Injured Athlete’s Perceptions About Social Support
Clement D, and Shannon VR. J Sport Rehabil. 2011 Nov(20): 457-469.
Approximately 17 million sports-related injuries occur annually in the United States and while these injuries inflict physical harm there are also psychological ramifications to dealing with these injuries. While some research has been done on this subject, only 2 studies have specifically assessed the perception of social support among injured athletes during the course of rehabilitation. Therefore Clement and Shannon, completed a study to determine injured athlete’s perceptions regarding satisfaction, availability, and contribution for 8 types of social support (i.e., listening support, emotional support, emotional-challenges support, reality confirmation, task-appreciation support, task-challenge support, tangible support, and personal assistance) from coaches, athletic trainers, and teammates. A total of 49 injured student-athletes (27 women, 22 men) from 1 of 2 Mid-Atlantic universities (NCAA Division II = 24 athletes and Division III = 25 athletes) took part in the survey study. Of the 49 participants, 22 reported their injury as “severe,” although this was not defined. Athletes were given a modified version of the Social Support Survey by certified athletic trainers at both institutions. The modified Social Support Survey was adjusted to examine social support from 3 sources (athletic trainers, coaches, and teammates) using 72, 5-point Likert-scale items (the validity of the modified instrument was not reported). Perceived social support from athletic trainers was statistically higher in terms of satisfaction, availability, and contribution compared to social support from teammates or coaches.
Overall this study highlights how valuable athletic trainers are not only as care givers, but as a source of social support to injured athletes. It was suggested by the authors that the reason for these findings may be that “athletic trainers work exclusively with injured athletes from their initial injury until they are allowed to return to unrestricted activity.” While athletic trainers were the primary healthcare professionals observed in this study, this reasoning suggests that all healthcare professionals play a critical role in helping athletes cope while they are injured, particularly clinicians with regular sessions with patients (e.g., athletic trainers, physical therapists). It will be interesting to see future studies elaborate on this finding especially when the surveys are provided by individuals that are not sources of social support (e.g., athletic trainers). Regardless this data suggests that we should consider including more extensive training in dealing with emotionally issues that an injured athlete may face. What do you think? Have you found yourself providing social support for your injured athletes, who may not be getting such support from friends, family or coaches? What is your educational background in dealing with these problems? Would you be interested or have already taken courses in how to help injured athletes through the difficulties of an injury?
Written by: Kyle Harris
Reviewed by: Jeffrey Driban
Clement D, & Shannon VR (2011). Injured athletes’ perceptions about social support. Journal of Sport Rehabilitation, 20 (4), 457-70 PMID: 22012499
While some principles of counseling/social support were provided in my undergraduate education, I found myself unprepared for the large social support role I have played since. I work at a military school where the emotional/psychological needs of my athletes are far greater than any other setting I have worked in before. The restrictions placed on incoming cadets also limit their access to the usual support system of family and friends. Even when my athletes are physically healthy they come to me with their personal struggles (in varying degrees of severity). As athletic trainers, we are often the first people to see our athletes, and it is important to have a solid understanding of how to provide social support. I think this is a skill that should continue to be further emphasized in education programs.
As a newly certified athletic trainer, I'm truly being exposed to the mental aspects of this profession. COmparing this experience ot my undergrad, it has changed so much. As an undergraduate, we were viewed as friends who happened to know what was going on with our athletes. Making the jump to being in the authoritative position of the sole health care provider changes that relationship. I want to be theri friend, their support system. But I also recognize that there needs to be boundaries. This article makes me feel alittle bit more comfortable with balancing those two aspects of the profession. Being someone that our athletes can trust, but also being more of an authoritative figure as opposed to an equal is an important balancing act for the athletic trainer.
I believe that the psychological component of working with athletes is truly a skill that only comes with experience. Athletic trainers have to work a delicate balance of keeping student-athletes strong both mentally and physically. Usually athletic trainers are one of the first people that have to give unwanted news when injuries occur, as most athletes don't want any answer other than everything is fine and you can return to play. But on the other side, athletic trainers are also the support that assist with many athletic career and potentially life altering decisions. How many times do our athletes, parents of athletes, and coaches come into our office to discuss surgery or rehabilitation options? I have had other experiences where athletes have talked to me over transferring due to unhappiness at schools. I have even had the ill fortune of experiencing the moments when careers were ended whether from injury or organizational management. Nothing prepares athletic trainers for those types of situations but the relationships bonded with athletes formulate these social ties. I, as many other athletic trainers have spent numerous trips to emergency rooms, staying in the office an extra 30-45 minutes, or come in an unexpected times for athletes. Most athletes acknowledge and respect the time, effort, and energy that we provide them, and that trust and respect for us at professionals and individuals is what allows that network to take place.
