Monday, September 20, 2010

Cognitive Approaches to Athlete Rehabilitation


WHAT: A volleyball player has just had surgery to repair a torn ACL and will be out of practice for 6-8 weeks.  The athletes main issues are dealing with her injury and how it may affect her future performance and skills as a volleyball player when she returns to practice.  She is aware that the ACL surgery is complex and requires a specific rehabilitation process to help with healing and reconditioning her leg.  She has questions running through her head wondering how she can successfully get through rehab and progress through the re-conditioning with her athletic trainer.  She wonders what the best approaches are for her to complete rehab and be healthy enough to return to practice and play as a volleyball athlete.

SO WHAT:  Having a rehab period of 6-8 weeks with an athletic trainer will require establishing goal setting (mainly short-term) to assure she is able to successfully get through the rehabilitation process.  Gill (2008) examines Locke and Latham’s goal setting model which includes attributes of effective goals.  Of these, specificity, difficulty, and valence are three aspects that can relate to our injured volleyball player.  Our athlete is experiencing a serious injury and recovery from surgery on her ACL, and wants to return to practice as soon as possible. To assure her return to the same athletic level and strength within her leg, she must establish firm and difficult goals throughout her rehab process that will guide her back into practice and play within the 6-8 week time period.  She must think about the progress she wants to seek at the end of each week, such as the strength and mobility of her leg during exercises and daily activity.  According to Naoi (2003), self-talk and home exercise completion in ACL injured athletes had a positive relationship.  The volleyball player needs to practice positive self-talk with herself throughout the rehab process.  Use of self-talk will also help her successfully complete her goals that she sets at the beginning of the rehab process.  If our athlete is having problems coping with the injury overall, we can utilize imagery to help them get through that process.  Gill (2008) shares that Ievleva and Orlick (1991) found imagery helpful with being motivated throughout the rehab process. 

NOW WHAT: Initially, we must find out from our athlete their perception of the injury and what they are thinking as they go into the rehab process.  Obviously, she wants to heal quickly and effectively so she can return to practice and play.  The first objective as the athletic trainer will be to set up short-term goals with our athlete that help guide her through rehab.  Gill (2008) states Weinberg’s goal-setting principles, which include specific, realistic and challenging.  These tie in with Locke and Latham’s model in that goals must be both specific and challenging.  Our athlete must set specific goals that relate to her reconditioning day by day.  Although they are short term goals in rehab, they must be challenging to our athlete to assure that she is ready to return within 6-8 weeks to practice with her teammates.  According to Carson and Polman (2008, p.82), “goal setting was a principle coping strategy used during rehabilitation.”  The first few weeks may involve simple stretches and light weight on machines to help strengthen her leg.  After the initial few weeks, the goals will transition into actual floor movement with the leg and movement that will simulate that of her position in volleyball.  Setting up initial goals for her will give guidance in the rehab process.  In a study by Carson and Polman (2008), self-talk was used as an emotion-focused strategy with a rugby player who had also torn their ACL and was in rehab.  They expressed that using this approach allows the athlete control in their rehab process.  Finally, imagery will be used in the rehab process to help our athlete visualize themselves back on the practice or game court, with a fully rehabilitated knee.  Gill (2008, p.75) states that “imagery can be effective for practicing other psychological skills such as modifying self-talk, practicing concentration, and building confidence.”  Imagery will be practiced when our athlete struggles to use self-talk effectively or if they experience negative self-talk during the rehab process.  Imagery will mainly focus on reflecting on past practice or competitive experiences when the athlete was completely healthy to help give her guidance and also complete goals to regain what she once had.  Imagery will be help her want to accomplish goals and will develop self-talk so that it is always positive.  Once our athlete has fully rehabilitated her knee at the end of the 6-8 weeks, we will congratulate and confirm this to her.  We will encourage continued self-talk and imagery during her initial return to practice.  Goal setting can also continue to be utilized as she returns, assuming that some limitations or adjustments due to the injury may still exist. 

CONCLUSION:  Our volleyball athlete is about to begin her 6-8 weeks of rehabilitation on her knee.  We are aware of the cognitive thoughts and feeling going through her head about her injury and how she believes the rehab process will go.  Once we know how she is feeling, we can begin the rehab process.  We will begin immediately with short-term goal setting as guidance for her through the rehab of her knee.  Research has shown that goal setting is a key factor in athlete rehabilitation.  Throughout our 6-8 weeks, we will also focus on the use of positive self-talk that will assist our athlete in completing her goals and also focusing on returning to practice.  If she struggles with self-talk and begins to have negative self-talk experiences, we will introduce the use of imagery to help adjust self-talk to a more positive aspect and also to help her visualize getting through the rehab process, accomplishing her goals, and ultimately returning to practice after completing rehabilitation.  When her knee is rehabilitated, we will congratulate our athlete and encourage continued use of goal setting throughout her volleyball season, as well as self-talk to guide her back into the season and ability to play as she did before the injury. 

REFERENCES:
Carson, F. & Polman, C.J. (2008). ACL injury rehabilitation: a psychological case study of a professional rugby union player. Journal of Clinical Sport Psychology, 2, 71-90.
Gill, D. L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL:Human Kinetics.
Naoi, A. (2003). The effects of cognitive and relaxation interventions on injured athletes’ mood, pain, optimism, and adherence in rehabilitation. Unpublished doctoral dissertation, West Virginia University, Morgantown, West Virginia. Retrieved September 16, 2010 from http://wvuscholar.wvu.edu:8881//exlibris/dtl/d3_1/apache_media/6598.pdf

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