Sport is inherently dangerous and as such the risk of injury exists. On occasion, this injury may be traumatic and may be cause for an athlete to fall under the diagnosis of acute stress disorder. According to the DSM-IV (2000) acute stress disorder occurs after an extreme traumatic event. There are a number of symptoms such as anxiety, detachment, re-experiencing the event, and interference with normal functions. This can last anywhere from 2 days to 4 weeks; any longer and the DSM-IV suggest that a diagnosis of posttraumatic stress disorder may be prudent. The athlete may feel a sense of hopelessness or despair that may lead to the additional diagnosis of major depressive disorder. The injury may be so severe the athlete may also have suicidal tendencies and engage in impulsive and risky behavior. “Symptoms can also occur after an extended time period and are then referred to as delayed post-traumatic stress disorder.” (Asken, 1999, as cited in Ray and Wiese-Bjornstal, p. 300).
Some of the signs to consider are:
1. Avoiding or withdrawing from the sport
2. Diminishing interest in social groups or co-workers
3. Performance in work, sport, or rehabilitation is lacking
4. Reoccurring thoughts or visions of the injury or events leading up to the injury
5. Zoning out
6. Decrease in motivation within and outside of sport
7. Difficulty feeling rested after sleep
8. Feelings of how could the injury or event could be avoided
In a rehabilitation setting, coaches, trainers, teammates, and other social support groups should understand that an athlete who has experienced a catastrophic injury may show some of the above signs and symptoms and they may be in need of psychological interventions. The support from those important to the athlete is vital as they progress through their rehab process as they transcend through the healing phases. The healing phases according to Flint (as cited in Pargam, 2007) are acute or inflammatory, fibroblastic, maturation phase, as well as discharge parameters and prehabilitation. Macro and microtramatic injuries relate to the acute phase due to the cause of the injury. Flint also states, macrotrauma is caused by a specific event and is easily identified, while microtrauma is caused by small amounts of injury over time and is not quite as noticeable, such as an overuse injury (as cited in Pargma, 2007).
The acute phase can last between two to four days and during this time the body works to manage the damage caused by the injury. The key signs of this phase are inflammation, heat, and skin color changes (Flint, 2007). During this phase, the athlete should begin to form a support group with others who are also injured. This group discussion could help athletes empathize with each other and allow for them to talk about their frustrations. According to Sternberg, video games or other forms of friendly competition introduced during rehab may reduce the pain by interrupting the pain sensors (as cited in Pargma, 2007). Other forms of pain reducing techniques include the use of imagery, distraction, or for some athletes, focusing on the pain.
The second phase of healing is the fibroblastic phase and may begin five days after the injury until three to four weeks. During this phase tissue is being created to heal the injured site. The athlete may believe they are ready to return to their sport because they are feeling better and injury site has a visual improvement. This may be frustrating to the athlete because the progress during this phase may be minimal and to aid the psychological wellbeing of the athlete, goal setting should aid in their recovery and put boredom at bay. Coping cards, cognitive behavioral therapy (CBT), imagery sessions, progressive muscle relaxation, and a dysfunctional thought record (DTR) may be implemented in their rehabilitation. It may be necessary to work with the athlete by discussing the pros and cons of the coping card, when they should be read, and the automatic thought generated (Beck, 1995). Additionally, the fibroblastic phase is “a perfect time for a psychological strategy called Rational Emotive Therapy or ABCDE technique” (Flint, 2007, as cited in Pargman, 2007, p. 329). This type of therapy is very similar to CBT by recognizing the stressors (antecedents) and disputing the irrational beliefs or thoughts associated thereby changing the behavior or outcome.
The final phase of the healing process is the maturation phase, and can last up to 18 months. The major characteristic of this rehabilitation phase is the sport specific rehab which develops range of motion and strength. During this phase, psychological interventions such as goal setting should be revisited as the athlete prepares to reenter their sport. Depending on the severity of the injury and the recovery time, expectations of their performance should be discussed. The athlete needs to be patient with the rehab and understand it is a process and they may encounter setbacks. If they do encounter setbacks, the coping strategies and anxiety reduction techniques implemented during the fibroblastic phase should be continued.
Prehabilitation is the period of time between the injury and surgery, and can be very frustrating for the athlete. They may feel as though there is no point in doing rehab only to have surgery and go through rehab again (Flint, 2007 as cited in Pargam, 2007). The support group as well as the professional should emphasize the importance of adhering to the rehab program and how it will relate to them getting back on the field. If the injury is career ending, the support groups will be very important and should consist of other athletes in a similar situation. This support will be a valuable tool in their healing process.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Asken, M . (1999). Counseling athletes with catastrophic injury and illness. In R. Ray and D. Wiese-Bjornstal, (Eds.), Counseling in sports medicine, (pp. 293-309). Champaign, IL: Human Kinetics.
Beck, J. (1995). Cognitive therapy: Basics and beyond. New York, NY: The Guilford Press.
Flint, F. (2007). Matching psychological strategies with physical rehabilitation: Integrated rehabilitation. In D. Pargman, (Ed.), Psychological bases of sport injuries (3rd ed.), (pp. 319-334). Morgantown, WV: Sheridan Books.
Sternberg, W. (2007). Pain: Basic concepts. In D. Pargman, (Ed.), Psychological bases of sport injuries (3rd ed.), (pp. 305-318). Morgantown, WV: Sheridan Books.