Topics: Psychology of Injury
Impacted sports: Applicable to nearly all athletes returning to play after injury
Researchers: Leslie Podlog, James Dimmock, and John Millera
Universities: Texas Tech University, University of Western Australia
Intro
Your star athlete suffers a dramatic injury. Doctors appointments. Surgery. Rehabilitation. Slow progress. Eventually, they start practicing. They’re moving and playing in practice like they used to. Maybe it’s all coming back. Finally, they are “medically” cleared by the physical team.
In their first competitive outing, they look like a shadow of themselves. You decide to give it time but time doesn’t help. What gives? You can almost see the stress in their face while competing.
In their 3rd week back, they re-injure themselves.
The logic is simple: once the body is healed, normal performance will return. Right?
Wrong.
This actually plays out in the research. Podlog et al. (2010) conducted a review to examine what athletes actually experience when returning to sport after injury—not just physically, but psychologically.
5 common concerns reported by athletes
Podlog and colleagues identify 5 recurring concerns in athletes returning to competition and training:
Re-injury anxiety: fear that the previously injured body part will breakdown again—even after being medically cleared
Worry about reaching pre-injury levels: doubts about speed, strength, skill and overall effectiveness
Isolation and loss of athletic identity: disconnection from teammates or the feeling of not being sure who they are without their sport
Pressure to return: fear that they will be forced to play before they are ready—comes from teammates, organizations, coaches. More prevalent where million dollar salaries are involved
Self-presentation: fear of appearing unfit, unskilled, or “just not the same.”
These are not rare, edge-cases ; they’re reported across sport and levels of competition.
How does this affect performance?
Podlog and colleagues draw on the Stress-Injury Model (Williams & Andersen, 1988) and its various offshoots to explain how this impacts athletic performance. There are a few psychological processes at play but in general:
Attention tends to narrow
Timing and coordination can struggle
Movements can be executed with hesitation
Decision-making becomes more cautious
Podlog and colleagues note that these attention and muscular disruptions explain two common outcomes observed after returning to sport:
Reduced performance quality
Increased likelihood of injury
Real world example from the National Football League (NFL)
The authors reference research from the NFL which aligns with this explanation. NFL players returning from serious knee injuries demonstrated significant declines in performance statistics after return to play. They write:
Running backs and wide receivers exhibited a 33% drop in rushing and receiving yards as well as touchdowns on their return. Although the researchers proposed several suggestions such as loss of strength, de-conditioning, and reduced proprioception, an alternate explanation may be that re-injury anxieties influenced athletes’ attentional focus and created a sense of hesitation.
Limitations
This paper is a review. It’s not an experiment.
Additionally, post-injury outcomes are always multi-factorial.
That being said, the consistent narrative that shows up again and again in this area of sport and performance psychology research is that psychological readiness is often not considered when making return-to-play decisions.
How to help injured athletes (your takeaway)
Podlog et al. make a core point:
Return-to-play decisions are usually made on physical readiness alone. But performance in competition depends on psychological readiness.
Their review shows that athletes often return to competition while managing fear of re-injury, doubts about personal level, and other pressures. When those concerns are present, attention can be stolen away to non-optimal factors during performance.
From a practical standpoint, this means physical and athletic staff and coaches should ask more than “is this athlete’s body ready?” And more:
Does the athlete trust themselves and their body?
Do they feel rushed or autonomous?
Do they feel connected to their role and their environment?
Authors note that when these questions are not addressed, performance can be lower and re-injury risks are higher. Even after medical clearance.
The authors also suggest to lean into Self-Determination Theory (Deci & Ryan) to help athletes through the rehabilitation and return to play process. Competent Mental Performance Consultants and Sport Psychologists can guide athletes through applying this theory. See the below chart, taken from the study, for a non-exhaustive list of how Self-Determination Theory can be applied to improve athlete’s return-to-play experience.
Final takeaway: being “medically cleared” is not the same as being psychologically read.
For many programs, this is where integrated mental performance support becomes less of a luxury and more of a missing piece in the return-to-play process.
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Reference
Podlog, L., Dimmock, J. A., & Miller, J. A. (2010). A review of return to sport concerns following injury rehabilitation: Practitioner strategies for enhancing recovery outcomes. Physical Therapy in Sport, 12(1), 36–42. https://doi.org/10.1016/j.ptsp.2010.07.005
