Athletic Trainers’ Influence on National Collegiate Athletic Association Division I Athletes’ Basic Psychological Needs During Sport Injury Rehabilitation
Bejar MP, Raabe J, Zakrajsek RA, Fisher LA, Clement D. J Athl Train, 2019. doi.org/10.4085/1062-6050-112-18
Take Home Message: An athlete’s overall motivation during the rehabilitation of an athletic injury is enriched when their psychological needs of competence, autonomy, and relatedness are met. Athletic Trainers have the unique ability to foster these needs while treating an injured athlete.
Many athletes will have negative thoughts and experiences during injury recovery, which may adversely affect their motivation and willingness to adhere to rehabilitation protocols. An athlete’s ability to be motivated during injury rehabilitation relies on 3 psychological needs during the recovery process:
1. competence = “successfully performing tasks and adapting to the demands of the environment”
2. autonomy = “having meaningful input into decisions and acting in accordance with one’s values”
3. relatedness = “feeling connected, valued, and accepted by important” people
However, we poorly understand how an injured athlete thinks an athletic trainer (AT) can influence their motivation and psychological needs during the rehabilitation process. Therefore, the authors conducted interviews with 10 NCAA Division I athletes (7 females) who had sustained an injury (< 1 year prior to interview) that resulted in at least 4 weeks of removal from practice and competitions. The athletes represented a wide range of sports (cross country and track and field, swimming and diving, basketball, and softball) and injuries (foot, ankle, knee, upper leg, hip, back, and shoulder). Seven of the athletes were fully recovered from their injury at the time of their interview and recovery times ranged from 7 weeks to 1 year (average 36 weeks). Transcripts from each interview were analyzed by 4 experienced researchers using a consensual qualitative research procedure. From this analysis, 4 main domains were identified:
1. An athlete’s concerns about injury and rehabilitation (for example, physical concerns about pain, loss of fitness, or lack of progress during rehab and psychosocial concerns about being disconnected from teammates, and decreased confidence)
2. ATs’ feedback and athletes’ perceptions of competence
3. A person-centered approach from an AT and an athlete’s perceptions of autonomy
4. A connection between an AT’s and athlete’s perceptions of relatedness
These themes emerged from athletes recounting their interactions and the positive effects of certain behaviors of their AT. However, some athletes expressed how these themes were lacking in their situations, which negatively impacted their physical and psychosocial recovery. Motivation during rehabilitation was determined by an athlete’s ability to provide input and receive feedback regarding their rehabilitation. Finally, athletes recounted how a personable relationship with their AT provided them with a sense of relatedness, which increased their motivation.
From these interviews, Bejar and colleagues were able to better understand an AT’s role in fostering a patient’s three basic psychological needs. Perceptions of competence were increased when an AT normalized a patient’s injury by confirming that similar feelings and challenges were experienced by other athletes. Furthermore, competence was perceived when clear goals and expectations were communicated with an athlete. All 7 female athletes expressed the importance of their AT providing reassurance, which increased their self-esteem and confidence in the recovery process. However, none of the male athletes expressed this concern. Patients felt their needs of autonomy were met when their ATs allowed input and provided choices of exercises. When ATs allowed an autonomy-supportive environment, while still providing knowledgeable and expert guidance without controlling how an athlete felt, thought, and acted, this allowed them a sense of ownership and boosted motivation and adherence to rehabilitation. An athlete’s feeling of autonomy was thwarted when an AT either put too much emphasis on overall health rather than an urgency to return to sport or too much pressure on performance. The balance of health and performance should be discussed on an individual basis, as each athlete will put more value in one over the other. Finally, an athlete’s perception of relatedness was reliant on their AT’s ability to create a positive attitude towards recovery and rehabilitation while fostering a positive relationship and rapport with the athlete. Overall, these findings highlight that an AT who treats the whole-person (athletic, academic, social well-being) had a positive influence on an athlete’s motivation towards their physical and psychosocial recovery after an athletic injury.
Questions for Discussion: Are you tailoring your rehabilitation protocols to meet the psychological needs of your athletes? When treating an athletic injury, how much emphasis do you place on psychosocial recovery?
Written by: Danielle M. Torp
Reviewed by: Jeffrey Driban
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When it comes to the athletes and me still being a student athletic trainer, I do tailor the rehabilitation protocols to meet the psychological needs of the specific athlete. If I am seeing the athlete having difficulties and see a decline in their performance, that tells me it’s something psychologically going on. It could be that they are having a bad day, family issues, school stressors, or the simple fact of them missing their sports. I believe tailoring the rehabilitation protocols and getting a clear understanding of their mental state is very important when it comes to getting the athlete ready for back to play.
Again with me being just a student athletic trainer, I don’t put much emphasis on psychosocial recovery because more of the certified athletic trainers are working with the athletes during rehabilitation process. In the future and when I become certified, I plan on putting a lot of emphasis on psychosocial recovery. Like in the article, it is very important to focus on the athletes’ basic needs of competence, autonomy, and relatedness. Getting more athletic trainers familiar with this concept of psychosocial recovery could increase positive outcomes of rehabilitation and even the time of recovery of the athlete!
Thank you for the comment. I am glad to hear as a student you are starting the practice of considering the psychological needs of athletes and plan to continue that as you progress in the profession. It is also important to talk with your current preceptors on how they handle communicating with athletes dealing with psychological issues. While as athletic trainers’ we are in a unique position to identify these cases, we also have to understand our limitations and know when to refer to more qualified health care professionals.
As an athletic training student, I learned all about the psychosocial aspect of an injury. I am a huge mental health advocate and think treating the mind is just as important as tearing the body. When dealing with an athlete who is struggling with their injury psychologically, how do you know the right questions to ask without being inappropriate?
Also, I like the second domain about AT feedback and athletes competence. In the future, I will make sure to reassure the athlete he or she is making progress even if they think they are not. Simply building a relationship can dramatically increase the motivation in an athlete. Keeping an athletes motivation is key in returning them back to play.
Thank you for the comment. I am glad to hear your program is teaching you the importance of mental health and injuries. I think the best way to check in on your athletes is just to ask them serioulsy “How are you doing?” “You don’t seem like yourself lately, what’s going on?” I also think it’s important to understand when to ask these questions. Try to find a time when the room is quite and there aren’t many people around. Athletes that are struggling may not want to open up in front of a room full of happy teammates. I agree with your second point as well, it is important to reassure your athletes through the process and ask their input.