I am glad to see new research about this topic because it is one commonly discussed among athletic trainers, especially in the collegiate setting. For as much time athletic trainers spend with injured athletes, it isn’t hard to believe we are a form of social support. It is also encouraging to see that athletes think we are a good form of support. I think it is important athletic trainers are well educated in understanding the psychological aspects of injury, but we must understand the scope of our practice (which varies among ATs). Personally I am comfortable listening and offering suggestions for minor issues such as remaining part of the team, but often encourage athletes to seek the guidance from a sports psychologist or counselor for more advanced help. Education for athletic trainers should focus on the best way to refer athletes without making it seem as though we are trying to “pawn them off” of label them as “crazy.” Also continuing education on motivation during rehab periods and ways to keep mentally and physically involved with their normal activities.
Great post! You certainily bring another element into the discussion. What about different settings? Certainly there are elements of a specific setting which lend its own complications. As I have learned at a community college, many of my athlete's issues lie with insecuritites about being in a community college rather than at a 4 year institution, or with issues happening in the home environment since many athletes are still living at home. I too found myself a little unprepared at first because much like you eluded to, I come from a different educational background and up-bringing. I too would like to see this emphasized more in an ATEP's.
Great point. Whenever we discuss the issue of support and being involved in a support system, we must also be wary of boundaries as we are part of the institution. I make a concerted effort to use phrases like "from my experience" and "I've dealt with something like this before." I find that phrases like that show the athlete that I understand what they're going through, but I also feel it gives them a sense of those boundaries when they see that I have professional experience in dealing with injuries and coping mechanisms. What have you found in your experience that helps you set boundaries but also makes a connection with the athlete in distress?
Interesting comments. Expereince is key. Even in this string of comments we see athletic trainers at all points in their careers, who are constantly concerned about the psychological aspect of our athletes and how to deal with them. I think as clinicians we can all remember the first time we have given unwanted news to athletes. I agree with you that experience is crucial to this. I think it parallels with being able to read athletes and different personality types. In my undergrad experience I was fortunate enough to take a class dealing with the psychological aspect of injury. The greatest piece of information that I took away from that course was how different personality types and identifiers cope. Athletes who see themselves solely as an athlete and have apirations beyond their present situation will deal much differently with unwanted news than someone who understands that their future is not dependant on athletics. I have learned that in my current setting (D-III JR college; athletes from 18-24 y/o) that if I tell them that my focus is on their future. Often I tell them that I want them to be able to pick up their kids when they're older or be able to demonstrate techniques in their future classroom (specifically used with health and phys ed. majors). This seems to be extremely effective as many of my athletes are beginning to think more and more about their future beyond athletics. Is there a special strategy that you use in your specific setting?
You offer a great concept. Just as we walk the line of being friend and authority figure, we also walk the line of advising athletes in our scope of practice. I have found that when I admit to an athlete that they would be better served by another medical professional they very much respect the idea. I am always careful though to make sure I tell them that I want them to see another professional to get "even better care than I can offer" or soemthing along those lines. Once an athlete understands that you decision is based off of wanted the best care possible for them, they are much more inclined to get on board. I would love to see more continuing education sessions on this. Every athlete is different and is motivated differently, the more techniques we are familiar with, the better we will be able to serve out athletes.
This is a topic that I thoroughly enjoy. As an athletic trainer, I feel that I am providing a lot social support. I think classes on how to handle certain situations, but there is nothing that compares to actually getting the experience. Most of the reason that I feel comfortable being a listening ear for athletes is because of the experiences that I had growing up and in undergrad. In undergrad, I had the opportunity to work with orthopedic doctors that saw the athletes and just by seeing how each doctor handled the medical element, but also the social elements for the athlete taught me a lot.
When I talk to athletes when they come to me for social/emotional support, I like to be able to show them multiple points of view and give them the ability to decide without my bias. One of the things that has helped me the most was that are the experience that I had growing up. As a former athlete and coach of a fairly emotional sport, I feel like I can relate to athletes well. I do, however think that if your not comfortable with the situation to ask for outside help (ex. sports psychologist, mentor, supervisor if available). If definitely would like to see more research on this incorporating high school, DI collegiate, and professional athletes.
