attainable. As the therapists are the experts in relation to the physiological aspects of the healing process, their knowledge and opinion in relation to the above should be one of the primary matters to consider. Second, the goals should be specific and concrete. Setting target dates enables the athlete to see beyond the present, and thus their motivation with the rehabilitation is likely to uphold during moments when the pain and discomfort take over. Gould also suggested that the athletes should focus on the degree of, rather than the absolute, attainment of the goals. Evidence to support the above has also been found in the literature (23). it is important to stress that even if the

athlete hasn’t necessarily achieved the goal you emphasis the progress eg. “We got eighty percent of the way there, it may be for the last twenty percent you manage to achieve on your own before I see you again next time”. It is very important that you never send an athlete out with an impression that the goal was never reached.

When setting goals, one should always

remember that goal setting is a dynamic process. In order for goal setting to be successful it is imperative for the athlete to be an active part of the process. An athlete should have an understanding of how

SIX STEPS FOR SUCCESSFUL REHABILITATION GOAL SETTING (for more details see Gould (27)

1. Set challenging, but realistic and attainable goals 2. Set goals that are specific and concrete

3. Focus is on the degree of, rather than on the absolute attainment of goals 4. Remember that the goal setting process is dynamic 5. Prepare a written contract with the injured athlete 6. Provide regular feedback

to set goals, and how these goals can have a positive impact on the rehabilitation outcome. If the goals are not accepted by the athlete, the goal setting programme is likely to be ineffective. Thus,

therapists should place great emphasis on including the athlete in the process of goal setting. By discussing goal setting with the athlete a therapist is more likely to be able to produce a programme that not only is effective, but is also tailored to the individual in question.

Once goals have been set and agreed upon, it is advisable to prepare a written contract with the athlete. Having a written contract is beneficial to the athlete and the therapist in a number of ways. A contract can hold the athlete accountable for the fulfilment of the contract. Finally, in order to ensure rehabilitation success, constant evaluative feedback is essential. This could be done through tangible physical measures (ie. changes in range of motion) or through psychological measures. Most importantly, it should be done through effective communication between the athlete and the therapist. By clearly demonstrating the progress so far to the athlete, he or she is then able to see rewards for their efforts, thus making these efforts worth while. Regular feedback also provides useful opportunity to assess the accuracy of the goals and any possible need for goal adjustment.

CONCLUSION Working with injured athletes requires a holistic approach. In order to achieve successful rehabilitation outcome, therapists are often required to address injured athletes psychological issues and concerns as part of the treatment. Research has found rehabilitation adherence and treatment compliance as being crucial for successful rehabilitation outcome.

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Amongst other factors, issues with self- motivation and the athlete-therapist relationship can both have an impact on adherence and subsequently on the rehabilitation outcome.

Using goal setting for treatment planning is crucial. Through effective goal setting, athlete self-motivation can be significantly improved, which will in turn have an effect on rehabilitation adherence and treatment compliance. In addition, goal setting can facilitate open and honest communication between the athlete and the therapist, which in turn has an effect on their relationship. Good rapport between the therapist and the athlete has also been found to have an impact on rehabilitation adherence. And finally, for most athletes, goal setting forms an integral part of their everyday training programmes. For that reason integrating goal setting into the physiotherapy process is not only profitable, but also easily transferable (7). Part of the therapist’s role when dealing with injured athletes, is to ensure that the individual athlete’s wellbeing comes first. According to Cathy Bulley and colleagues (28), a central part of sports therapists’ thinking and behaviour is the ability to be sensitive and to understand the range of implications of injury for the athlete. After all, when first entering the treatment room after an injury, there is only one thing an athlete wants an answer to: When can I play again?

References 1. Kolt GS. Psychology of injury and rehabilitation. In: Kolt GS, Snyder-Mackler L, eds. Physical therapies in sport and exercise. Churchill Livingstone 2003; 165-183. ISBN: 0443071543 2. Blair SN, LaMonte MJ, Nichaman MZ. The evolution of physical activity recommendations: how much is enough? American Journal of Clinical Nutrition 2004; 79(5):913S-920 3. Uitenbroek DG. Sports, exercise, and other causes of injuries: results of a population survey. Research Quarterly for Exercise and Sport 1996;67:380-385 4. Orchard JW, Powell JW. Risk of knee and ancle sprains under various weather conditions in American football. Medicine and Science in Sports and Exercise 2003;35:1118-1123 5. Walsh M. Injury rehabilitation and imagery. In: Morris T, Spittle M, Watt AP, eds. Imagery in sport. Human Kinetics 2005;267-284. ISBN: 0736037527

sportEX medicine 2008;37(Jul):15-19