A Systematic Review of the Psychological Factors Associated with Returning to Sport Following Injury
Ardern C, Taylor N, Feller J, Webster K. Br J Sport Med 2012; 0: 1-8
An often overlooked aspect of a clinician’s responsibility is to manage and mitigate an athlete’s psychological response to injury throughout the rehabilitation process, which is often associated with tension, low self-esteem, depression, and anxiety. Self-determination theory has been applied to identify factors that may influence an athlete’s psychological response, particularly emphasizing the basic needs of autonomy (motivation), competence (fear and confidence), and relatedness (social belonging). When all three needs are met, self-motivation and psychological development are augmented and may complement our physical rehabilitation to influence a successful return to play. Ardern and colleagues performed a systematic review to evaluate if psychological factors are associated with returning to sport within the context of self-determination theory. The authors used nine electronic databases to identify studies in which participants were evaluated following a sport-related injury, participated in rehabilitation, return to sport rate was reported or could be calculated, and data were reported for at least one psychological variable. Based on these criteria, 11 articles were eligible for full review and included in the systematic analysis, totaling 983 athletes and 15 psychological factors. The authors found that the three central needs of self-determination theory were related to return to sport (autonomy, competence, and relatedness). Positive responses such as motivation, confidence, and low levels of fear were associated with better return to sport outcomes. Fear associated with re-injury and return to sport persisted over time despite a decline in other negative emotions throughout the rehabilitation process.
While not always addressed, these results suggest that it is imperative for clinicians to consider the psychological response of athletes not just post-injury, but in anticipation of return to sport as well. The intention of sport-specific tasks and rehabilitation techniques should not just be about the preparing the athlete for the physical demands of competition but also reducing fear and anxiety that the athlete may possess related to their ability to perform the task and/or risk of re-injury. Setting goals for the athlete that allow them perceive their return to sport as positive may reduce fear about their first few times back to competition. How do you manage an athlete who is fearful about return to sport? Do you address psychological factors throughout your rehabilitation process with an athlete?
Written By: Laura McDonald
Reviewed by: Jeffrey Driban
Related Posts:Ardern CL, Taylor NF, Feller JA, & Webster KE (2012). A systematic review of the psychological factors associated with returning to sport following injury. British Journal of Sports Medicine PMID: 23064083