This topic is one of which I do not think gets the attention it deserves. Many people feel as if they are fairly well equipped to handle emotional stresses athletes go through when asked to self evaluate their communication skills. I commend those who are willing to state they feel unprepared for such instances. Also I completely agree with Shandi in that having experience as an athlete and having gone through many of the same emotional stresses our athletes' are dealing with gives me a slight perspective into what they are dealing with, but I understand my own experiences do not adequately prepare me to handle the 'counseling' role athletic trainers often have to assume. I think being able to actively listen is probably one of the most helpful characteristics I have developed as an athletic trainer. Using what the athlete tells you to facilitate what kind of support you provide is essential as the same level of support and care cannot be provided to every athlete. We recently had a brief teaching session on psychological considerations when dealing with these instances and just talking through situations with co-workers was very beneficial for myself as a clinician.
Mark and Shandi,
I like your points and I too feel experience is crucial, as I've said before. When I think to my first few encounters with athletes in a "counseling" role though, I know there are things which I would now do differently. What about undergraduate compentancy and proficiency additions? Do you think that a change like this would prepare a "brand new" athletic trainer for those first few encounter? Or would an already fast-paced and "crammed" ciriculum be made even more so? What are your thoughts?
Kyle those are great questions as every athletic trainer knows how fast-paced and "crammed" the typical athletic training curriculum can be. However I feel as athletic training as well as any other allied medical field is always evolving and so should the education those health care providers receive. I would imagine 30 years ago asking an athletic trainer to be emotional support for an injured athlete would be unheard of but today it is an every day occurrence. With the profession evolving and the emotional support demanded of athletic trainers I think it would definitely be beneficial to provide additional education in psychological aspects of sports medicine and competency additions or changes is a great suggestion.
I do not feel that the psychological aspects of our profession are adequately addressed in undergraduate programs. I recall learning the stages of grief as they relate to injuries in about a day. We covered some difficult hypothetical scenarios, but I’m with Mark – I’m not sure anything can adequately prepare you for the real thing. When other professionals are available for referral, that’s fantastic but there are many situations when that’s not economically feasible. I find the results of this study particularly interesting because they come from division II and III schools. My perception (which could be far from the truth) is that these ATs might be stretched a bit thinner than at some larger division I schools, and yet they still received positive results about the social support they provide. Good information, and an aspect of our profession that we shouldn’t ignore.
I agree that experience is important for learning how to properly handle the psychological aspects of an injury or any of the other psychosocial issues we often encounter when working with our patient population.
It's also important to understand how to use other healthcare professionals with experience in dealing with these issues and how to communicate with our patients that it might be helpful for them to talk with another member of our healthcare team with more experience in those areas.
But as many of the people above have suggested, it seems we need a stronger foundation in our training and then we can use our experience to add to that foundation. This doesn't have to be just in undergrad but even having more talks at the annual meetings about these topics.
The one thing that keeps coming through all of the comments is that these issues are common in sports medicine (or at least among sites where SMR readers work 🙂 and that there is definitely a need for more experience/training in these areas.
As an educator in an ATEP program, there are efforts made to help prepare students for these psychosocial aspects. However, performing a mock interaction to meet the needs of a competency never seems to be simulated enough for the "real thing." And often times in the clinical environment as an ACI it is difficult to allow students to attempt to take a lead role in these matters. Does anyone have any strategies that they have successfully utilized or situations where they have allowed (or been allowed to as a student) a student to take lead on?
I do not have a substantial amount of experience in dealing with psychological issues in my time as an athletic trainer. However in response to Nicole's question on strategies to prepare clinicians for such tasks I may have some insight. In recent discussions about phycological considerations in an athletic population, the idea of teaching clinicians ways of which to improve upon their communication skills is an alternate approach to mock interactions. For example teaching clinicians ways in which to effectively facilitate such a conversation, to clarify athletes emotions and feelings, to encourage elaboration on imperative details, and to utilize the patients own words when summarizing or clarifying the situation are all skills that can simply be taught so a clinician doesn't feel unprepared when an athlete needs their support. These are just a few examples, but like any other aspect of an athletic training undergraduate curriculum, students are given a set of skills in hopes they can utilize those skills when a situation presents itself. We cannot mock every condition athletic trainers are going to be exposed to so we take a different approach to our teaching on prevention, assessment, evaluation, rehabilitation ect. and I believe this may be an area that same approach may be needed. Any thoughts?