GOAL SETTING

9. Monitor and evaluate progress Consistent evaluations are necessary to modify goals and provide feedback. Committing goals to paper enhances this process (4,5) and holds the athlete accountable. Graphing progress weekly is par- ticularly helpful. A visual display highlights the modest gains that an athlete might otherwise not realise.

10. Combine sport, rehabilitation, and life goals Rehabilitation goals can be linked to both sport and life. This approach can be especially helpful for an athlete whose return to sport is doubtful by putting sport in a broader perspective. For example, how else might rehabilitation improve an athlete’s quali- ty of life?

Barriers to effective goal-setting Addressing barriers to effective goal-setting early in treatment can prevent them from slowing an athlete’s recovery.

A study by Danish, Petitpas, & Hale (6) describes four major obsta- cles to goal attainment:

i) Lack of knowledge about rehabilitation Education is essential when working with pain and rehabilitation. Knowledge reduces anxiety and facilitates compliance. An athlete cannot give her best effort to a task she does not fully understand. Education helps the injured athlete become active in her rehabili- tation, and increases independence and confidence. Heil (3) encourages treatment providers to describe the cause and physical consequences of injury in terms the athlete can understand. Predictions of how the injury will heal, and specific information about methods of rehabilitation and how they aid healing is useful. Address pain issues and the difference between ‘rehabilitation/per- formance pain’ and ‘injury pain.’ Descriptive language and pictures enhance understanding and facilitate mental training (eg. imagery). Treatment providers should describe the timetable for rehabilitation and the expectations of the athlete.

ii) Lack of skill People set goals all the time, such as New Year’s resolutions that fail in the first week. It is not always a lack of motivation but a lack of goal-setting skills (usually specific goals) that leads to failure. Involving the athlete in the goal-setting process increases invest- ment and informally teaches him the skill. Other skills may also be necessary. They may be physical (eg. exercise technique) or psy- chological (eg. positive self-talk) and should be developed early to ensure success.

iii) A perception that the risks of treatment outweigh the benefits Rehabilitation is not easy. The risk of failure is constant. While the motivators to complete rehabilitation are often obvious (eg. return to sport), there are also reasons not to give it everything (eg. avoid pain). Creating and discussing a decision balance sheet is often helpful to clarify the motivating factors of each choice. Elaborate on the positive and negative aspects of fully committing oneself to rehabilitation, and the positive and negative consequences of tak- ing it easy. In this way, each risk and barrier is addressed directly.

iv) Lack of social support Numerous studies in both the general medical and sport injury lit-

8 SportEX

erature illustrate the benefits of social support in rehabilitation. Social support buffers the effects of stress on health and improves the recovery scenario for those who are ill or injured (3). A lack of support, or personal dissatisfaction with support, increases the risk of emotional distress during recovery (7,8). The athlete’s support system includes the team mates, the sports medicine team, and parents, spouses, and friends. Each group offers a different, but equally beneficial, type of support.

Consistent involvement with treatment providers is particularly important as an injured athlete’s adherence to a goal-setting pro- gramme decreases with prolonged time away from clinical expertise (9). Research by Richman and his team (10) recommends that social support be provided by a network of individuals, be devel- oped and nurtured, and be part of an ongoing programme rather than a just a reaction to crisis. Treatment providers are encouraged to be willing listeners, acknowledge both effort and mastery, and balance the use of acknowledgement of good performance and encouragement to meet performance goals.

Conclusions Goal-setting is a skill that can greatly enhance an athlete’s sport performance and rehabilitation. It is a skill that focuses attention and improves confidence as well as physical outcomes. Treatment providers are encouraged to spend time with their athletes devel- oping specific goals together, frequently providing feedback and problem-solving potential barriers to successful rehabilitation.

References 1. Taylor J and Taylor S. Psychological approaches to sports injury rehabil- itation (pp. 125-143). Gaithersburg, MD: Aspen Publishers 1997. 2. Ames C. Achievement goals, motivational climate, and motivational processes. In G.C. Roberts (Ed.), Motivation in sport and exercise (pp. 161- 176). Champaign, IL: Human Kinetics 1992. 3. Heil J. Psychology of sport injury (pp. 137-149). Champaign, IL: Human Kinetics 1993. 4. Ievleva L and Orlick T. Mental paths to enhanced recovery from a sports injury. In D. Pargman (Ed.), Psychological bases of sport injuries (pp. 219- 245). Morgantown, WV: Fitness Information Technology 1993. 5. Gould D, Petlichoff L, Hodge K and Simons J. Evaluating the effective- ness of a psychological skills educational workshop. The Sport Psychologist, 1990;4:249-262. 6. Danish SJ, Petitpas A, and Hale BD. Psychological intervention: A life development model. In S.M. Murphy (Ed.), Sport Psychology Interventions (pp. 19-38). Champaign, IL: Human Kinetics 1995. 7. Brewer BW. Review and critique of models of psychological adjustment to athletic injury. Journal of Applied Sport Psychology 1994;6: 87-100 8. Green SL and Weinberg RS. Relationships among athletic identity, coping skills, social support, and the psychological impact of injury in recreational participants. Journal of Applied Sport Psychology 2001;13:40-59 9. Gilbourne D, Taylor AH, Downie G, and Newton P. Goal-setting during sports injury rehabilitation: A presentation underlying theory, administra- tion procedure, and an athlete case study. Sports Exercise and Injury 1996;2:192-201 10. Richman JM, Hardy CJ, Rosenfeld LB and Callanan RAE. Strategies for enhancing social support networks in sport: A brainstorming experience. Applied Sport Psychology 1989;1:150-159

Dr Edmund O'Connor, PhD is chief psychologist of the PEAK, Pain, and Headache Programmes at Rehabilitation Professionals in Grand Rapids, Michigan, USA. He is also the sports psychologist for the sports medicine facility, GRSportsCenter.com. Dr. O'Connor is a certi- fied consultant through the Association for the Advancement of Applied Sport Psychology and member of the United States Olympic Committee Sport Psychology Registry.