDT Motivational Model (1997)
Autonomy Competence Relatedness
PAIN DEFINED
Sensory & Emotional…
Actual or Potential Injury
Tissue Damage…
Intl Assoc Study Pain (1979)
• Supersystem
Neurological
Endocrine
Immune Systems
w/ Integrated/Overlapping
Neural Circuitry &
Biochemical Mediators
Chapman, Tuckett, & Song, C. W. (2008).
PAIN & PERFORMANCE
• BioPsychoSocial
• Subjective+Variable
Person x Situation x History x
Culture
e.g., Beecher (1956)
PAIN & PERFORMANCE
• BioPsychoSocial
• Subjective+Variable
Person x Situation x History x
Culture
e.g., Beecher (1956)
SPORT-PAIN ATTENTIONAL MATRIX
PAIN & SPORT Association
Beneficial when pain signals proper technique
Changes in movement patterns to avoid pain
could result in compensatory injury
PAIN Association - SPORT Dissociation
Use in breaks between activities to assess
pain or muscular guarding with overuse &
chronic injury
Sport can fully absorb attention, with pain
signals suppressed to the detriment of
performers’ physical well-being
PAIN & SPORT Dissociation
Problem if focus performance is sacrificed for
pain management
Beneficial during natural breaks from activity as a
way of getting psychological rest
PAIN Dissociation - SPORT Association
Appropriate when pain is understood as routine or
benign
Avoids pain as a distraction which may undermine
performance.
Heil & Podlog (2012)
Elite Fencer with Knee Injury
• Knee injury during competition with surgery and reinjury,
now returning to sport, after a protracted period away from
sport
• Continuing rehab of injury while reconditioning for sport and
returning to competition
• Pain at multiple sites w/ varying underlying dynamics
• Significant anxiety which results in guarding behavior and
ruminative focus on reinjury
19
Pain-Sport Attentional Matrix -- Case Study
PAIN & SPORT Association
Beneficial when pain signals proper technique
Compensatory change in lunge mechanics to
avoid pain, undermining performance
(accuracy of attack) & increasing new injury
risk
PAIN Association - SPORT Dissociation
To assess pain with overuse & chronic injury
As athlete reconditions, is vulnerable to groin
strain. Brief breaks from bouting to determine
if rest is needed to avoid developing new
injury
PAIN & SPORT Dissociation
During natural breaks in activity to facilitate
recovery
Relaxation/Quieting between bouts to optimize
physical recovery and counter worrisome focus
on injury risk
PAIN Dissociation - SPORT Association
When pain is understood as routine or benign
Experiences ankle pain as part of reconditioning,
although this is well tolerated and not creating
injury risk
Heil & Podlog (2012)
Discussion
How has your ability to influence the likelihood of remarkable
recovery become more informed?
Stress-Related Growth
• Organismic Valuing Theory
Joseph & Linley (2005)
Innate Drive to Modify Worldview Positively after
Trauma
Positive Accommodation - Growth
Pre-Trauma Function - Recovery
Negative Accommodation – Distress
Competence, Autonomy, Relatedness
DETERMINED COPING: Concept
• Zone Theory Hanin (2000)
Positive & Negative Affect Independent
Dimensions
• Determined Coping
Hi Positive Affect
Hi Negative Affect
• Denial
Negative Affect Reduced
Determined
Coping
[Hi +/Hi-]
Zone
Flow
[Hi+/Lo-]
Distress
[Lo+/Hi-]
Denial
[Lo+/Lo-]

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Sports Injury Recovery and Return to Play: Tools for the Practicing Psychologist

  • 1. Sports Injury Recovery and Return to Play: Tools for the Practicing Psychologist Skill Building Session at the American Psychological Association Convention Chicago, Il 2019, August Heil & Podlog
  • 2. SUMMARY Injury is recognized as one of the most debilitating experiences among high-performance individuals (e.g., athletes, police officers, dancers, and soldiers). Despite a wealth of evidence highlighting the deleterious ramifications of injury, few sport psychology practitioners are sufficiently skilled to intervene in this relatively wide-spread challenge in sport and performance environments. This skill- building session addresses this critical need by building practitioner expertise in implementing evidence-based treatment strategies for achieving timely recovery and psychological readiness for return to play. The session is comprised of three main components. First, we articulate a conceptualization of injury rehabilitation as a form of competitive challenge in which athletes ability to transfer sport-specific skills to the rehabilitation setting is crucially important for optimizing effective recovery. The six skills requiring mastery include: 1) understanding injury recovery processes, 2) pain management, 3) overcoming debilitating thoughts and emotions, 4) cultivating motivation for rehabilitation exercises, 5) seeking social support, and 6) promoting psychological readiness to return to play. Second, we briefly discuss Self-Determination Theory (SDT) principles, which inform the injury treatment strategies. In the third and final component, participants practice sport-specific, SDT strategies designed to foster the six essential rehabilitation skills outlined above. The strategies include (but are not limited to): implementing an injury education heuristic, identifying irrational thinking, use of goal-setting techniques, and practice receiving/delivering relaxation, imagery, and social support. Use of such strategies can help athletes channel the injury experience into an opportunity for stress-related growth. The session will include a variety of pedagogical strategies such as PowerPoint, self-reflection exercises, think-pair-share exercises, group discussion, and role-play exercises.
