Unfortunately, injuries are part of being an athlete and will likely affect the majority of those who participate in organized sports. Sometimes, enduring an injury can sideline you for a few days. Other times, it can take you away from the game for months or even a full season. When athletes are cleared, they are physiologically cleared, meaning they are allowed to go back to full contact and no restrictions because the injury is healed. On the other hand, psychologically speaking, the athlete may not be ready to return. Athletes are typically eager to get back into their sport after an injury. However, when they are finally able to participate again, the feeling isn’t quite the same. When performance isn’t familiar upon return, athletes may be discouraged and upset, which may lead to aggravation and loss of passion for the game. This could lead to depression and anxiety. 

 

In the past, the psychological piece of healing has been severely overlooked, which in turn has the potential to cause the athletes’ performance to be tentative or hesitant when returning to play. Within the last few years, the field of sport psychology has grown substantially. The growth of sport psychology allows for medical professionals and athletic trainers to see the importance of a positive and understanding force to guide an athlete along in the healing process. Sport psychology also provides different techniques that will stick with the athlete even after the individual has recovered from the injury and is ultimately done with the sport. With that being said, it is very important to implement a variety of skills and techniques that can allow the athlete to have optimum performance when the athlete returns to play. An example of some skills and techniques involve goal setting, imagery, relaxation techniques, self-talk, and social support (Kamphoff, 2013).

 

Imagery is a very useful technique in the healing process. Cumming and Ramsey state that imagery is, “…an experience that mimics real experience, and involves using a combination of different sensory modalities in the absence of actual perception”.  An example of this may involve sitting and closing your eyes, imagining you are sprinting after a ball and your knee is stable, strong, and healthy with no pain. It is going through the rehearsal of the skills your mind has already mastered and refined — which is an important component of recovery. An article from Psychology of Sport and Exercise describes imagery as having four different types: cognitive, motivational, healing, and pain management. The imagery that seems the most intriguing in regards to the rehabilitation process is healing imagery and pain management imagery (Wesch, 2016). 

 

Healing imagery symbolizes recovery, meaning that one can picture the body healing (Dworsky & Krane). When imaging healing, it is the process of  “watching” broken bones fuse or muscles and ligaments start to slowly intertwine and become healed. According to AASP, to develop healing imagery, asking oneself a multitude of questions regarding images that associate with injury and pain will imitate the feeling. Therefore, imagining being strong, mobile, and healthy, can allow one to feel healthy (Dworsky & Krane). Imagery is so powerful a technique that it actually allows bodies to heal more quickly and return to sport sooner with less fear of re-injury. Imagery allows individuals to put a positive mental note in their head of healing, getting better, and having an opportunity to perform better than before. This positive mindset allows healing to quicken and confidence to build. 

 

Another type of imagery that athletes’ can use is pain-management imagery. This type of imagery allows an individual to be more aware of what is painful and what is hurting within their body. It allows one to use their mind to imagine the muscles relaxing and being put to ease. Imagine ending a week of hard practice and walking down the stairs is a difficult task. Visualize the tight muscles relaxing and finally being able to sit and stand without wincing in pain. Visualizing the various muscles and fibers relaxing actually leads to tense muscles calming down and reducing pain within your body. AASP mentions that “sometimes it is helpful to distract yourself from thinking about pain (Dworsky & Krane)”. Distractions from pain could consist of visualizing something one thinks is relaxing. For example, laying under the sun or listening to the birds chirp in the morning while drinking coffee. Imagery will differ from person to person, but it can allow you to be calm, collected, and relaxed. 

 

Combining pain and healing imagery allows the athlete to heal more quickly and effectively. Using imagery and medicine can make a world of a difference in the healing process. Imagery itself will not make the injury heal quicker, but using imagery along with a rehabilitation plan will allow the athlete to return to the sport strong and confident. Another piece that sport psychologists touch on with imagery is having a positive outlook and an open mind to imagery itself. Having an open mind and an understanding of what imagery is may make it more effective in terms of the healing process. Imagery is a great tool to use, especially when it is being used positively. Being able to take responsibility, understand the given situation, and be aware of the progress within their rehabilitation program is a big step in the healing process. Being aware and not letting the injury define you or take you away from the sport that is beloved is a great way to have success in the recovery process. The positive thoughts will allow an athlete to become a stronger, more patient, and a more understanding person. 

