First, the appraisal model of injury reaction emphasises the importance of taking into
account cognitive and perceptual factors such as the way in which the afflicted person
makes sense of what has happened to him or her. Clearly, a practical implication of this
theoretical approach is that athletes’ beliefs about the causes and likely course of the
injuries from which they are suffering should be addressed explicitly by the treatment
specialist. Therefore, as early as possible, incorrect assumptions or naïve theories about
the injury should be elicited and challenged. Influenced by this approach, A.M.Smith et
al. (2001) stressed the need for therapists to convey to their patients an accurate
understanding of the nature and prognosis of the injury in question. It is also important
for treatment specialists to assess the degree to which injured athletes believe that they
can exert control over the pace of the rehabilitation process. The theory here is that the
more control that athletes perceive they have over the injury, the more likely they are to
take personal responsibility for adhering to the prescribed treatment regime. Conversely,
athletes who fail to understand the nature of their injury, and/or who believe that they are
helpless to overcome it, will probably take longer to recover from it than will
counterparts who have more accurate knowledge about it. In summary, the first principle
of injury management is the idea that accurate knowledge and perceived control will help
to reduce the stress generated by physical injuries.
Second, based on the grief stages model, it seems likely that afflicted athletes will tend
to experience a characteristic sequence of emotional reactions as they work their way
through the rehabilitation programme. Therefore, treatment is likely to be more effective
if it is matched to the athlete’s current position in this emotional sequence. Thus advice
such as “cheer up, it could be worse” is ineffective and insensitive if the injured athlete is
not ready to accept such comments (e.g., due to the fact that s/he is in the denial stage).
The third injury management principle is concerned with the behavioural level of the
injury experience. To explain, perhaps the biggest danger for recovering athletes is to
make a premature return to their sport. As Robert Pires, the Arsenal and French
international soccer star admitted after his long layoff through cruciate knee damage,
“you need to be patient, not precipitate your return. You want to come back, that’s
natural, but it has to be all in good time” (cited in Fotheringham, 2002b, p. 2). Clearly,
any unrealistic expectations of an early return to action must be dealt with sensitively
during the rehabilitation programme. Therefore, the therapist should try to help athletes to
discuss any fears which they may have about their impending return to sport.
Interestingly, there is evidence that athletes who are passive and/or unco-operative tend
to recover more slowly and less successfully than do athletes who take a more active role
in the process. For example, Fisher, Damm and Wuest (1988) studied the differences
between athletes who adherered to their rehabilitation programme and those who did not.
Not surprisingly, results showed that the “adherers” scored higher on self-motivation and
also worked harder to recover from their injuries than did the “non-adherers”. A final
treatment principle stems from research findings on the importance of helping athletes to
develop constructive interpretations of their injuries in order to minimise the stress
experienced. The key objective here is to encourage injured athletes to restructure
depressive thinking (“this is the end of my career”) in more optimistic terms (e.g., “this
injury gives me the opportunity to work on my weaknesses”).
Turning to practical psychological techniques used in injury rehabilitation, mental
practice (see Chapter 5) is an obvious candidate. Thus many applied sport psychologists
Sport and exercise psychology: A critical introduction 260