By Dana Smith
(December 14, 2022)
As positive coaches, we observe athletes as humans going through a heightened emotional process when they face the prospect of returning to play (RTP) from injury. We must see athletes as individuals processing these emotions that are intensified throughout this experience and not as a simple cog in our sports machine to be replaced when it breaks. We must recognize the fluctuations in an athlete’s emotions throughout the rehabilitation process as progress and regression impact the appraisal of recovery. The injury can serve as a life experience that can help them reexamine their outlook on life, participation in sports, resilience, goal setting, and knowledge of their sport.
Our role as coaches, unless we are trained medical professionals, is not to design the rehabilitation program for injured athletes, instead, we act as a coordinator of RTP from injury. Educate yourself about your athlete’s injury to provide appropriate support. Know the past injury history of all your athletes. Communicate with parents regarding any past injuries and educate yourself to be aware of any possible residual effects of those injuries. Be mindful of the possibility of overuse injuries for your sport and the other sports your athletes may participate in during and out of your season. Treat the RTP process as a continuation of the rehabilitation process for athletes.
In the physical realm of RTP, there are negative actions we want to avoid throughout the process. Never put pressure on an athlete to play with an injury. Do not allow parents to pressure their athlete to train or compete with an injury they have not fully rehabilitated if they have not been given clearance to return to play. Do not make decisions about RTP without the consultation and consent of medical professionals. Never pressure an athlete to train or compete if they suffer discomfort or pain from an earlier injury.
Coaches can use a growth mindset to reframe the situation, by exhibiting and communicating belief in our athlete’s ability to recover through the process. In reframing the situation, point out how the event fits into the problems they will face in life. Discuss the possible personal benefits following their injury that will help them grow and develop into a better person, such as the improved ability to regulate emotions, enhanced academic performance with more available time, and increased knowledge of their sport as the coach can make time to explain technique and strategy to them while they are not training and competing.
The RTP process can negatively impact an athlete’s confidence throughout rehabilitation and when returning to training and competing. As part of our communication with the medical team, we can develop opportunities for an athlete to test the injury in a way that will help to build confidence. We must also communicate with the athlete to encourage them to be open about their confidence level in not suffering re-injury as we work through phasing them back into practice and competition. To assist our athletes in the RTP process, coaches can take action in the following areas:
Guided imagery reduces negative psychological consequences, supports coping, and reduces anxiety. We can show injured athletes how to use guided imagery to visualize positive rehabilitation sessions, achieving program goals, successfully returning to play, and positive performance outcomes. Include sensory aspects: smells, sounds, feel, sights, and any taste involved with the scene. Suppose we regularly use guided imagery as a mental training tool for our teams. In that case, it will make the benefits even more potent for injured athletes through confidence in mental imagery as a tool for success and a consistent part of their preparation. Deep breathing techniques can be used to improve arousal control. Mindfulness techniques help to keep injured athletes in the present moment as they proceed through their rehabilitation program.
Journaling can be a powerful tool for athletes to write about their feelings regarding progress in rehabilitation, setbacks in the process, frustration with not being as active as they were pre-injury, and their relationships with coaches and teammates. Through journaling, the athlete reflects on emotions and reframes setbacks into a favorable situation. It will enable the athlete to express themself and can serve as a source for scheduled meetings with a coach.
Scheduled meetings with injured athletes are powerful as they work through RTP. Empathetic communication, inquire about how they are feeling physically, what emotions they may be feeling as they progress through the process, and get input from them about how we can best support them as they deal with the emotional aspects of RTP. Focus on positive aspects of the process, including goal attainment regarding physical fitness, proprioception, and rehabilitation adherence. Help athletes reframe with fear of re-injury, reframe by pointing out that the rehabilitation can result in the injured part of the body becoming more robust.
Provide coping strategies for your athletes, especially for intense emotions. An athlete can use relaxation techniques to reduce stress and promote healing. Progressive muscle relaxation can help reduce stress. Breathing exercises to reduce anxiety – 5 seconds in breath filling up the lungs and diaphragm, hold briefly, and breathe out for a five count, repeating until stress levels are reduced.
An athlete’s return to play from injury is challenging yet navigable. There are confidence issues regarding fear of re-injury, performance anxiety, detachment from the team, and fear of failure. By providing a program designed to meet the emotional needs of the injured athlete, we increase the probability that they can successfully return to play. In addition to the above strategies, focus on strengthening the coach/athlete relationship throughout the recovery process to positively assist athletes with the psychosocial issues associated with recovery from injury and RTP. Make sure to contact an injured athlete as soon as possible after the injury and maintain daily contact to build rapport. Make sure you are not being distant or avoiding an injured athlete. We also want to share with family members to maintain that relationship and to help them understand how they can help with in-home exercises and rehabilitation.
Any rehabilitation that an athlete can do outside of the physical therapy setting should be done at practice while the team is training together. Ensure to provide the space and equipment necessary for this to occur. This participation means not having them stand there and observe. Try to include them in your thinking about planning practice, what the drills intend to achieve, and how the training session relates to their role on the team, and include them in running parts of training when appropriate. Consider having them help with lower-level teams in your program. For instance, have injured varsity athletes help with the JV practice Remember that we only want to include athletes in training sessions in a way that does not harm their emotional state. Monitor their emotional state when involved to ensure that it does not turn negative as they participate.
Teammates should continue to honor injured athletes as part of the team by including them in all team activities when possible. Make sure to include them in team meals, uniform distribution, team meetings, charitable activities, etc. Teammates and alums, and coaches who have recovered from a similar injury can serve as mentors and role models to support an athlete through their process, provide guidance, and serve as an example of a successful RTP. Teammates are important in helping our athletes maintain a positive social connection with coaches, teammates, and the extended team family which is critical to a healthy and prosperous process of recovery for athletes who are injured. As positive coaches, we must fulfill our role to maintain these connections and continue to grow as an athlete goes through this process.
Being a positive coach is about fostering the life lessons available through sport. Although we never want our athletes to suffer from injury, like other setbacks in life, it is going to happen for many of them. By focusing on not only the physical aspects of return to play, but also the mental, emotional, and social aspects, we can provide an opportunity to support the life skills necessary for our athletes to be successful in the future when faced with adversity.
