Athletic Injury and Stress Management

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February 19, 2019

By Desi Rotenberg, MS, LAT, ATC

As mental health awareness continues to become integrated into clinical and therapeutic rehabilitation paradigms, the athletic population remains at-risk for developing a behavioral or mood disorder following an injury. As Athletic Trainers (AT), we are constantly surrounded by a vast spectrum of personalities, learning styles and learned coping mechanisms that can all be thrown into flux when an unexpected trauma takes place. While the referral process is an important resource when an individual is suffering from an injury-induced anxiety or mood disorder, ATs have the ability to improve the trajectory of a patient’s rehabilitation. Through the incorporation of stress management techniques into the day-to-day rehabilitation plan, ATs can facilitate a positive progression that can “reduce the impact of the stress reaction” in injured patients.1

The first technique recommended is the use of various mindfulness exercises. This can also be referred to as “increased awareness.” The goal of this technique is to help the patient develop a clear understanding of the thoughts, emotions and stressors associated with any traumatic event and the injury at hand. Awareness can be facilitated through honest, open discussions that can take place during therapeutic treatment and allow the patient to view the injury in the correct context. The insight gained by an AT can also be a good barometer for how the patient is responding to therapeutic treatment and how the injury itself is affecting overall mood and behavior.1 In some cases, relaxation techniques (guided meditation, visualization, purposeful breathing, etc.1) can be used to create a “positive head space” for a patient, and allow for the reduction of stress and anxiety prior to the beginning of a rehabilitation session.

Another useful technique is “pain education.” Often, patients may not understand the physiological purpose of pain. Educating the patient on the body’s pain response, can help the patient better discriminate between “normal” pain, and pain that can be considered adverse. It is important as clinicians to understand the common response to physical pain is fear, and fear can open the door for anxiety, stress and behavioral responses that can be detrimental to rehabilitative progress.2

Personalities amongst patients vary so it is important for ATs to offer a range of social support to an injured individual. This social support is dependent on the individual (i.e. active listening versus open dialogue) and will require you to differentiate between which technique is indicated. These skills involve the recognition of personality traits exhibited by the patient in response to various situations and challenges and should be practiced each time a new injury presents itself.

Another technique used to manage stress and anxiety in an injured patient is to facilitate specific behavior and outlook modification. Stress associated with injury can induce various thoughts of worry or concern, which can negatively influence “self-talk.” Positive self-talk can be a technique that improves both motivation and behavior.3 Through dialogue, ATs can demonstrate to the patient various ways to limit the negative thoughts that flood the mind following injury, and replace them with internal thoughts of hope, empowerment and positivity (i.e. “I can do this”; “my pain is temporary”; “with patience, I can overcome any obstacle”).This self-talk leads to empowerment and allows the patient to feel a degree of control over their rehabilitation. Teaching the patient to assume some control and responsibility for the rehabilitation process helps to increase compliance and avoid feelings of helplessness.3,4,5

Patients put their trust in ATs to, not only care for physical rehabilitative needs, but to also offer emotional and psychological support. The goal remains the same: to create an environment that allows patients to return to pre-injury functioning and achieve a full quality of life. This task can only be accomplished with a strong sense and understanding of the human mind and its response to physical and/or emotional trauma.

1. Hedgpeth, E. G., & Sowa, C. J. (1998). Incorporating stress management into athletic injury rehabilitation. Journal of Athletic Training, 33(4), 372.

2. Taylor, J., & Taylor, S. (1998). Pain education and management in the rehabilitation from sports injury. The Sport Psychologist, 12(1), 68-88.

3. Heil, J. (1993). Psychology of sport injury. Human Kinetics Publishers.

4. Crocker, P. R. (1992). Managing stress by competitive athletes: Ways of coping. International journal of sport psychology.

5. Seaward, B. L. (2017). Managing stress. Jones & Bartlett Learning.


About the Author

Desi rotenberg

Desi Rotenberg, originally from Denver, Colorado, graduated with his bachelor's degree in 2012 from the University of Northern Colorado. He has been a BOC Certified Athletic Trainer since 2012 and earned his master's degree in Exercise Physiology from the University of Central Florida in 2014. He currently is a high school teacher, teaching anatomy/physiology and leadership development. Along with being a teacher, he wears many hats, such as basketball coach, curriculum developer and mentor. He has been a contributor to the BOC Blog since the summer of 2015.

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