{"id":2274,"date":"2015-06-09T20:05:07","date_gmt":"2015-06-10T03:05:07","guid":{"rendered":"https:\/\/blog.brianschiff.com\/?p=2274"},"modified":"2015-06-09T20:05:08","modified_gmt":"2015-06-10T03:05:08","slug":"the-psychology-of-returning-from-acl-injury","status":"publish","type":"post","link":"https:\/\/blog.brianschiff.com\/?p=2274","title":{"rendered":"The Psychology of Returning from ACL Injury"},"content":{"rendered":"<p>So many times, athletes and parents alike are singularly focused on the physical rehab necessary after an injury. \u00a0Often, what the athlete is not talking about is the psychological impact of the injury. \u00a0Suddenly, their identity and self worth may come into question. \u00a0They feel disconnected from teammates and coaches. \u00a0Their daily routine consists of rehab and not practice\/play. \u00a0Deep inside their head they are quietly wondering, &#8220;Will I ever be the same again?&#8221;<\/p>\n<p><a rel=\"attachment wp-att-2276\" href=\"https:\/\/blog.brianschiff.com\/?attachment_id=2276\"><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-medium wp-image-2276\" title=\"mind-of-the-world\" src=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2015\/06\/mind-of-the-world-300x178.jpg\" alt=\"mind-of-the-world\" width=\"300\" height=\"178\" srcset=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2015\/06\/mind-of-the-world-300x178.jpg 300w, https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2015\/06\/mind-of-the-world.jpg 555w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><\/p>\n<p>Aside from some of the obvious questions that race through an injured athlete&#8217;s mind, one of the biggest and most often unspoken concerns is the fear of re-injury. \u00a0Having worked with athletes of all sports, ages and abilities, I have seen firsthand how important it is for an athlete to go through a functional and sequential progression that assures that they are able to run, jump, cut, pivot and decelerate again without pain or instability.<\/p>\n<p>I have worked with hundreds of athletes over the course of my career that have suffered ACL injuries. \u00a0The longer I practice, the more I become convinced that we probably have been pushing or allowing these athletes to go back to their sports before they are really ready (physically and\/or mentally). \u00a0Six months has long been the benchmark for most orthopaedic surgeons. \u00a0The graft is well healed, but often the mind and body are not really ready.<\/p>\n<p>While I have seen athletes who have great strength, stability, hop testing scores above 90% and look good on movement drills, sometimes these same athletes still have asymmetrical squat patterns, FMS scores lower than 14 or apprehension about returning to their sport. \u00a0In addition, fear of re-injury is a big factor that impacts confidence and readiness to return to activity.<\/p>\n<p>Consider some of these facts about modifiable factors with return to sports after ACLR from the May\/June 2015 Sports Health Journal:<\/p>\n<ul>\n<li>Motivation, confidence, self-efficacy, optimism and low fear are associated with a greater likelihood of returning to preinjury level \u00a0after athletic injury and ACLR<\/li>\n<li>Lower fear of reinjury and greater pyschological readiness to return to sport favored returning to preinjury level after surgery<\/li>\n<li>Combinable data from 10 studies suggests that fear of reinjury, psychological readiness to return to sport and one&#8217; subjective assessment of knee function were predictive of level of return to sport<\/li>\n<li>As many as 1 in 2 athletes who do not return to their preinjury level of sport report the main reason is fear of reinjury<\/li>\n<\/ul>\n<p><!--more-->Interestingly enough, nonmodifiable factors that may increase the risk of not returning to preinjury level of sport after ACL surgery include: female sex, older age and participating at a nonelite level prior to injury. \u00a0Research also indicates that 1 in 3 do not return to their preinjury level of sport, while 1 in 2 athletes do not return to competitive-level sport after surgery.<\/p>\n<p>Athletes may fear pain, possible consequences of a subsequent injury or having to go through rehab again. \u00a0As clinicians, strength coaches and trainers, we need to be cognizant of this piece of the puzzle. \u00a0Understanding the athletic mind and recognizing the warning signals of a non coper or someone struggling with modifiable risk factors will impact the rehab process and athlete&#8217;s success rate. \u00a0Using scales such as the IKDC, Tampa Scale for Kinesiophobia (TSK) and ACL-Return to Sport after Injury scale all provide insight and clues about how an athlete views their recovery and ability to return.