 

References:

 

Dworsky, D., & Krane, V. (2018). Using the Mind to Heal the Body: Imagery for Injury Rehabilitation. https://appliedsportpsych.org/resources/injury-rehabilitation/using-the-mind-to-heal-the-body-imagery-for-injury-rehabilitation/ 

Tubilleja, K. (2005). Sport psychology strategies, types of social support, and adherence to injury rehabilitation among university student-athletes. Dissertation Abstracts International: Section B: The Sciences and Engineering. ProQuest Information & Learning.

Kamphoff, C. S., Thomae, J., & Hamson-Utley, J. J. (2013). Integrating the psychological and physiological aspects of sport injury rehabilitation: Rehabilitation profiling and phases of rehabilitation. In M. Arvinen-Barrow & N. Walker (Eds.), The psychology of sport injury and rehabilitation. (pp. 134–155). New York, NY: Routledge/Taylor & Francis Group.

Walker, N., & Hudson, J. (2013). Self-talk in sport injury rehabilitation. In M. Arvinen-Barrow & N. Walker (Eds.), The psychology of sport injury and rehabilitation. (pp. 103–116). New York, NY: Routledge/Taylor & Francis Group 

Wesch, N., Callow, N., Hall, C., & Pope, J. P. (2016). Imagery and self-efficacy in the injury context. Psychology of Sport and Exercise, 24, 72–81. https://doi-org./10.1016/j.psychsport.2015.12.007

 

 

 

It was a chilly October night in downtown Boston. I looked around as I walked onto the field for one last time. The leaves on the trees ruffled as the cool crisp air blew through them. The lights of the scoreboard caught my eye as I read off the names of my teammates as they appeared. I looked back and saw my teammates walking behind me listening to their music, laughing, and smiling. Across the field, our bench was filled with posters with the seniors’ names on them and other decorations. I caught myself reminiscing on all I had overcome to get to this point in my soccer career. I thought to myself, “I really made it against all odds.”

 

As a child, I, like so many others, had big dreams of becoming a professional soccer player. I wanted to be the next Mia Hamm; I was a good athlete that might have been able to make it if not for my unfortunate circumstances. Even at a young age my parents and coaches recognized I had the natural ability to be a great soccer player. I was skilled on the ball, an excellent passer, shooter, and most of all, I had a passion for the game. By the age of nine, I was recognized by a scout and joined a premier program in my home state where I was able to further my technical skills and advance my talent. I remember being able to play outside midfield and run up and down the field. I would chase down any ball and felt like I could run forever. 

 

After years of consistently grueling practices, fitness sessions, games, and tournaments, my knees gave in under the pressure. During a tournament weekend, I recall an incident where I slid to make a tackle and something happened at that moment that changed my athletic career forever. I felt sharp, extreme pain coming from my left knee and I was momentarily unable to get to my feet. After analyzing my leg with absolute fear I hesitantly got up and began limping down the field, trying so desperately to continue playing. I was extremely concerned about my chance of recovery from this injury because I could tell how serious it was. The thought that there could be a chance I would never be able to play soccer again terrified me. As with any dedicated athlete, this was my worst nightmare becoming a reality. 

 

Fast forward to my sophomore year of high school; I was a three-sport athlete playing soccer, basketball, and track, as well as playing for my premier soccer team year-round. I had been experiencing excruciating pain in both my knees for a while and finally felt the need to address this with my parents. I did not want to go to the doctor. I was afraid to discover what was actually wrong with me. I knew my knee pain wasn’t going away this time. This persuaded me to make an appointment with an orthopedic specialist. After the doctor examined my knees and took an x-ray, I was told I had a condition called bipartite patella. Even before I knew exactly what that meant, I was petrified. What did this mean for my athletic career? Was I going to be able to continue to pursue my dreams of playing soccer at the collegiate level? A million questions rolled through my head as I waited to discover my fate. 