  • 4. Reflection In groups of 3, take 3 minutes and discuss… • What are the critical challenges of sport injury rehabilitation? • What skills or athlete attributes facilitate effective recovery?
  • 6. REMARKABLE RECOVERY Injury as Learning Higher Order Factors • Psychological Momentum • Body Awareness Heightened • Pain Assessment Enhanced • Mental Skills Sharpened • Sport Revalued Heil (1993); Wadey, Evans, Evans & Mitchell (2011)
  • 7. PSYCHOLOGICAL MOMENTUM Negative & Positive Affect Independent Injury & Emotion Negative Affect Up w/Injury Positive Affect Maintained Negative Affect Down w/Rehab Balance Shifts to Positive Determined Coping [Hi +/Hi-] Zone Flow [Hi+/Lo-] Distress [Lo+/Hi-] Denial [Lo+/Lo-] Heil (2000)
  • 8. BODY AWARENESS HEIGHTENED • Motor Genius Ogilvie • Fine Tuned Fitness • Biomechanics Macchi & Crossman (1996) Ballet Udry et al (1997) Skiers
  • 9. PAIN ASSESSMENT ENHANCED • Pain vs Injury • Finely Tuned Perception • Decision Making e.g., Sport-Attention Matrix
  • 10. MENTAL SKILLS SHARPENED • Mental Game to Rehab • Mental Rehearsal as Preparation Case Study: Morten Anderson NFL leading scorer; FG Kicker I made it to the Pro Bowl through mental preparation and visualization. There was no foot to ball practice until Sunday afternoons. Andersen (2013)
  • 11. SPORT REVALUED • Self-Actualizing Maslow (1971) • Paradoxical Day-to-Day Grind Sense of Loss
  • 12. Eight Rehabilitation Skills 1) Understanding injury recovery processes 2) Pain management 3) Overcome debilitating thoughts and emotions 4) Creating realistic expectations 5) Cultivating motivation for rehabilitation exercises 6) Seeking social support 7) Communicating with treatment team members 8) Psychological readiness to return to play Podlog, Heil et al. (2014, 2018)
  • 13. Self-Determination Theory (Deci & Ryan, 1985) 1. Motivation quantity vs. quality 2. Controlled motivation – external or internal pressures 3. Self-determined motivation – valued benefits, personal interest
  • 15. PAIN DEFINED Sensory & Emotional… Actual or Potential Injury Tissue Damage… Intl Assoc Study Pain (1979) • Supersystem Neurological Endocrine Immune Systems w/ Integrated/Overlapping Neural Circuitry & Biochemical Mediators Chapman, Tuckett, & Song, C. W. (2008).
