The Psychological Impact of Rehabilitation among Injured Student Athletes

“According to the annual High School Athletics Participation Survey, conducted by the

National Federation of State High School Associations (NFHS), the overall number of

participants in high school sports has increased for the 28th consecutive year in 2016-17”

(Koebler). However, orthopedic injuries are becoming more prominent and even more severe,

limiting athletes from playing and returning to their sport. According to the Catholic Mutual; Commented [1]: American Orthopedic Society for
Sports Medicine
“high school athletes account for an estimated 2 million injuries, 500,000 doctor visits and

30,000 hospitalizations each year”. Parents and coaches of high school athletes must understand

the social/emotional impact of serious injury in order to alleviate isolation, encourage recovery

and build more effective teams.

Physical activity and exercise is promoted as part of a healthy lifestyle for a student’s

physical and mental health. However, sports injuries are withholding students from wanting to

continue participation in sport. And though teenage athletes are stressed from schoolwork and

extracurricular, a majority of students rely on physical activity and/or sports for not only stress

relief, but also opportunities (scholarships), confidence, and even as social identity. Sports can

even be applied in academics; “in a 2007 survey of high schools in Minnesota, it was found that

student athletes had a mean grade point average of 2.84, while non student athletes had a mean

GPA of 2.68” (Koebler). Also, colleges are eager to gain more student athletes that exceed in

academics and athletics. Thus, including a sport on a high schooler’s resume will not only give

an academic boost, but also give the applicant an edge in applying. Majority of student athletes

explain how their character would not be the same without sports or physical hobbies that they

enjoy to do, since their practices and games are apart of their everyday schedule. However, when

injured, his/her stress reliever, identity, and confidence are taken away. Athletes needing to sit
out become isolated, creating the pressure to recover. This can lead to a decrease in a student

athlete’s desire to continue playing, and worst of all, may take away the athlete’s overall joy in

playing the sport.

For an injury to be classified as serious, there needs to be the risk of permanent disability.

Minor injuries can escalate to major injuries as athletes use ways of compensation that cause

disadvantages, such as a longer and painful recovery process. The American Academy of

Orthopaedic Surgeons states, “the pressure to play can lead to decisions that may lead to

additional injury with long-term effects. High school sports injuries can cause problems that

require surgery as an adult, and may lead to arthritis later in life”. Minor injuries, such as ankle

sprains, create the risk of worsening an athlete’s injury, especially if the injured limb is still

being played on. The most common high school sport to cause the most serious injuries is

basketball, injuring 74% of male and 26% of female athletes, annually (Hoffman). Chances of

reinjury are very high for basketball because of the limited time for scoring, so high quality

playing is needed for that time. The rate and intensity of injuries high school students is rapidly

increasing.

Unfortunately, injury can subdue an athlete from continuing a sport. Michael Greenspan,

working with injured athletes at Michigan State University, relates the impact of psychological

support to physical activity by stating, “the process athletes suffering a serious injury will

typically experience… involves: (1) disbelief, isolation and denial of the severity of the injury;

(2) anger, possibly rage; (3) going through a ‘bargaining’ process; sadness and depression; and

(5) eventual acceptance of loss” (Biddle, Greenspan, and Fitzsimmons). The grief stages and the

recovery process are much alike in the relation of the psychological and physical progress.

Isolation from serious injuries can lead to depression, mental illnesses, eating disorders and
overall unhappiness. An example of major isolation from sport is a form of athletic neurosis

where athletes develop an extreme psychological dependence on athletic activity leading to

major mental illnesses. Major injuries can also lead to significant future trauma. In recent

studies, a significant amount of injured college football players had higher depression and life

stress scores than uninjured players (Appaneal, et al). This suggests that injured athletes can drift

into anxiety and depression, either during or after rehabilitation, which is why parents, coaches,

and even teammates need to recognize the emotional stress for an injured high school athlete. To

prevent this drift, it is up to the coaches, parents and teammates to be able to act as a support

network in and out of practices, as relationships with coaches, parents, and teammates play a key

role in the recovery process. Athletes hope to acquire emotional help and support from others,

thus building a strong relationship with the athlete can help reduce mental stress and physical

pain when the athlete is injured.

As high school sport popularity has heightened, injury rates have also sufficiently

increased. Student athletes that experience a major injury, most likely do not come back to the

sport because of the traumatic rehabilitation process. However, a student athlete’s injury process

needs to be taken as a learning experience for parents and coaches so they can understand the

difficult physical and psychological journey of recovery. The happiest and most successful

athletes let their hard work and training bring out the best in himself/herself. Athletes that are

able to maintain a positive attitude, with the help of his/her relationships, are more likely to fully

tap into his/her mental and physical abilities and quickly get back on the field.

