WHAT:
Some of the biggest challenges that this athlete will face with an injury of this magnitude are; motivation, to rehab or return to play; retraining the body to not favor the injured leg; also, arousal and anxiety placed on the athlete throughout the rehab process. Also, injury is often accompanied by depression, tension, anger, and low self-esteem, particularly in competitive athletes. Mood disturbance relates to the athlete's perceived progress in rehab and has been shown to negatively relate to attendance at rehab sessions (Smith, 1996). Any/all of these issues can and may contribute to stalling of the rehabilitation process. When rehabbing an injury, the athlete not only needs to regain physical strength, but mental strength is just as important to regain a fully recovery. Ideally, to have a successful recovery, an athlete needs to be in touch with their mental and physical abilities.
SO WHAT:
With this sort of injury, ACL surgery, the athlete needs to use cognitive skills to stay focused, motivated, and determined throughout this tough adversity that athletes, at times, go through. It's all about how they bounce back mentally, more so than physically. This type of injury tends to place a lot of doubt and second guessing within an athlete. This can be either on the field, "I'm not the same athlete," or during rehab, "this isn't helping, what's the point of rehabbing?"
Elite athletes often make skilled moves without thinking (Gill & Williams, 2008), this is known as control and automatic process. By allowing the athlete to regain the proper motor pathways necessary, through rehab, to perform sport specific movements without thinking will help this athlete regain the ability to perform and react like they did prior to the injury.
Developing imagery abilities can assist the athlete in motivational specific and general, mastery and arousal; cognitive specific and general skills (Gill & Williams, 2008). These skills can help the athlete overcome adversity, whether it's physical or mental challenges they may encounter throughout the rehab process. This also ties in with automatic process. It allows the them to develop "muscle memory" to regain control and reaction of the injured leg in this situation (Gill & Williams, 2008). Imagery isn't only helpful with rehab, but can also assist the athlete in training and competition. Whether it's to deal with anxiety, arousal, or performance skills. Imagery of the healing process may also contribute to a speedy recovery process (Smith, 1996).
Goal setting is another important aspect that the athlete should use throughout the rehab process. Similar to using goals to improve drive and performance during sport. By setting goals it can give the athlete something to look forward to and be motivated to achieve while rehabbing.
Self-talk throughout the rehab process can influence a positive attitude towards the effort, time and patients needed to have a successful recovery. It's important to use positive self-talk skills to stay motivated and have a positive mind set (Hamson-Utley, Martin, & Walters, 2008).
NOW WHAT:
First off, I will sit down with the athletes and discuss her thoughts and feelings about the injury, recovery, and physical activity. I want to do this to see how she feels and her mind set going into the rehab to get a feeling for her motivation. This will allow me to determine what cognitive skills might work best for her, or which one needs to be more heavily focused on.
I will have the athlete set short and long term goals directed towards rehab and physical activity. She will set a couple different short term goals for week to week, and the long term goal to be accomplished between weeks 6 and 8. As she meet each short term goal, I will have them make another and another leading up to their long term goal. By setting goals, the athlete will have something to look forward to and be motivated to achieve to keep their mind at peace. Also, this will help the rehab process run more smoothly, in hopes that the recovery process happens more quickly. When the athlete encounters a hurdle along the way, goals will allow the athlete to bypass this hurdle and look at the positive to get back on track and staying positive.
To develop the proper skills needed to allow this athlete to perform movements without thinking, automatic process, I will use imagery skills to assist the athlete in developing control and muscle memory. After surgery, an athlete tends to favor their weaker leg and by using imagery skills, the athlete can think of using both legs equally, and imagining the muscles of the injured leg firing throughout the movement. By being able to control this process, and imagining yourself going through the movements properly and correctly, proper muscle memory and motor units will develop and once this has occurred, less thought will be needed to perform the movements allowing automatic process to occur.
Lastly, by using self-talk skills, positive, the athlete may be able to speed up the automatic process to occur. While they are performing specific movement, they shouldn't only imagine them going through the movement, but also tell themselves what to focus on. For example, if the athlete is performing single leg squats, they should focus on the movement by seeing themselves doing the movement as well as saying "squat deep," "knee out," or "drive using your leg, not your back." Self-talk isn't only good for performing movements, but also for keeping a positive mind set towards daily rehab activities. There may be days where the athlete's knee is sore, but as long as she tells herself that she can perform the activities and that the soreness will work out, she'll be able to overcome the negative feedback.
CONCLUSION:
In conclusion, being able to understand the mind set of the athlete when beginning a rehab program is important to determine which cognitive skills may work best to put the athlete in the most successful outcome possible. Sitting down and discussing how the athlete feelings towards the rehab process and return to their sport will direct you down the correct path for program design, cognitive aspect none the less. Once you have determined which cognitive skills will best suit this athlete, have them set long term and short term, week to week, goals. Be sure that the short term goals are goals that can be accomplished, yet push the athlete to achieve them. Too easy of goals can allow the athlete to become easily distracted from the goal. Too difficult goals will also distract the athlete, as well as frustrate them and make the rehab process more difficult, to the point of wanting to give up possibly. Developing the athlete's mental ability is as important as physically. A strong focus should be devoted to the mental and physical connection while performing specific movements. After an injury, motor pathways are disrupted or unclear. Being able to perform movements during an event without thinking, known as automatic process, is key. To develop this, the athlete needs to be able to perform the movements correctly, using imagery and self-talk to guide them through the movements to develop muscle memory. Once they are able to perform the movements with proper technique, over time, the athlete will require less imagery and self-talk during the execution of the movement, and be able to use these skills prior to the movement, and react and move freely when performing in a live situation. Imagery and self-talk can also be used to motivated the person. This can be either specific or general motivation, as well as to control anxiety and arousal. Each one of these aspects are important to a successful rehab of an athlete. The ability to be mental strong after an injury is as important as being physically strong. Rehab is more than the development of physical strength, but mental strength and skills are equally as important.
REFERENCES:
Gill, D. L., & Williams, L. (2008) Psychological Dynamics of Sport and Exercise. Champaign, IL: Human Kinetics.
Hamson-Utley, J. J., Martin, S., & Walters, J. (2008). Athletic Trainers' and Physical Therapists' perceptions of the effectiveness of psychological skills within sport injury rehabilitation programs. Journal of Athletic Training, 43(3), 258-264.
Smith, A. M. (1996). Psychological impact of injuries in athletes. Sports Med, 22(6), 391-405.
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