 

As the orthopedic specialist explained to me, the structure of the knee, and how with bipartite patella the kneecap is made up of two bones instead of one. When you are born, your kneecap is made of mostly cartilage and blood vessels. When you are around three to five years old, the cartilage starts to turn into bone and by the time you are 10, your kneecap should be developed into one piece. Most cases of bipartite patella are considered asymptomatic where it is usually discovered incidentally after getting an x-ray or MRI scan due to a separate injury. Whereas, symptomatic bipartite patella can be caused in adolescent athletes from a specific trauma to the patella or overuse. (Christanio, https://www.healthline.com/health/bipartite-patella). 

In agreement with research presented by Ferrari et al. (2017), I was identified as having symptomatic bipartite patella from experiencing anterior knee pain from overuse. I had the option to either have double knee surgery to correct the abnormality or learn to manage the pain through conservative treatment options. Either way, the specialist told me I should consider putting a halt on my athletic career since that would be best for my knees.

 

I decided to limit my athletic career to just soccer in an effort to reduce the strain on my knees. I was simply unwilling to give up soccer, a sport I had poured my heart and soul into, and something that had come to define me. Somewhat against the doctor’s recommendations, I declined to have the surgery. Being so young when facing the option of double knee surgery was overwhelming. I was afraid that if something went wrong, I would lose soccer forever. As an adolescent, I had always thought overcoming an injury only related to the physical pain associated with the injury. However, there is much more to it. The 2015 World Cup Champion Abby Wambach wrote, “For 30 years, scoring goals was my currency, the one skill I could barter for security and acceptance and love. Rarely did I pause long enough to consider what might come next, and how the shape of my life would look without soccer to fill it up.” (Abby Wambach Facebook page) The problem many athletes have when dealing with injuries is losing their sense of identity, self-esteem, and constructive way of coping with stress during the time they cannot play (Goldberg, 2016).

 

According to Goldberg (2016), the psychological pain of losing everything you worked for, whether it is temporary or permanent, can be more devastating to an athlete than the physical pain associated with the injury. I used soccer as a coping mechanism to deal with anger, stress, or any other negative emotions I felt. I was now faced with the chance of losing a critical piece of my identity. I was always known as the “soccer girl,” and I felt as though if I no longer had soccer, I’d lose my sense of self. The thought came over me, “Who would I be without soccer?” 

 

To answer this, it is important to understand athletic identity, which is defined as how much an athlete identifies with the athletic role and can be conceptualized as a cognitive structure or plan as well as a social role (Horton & Mack, 2000). By high school, if not college, an athlete should have dedicated enough time and have enough psychological commitment to have a strong sense of identification with the athlete role (Johnson & Migliaccio, 2009). A concern to many athletes, including myself, is what to do after an injury when there is an over-identification with the athlete role? Counselors and sports psychologists working with athletes look to interpersonal psychotherapy (IPT) as a solution because it focuses on how identity influences a person’s roles and relationships. This framework can help athletes who strongly identify with the athletic role cope with a temporary injury, permanent injury, and even retirement from sports. 

 

Having a sense of over-identification towards the athlete role can have negative consequences in regards to one’s social well-being and identity as a whole. Obtaining an injury can lead to social isolation from teammates and retirement from sports, whether it is chosen or forced due to injury. It can also lead to grief and depression. Another adverse effect of having a strong sense of identification with the athlete role relates to help-seeking behavior. Steinfeldt et al. (2009) found help-seeking behavior was the most stigmatized for football players who have the strongest sense of identification with the athlete role. 