  • 16. PAIN & PERFORMANCE • BioPsychoSocial • Subjective+Variable Person x Situation x History x Culture e.g., Beecher (1956)
  • 17. PAIN & PERFORMANCE • BioPsychoSocial • Subjective+Variable Person x Situation x History x Culture e.g., Beecher (1956)
  • 18. SPORT-PAIN ATTENTIONAL MATRIX PAIN & SPORT Association Beneficial when pain signals proper technique Changes in movement patterns to avoid pain could result in compensatory injury PAIN Association - SPORT Dissociation Use in breaks between activities to assess pain or muscular guarding with overuse & chronic injury Sport can fully absorb attention, with pain signals suppressed to the detriment of performers’ physical well-being PAIN & SPORT Dissociation Problem if focus performance is sacrificed for pain management Beneficial during natural breaks from activity as a way of getting psychological rest PAIN Dissociation - SPORT Association Appropriate when pain is understood as routine or benign Avoids pain as a distraction which may undermine performance. Heil & Podlog (2012)
  • 19. Elite Fencer with Knee Injury • Knee injury during competition with surgery and reinjury, now returning to sport, after a protracted period away from sport • Continuing rehab of injury while reconditioning for sport and returning to competition • Pain at multiple sites w/ varying underlying dynamics • Significant anxiety which results in guarding behavior and ruminative focus on reinjury 19
  • 20. Pain-Sport Attentional Matrix -- Case Study PAIN & SPORT Association Beneficial when pain signals proper technique Compensatory change in lunge mechanics to avoid pain, undermining performance (accuracy of attack) & increasing new injury risk PAIN Association - SPORT Dissociation To assess pain with overuse & chronic injury As athlete reconditions, is vulnerable to groin strain. Brief breaks from bouting to determine if rest is needed to avoid developing new injury PAIN & SPORT Dissociation During natural breaks in activity to facilitate recovery Relaxation/Quieting between bouts to optimize physical recovery and counter worrisome focus on injury risk PAIN Dissociation - SPORT Association When pain is understood as routine or benign Experiences ankle pain as part of reconditioning, although this is well tolerated and not creating injury risk Heil & Podlog (2012)
  • 21. Discussion How has your ability to influence the likelihood of remarkable recovery become more informed?
  • 22. Stress-Related Growth • Organismic Valuing Theory Joseph & Linley (2005) Innate Drive to Modify Worldview Positively after Trauma Positive Accommodation - Growth Pre-Trauma Function - Recovery Negative Accommodation – Distress Competence, Autonomy, Relatedness
  • 23. DETERMINED COPING: Concept • Zone Theory Hanin (2000) Positive & Negative Affect Independent Dimensions • Determined Coping Hi Positive Affect Hi Negative Affect • Denial Negative Affect Reduced Determined Coping [Hi +/Hi-] Zone Flow [Hi+/Lo-] Distress [Lo+/Hi-] Denial [Lo+/Lo-]

Editor's Notes

  1. John – discuss notion of remarkable recovery. Transfer sport specific skills to rehab (Heil et al., 1996)
  2. Book – Assassin - https://www.google.com/search?hl=en&tbm=isch&source=hp&biw=1920&bih=938&ei=Q-WSW7iaHs645gKpi46wBw&q=they+call+me+assassin&oq=they+call+me+assasin&gs_l=img.1.0.0i10i24.1793.6631..8034...0.0..3.156.1192.19j1......3....1..gws-wiz-img.....0..0j0i24.Px4Ngw_8ssI#imgrc=Nkf7HfiRnRqp0M:
  3. Hanin, Y. L. (Ed.) (2000). Emotions in Sport. Champaign, IL: Human Kinetics. Heil, J. (2000). The injured athlete. In Y. L. Hanin (Ed.), Emotions in sport (pp. 245-265). Champaign, IL: Human Kinetics.
  4. Udry, Gould, Bridges and Beck (1997) found that over 50% of injured US Ski Team athletes gained a deepened appreciation for the opportunities their sport provided. Lance Armstrong (2000)
  5. Insert SD continuum if I have time.
  6. Update: Merskey H., & Bogduk, N. (1994). Part III: Pain terms, a current list with definitions and notes on usage. In Classification of chronic pain (2nd ed., pp. 209–214). IASP Task Force on Taxonomy. Seattle: IASP Press.
  7. Perception-Run-No Pain (no effort); Meaning-Danger
  8. Perception-Run-No Pain (no effort); Meaning-Danger
  9. Passoc-Sport Dissoc – Overuse or chronic injury
  10. Passoc-Sport Dissoc – Overuse or chronic injury
  11. Drive =innate tendency
  12. Hanin, Y. L. (Ed.) (2000). Emotions in Sport. Champaign, IL: Human Kinetics. Heil, J. (2000). The injured athlete. In Y. L. Hanin (Ed.), Emotions in sport (pp. 245-265). Champaign, IL: Human Kinetics.