In this week’s installment of Ask the Expert, Dr. Julia Kim, psychologist, answers questions on mental readiness for athletes returning from injury.
Q1. What is the Psychological Readiness to Return to Sport Scale (PRRS)?
The PRRS was developed in 2009 to measure the psychological readiness of injured athletes to return to sport participation. It consists of six questions tapping one’s confidence level. You know what the question is assessing, there is no hidden agenda. It is a quick tool to assess confidence to return to sport. As a psychologist, I do not use this scale, but I believe it can be useful for non-mental health professionals working with athletes (i.e., athletic trainers, physical therapists, coaches, etc.).
Assessing psychological readiness is a complex process. I assess readiness through dialogue (psychotherapy). It involves understanding the nature and extent of the injury, the athlete’s understanding of the situation, and emotional and physical experience, and the expectations of the athlete and other’s involved (i.e., team, coaches, family, friends, etc.). Here are things I look out for: fears (re-injury, new injury, disappointing oneself or others, not playing as well or even losing your position on the team, etc.), anxiety/mood/stress, motivation, overall personal situation, internal resilience and coping skills, and social support. This is not an exhaustive list, but it gives a sense of the complexity involved in recovering from an injury.
Q2. How important is psychological readiness for an athlete when considering returning to activity after an injury?
I believe psychological readiness is equally as important as physical readiness. An athlete may be physically cleared to play, meaning the body has the ability to perform, but with fear and lack of confidence one’s ability performance can easily be inhibited. For example, tentativeness to put full weight on the injured side may lead to imbalances, guarding of the injured area, and overall changes in mobility. This leads to sub-optimal performance (which reinforces fears and low confidence) which can lead to re-injury or a new injury. This has the potential to be an ongoing cycle if not addressed.
Q3. Is there a common trend between psychological readiness and fear of re-injury?
Yes, there is a very strong correlation between fear of re-injury and psychological readiness. The nature of the fear and how it affects performance is different for everyone. The commonality is that fear of re-injury can inhibit or alter performance in some manner. To be psychologically ready, that is to be confident in your ability to perform as you want; one’s fears need to be under-control. This does not mean you can’t have fears. It means your fears don’t have the power to change what your body is physically able to do. You have control over your fears and your ability to reach your physical potential.
Q4. What are some common symptoms that athletes exhibit when faced with an injury?
Fear is a big one. Fears are unlimited, but typically revolve around re-injury, injury and disappointing self and others. This has the potential to set-off other reactions such as anxiety, stress, depression, anger, low self-esteem/confidence, treatment non-compliance and feeling out of control.
Q5. What can an athlete do to help themselves recover from an injury?
There are many things athletes can do much of which is most effective when tailored to the athlete’s specific situation and needs. In general, the following are important:
- It is important to have a realistic understanding of the injury and expectations for recovery. Unrealistic expectations, or expectations that differ from your medical team, can lead to disappointment. Make sure you and your teammates are on the same page.
- Set short-term and long-term goals. They should be realistic, challenging and obtainable. Short-term goals can be made weekly (What do I hope to achieve this week?), or it can be task-oriented (The first thing I want to be able to do is?). Then, the long-term goal is based on your expectations once you have recovered.
- Know how you normally cope with stress (injury is a type of stress). This provides insight into how you can utilize your strengths and improve less optimal styles for coping (i.e., Do you rush through problems and look for a quick fix? Do you have a hard time with waiting? Do you use physical activity/exercise as a stress relief?).
- Use positive self-talk to redirect negative thoughts. Focusing on positive thoughts and affirmations (“I will reach my goal”) keeps you motivated and silences negative thoughts. Our thoughts have the ability to change our emotions and actions. Use them to your benefit!
- Do things that help you to relax. Relaxation helps control thoughts and emotions, as well as keeping muscles relaxed. Muscles often become very tight when injured (and stressed). Relaxation can be by engaging in things you enjoy doing, or through more formal methods such as meditation, deep breathing exercises, progressive muscle relaxation, or massages.
- Live your life. Injuries should not stop you from enjoying your life (family, friends, interests, etc.). It is important to have a balanced life to prevent your injury from becoming your life. When your injury becomes your life pain and struggles can be magnified. This also allows you to stay in touch with your social support group – needed when injured.
- Use your resources. Your medical team, coaches, trainer, etc. are there to support and guide your recovery, so use them. A psychologist can also be helpful to help address obstacles in your recovery, or even just to help you get through a difficult time. Injury is difficult for anyone. As an athlete it takes on other dimensions as one’s sport is a big part of an athlete’s life. Take action – take advantage of all the resources available.
Dr. Julia Kim is a clinical psychologist at Hospital for Special Surgery. She is the first clinical psychologist to formally work within the HSS family and her focus is to develop an integrative care program, designed to incorporate psychological services into a multi-disciplinary care team. She works closely with physicians and surgeons to optimize the best possible medical outcome.