 

A tragic example portrayed by Hochman (2010) is the suicide of professional football player Kenny McKinley, former wide receiver for the Denver Broncos. McKinley was depressed over several knee injuries that occurred over a period of eight months and had made statements about not knowing what to do without football. The isolation athletes (who strongly identify with the athletic role) experience resulting from injury can have devastating effects when not treated. Interpersonal psychotherapy can help athletes deal with their losses and hopefully prevent any future situations similar to that of McKinley by exploring the grief the individual experiences, discussing role transitions, and role disputes. (Heird & Steinfeldt, 2013)

 

When dealing with a condition like bipartite patella, it is important to be resilient and to overcome adversity. There were many times on the field that my knees hurt so bad I felt like I could not continue playing, but because I was resilient, I learned to acknowledge the fact that I do have limitations now. Also, I learned it is okay to accept the emotions you are feeling in regards to the injury — anger, sadness, and disappointment are all common and completely normal feelings. Accepting negative emotions allows you to grieve with the loss or change you are facing and is part of the process of overcoming those feelings. Most importantly, remember that you are not alone in your recovery process! Your family, friends, teammates, and coaches are all there to support you no matter what. Feel no shame in confiding in someone for support, because at the end of the day, it will benefit your physical and emotional recovery. 

 

During my ongoing recovery, I used sports psychology to change my mindset and chose to focus on process-oriented goals; i.e. making an accurate pass or having my mark on defense. Goldberg (2016) concluded that changing your mindset and recognizing more realistic or attainable goals for yourself allows for more reward once you reach the goal you set. Instead of focusing on limitations, I focused more positively on the task I needed to complete and made sure I did it. Trust me, the feeling of achieving a goal you set, no matter how small, is enough to keep you motivated to set more goals along the way. Nothing about recovery is easy, but it is important to be positive, patient, and have trust in the process! 

 

Since discovering I have bipartite patella I have had a great soccer career: being on the starting lineup for my high school varsity team freshman to senior year, having a wonderful 10-year experience playing premier with teammates, I was able to grow and develop skills with, and more recently, finishing my soccer career as a Division III athlete where I played in every single game of my four years on the team, as well as receiving athletic honors. I hope you are able to learn that if you are resilient and work with your condition using sports psychology, there are ways to persevere and deal with the long-term effects of injuries so you can continue to do what you love. 

 

I think back to my senior night. During the national anthem, I felt butterflies in my chest for the last time ever and smiled as I thought back on the journey that had got me to that point. During the game I played well, I focused on the task at hand despite the distractions like the internal emotions or any discomfort my knees were giving me. Finally, I heard the final whistle blow and the game came to an end. I was so lucky to have this amazing opportunity and be able to continue on with the journey I started when I was just five years old. In the world of athletics where an injury is so common, resilience is possible — you just need to learn how to cope with the physical and psychological aspects in a way that works best for you.

 

 

 

As a kid who grew up in Mason, Ohio, I have always eagerly and impatiently waited for the month of August to approach — a time of year when the Cincinnati suburb fills with energy and excitement as the world’s top tennis professionals flock to the area for the ATP World Tour event. I have had the privilege of watching these elite athletes perform on court for numerous years at the Western and Southern Open tournament, which is hosted within just a five-mile radius of my house. As a young, novice tennis player sitting in the stands, I remember watching in awe hoping to acquire their skills, strokes, and strategy — it was not until my more recent years that I realized it was actually their mentality that I should have been striving for.  

Every sport has its unique physical challenges, but there is one challenge that all athletes face: the mental game of sports. This sports psychology component is critical, and it became evident to me when I signed to play Division I college tennis. I had entered a playing field where everyone’s skill set had mostly leveled out and it was an athlete’s mentality that prevailed to be the differentiating factor. I learned that the mind could serve as a hindrance or a competitive edge and make the difference between a win and a loss.

Unfortunately, the mental aspect of sports is often overlooked by the technical, tactical, and physical side. In addition to the importance of training one’s body, it is essential to train one’s mind to obtain optimal performance. Achieving inner excellence is a process — building mental muscle, just like acquiring any other skill, requires time, effort, and commitment. The more an athlete works on their mental skills and inner processes, the more it will show in their outside performance, given that the way one thinks affects how one acts (Mack & Casstevens, 2002). Athletes can take their game to the next level by choice by learning to control and use their minds to their advantage rather than letting their minds control them and serve as a disadvantage. 