<\/p>\n<p>Below are some links to abstracts pertaining to ACL surgery and the Tampa Scale<\/p>\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24175594\" target=\"_blank\">Kinesiophobia after ACL injury and reconstruction<\/a><\/p>\n<p><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21677565\" target=\"_blank\">Analysis of shortened versions of the Tampa Scale<\/a><\/p>\n<p>To assist athletes in the mental recovery after ACL surgery, I suggest the following:<\/p>\n<ol>\n<li>Have an honest conversation at the outset about general timeframes but not specifically promising return to sport at 6 months post-op. \u00a0Instead, discuss milestones, functional testing goals\/norms and educate them that athletes go back at different points in time.<\/li>\n<li>Assess their mental state of mind early and often through conversation and outcome measures<\/li>\n<li>Refer to a sports psychologist when appropriate and provided the athlete is willing<\/li>\n<li>Maintain close communication with parents, coaches and others involved in the athlete&#8217;s care who may have additional insight and input<\/li>\n<li>Encourage positive self talk, visualization and use words of affirmation during the rehab process<\/li>\n<\/ol>\n<p>In the end, we must partner with the athlete in their recovery. \u00a0We need to assess their mental profile, readiness to return to sport and fear of reinjury. \u00a0As therapists and conditioning coaches, we must let them know it is normal to have apprehension and fear, while consistently assisting them to overcome those obstacles in order to return to their physical and mental best again.<\/p>\n<p>Reference: Arden CL. Anterior cruciate ligament reconstruction-not exactly a one-way ticket back to the preinjury level: a review of contextual factors affecting return to sport after surgery. <em>Sports Health<\/em>. 2015;7(3):224-30.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>So many times, athletes and parents alike are singularly focused on the physical rehab necessary after an injury. \u00a0Often, what the athlete is not talking about is the psychological impact of the injury. \u00a0Suddenly, their identity and self worth may come into question. \u00a0They feel disconnected from teammates and coaches. \u00a0Their daily routine consists of [&hellip;]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[158,7,31,8,26],"tags":[138,89,139,309],"class_list":["post-2274","post","type-post","status-publish","format-standard","hentry","category-acl","category-injury-prevention","category-knee","category-rehab","category-training","tag-acl-injury-prevention","tag-acl-rehab","tag-acl-surgery","tag-return-to-sport"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.10 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>The Psychology of Returning from ACL Injury - Brian Schiff&#039;s Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blog.brianschiff.com\/?p=2274\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"The Psychology of Returning from ACL Injury - Brian Schiff&#039;s Blog\" \/>\n<meta property=\"og:description\" content=\"So many times, athletes and parents alike are singularly focused on the physical rehab necessary after an injury. \u00a0Often, what the athlete is not talking about is the psychological impact of the injury. \u00a0Suddenly, their identity and self worth may come into question. \u00a0They feel disconnected from teammates and coaches. \u00a0Their daily routine consists of [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blog.brianschiff.com\/?p=2274\" \/>\n<meta property=\"og:site_name\" content=\"Brian Schiff&#039;s Blog\" \/>\n<meta property=\"article:published_time\" content=\"2015-06-10T03:05:07+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2015-06-10T03:05:08+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blog.brianschiff.com\/wp-content\/uploads\/2015\/06\/mind-of-the-world-300x178.jpg\" \/>\n<meta name=\"author\" content=\"Brian Schiff\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Brian Schiff\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/blog.brianschiff.com\/?p=2274\",\"url\":\"https:\/\/blog.brianschiff.com\/?p=2274\",\"name\":\"The Psychology of Returning from ACL Injury - Brian Schiff's Blog\",\"isPartOf\":{\"@id\":\"https:\/\/blog.brianschiff.com\/#website\"},\"datePublished\":\"2015-06-10T03:05:07+00:00\",\"dateModified\":\"2015-06-10T03:05:08+00:00\",\"author\":{\"@id\":\"https:\/\/blog.brianschiff.com\/#\/schema\/person\/d7ecfca77bb5641821016294c8190473\"},\"breadcrumb\":{\"@id\":\"https:\/\/blog.brianschiff.com\/?p=2274#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/blog.brianschiff.com\/?p=2274\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/blog.brianschiff.com\/?p=2274#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/blog.brianschiff.com\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"The Psychology of Returning from ACL Injury\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/blog.brianschiff.com\/#website\",\"url\":\"https:\/\/blog.brianschiff.com\/\",\"name\":\"Brian Schiff's Blog\",\"description\":\"Injury Prevention, Sports Rehab &amp; 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