Return to Sport

• Return to sport is both the ultimate goal of rehab

• A source of doubt and worry about the uncertainty of injured athlete’s abilities to return to a level at or above where they performed prior to the injury

Approaches

• It can be threat– Low confidence– Decreased adherence to

rehab– Increase in pain– Display avoidance

behaviors– Increases anxiety– Reduced motivation

• It can be challenge– Positive attitude– High motivation– Excitement– Increased effort in rehab– Greater desire to return to

sport– Overadherence to rehab– Greater risk of reinjury due

to permature return

Stages of Return to Sport

Initial Return to Sport

Recovery confirmation

Return of Physical & Technical Abilities

High Intensity Training

Return to Competition

Initial Stage

• Considered to be the most difficult• Athlete quickly determines the effectiveness of the

rehabilitation• Entire stage should include a series of tests of the

healed area• Athlete’s expectation are:

– They will perform at the same level as prior to the injury– Pain will not be present

• Discussion with the athlete are needed to examine their expectations.

• A concern of AT is that athlete become “overzealous” in their approach to train and compete.

Recovery Confirmation

• More psychological than physical• Involves the athletes’ obtaining evidence from initial

stage that the injury is healed and ready to face the demands of the sport participation

• This is considered the make or break period– Athlete’s initial play will confirm their attitudes and approaches

• Success will lead to higher levels of self-confidence and motivation– Injury does not swell, no pain, full range of motion,– Self-confident and motivated

• Not being successful will lead to doubt if they will be able to return.– Swelling occurs, unexpected pain, little range of motion, decrease

strength– Highly anxious and depressed

Return of Physical & Technical Skills

High intensity training marks the absolute conclusion of athlete’s identification that they are fully healed.

Re-establishment of their regimen of physical conditioning and technical training

Major psychological concern is their level of perceived preparedness:- Provide a safe,- progressive conditioning program developed by the AT or physical trainer

Return to Competition

• First post-injury competition is key concern:– Athlete is usually more anxious than at any other time– Initial uncertainty– Athlete may have a distorted perception of the

probability of the injury occurring again.

• Need to discuss with the athlete’s their attitude and feeling about the upcoming competition– Athlete should not be thinking negatively– Athlete needs to redirect their focus to their skills,

game strategy, and goals.

Fear of Injury: A Major Concern

• Perception that recovery is incomplete,

• returning to sport to soon,

• impatient in returning to sport,

• lack of acceptance of the risk of the sport,

• low confidence,

• highly anxious,

• and preoccupied with being re-injured

Prevention of Fear of Reinjury

Continue involving in the sport during rehab

View rehab as a form of athlete performance

Becoming involved with a coping model

Performance imagery

Give the athlete time to progressively regain their physical, psychological, and technical skills.

Treatment of Fear of Injury

• Need to take a proactive approach to alleviate the fear– Athlete needs to face a similar situation as

when the injured occurred.– Rational self-talk helps the athlete refocus– Simulation practice– Relaxation techniques – Athlete establish pre-competition and

competition routines

Self-Determination Model & Return to Sport

• Ryan & Deci (2000) focused on:– Competence,– Autonomy, and– Relatedness in explaining the athlete’s return

to sport.

• From the self-determination perspective, the success of an athlete’s return to sport from injury is related to meeting these psychological needs

Investigation of Competitive Athletes’ Return to Sport Following Serious Injury

(Podlog & Eklund, 2004)

• 12 competitive amateur and semi-professional athletes

• Average length of rehab was 7 months

• Each athlete was interviewed

- 1-2 months

- 3-4 months

- 6-8 months

Findings

Pre-competitive experiences of athletes from their re-commencement of sport training until the return of competition

Participant’s experiences following their return to competition

Competency Issues

Athlete’s fear and concerns of returning to sport

Loss of enjoyment because they could not participate in the sport

Injury blocked their short & long term goals

Letting down others, teammates, and coaches

Issues

Competence

Relatedness

Autonomy

Competence Issues

- Fear related to returning to sport

- Injury blocked their sport goals

- Overcoming their fear of reinjury

Relatedness Issues

- Feels of separation from team

- Support in re-entry into sport

- Having role models

Autonomy Issues

- Sense of personal control

- Pressure to return to sport

Implications

Competence

Relatedness

Autonomy

Regarding the assistance and management of athletes returning to sport following an injury:

- Rehab environments meet these three basic needs of the athlete by:

1) Implementing goal-setting

2) Giving the athlete choices when to return to sport

3) Provide role models

4) Rehab progress should be safe and successful

The End