Psychological Factors Influencing Sport Injury Rehabilitation

Overview:

Injuries are an inevitable part of an athlete's career, and their successful rehabilitation is vital for returning to peak performance. Beyond physical recovery, the psychological dimensions of injury rehabilitation play a critical role in shaping an athlete’s journey back to sport. The psychological factors influencing injury recovery largely fall into three categories: cognition, emotion, and behaviour as posited within the integrated model of response to sport injury (Weiese–Bjornstal et al., 1998). The following piece explores these key dimensions and highlights strategies that can optimize rehabilitation outcomes.

Cognitive factors such as self-efficacy and motivation are pivotal in facilitating an athlete's recovery. High self-efficacy—belief in one’s ability to successfully execute the rehabilitation program—has been shown to improve outcomes in both junior and senior athletes (Te Wierke et al., 2013; Beischer et al., 2019). When athletes trust their ability to recover and adhere to rehabilitation plans, they are more likely to return to their pre-injury performance levels. Motivation is another key cognitive factor that influences rehabilitation success. Athletes who are highly motivated to recover tend to experience greater satisfaction with the rehabilitation process and are more likely to return to their prior levels of activity (Brinkman – Majewski et al., 2022). Patient motivation not only impacts the physical aspects of recovery but also improves mental readiness, making athletes more likely to stay committed to their rehab goals.

Emotions play a significant role in shaping the rehabilitation experience. Early research primarily focused on the negative emotional impacts of injury, such as mood disturbances, fatigue, frustration, depression, and anxiety. Fear of reinjury is particularly common and can slow recovery, as it fosters hesitation and self-doubt (Weise-Bjornstal 2010) However, recent research has begun to shift its focus toward the positive emotional states that can enhance rehabilitation. Emotions such as optimism, self-compassion, and gratitude have been shown to improve mental resilience and overall well-being during recovery (Salim et al., 2021; Huysmans et al., 2017). Athletes who cultivate these positive emotional states tend to have a more constructive approach to rehabilitation, which can speed up their return to sport.

Behavioural factors, such as adherence to the rehabilitation plan and help-seeking behaviours, are crucial to a successful recovery. Psychological factors like motivation, self-efficacy, coping mechanisms, and social support heavily influence adherence (Goddard et al., 2021; Podlog et al., 2013). Athletes who stick to their rehabilitation plans are more likely to return to sport at their previous levels of competition. However, some athletes may over-adhere to rehabilitation, performing too much or excessive rehab, which can lead to further injury. Research shows that high athletic identity and self-presentation concerns, particularly the pressure to meet expectations, are associated with over-adherence (Podlog et al., 2013). Thus, finding a balanced approach is critical.

The Stigma Of Seeking Help

A significant barrier to help-seeking behaviour, particularly for mental health support, is the stigma surrounding psychological assistance. This is especially prevalent among elite athletes, who may view seeking help as a sign of weakness or face accessibility issues in obtaining professional support. Addressing these barriers is essential for holistic rehabilitation (Maschke et al., 2022)

Social support from physiotherapists, doctors, coaches, teammates, and family members can have a profound impact on an athlete's rehabilitation journey. Athletes who perceive a strong support network report lower anxiety levels and greater satisfaction during their recovery (Forsdyke et al., 2022). Conversely, a lack of support—especially from teammates or coaches—can negatively affect an athlete's mental state and slow the recovery process (Norlin et al., 2016). Physiotherapists play a key role in recovery but often use a limited number of behaviour change techniques. However, they are increasingly recognizing the value of integrating psychological interventions, such as goal-setting and relaxation techniques, into their practice as part of a more holistic approach to injury rehabilitation (Alexanders et al., 2015).

Incorporating psychological strategies into rehabilitation can create favourable conditions for recovery. Research has shown the effectiveness of interventions such as imagery, relaxation techniques and goal-setting. These strategies help athletes cope with the emotional toll of injury and reduce anxiety around reinjury (Shapiro et al., 2018).

More recent approaches emphasize mindfulness and acceptance-based practices, as well as cognitive-behavioural therapy (CBT). Mindfulness helps athletes remain present during the rehabilitation process and can aid in reducing stress. CBT, meanwhile, helps athletes reframe negative thoughts and develop coping strategies for anxiety, particularly around reinjury (Podlog et al., 2020).

A recent consensus statement proposed key recommendations for integrating psychology into sport injury rehabilitation. These include mindfulness and CBT to enhance coping and well-being, as well as encouraging athletes to focus on gratitude and self-compassion to foster positive emotional states (Tranaeus et al., 2024)

Psychological Needs During Return to Sport

When athletes are physically cleared to return to sport, psychological readiness is equally important. Three key psychological needs—competence, autonomy, and relatedness—are critical to facilitating a successful return (Podlog et al., 2011).

(Podlog et al., 2007).

Fear of reinjury is one of the most significant psychological barriers to returning to sport. Athletes who have not adequately addressed their anxieties are more likely to withdraw from sport, experience reinjury, or return to lower levels of competition (Wadey et al., 2014). Addressing the psychological needs of competence, autonomy, and relatedness can prevent these concerns from negatively impacting the return to sport.

Re-injury concerns are the most cited reason for reduced sports participation. According to a meta- analysis, only 63% of athletes return to pre-injury levels, despite 85% achieving clinically satisfactory recovery (Arden et al., 2011). Reinjury concerns typically involve reductions in perceived competence as athletes being to doubt their body’s ability to handle their demands of sport or worry that reinjury will hinder future proficiency. Autonomy also features when athletes feel a lack of control over the athletes ability to stay healthy and avoid reinjury. Fear of reinjury can also cause athletes to be concerned about once again being removed from the sporting environment and threaten their athletic identity (Sonesson et al., 2017)

Conclusion

To foster both physical and psychological readiness for a return to sport, evidence-based strategies such as goal-setting, self-talk, and imagery are crucial. Sport psychologists can work with the athlete and medical team to successfully integrate psychological skills within rehab and particularly as they begin to prepare for returning to sport (Podlog et al., 2007)

Athletes who actively engage with these techniques report greater confidence in their recovery and are better prepared to meet the demands of competitive sport. Collaboration between athletes, coaches, and medical professionals ensures that both the physical and psychological aspects of recovery are addressed, leading to more successful rehabilitation outcomes (Gledhill et al., 2022).

By incorporating these psychological strategies into rehabilitation plans, athletes can optimize their recovery, reduce the likelihood of reinjury, and ensure they are mentally prepared for the demands of competitive sport.

If you would like to contact Shane for an appointment please do not hesitate to contact him on Shane.Carrington@tus.ie

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