Sports Medicine Research: In the Lab & In the Field: The Power of the Mind May not be as Well Utilized as it could be (Sports Med Res)


Wednesday, July 1, 2015

The Power of the Mind May not be as Well Utilized as it could be

Athletes' use of mental skills during sport injury rehabilitation

Arvinen-Barrow M, Clemen D, Hamson-Utley JJ, Zakrajsek RA, Lee S, Kamphoff C, Lintunen T, Hemmings B, and Martin SB. J Sports Rehab. 2015. 24, 189-197.

Take Home Message: Of 1283 survey respondents, only 27% of athletes reported using mental skills such as goal setting, positive self-talk, imagery, and relaxation. Of the 249 respondents who used mental skills 72% reported they felt it helped expedite their recovery process.

The use of mental skills (e.g., imagery, goal setting) during rehabilitation from injury is beneficial to athletes. Clinicians could optimize and integrate mental skills into rehabilitation programs if they better understood what skills are most utilized, and who teaches these skills. Therefore, Arvinen-Barrow and colleagues completed a cross-sectional survey study to determine what mental skills are used during rehabilitation, and who taught the athletes the mental skill. The authors surveyed a total of 1283 athletes (62% male, 12 to 36+ years of age, 699 American, 584 European) ranging from college student-athletes to elite athletes. The survey was changed to include language which was most familiar to surveyed athletes (i.e., physiotherapist for European athletes, athletic trainer for American athletes) and included both open-ended and close-ended questions. Overall 346 (27%) of athletes responded that they have used mental skills during the rehabilitation of an athletic injury. Of these 346 athletes, 249 (72%) responded that using mental skills helped them recover faster. A significantly higher number of American athletes reported using mental skills than European athletes (33% versus 23%). The top mental skills reported were goal setting, positive self-talk, imagery, and relaxation (47%, 33%, 32%, and 24% respectively). Respondents further reported that sports medicine personnel (athletic trainers and physiotherapists) were most likely (28%) to teach athletes to incorporate mental skills into their rehabilitation. Other sources included coaches (15%), themselves (8%), family members (8%), and sports psychologists (3%).

Overall, the survey results of this study present some interesting information for clinicians. Firstly, a relatively low number of athletes reported using mental skills. This result is especially interesting when one considers that a high percentage (72%) of those who used mental skills felt it was beneficial to their outcomes. Furthermore, sports psychologists, the professionals most equipped to teach and help athletes hone mental skills, were the lowest reported source of training. This is most likely due to limited access to sports psychologists. Also of note, sports medicine professionals were the most common source of teaching mental skills despite little or no standards of training in teaching mental skills. Therefore, the current study suggests that injured athletes may benefit from professional help with mental skills. Thus, sports medicine personnel may want to consider having a certified sports psychologist as part of their sports medicine team. Furthermore, sports medicine personnel may also benefit from seeking continuing education opportunities that would better equip them to teach mental skills.

Questions for Discussion: Do you incorporate mental skills into your rehabilitation programs? What kind of access do your athletes have to certified sports psychologists?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

Related Posts:
Are We Doing Enough to Plan for How Injuries Affect Players Later in Life?

Arvinen-Barrow M, Clement D, Hamson-Utley JJ, Zakrajsek RA, Lee SM, Kamphoff C, Lintunen T, Hemmings B, & Martin SB (2015). Athletes' use of mental skills during sport injury rehabilitation. Journal of Sport Rehabilitation, 24 (2), 189-97 PMID: 25996227


Candace Bernitt said...

Sports psychologists are not always easily accessible in sports medicine clinics. This is unfortunate, as implementing mental skills into a rehabilitation plan has shown promising results. Because this is not a resource that is readily
available, it will be important for us as athletic trainers to incorporate strategies that are familiar to us such as goal setting. From my experience, something as simple as setting short-term and long-term goals can positively influence the athletes rehab. This is because goal setting allows them to see their own progress, which can contribute to a positive outlook on the situation.

Christina Hollis said...

Not often enough do I try and use mental skills to help facilitate rehabilitation. It is more common in the long term rehabilitation such as post-surgery that I will try and use goal setting and positive mental imagery to help the athlete. I wish we as Athletic Trainers had more eduction on the use of mental skills during the rehabilitation process, even for the more short term injuries. My athletes at the college setting have a sport psychologist available to them, but at the high school setting not so much. In the high school athletes can utilize the guidance counselors and school psychologist but they may not fully understand the difficulties an athlete is having. I think sport psychologist are especially important during the concussion rehabilitation process.

Jeffrey Driban said...

Hi Candace and Christina: Thanks for the comments. I think the use of goal setting is a great idea with our patients. Christina, I think you make a good point that sports psychologists may be beneficial not just with musculoskeletal rehab but also after concussions. Hopefully, in the future we'll have better access to sports psychologists and have more training in these areas.

Mark Colapietro said...

Goal setting can have a large impact during the rehabilitation process and should be utilized more by clinicians. As a clinician, I work with my athletes to set realistic goals in the short and long-term (especially during long rehabilitation processes), simple breathing exercises to promote relaxation, and positive encouragement whenever applicable. I have seen great results with athletes who implement these strategies on a regular basis. It is always best to remember you are treating the person, not the injury all the time.
Reflecting on my experiences previously at the college level, the university was lucky enough to have access to a sport psychologist that was available to meet with all student-athletes whenever needed. Unfortunately, that is not the case in most college settings, so the athletic trainer may be put into a situation to provide what help he/she can before referring for severe cases of psychological distress. In the high setting, athletic trainers should develop a working relationship with guidance counselors/high faculty members to develop plans whenever a student is demonstrating psychological problems.