Understanding the importance of the mind as a weapon was not achieved solely on my own — it was catalyzed by my coaches and mentors who not only helped me rebound from defeat, but also provided me with the mental skills and strategies necessary to enhance my performance on a daily basis. Over the years, I have learned, developed, and applied several of these sport psychology skills and strategies in aims to optimize my athletic success and assist others. As a recently retired collegiate tennis player looking back at the mental skills I added to my repertoire, I found that “playing to progress” and “playing in the present” were vital mentalities to embrace in reaching peak performance. 

One of the most common questions an athlete comes across is “Did you win?” It is undeniable that we live in a society where athletes are defined by numbers — performance stats, rankings, wins, and losses. Societal pressure creates a tendency for athletes to be outcome-oriented rather than process-oriented. Outcome goals are the results people would like to achieve and are not in an individual’s control, while process goals are the action steps that are taken to help reach the desired result and are in an individual’s control (Taylor & Wilson, 2005). Outcome goals are important in recognizing one’s desired destination, but focusing on the processes day in and day out is what will lead to reaching that destination.   

Athletes are inclined to have an outcome focus over a process focus for two main reasons: people are wired to be discontent with the present and have a desire for a better future, and because results are easier to measure and evaluate (Taylor & Wilson, 2005). This human tendency in culmination with societal pressures leaves athletes susceptible to direct their focus on outcomes such as beating an opponent, winning a tournament, or attaining a ranking as opposed to focusing on the process that will get them there. Having an outcome focus interferes with reaching the outcome by diverting focus from the actions that will encourage peak performance and lead to the desired results. There is no denying that good results are necessary for being a successful athlete, but it is important to recognize that the best way to attain those results is by not focusing on results and focusing on the continuous process that will enable performance and progress instead. 

Novak Djokavic, a top-ranked ATP player stated, “We don’t know how much we can really achieve until we have this kind of mindset of wanting always to evolve and improve.” Players on the pro tour will rarely speak of their desire to win a tournament or attain a certain ranking, but rather, they talk about wanting to continuously progress and improve their game. This process-oriented over outcome-oriented mindset is what gives these professional athletes their best chance to reach their desired results. In order to achieve a process-oriented mentality that fosters the idea of “playing to progress,” it is important to embrace the mindset of “playing in the present.”

No one is usually harder on athletes than the athletes themselves — often dwelling on past failures and future results. It is easy to linger over a lost match, a missed shot, or a careless error and to feel pressure to please a coach or parent, earn a scholarship, or win a title. But sports psychology tells us that this is a detrimental mindset to performing one’s best. If a player comes to the court thinking “If I don’t win this match my coach is going to take me out of the lineup,” their focus isn’t on the task at hand, which is where it needs to be. 

The overwhelming thoughts revolving around past mistakes and future outcomes deter focus from the present moment. The present moment is where athletes perform their best because there is no pressure in the present moment. Pressure stems from anxieties about the future and remembered setbacks from the past (Mack & Casstevens, 2002). Athletes are also more likely to have optimal performance when they are in the present because they have a sense of control, whereas an athlete has no control over past or future occurrences.  Athletes often find it difficult to focus on the present due to ideals promoting perfectionism and high expectations (Taylor & Wilson, 2005). In order to counteract a poorly focused state, athletes should direct their minds towards one essential question: “What do I need to do now to perform my best?” 

When the Western and Southern Open tournament begins, the players aren’t at the Roger’s Cup tournament that just finished or at the US Open tournament which shortly proceeds, they are within the perimeters of the Lindahl Family Tennis Center in Mason, Ohio on their respective courts. These professional players often talk about not only playing it “one match a time,” but “one point at a time” — they are playing in the present. 

As I go back home to Mason this August and the countless years to come for the ATP event, I will continue to watch with the same excitement as I did growing up, but this time with an appreciation and awareness for the distinguishing factor that brought these world-renowned athletes to the center stage — not their strokes and skills, but their mentality. 

 

References

Mack, G., & Casstevens, D. (2002). Mind gym an athlete’s guide to inner excellence.

Lincolnwood, IL: Contemporary.

Taylor, J., & Wilson, G. (2005). Applying sport psychology: Four perspectives. Champaign, IL:

Human Kinetics.