Return to sport concerns following injury rehabilitation


The World Sports Trauma Congress 17th -20th October 2012, London is being held this week with international speakers discussing topics such as “footballer’s ankle” and “sport after joint replacement”. The congress is connected to the Summer Olympics Games and occurs every four years. This year in London delegates, like us Elves, will undoubtedly be celebrating the athletes of the Paralympics and Olympic Games for not only their physical talent, but their courage, perseverance and mental discipline.


But it made me wonder what it must be like to be an injured athlete who is trying to return to sport – what hurdles do they face in addition to their physical injuries and how can these be overcome? I was pleased to find this question had been posed by the authors of the above paper.

Here’s what they did

This review explored some psychosocial stresses and anxieties common to athletes returning to sport, focussing on issues identified in previous research. The authors acknowledged the review was not exhaustive and concentrated on the potentially problematic source of apprehension that is re-injury anxiety.

Here’s what they found

Returning athletes experience concern about:

  • competence – re-injury anxieties, concerns about performing to pre-injury standards;
  • autonomy – external and self-induced pressure to return to sport, and
  • relatedness – feelings of social isolation and lack of identity

The authors suggested intervention strategies such as;

  • graduated physical tests to build confidence,
  • positive visual imagery during rehabilitation,
  • buddy systems,
  • relaxation techniques
  • education and advice on how to retrain safely.

Athletes should be involved in determining recovery goals and maintain contact with their training team to provide social support and identity.

The authors also outlined a theoretical framework based on self-determination theory (SDT) and discussed its relevance to sports medicine practitioners in making sense of the return-to-sport experiences and concerns of injured athletes. The psychological needs of competence, autonomy and relatedness are significant to athletes during rehabilitation. It is important that sports medicine practitioners ensure re-injury anxiety does not prevent return to sport.

The authors concluded

“Using the SDT framework to explore intervention efforts and applying suggested strategies can provide them with knowledge of how to reduce or avoid significant athlete concerns.”

The Musculoskeletal Elf’s view

The Musculoskeletal Elf

This review was not exhaustive but provides insight into the psychosocial problems facing injured athletes and suggests strategies to manage these. The theoretical framework is described in an earlier paper by the first author of this review and self-determination theory (SDT) has been explored across a variety of situations. A recent systematic review by Teixeira including 66 studies examining SDT, exercise and physical activity concluded that overall the literature provides good evidence for the value of SDT in understanding exercise behaviour.

Returning to sport after injury must be difficult for both the athlete and the rehabilitation team.

  • Have you struggled with a sports injury or been responsible for rehabilitating an injured athlete?
  • Do you recognise these anxieties and concerns?
  • How did you overcome them?
  • Would this framework have been useful to you?

Send us your views on this blog and become part of the Musculoskeletal Elf community.


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