A Systematic Review of the Psychological
Factors Associated with Returning to Sport Following Injury

C, Taylor N, Feller J, Webster K. Br J Sport Med 2012; 0: 1-8

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?

By:  Laura McDonald
by: Jeffrey Driban


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