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	+ LSSC Home + RehabWorks Home + Rehabilitation Protocols + Instructional Videos + Microbreaks - Sportsmedicine Articles + Ultra-Stretch Program + Anatomy 101 + Back at Work + Pamphlets Online Forms: + Education Outreach Request + Doctor Referral Form + Appointment Scheduling + Initial Paperwork + Patient Survey		The Psychology of Exercise Related Injuries Emotional Responses When psychologists began to study the psychology of injury, they first speculated that the reaction to an exercise-related injury was similar to the response of people facing imminent death. According to this view, exercisers who have become injured often follow a five-stage grief response process: Denial Anger Bargaining Depression Acceptance As research has grown on this subject, recent evidence shows that although individuals may exhibit many of these emotions in response to being injured, they do not follow a set stereotypical pattern, or necessarily experience each of the emotions in these five stages. Psychologists now recommend that we view typical responses to injury in a more flexible and general way due to the fact that people do not move neatly through set stages in a predetermined order. Rather, many have more than one of these emotions and thoughts simultaneously or revert back to stages that they have experienced previously. Nonetheless, although emotional responses to being injured have not proved to be as fixed or orderly as psychologists once thought, injured individuals will exhibit three general categories of response: Injury-relevant information processing. This is when the injured patient focuses on information related to the pain of the injury, awareness of the extent of injury, and questions about how the injury happened. The individual recognizes the negative consequences or inconvenience. Emotional upheaval and reactive behavior. Once the patient realizes that he is injured, he may become emotionally agitated; experience vacillating emotions; feel emotionally depleted; experience isolation and disconnection; and feel shock, disbelief, denial or self-pity. Positive outlook and coping. The patient accepts the injury and deals with it, initiates positive coping efforts, exhibits a good and optimistic attitude, and is relieved to sense progress. When injury occurs, most patients move through these general patterns; but the speed and ease with which they progress vary widely. With the three definite categories listed above there are several other reactions that may occur in this process Identity loss Fear and anxiety Lack of confidence Performance decrements Signs of Poor Adjustment to Injury Most people work through their response to injury showing some negative emotions but not great difficulty in coping. How can you tell whether a patient exhibits a “normal” injury response or is having serious difficulties that require special attention? The following are warning signs of poor adjustment: Feelings of anger and confusion Obsession with the question of when one can return to play Denial Repeatedly coming back too soon and experiencing reinjury Exaggerated bragging about accomplishments Dwelling on minor physical complaints Guilt about letting others down Withdrawal from significant others Rapid mood swings Statements indicating that no matter what is done, recovery will not occur Phases of Injury Recovery from a Psychological Aspect There are three main phases of injury recovery. They include: Injury-Illness Phase: in this phase the athletic trainer must help the patient deal with the emotional upheaval that accompanies the onset of injury. Helping the athlete understand his/her injury is important. Rehabilitation-Recovery Phase: the athletic trainer must help the patient sustain motivation and adherence to rehabilitation protocols. Goal setting and maintaining a positive attitude, especially during setbacks, are extremely important in this phase. Return to Full Activity Phase: full recovery is not complete until the patient can return to normal functioning within his or her position. Psychological Techniques to Facilitate the Rehabilitation Process There are several basic techniques that athletic trainers can implement into their patients rehabilitation program that can help with the healing process. Build rapport with the injured patient: empathy is helpful, and be realistic with goals. Educate the patient about the injury and recovery process: especially when someone is working through a first injury, it is important to tell them what to expect during the recovery process. Help them understand the injury in practical terms. Teach specific psychological coping skills: the most important psychological skills to learn for rehabilitation are goal setting, positive self-talk, imagery visualization, and relaxation techniques. Teach how to cope with setbacks: people recover at different rates, and setbacks are not uncommon. Thus, it is extremely important to prepare an injured person to cope with setbacks. Inform the patient during the rapport stage that setbacks will likely occur. At the same time, encourage the person to maintain a positive attitude toward recovery. Setbacks are normal and not a cause for panic, so there’s no reason to be discouraged. Learn from injured patients: another good way to help injured patients with injury is to heed recommendations that injured patients have made. Source: Gould, D., & Weinberg, R. (2003). Foundations of Sport and Exercise Psychology. Champaign: Human Kinetics. Micah Holland Rehabworks Summer 2006 Intern
	+ Freedom of Information Act + NASA Privacy Statement, Disclaimer, and Accessibility Certification Editor: Erik Nason NASA Official: David A. Tipton Last Updated: July 18, 2006