Sports Medicine: Just the Facts

CHAPTER 74 • PSYCHOLOGIC CONSIDERATIONS IN EXERCISE AND SPORT 451

examined 45 studies that used either relaxation-based,

cognitive, cognitive-behavioral, or behavioral inter-

ventions aimed at improving athletic performance

across sports. They found that 38 of 45 studies yielded

positive performance outcomes.

• Behavioral strategies for performance enhancement
  might include the use of visual imagery, diaphragmatic
  breathing, progressive muscle relaxation, biofeedback,
  autogenic training, yoga, meditation, and desensitiza-
  tion (Hendrickson, 2003b).
  
  
  1. Visual imagery can involve imagining a relaxing
     scene or mental rehearsal of one’s performance
     and a desired course of action.
  
  
  2. Diaphragmatic breathing is a simple relaxation
     technique which involves taking slow, deep inhala-
     tions, concentrating on only moving the abdomen,
     holding each inhalation for a few seconds, and then
     exhaling.
     3.Desensitization is technique in which the athlete
     gradually diminishes anxiety associated with
     certain performance aspects (e.g., free-throws in
     basketball) or specific anxiety disorders (e.g.,
     social phobia) through gradual exposure, either
     imaginal or in vivo, to the feared or anxiety-eliciting
     stimuli.
  
  
  
  


• Cognitive strategies can also help athletes develop a
  greater sense of arousal control, and more importantly,
  improve performance. This might include encouraging
  the athlete to replace any sabotaging negative self-
  statements (e.g., “I will never make this shot.”) with
  reassuring, realistic self-statements (e.g., “I have made
  this shot before and will try my best to make it
  again.”). Additionally, goal-setting can be an effective
  strategy for improving identified areas of performance
  weakness (Hendrickson, 2003b; Robinson, 2001).

INJURY REHABILITATION

• It is estimated that more than 3 million injuries occur
  each year in the United States to children and adults
  participating in sports and recreational activities (Bijur
  et al, 1995; Booth, 1987). The injured athlete may
  present with a concern about the injury itself, but also
  with concern over the impact of the injury on present
  and future performance, and concerns regarding the
  nature of the rehabilitation process (Robinson, 2001).
  In fact, Thompson and associates suggest that
  “Rehabilitation is 75% psychologic and 25% physical”
  (Thompson, Hershman, and Nicholas, 1990; p 265).
  
  
  1. Successful rehabilitation should begin with a com-
     prehensive case-conceptualization using the
     biopsychosocial model, which then allows target
     areas for treatment to be effectively identified
  
  
  
  

(Robinson, 2001) (see Table 74-5). This will address

the three areas of rehabilitation proposed by

Steadman (1993) to encompass a complete reha-

bilitation program. They are physical recovery

from the injury itself, specific rehabilitation to the

injured area, and psychologic rehabilitation.

2. Effective treatment must then begin with a thor-
   ough understanding of the component parts of
   the rehabilitation process and a collaborative
   agreement on specific goals for treatment
   (Robinson, 2001). Studies have shown that belief
   in the efficacy of treatment is correlated posi-
   tively with adherence (Brewer et al, 2003; Duda,
   Smart, and Tappe, 1989).

• The provider may then choose from among several
  effective interventions to tailor a rehabilitation pro-
  gram to meet the athlete’s needs. This might include
  the use of imagery and other mental devices, increas-
  ing social support, pain management, and/or other
  cognitive-behavioral techniques such as self-manage-
  ment training (Robinson, 2001).

TABLE 74-5 Biopsychsocial Factors in Injury

Rehabilitation

Physical Factors Where is the injury? What is the frequency,

intensity, and duration of any associated

pain? Are there any other current significant

medical problems? What is their energy

level? How is their sleep? What is their

history of sports injuries?

Behavioral Factors Are they adhering to the rehabilitation

program? Do they put forth their best effort

at rehabilitation sessions? Are there any

substance abuse issues (e.g., alcohol, tobacco,

excessive eating)? How have they changed

their life since the injury (e.g., have they

skipped important responsibilities?)

Cognitive Factors What is their attitude about the injury, the

treatment they have received, and the

rehabilitation process? Do they engage in

predominantly positive or negative

self-statements?

Emotional Factors Have they recently felt more sad, anxious,

upset, and/or irritated than they would have

liked? Do they have any fears about returning

to their sport? Are they experiencing grief

over the loss of their sport or exercise

activity?

Relationship Factors Do they have an adequate social support

system? Have coaches and/or teammates

been constructive in the rehabilitation

process? Have they changed their behavior

towards family and friends (e.g., more

isolative)? Are they experiencing any

relationship difficulties/stressors as a result of

the injury?

SOURCE: Robinson CS: Psychology and the injured runner: Recovery

enhancing strategies, in O’Connor FG, Wilder RP, Nirschl R (eds.):

Textbook of Running Medicine. 2001, Chap. 49.