Ryan Eddy said...

Many athletic trainers who are not working at the collegiate or professional level do not have easy access to a sports psychologist. With that in mind, it is good to see the results of patients who use mental skills during rehab. Since we can see that patients have improved outcomes, athletic trainers should learn how to teach mental skills to their athletes. These mental skills could increase outcomes with our own teams. I also believe that the athlete has to trust that the mental skills will work. If an athletic trainer can show that it worked for just one teammate, it will be able to send a ripple effect through the team and the team could begin seeing small increases in rehab time.

Matt Kneece said...

Previously in my experience, sports psychologist staffs have not been available to athletes. It is our responsibility as clinicians to instrument these mental skills because these are skills that play an important role in rehabilitation, sport, work and life in general. Rehabilitation offers a safe environment for one to practice these skills while becoming comfortable with the mental and physical gains they may experience with mental skill use.

Chris Donner said...

Especially in athletes with long term injuries, mental skills can definitely help them get through their rehab. If an athlete has a better outlook upon their injury and their rehab, they they are more likely to complete it and return to play. Sports psychologists can be helpful with this process, but are not always readily available to athletic trainers. Even in saying this, athletic trainers can help their athletes by using mental skills. Using verbal cues and goal setting can help keep an athlete focused on their rehabilitation.

Sarah Hontz said...

Athletic trainers are trained in basic mental skills that can help athletes during the rehabilitation process. While I am a big supporter and use mental skill training in my clinical work, it is extremely underutilized across the profession. One question I have is did the study look at specific sports and the willingness of the athletes to use the mental skills? I ask because in my practice I have found that certain sports are more open to it then others but I was wondering if this came up in the research?

Kyle said...

Thank you Mark, Ryan, Matt, Chris and Sarah for your comments. I think the resounding comment I see here is the lack of access to sports psychologists which other have commented about as well. I too have found access to sports psychologists a hurdle in getting my athletes the well-rounded treatment they need.

Sarah, you point that athletic trainers are in fact trained in basic mental skills is very accurate and a good one. While we have the skills, do you feel that during our academic and clinical education we are trained enough? Knowing the value of mental skills perhaps we could use more time and encouragement to use these skills.

Mark, I would also like to point out your comment which I found particularly poignant. As you said we as clinicians are treating the person, not the injury. This is an excellent point and as someone who interact with athletic training students, I do my best to remind students of that often. Each patient is different, has a different approach to dealing with the injury and thus needs a specific and individualistic treatment plan. Thank you for bringing up a simple, but very important point. I also enjoyed what you said about seeking to make relationships with your school's counselors. This is a excellent idea. Depending on your setting, other professionals may also be able to help. I know in my past experiences, I have also looked to academic advisers and other faculty help students in times of need.

Overall, I think many athletic trainers have the same experience of understanding and desiring the help of a experienced sports psychologist but lacking proper access. Although this problem does exist, I think some good ideas to help navigate have been surfaced here.

Jessica Schwegler said...

I believe this blog shows somewhat of a relevance to the nature nurture issue. Not so much as in young humans but just as an environmental standpoint. Athletes have different statuses of recovery given different uses of mental skills. If they are using their mental skills and seeing quicker recovery time then somehow this has an effect. They are not simply using the nurture they have built throughout life in order to recover and repair themselves mentally and physically. Use of their nature, or environment, has be used and adapted in order to increase their likeliness of recovery at a faster pace.

Kyle said...


That is a very interesting point you make. I would be very interested in seeing a study which looks at 2 different clinic environments. One which teaches and encourages the use of mental skills and another which does not. This would give us a better understanding how much of an affect the environment has in this situation. Thanks for the comment!

Brandi Weaver said...

It is very interesting to see that such a high percentage of athletes who used the technique of mental skills felt it was beneficial, but that such a low percentage of athletes have actually used mental skills in their rehabilitaion programs. The undergraduate program I attended for athletic training required us to take a class called Mental Training. Our professor was a sports psychologist and she taught us some techniques for working with the athlete's, such as mental imagery and positive self talk. That being said my knowledge from this course did not instill in me the confidence to use such formal mental skills training with my athletes and access to a sports psychologist is hard to come by.

I know there are many athletes out there already using mental tactics like imagery and positive self talk to improve their game performance. Drawing an inference based off this it would make sense to believe that mental skills would be particularly beneficial in the rehabilitation process. Although anectodal it may be worth the try.

I agree that it would be interesting to see a study which looks at 2 different clinic settings where one encourages mental skill use and the other does not. Even without a study like that and just from this current one, I am more inclined to read other studies on the use of mental skills and to introduce the idea to athletes I am working through rehabs with. If this is a strategy where the majority of users thought mental skills were beneficial to them, I think that holds merit. Psychology is a large part of sports, some more than others, but still an important aspect. Many of the modalities used in rehab programs seem to utilize the placebo effect and therefore if the client feels it works, it may be worth the effort.

Kyle said...


I agree with your points. I too had some introduction to the information and concepts behind mental imagery, but would not feel confident enough to implement them myself. I think something else to look for that would also be highly interesting in this discussion is which mental skills are most effective compared to others. This would also help clinicians and clinical education focus on the skills that would most likely lead to the best outcomes.

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