REHABILITATION PSYCHOLOGY

the most frequently experienced emotion- al responses by injured athletes (4). Recognition and treatment of depression and anxiety is necessary to maximise rehabilitation outcome.

Stress, anxiety and depression Stress and anxiety are among the most frequently cited psychological conditions observed by sports medicine physicians (8). Such distress will affect the injured athlete physically as well as emotionally.

For example ● Stress inhibits the production of pro- inflammatory cytokines, delaying wound recovery (9)

● Muscle tension is commonly associated with stress and it increases pain

● Anxiety can restrict blood flow to the injured area and impede healing. The resulting pain, fear and discomfort pre- vent the athlete from fully participating in therapy, hindering improvement.

RECOGNITION AND REFERRAL OF PSYCHOLOGICAL ISSUES IN

SPORTS MEDICINE

Edmund O’Connor, PhD, sports psychology

The role of a clinical sport psychologist as part of the sports medicine team is becoming increasingly endorsed. Research tells us that sport psychology skills such as positive self-talk, goal-setting and imagery are associated with rapid recovery from injury (1).

Although many physiotherapists also feel the psychological components of injury recovery are important (2), the majority feel limited in their ability to deal with these concepts and desired additional train- ing (3). Psychological interventions may be especially important when difficulties with adjustment arise. For example, physiothera-

pists have endorsed noncompliance with the rehabilitation programme as a signifi- cant problem preventing effective recovery and rehabilitation (4). This behaviour often may not be a lack of motivation by the ath- lete, but a symptom of emotional distress. Adherence tends to decrease as mood dis- turbance increases (5).

Five to thirteen percent of patients with sport injuries experience clinically signifi- cant levels of emotional distress (6). Symptoms of depression and anxiety that do not meet diagnostic criteria are likely to be present in a larger percentage (7) and can still significantly compromise rehabilitation. Sport physiotherapists from Australia, New Zealand and Canada perceive anxiety, frustration, and fear as

The physical symptoms of anxiety may be recognised as muscle tension and bracing, poor coordination, rapid breaths and speech, recurrent physical complaints or secondary injuries. Cognitively, the anx- ious patient will be overly self-critical and negative, have low confidence in rehabili- tation and express a fear of the future. The anxious athlete will often verbalise extreme thinking or unrealistic expecta- tions. Former National Football League player, Keith Millard, illustrated this thinking style following an injury when he exclaimed, “My knee’s shot. My knee’s shot. There goes my whole career. It’s over. I’m through” (10). Emotionally the athlete may be angry, irritable or impa- tient.

Socially, he or she is less communicative and socially withdrawn. The anxious patient’s performance suffers and the ath- lete may demonstrate less motivation or enjoyment in rehabilitation, less interest in sport and other activities and give up easily in response to setbacks. At the other extreme, he or she may ‘try too hard’ in therapy.

Physiotherapists can reduce an athlete’s anxiety by educating the patient about his or her injury and recovery timeline. Daily, specific, behavioural goals foster a sense of accomplishment and further reduce worry. Modelling positive self-talk

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