The emotional support from parents, coaches, and teammates is necessary for alleviating

isolation among injured high school athletes to help their recovery process. The athletes’

relationships can make a significant impact on alleviating many stressors. The coach’s leadership
position is very significant in the psychological care of an injured athlete and takes an active role

in alleviating stress associated with athletic injury (Gilbert, Lyon, and Wahl). Parents can also

help boost the moral of injured athletes by communicating with coaches and staying up to date in

the recovery process. This can make athletes feel acknowledged, thus allowing themselves to

feel important and boost their self esteem. The social factor comes into play when helping deal

with alleviation of isolation; coaches, parents, and teammates should be aware and learn of the

solutions to help ameliorate isolation and sustain the emotional impact of an injured athlete.

High school athletes today are more talented; stronger, faster, smarter, and better

conditioned than in the past years (May). Athletes receive outstanding outside training, high

experienced coaching, and are expected to play at very high levels. Sometimes the emphasis

placed on sports can be heavy for teenagers, thus rely on their experienced coaches to help and

support them. The inexperienced coaches should become aware of the major expectations that an

athlete wants to overcome when injured. Dismissing an injured athlete from practice or paying

little no attention to them could prolong their physical and mental recovery (Gilbert, Lyon, and

Wahl). There are some little changes that the coaches can do that can really help injured athletes

psychologically. For example, a coach can modify physical workouts and exercises or ask for the

injured athlete’s opinion/input. When movement restrictions prevent physical participation,

coaches can use imagery to create or re-create an experience in the mind (Gilbert, Lyon, and

Wahl). Imagery can help athletes engage in mental encouragement and boost the athletes’

confidence during recovery. For coaches to help when not there, coaches can also encourage

parents to serve as a safe sound board for their injured son or daughter. In some cases, athletes

may even feel uncomfortable telling teammates and coaches certain information about their

recovery; thus, parents can assist in translating communication to coaches (Clement, et al).
Coaches who are open to communication with parents and are open minded of the feelings of the

injured athlete, will not only help the athlete, but will successfully alleviate the injured athlete’s

fear of hate and neglect from the team.

Parents also provide strong relationships to athletes to alleviate isolation. A study by the

College of Physical Activity and Sport Science in West Virginia claimed that, “ the majority of

the initial emotional reactions after an injury is to seek social support from family and significant

others”. Parents that stay up to date with an athlete’s injury and recovery are more reliable and

understanding of an athlete’s situation. Thus, parents can serve an important role in the social

support network of the injured athlete (Appaneal). In “Coping with the Stress of Athletic Injury:

How Coaches Can Help,” the article explains the impact parents can contribute from an injured

athletes’ standpoint. One athlete from the article stated that his parents “really helped [him]

because [he] could just talk about what was on [his] mind. It felt good sometimes to just get it

out. It also really helped with accountability. [His] dad would always ask what I was doing and I

would have to report to him how my rehab was going” (Gilbert, Lyon, and Wahl). Parents who

act as a sound board and continue to attend games will help aid in the quickest possible recovery

for an athlete and can help minimize stress related isolation (Armstrong). Acknowledging an

injured athlete’s emotional struggle is key to learning the impact rehab can psychologically do to

an athlete. Parents that acknowledge that the moodiness, frustration and anger are normal can

help the athlete work through this state and can partially alleviate the feeling of isolation. Pete

Temple, creator of Mind-Eye’s Sport Performance, explains the technical signs that parents

should look out for in their injured athlete, “(1) persistent feelings of intense anger or sadness,

(2) denial related to the seriousness of the injury (“It’s not that bad,” “The doctors are wrong,”

“I’m playing in the next game”), (3) Disengagement from activities and/or withdrawal from
friends and teammates, (4) sudden non-compliance with treatment, (5) suspicions of maladaptive

coping mechanisms (e.g., substance abuse” (Pete Temple). Parents can also set up goals such

using the SMART principle: goals should be specific, measurable, adjustable, realistic but

challenging, and time-based (Gilbert, Lyon, and Wahl). The goal of writing is to drive the athlete

to feel committed in a objective, and gain a sense of power in their own decisions when

completing the goal. Parents that can alleviate the feeling of isolation and overall unhappiness

will relieve more stress and anxiety in their athlete when coming back in to action.

Parents and coaches act as the key to communication when supporting the athlete during

recovery by taking part of an active role in the athlete’s recovery process. Coaches can make a

significant impact in controlling what goes on during practices. By acknowledging the athlete’s

view, coaches can have a better perspective in helping them, and also decide with parents about

at-home decisions for the athlete’s health. Social acknowledgment from coaches, parents, and

teammates will help strengthen the athlete’s emotional stability and help alleviate isolation.

