By Tom Hurley

It is estimated that between 15 and 20 million sports injuries occur in the United States alone. These injuries can range from nagging constant pain due to overuse, to season ending injuries such as ligament damage in the ankle, knee or shoulder; and the age of the athlete’s affected can range from very young, (7 years) to not so young, (70 years and beyond). The statistics are staggering, but not necessarily unpredictable. The bottom line is, in terms of classifying athletes, it has been said that there are two types: those who have been injured, and those who have not been injured yet.

As opportunity for youth participation in sport grows, the number of injuries related to participation naturally rises. Not only does this create a larger need for the biological, (physical) problems associated with the injury to be addressed through possible surgery, rehabilitation and conditioning, it also creates a necessity for young athletes, parents and coaches to understand the mental and emotional, (psychological) factors that need to be addressed for a full recovery.

“Get back on the horse”
So you want to get your son/daughter/team member/athlete back in the game. The Doctor has given them “medical clearance” and all physical indications are that he/she should be able to participate at their pre-injury level. You’ve tried everything to get them there, but nothing seems to be working. You wonder “what will it take to get them back on the horse”? This is a huge subject matter, one that can not be fully addressed in a simple article. There are however, some specific strategies that can be noted for further exploration.

Scenario 1:
The young athlete begins practicing with the team and aside from a let down in physical “game-time” conditioning, seems to be performing at or near pre-injury level. This is the scenario that we would all like to experience. In this case the child simply needs to know that there is an open, non-judgmental line of communication available to them should they begin to experience pain or inhibition.

Scenario 2:
The young athlete refuses to return, or when they do begin practicing, doesn’t seem to have the same intensity or focus that they once had. They are noticeably more “timid” in their approach to the sport. This is an extremely common scenario whereby we see the physical return to the sport but factors are in play that are creating inhibition. It can not be understated that open non-judgmental communication between the athletes, parents, and coaches is vital in all of these situations, and should be the standard for all youth athletics. There are usually three different factors involved in the “timid play” scenario.

“It still hurts”
The first factor could quite simply be that the child still experiences pain as they are trying to play. Though it may sound simplistic, we often forget to ask the proper question. If the young athlete feels empowered as a member of their own re-habilitation team, they will be more likely to let you know that “it still hurts”. The fix here is simple; go back to the doctor or get a second opinion.

“I’m all done”
This factor is a little more difficult to rule out. In our efforts to promote our children through sport we sometimes forget that they are not little adults. Their likes and dislikes are fickle at best as they move through development and maturation. Today’s favorite activity may be tomorrow’s memory. Your child/athlete may be trying to let you know that they have simply lost interest in this sport and don’t know how to tell you for fear that they will let you down.

The temperament, coping skills, daily stresses, trait anxiety and emotional maturity of each young athlete is unique and under construction. The injury and pain associated with it may have been enough to disengage that child’s desire to continue with this particular sport.

Of course we all want athletes to “get back up on the horse” because it “builds character”. The suggestion here is to begin having conversations with the athlete about their continued participation. It has been my experience that once a child knows that they are able to have good honest “talks” about how they feel; they are more likely to make decisions based on how they actually feel as opposed to how they think they should feel. Often times the child will understand where the apprehension to perform is coming from, and will be willing to try to work through it and continue with the activity. Of course, the fact remains that they simply may be “all done”.

“I’m Scared”
Fear is a primary emotion. That said, when a young athlete focuses on the fear of re-injury it is nearly impossible for them to focus on the prospects of returning to pre-injury play. The fear of re-injury not only inhibits intensity of play, but places the athlete at a higher risk of more injury due to compensatory movement patterns as they avoid using the injured or affected body part. This is the factor most commonly associated with an athlete’s return to full participation, and can be the most frustrating for the athlete to try to overcome.

There are four vital elements that should be considered when dealing with the psychological aspects of all of these injury scenarios. For this scenario, since it is often times the most difficult to deal with, it’s important to be familiar with all four, though within the confines of this article, and because we are focusing primarily on the child athlete, concentration will be on the first two of these.
1) First and foremost it is vital to validate the child’s fear as a rational, normal and completely expected outcome of having been injured.
2) Set specific, progressive, reasonable goals for the athlete’s full return to play.
3) Utilize imagery and relaxation techniques.
4) Incorporate positive self-talk.

Encouraging a young athlete to discuss feelings of apprehension or of being “afraid” to play again is extremely important for their emotional development, not only as an athlete but as a person in general. The realization that they are experiencing a normal consequence of having felt pain, and that all athletes at some point experience the same thing, allows them the freedom to move toward dealing with this emotion. Remember, we are talking about children who are still in the process of developing psycho-socially. This is an important first step toward eventually returning to activity; especially when it is a young athlete’s first injury.

Setting goals may sound easy, but requires that you know whether your child is ego oriented or task oriented. In its simplest terms, an ego oriented athlete bases their self-worth on how well they perform compared to others, while a task oriented athlete is driven by an internal desire of skill mastery, effort and self-improvement.

An example of a simple ego-oriented goal may sound like this: “Jane (a teammate) made four lay-ups in a row from the right side, now it’s you turn to see how that knee holds up.” Though the focus of the goal ends with a statement regarding this athlete’s knee (the site of the prior injury), this ego oriented athlete will focus on trying to do as well as Jane; allowing her to perform on the rehabbed knee while focusing on performance.

An example of a task-oriented goal may sound like this: “Today you will perform 3 sets of lay-ups from the right side. Each set will be made up of 10 reps. Try to make as many in a row as possible.” Here the focus is on the lay-up, which will require her to decelerate then drive through her previously injured knee. No concrete number is given as a goal for completed lay-ups per set, as this athlete will use the first set as a benchmark and attempt to improve on each subsequent set. Remember, a task oriented individual is driven by self effort and improvement.

Notice, in each of these examples we kept it as simple as possible by not creating a time limit or actual person to person competition. The point here is whether ego or task-oriented, the goals remain attainable, reasonable and progressive. We also need to remember to debrief or discuss with the athlete how they felt during these performances. Allow them the opportunity to share what it felt like. When a goal is achieved, celebrate with them by recognizing the achievement, and then increase the difficulty of the goal. The young athlete’s self-confidence should continue to improve. As adults we need to be aware that all healing takes time and sometimes the emotional and mental healing requires more time than the physical healing. These are, above all, developing human beings.

Earlier I mentioned imagery, relaxation, and positive self talk as vital elements to incorporate in the injury recovery process. Though I use them on a regular basis with athletes that I work with, it is not something that was learned overnight or in a brief article such as this. Concentrating on good open communication and development of proper goal setting skills can go a long way in helping young athletes through emotional challenges.

Reference:
Murphy, S. (2005). The Sport Psychology Handbook. Champaign, IL: Human Kinetics.

Tom Hurley, M.Ed., YFS3, YNS, SAS, HSSCS applies over 30 years of combined knowledge as a Behavioral Therapist, Health and Physical Education Teacher, and Mental Skills Coach in his current business as a Performance Specialist. He currently programs with over 200 athletes and is dedicated to providing each one with the opportunity to develop spirit, mind and body.