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Musculoskeletal Problems

It would seem to me that Ireland has an amazing number of psychologists circulating at present and that most of them arrange to meet at GAA matches every weekend, (and I’m not talking about the four men in white coats that stand beside the goals). You’ll rarely attend a game during which you won’t hear, “his head isn’t right”, “that lad has nothing upstairs” or “all he needs is a shot of the magic bottle”.  Could it be that people are becoming more aware of the role of psychology in sport?

Psychology is an aspect of sport that has been growing rapidly over the past few years and one which has many facets. It can help athletes manage their emotions in pressure situations, help them bounce back from defeat and teach them how to handle success. It can facilitate relaxation, motivation, leadership and goal setting.  Psychology can improve technique and performance through visual imagery. It plays a major role in helping athletes maximise their potential as individuals while working as part of a team. One of the areas that psychology overlaps with physiotherapy is in the area of injury management.

Every athlete, whether competitive or recreational, will experience injury of some level at some stage.  While it is important to treat the physical aspect of the injury it is also important to address the psychological aspect. For professional athletes any injury that rules them out of their routine of training and playing can be extremely traumatic and can raise issues of loss of self worth and identity. On the other hand, injury to the recreational athlete can be equally traumatic for different reasons. It can remove them from their social circle and can rob them of their mechanisms for stress relief.

Many factors can influence how somebody copes with injury. These can include previous injury, the severity of the injury, the position of the athlete on the squad, the type of sport, the reaction of team management and team mates, and the social structure of friends and family around the athlete at the time.

Whether the injury is mild or severe, or whether the athlete is recreational or professional the individual’s mechanism to deal with the injury is similar. It is extremely important for the physiotherapist working with the athlete to be aware of this if the athlete is to recover optimally. It is also important for the athlete to be aware of how they react to injury and, it can also be beneficial for those close to the athlete to be aware of the coping mechanisms that occur in response to injury.

Scientists have discovered that the coping mechanism that people employ to deal with serious injury is very similar to that used by people when grieving or dealing with a serious loss. There are five stages identified that an individual will go through.

The first is denial and isolation. This manifests as a reluctant to accept the injury. The athlete may be reluctant to talk about the injury and may withdraw from friends and family. The athlete can feel very alone in this stage and a support structure is very important.

The second stage is anger. This is where the finger begins to be pointed either at themselves for allowing the injury to happen or at others for their part in it. This can be an extremely difficult time for all concerned.

The third stage is one of desperation. The athlete will try to speed up their return to sport by bargaining with anyone in a position to change their circumstances. Statements such as, “Just let me play the first 20 minutes”, or “I promise I’ll rest for two weeks after the match” are common at this stage. This is also the stage where an athlete may seek several different opinions on their injury in an attempt to get a better prognosis.

The fourth stage is depression. The athlete enters a state of self-pity and can only focus on the negative aspect of the injury. A sense of dread fills them. Athletes often worry about never being able to return to their level of sport or never getting the chance to play in another final again. Positivity is the most important thing for the athlete at this stage. Coaches, team mates, friends, family and therapists all have an important role to play here.

The fifth and final stage of the process is acceptance. The athlete finally realises the reality of the situation and can begin to focus on rehabilitation.

An athlete can spend different amounts of time in each of the five stages depending on the maturity of the athlete and how well informed the athlete is of the injury. It is imperative to educate the athlete in all aspects of the injury and the rehabilitation involved. The athlete needs to be involved in planning the rehab and goal setting. If the athlete feels that they have a level of control in the situation they will reach the acceptance stage much more quickly.

By addressing the mental aspects of injury much of the stress involved can be removed from the athlete. This facilitates an optimal recovery in terms of time out of sport and the physical and mental state of the athlete returning to sport.

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