Sep 12, 2017
Psychology of Injury: Part 1
Timothy Neal

The athletic trainer is tending to an athlete who injured their knee the day before. The initial evaluation determined that the severity of the injury necessitated an MRI. As the athletic trainer is setting up a compression device to address the swelling in the athlete’s knee, the athlete is quiet and responds in murmured tones when asked if there is any pain. As the treatment starts, the athlete looks blankly at the ceiling. What other care interventions should the athletic trainer consider before walking away?

The health care of athletic injuries is evolving rapidly in the areas of physical treatment. Be it hands-on, electrotherapy, kinetic chain evaluation and correction, or other modes of care, technological advancements are improving our ability to heal joints and muscles following injury. But what about the most important part of the body: the mind? It is time to reconsider the psychological component of care for injuries and its important role in holistically caring for an athlete once an injury occurs.

This article will touch on some initial considerations for the athletic trainer to use in addressing the psychological concerns of athletes when they are injured. These considerations are offered from my nearly 40 years of experience as a certified athletic trainer who has evaluated and cared for thousands of injuries, talked with athletes about their responses to injury, and researched and studied mental health wellness of athletes through my involvement in NATA and NCAA endeavors.

This week, we’ll start with what athletic trainers can do immediately after an injury.

Moment of Injury

Experiencing an injury can be very traumatic for an athlete, no matter how minor the injury is assessed. Certainly, any life-threatening, life-altering, season-ending, or time-loss ailment has its own dynamics, but the important point here is not to attempt to reassure or calm an injured athlete by unduly minimizing the severity of an injury. To that athlete, their injury is painful physically, as well as psychologically. Most athletes identify themselves as an athlete, and once that identity is threatened by an injury, they may suffer mild to severe disruption of their psychological balance. Once injured, an athlete may worry about their place on the team, their starting position, or their relationships with their teammates and coaches.

The important point here is not to attempt to reassure or calm an injured athlete by unduly minimizing the severity of an injury. To that athlete, their injury is painful physically, as well as psychologically.

In the event of an injury, I have been — and have taught those I have mentored to be — realistic with the athlete when speaking with them. If they are severely injured (e.g., open fracture and dislocation, neck or back injury, internal organ injury, eye injury, torsion testicle, heat stroke, or seizure), don’t minimize the issue. If an athletic trainer tells an athlete with a dislocated hip, “Don’t worry, you will fine and back in no time,” as a way to reassure the athlete, they may feel as if their injury’s severity is not being fully appreciated, which may heighten their anxiety.

Instead, it is reassuring if you outline the next few steps of the process for the athlete. I use the following statement: “I (we) know you have a significant injury. We are activating EMS so we can get help and properly transport you to the hospital, where you can be further evaluated and cared for. I will be with you all the way during this process. Keep talking with me so I know how you are doing, so I can inform the emergency squad and the doctors at the hospital.” This statement conveys to the athlete three things:

1. That the athletic trainer knows the athlete is significantly injured. I usually don’t use the terms “severely” or “gravely,” as I have seen others use. These words elevate the anxiety of others watching or attempting to help and lessen their effectiveness. The athlete already knows they are severely injured.

2. It lets the athlete know everything is being done to get more medical care to the scene and that the athlete will be properly transported for advanced care.

3. The athletic trainer is going to stay with the athlete as their advocate in care. Helping the athlete focus on the immediate future is a helpful way of calming them during an emergency.

Check back in next week’s newsletter to get Neal’s tips for addressing an injured athlete’s mental state during follow-up care and rehab.

Image by EricEnfermero

Timothy Neal, MS, AT, ATC, CCISM, is Assistant Professor and Program Director of Athletic Training Education at Concordia University Ann Arbor. Previously, he spent more than 30 years at Syracuse University, serving in a variety of sports medicine roles. He can be reached at: [email protected].

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