Comebacks: The psychology of returning from injury

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Louise Capicotto is a sport and exercise psychologist, retired GB powerlifter and athletics throws coach. Photo: Louise Capicotto.

Injury is any sportsperson’s worst nightmare. Whether it be a little niggle that stops you training for a few days, or a major setback which prevents you competing for months on end, anyone who has experienced an injury will be in agreement that they cause anguish.

However, how many athletes have given serious thought to how important it is to keep on top of your mental health and psychological wellbeing whilst injured? I chatted with Sport Psychologist Louise Capicotto about what we should be doing to keep ourselves in tip top mental health when away from the track. Louise is currently the Academy Sport Psychologist at Leicester City Football Academy, and volunteers for the Female Coaching Network and Spar UK at athletics events across the UK.

For many competitors, the sport they participate in forms part of their identity and has often been part of their lifestyle for a significant amount of time. Injuries, Louise explains, can have a devastating effect on an athlete’s perception of themselves and can place a degree of threat on their identity.

“If an athlete’s sense of self is largely comprised of being an athlete with few alternative activities or hobbies to draw self-confidence from, when they become injured their predominant source of self-confidence has been ‘taken away’ from them. Athletes who have no other sources of self-confidence can find themselves at a much greater risk of experiencing a prolonged period of low self-esteem, feelings of anxiety and low mood which can potentially lead to depression”.

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You don’t need to have a degree in Sports Psychology to work out that ending up in a state of mental depression is going to be detrimental to an athlete’s all-round wellbeing. From Louise’s point of view, what does she think an injured athlete should do to maintain their sense of identity and try to keep their confidence as high as possible?

“Firstly, I would encourage all injured athletes to ensure they communicate with their coach and their training group. The easiest thing to do during times of injury or illness is to isolate yourself and take yourself out of the training environment completely, which will only exacerbate feelings of frustration and re-emphasise any psychological loss of identity. If you can, attend some of the regular training sessions where you can complete rehab exercises whilst having the benefits of seeing your training group. This will help you to still feel like an athlete”.

Louise endorses a holistic approach when dealing with injured athletes; ensuring that they, coaches and anyone providing physical treatment are singing off the same hymn sheet is crucial for the athlete’s wellbeing.

“It is important for me within sport psychology to liaise as much as possible with the whole team around the athlete, so that the athlete themselves can be educated about their injury. Often, sportspeople experience feelings of uncertainty due to a lack of understanding about the injury”.

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As difficult as it may be when experiencing feelings of negative mental health, Louise explains that it is important for athletes to get actively involved in this stage of their recovery. “One of the first things I do as a sports psychologist is to encourage athletes to take ownership over researching and learning about what has happened to them”.

On the subject of taking ownership, Louise is also a huge advocate of trying to make the most of what can be a very stressful time. “Athletes can take advantage of the time that they are injured; they have some extra time available to focus on the areas of their training which they may not have had much time for before, such as psychological skills training, which will support the physical and psychological rehabilitation of the injury”, she explains.

“Learning how to effectively use imagery (i.e visualising movements) would be a great challenge for injured athletes to set themselves because it is actually quite difficult to do! There is research suggesting that an athlete’s effective use of imagery can stimulate motor neurons and promote neuron growth, which can mirror the growth caused by actually physically training”. So, as Louise explains, whilst you can’t physically complete a movement, teaching yourself to effectively and accurately visualise said movement may in fact reduce the time that you are injured.

So an athlete has followed all of the advice, completed their rehabilitation, kept in touch with their training group and spent their time away from full training learning how to visualise certain skills. They are now physically and mentally able to come back to training. What advice would Louise offer to ensure the transition back to training and competition is as smooth as possible?

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“The first piece of advice I would give would be around managing their own expectations of their performances. When an athlete has suffered an injury, it is really important to understand and factor in the time that it will take for their performances to reach the level they experienced prior to injury. Coaches and athletes should work together to set realistic targets for training and competition”.

However, Louise goes on to explain that athletes – and their coaches – should prepare for and expect bumps in the road. “Progression may be interrupted with feelings of pain and further frustration. It is very unrealistic to expect an athlete who is returning from an injury to experience a linear rate of progression back towards their previous self. It may take some time for the athlete to develop the confidence to participate in certain drills or exercises due to fear of re-injury”.

On this, Louise says the location where the original injury was suffered needs to be considered. “If an athlete is returning to the exact place where they suffered an injury, this can increase their level of anxiety, and result in painful memories”, she explains. In other words, you can begin to associate that particular location with the pain you experienced. Even if an athlete’s post-traumatic experience isn’t that severe, their psychological memories could affect their subsequent performance in there.

“Cognitive anxiety can result in an increase in unwanted muscular tension when the athlete is worrying about being in that location. This muscular tension can put an athlete at risk of re-injury, all from being anxious about being back in that place”.

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Again, in this instance, a degree of honesty is required from the athlete, who should inform their coaches about their anxiety. Gradual reintroduction to the location could be beneficial, Louise points out; for example, conducting drills or warm-ups on a different part of the track to where the injury took place.

Recovering is tough and it can often take time to get back in to the swing of training and competing again. If you are currently injured, in amongst the rehabilitation exercises and physiotherapy, remember Louise’s advice that as well as looking after your body you need to be looking after your brain and hopefully you will be back to peak performance in no time!

If you are a coach, expert or athlete and think you might have tips or experience worth sharing, get in touch.