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MEDICINE IN SPORT SPORTS PSYCHOLOGY
The aim of the article is to introduce the concept and present the psychological principles of rehabilitation goal-setting. The article will mainly focus on presenting practical suggestions as to how goal setting could be used to enhance athletes’ rehabilitation adherences.
BACK TO BASICS: USING GOAL SETTING TO ENHANCE REHABILITATION
BY MONNA ARVINEN-BARROW F
or the past four years I have dedicated a big part of my life to researching the role of therapists in providing psychological support to athletes when injured. Coming from a non-physiotherapy background myself (apart from being on the receiving end in late 1980s when seriously rupturing my ankle ligaments); I believe my perspective on these issues has been that of a learner, observer, and now after few years of extensive research, hopefully of an informer. By no means am I trying to place myself into “therapists’ shoes”, but rather give some suggestions as to how could psychology be used as part of rehabilitation physiotherapy. How to conveniently implement such within practice, in my opinion is up to the individual therapist in question.
BACKGROUND In recent years the number of people taking part in sport and exercise related activities has been on the increase (1). Such trends are encouraging given the research and evidence supporting the role of activity in health and the risks of physical inactivity (2). Unfortunately, along with increased levels of sport and exercise participation, the risk of encountering sport and exercise related injuries has also increased. In the UK, sport and exercise related injuries account for nearly 33% of all injuries (3), and the likelihood of injury has significantly increased over the past 15-20 years (4). As a result, the risk of sustaining a sport injury is a real and ongoing threat for recreational and elite athletes alike (5) and it has even been suggested by Brown (6) that “serious athletes come in two varieties: those who have been injured, and those who have not
been injured yet”. There is no question that sport injury is often a result of a range of external and internal factors. In most cases, due to advanced medical technology, full physical recovery can usually be seen as a likely outcome. However, despite the potential for full physical recovery, many athletes are unable to return to their pre-injury level of performance (7). Often the inability to return to sport is due to psychological factors such as re-injury anxiety, lack of motivation, or feelings of self-doubt. In essence, “the impact of injury is far more than physical; it can jeopardise an athlete’s confidence, self-esteem, and sense of identity” (6). Over the past few decades, the interest in the role of psychosocial factors as part of the injury process has rapidly increased (8, 9). Early psychological research into sport injuries has focused largely on trying to determine a variety of psychosocial antecedents (10). It has been proposed that individuals with inadequate personal resources and skills and who have experienced several recent stressors in their lives are more likely to encounter injuries than those with converse characteristics (9). In addition to the above, an injury itself is also regarded as a stressor. That is, an injury is the cause of stress, and the ways in which individual athletes evaluate the injury can vary greatly. According to the integrated model of psychological response to sport injury and rehabilitation (11), the athlete’s evaluation of the injury and rehabilitation is influenced by personal and situational factors. These include injury characteristics, personal demographics, psychological and physical differences, and a range of social, environmental and sport related aspects. An outcome from the evaluation process will then in turn have an effect on the athlete’s emotional and behavioural responses, all of which will have
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