Encouraging recovering means to acknowledge the healing progress and to value the

injured athletes journey of recovery. Parents and coaches can deeply impact the encouragement

of recovery by enforcing positive attitude and acknowledging the athlete’s progress. Both

coaches and parents should maintain positive attitudes around injured and non injured athletes. A

majority of athletes show universal signs of frustration and irritations when injured (Armstrong).

Endorsing an optimistic behavior can highly influence the athlete to look beyond his/her injury

and focus on recovering. Acknowledging an athlete’s progress is also important to recognize. It

is hard to deal with a serious injury alone, so having coaches and parents to acknowledge even

the smallest progress is important to an athlete to know that he/she is not alone.
 Parents and coaches can enforce a positive attitude by encouraging flexible thinking.

When an athlete is injured, there is one thought in their mind: to get better as quickly as possible.

The first emergent theme in the reaction-to-rehabilitation phase was being cautious on excessive

pressure upon body in fear of worsening injury.. A recent study conducted by the College of

Physical Activity and Sport Science of West Virginia University reported that, “recovery started

off slow...just took it day by day, it is efficient to take baby steps, a little at a time really”

(Clement, et al). Teaching athletes techniques to remain patient such as reminding them of their

progress and remaining optimistic, is beneficial in relieving stress. Even though every athlete has

a different mindset, the outcome is the same when each athlete’s attitude is positive: the healing

process is sped up and emotional pain is lessened.

Coaches and parents should highlight the importance of understanding that the injured

athlete had suffered a mental block, and his/her feelings of self-worth must feel vulnerable.

Letting the athlete know, not only in words, but actions from the coaches and parents, that they

still value them as a person and an athlete will benefit the injured athlete’s esteem, enforcing

positive attitude. Dr. Alan Goldberg, a Sports Performance Consultant for a wide range of

athletes explains how “ far too many coaches completely ignore the injured athlete, which ends

up truly destroying his [or her] already shaky self-esteem”. Parents should know that their

injured athlete will go through their ups and downs, thus they need consistent optimism from

parents to sustain emotional support. However, parents should be careful not to set them up for

disappointment. If a doctor had set a direct time, it does not help the injured athlete to suggest

that he/she might be able to do it shorter. Instead, parents should encourage the athlete to focus

on the treatment plan and their process (what they need to do that is within their control). If their

hard work and positive approach speeds up their recovery, it’s not only a victory but also a major
confidence booster. Treating an injured athlete with respect and value will not only encourage a

positive behavior, but will also help an athlete over overcome sports fears and blocks to perform

to his/her potential.

Parents and coaches can recognize an athlete’s progress by staying up to date with the

medications, exercises, and stretches. Reminding the athlete of his or her physical therapy

exercises will keep them organized and less stressed, resulting in a optimistic athlete. Coaches

can also reduce reinjury by communicating the the athletic trainers and physical therapists with

the modified exercises, so that the athlete can still involved with the team and partially

participate in activities. Coaches and parents should assure the athlete that they will be apart of

the journey with them and should let the athlete know that they will support and assist them

throughout their entire recovery. They can do this by trying to learn as much about the injury and

rehabilitation progress so that the athlete can acknowledge them as a knowledgeable advocate for

their emotions and feelings. However, parents/coaches that pressure athletes to recover quickly,

can cause athletes to be stressed. Thus, parents and coaches that can enforce recovery in a less

stressed behavior, can result in a positive, reasonable athlete.

Overall recovery is very important to injured athletes, so parents and coaches that can

spread awareness and encouragement can help the athlete’s healing progress. Parents and

coaches can deeply impact the encouragement of recovery by enforcing positive attitude, and

acknowledging the athlete’s progress. The parent and coach dynamic can deeply benefit an

injured athlete to enforce a positive attitude and being able to acknowledge a athlete’s successful

progress. With the help of these tactics, athletes will be ready to learn how to accomplish their

goal of returning to their sport, physically and mentally ready.

 In high school sports, it is important to work as a unit to succeed. Building an effective

team means creating strong bonds with teammates and being able to value each others hard

work. Furthermore, building a more effective team ties into the social impact of an injury, as the

injured athlete relies on moral support from others to recover. Looking at the importance of the

relationships among high school athletes is important. Teammates are overall, the biggest factor

in forming a strong team. Each member of the team contributes to the overall personality of the

team, however but the coach is the one who determines the morality and enforces the appropriate

behavior for teammates to exhibit. By one member of the team enduring a significant sport

injury, student athletes become closer, coaches exhibit stronger leadership, and teams become

more effective.

Teammates play a large factor in the efficiency of a sports team. Injured athletes rely on

teammates for support and to value his/her recovery progress. To build an effective team, one

must look at the importance of being able to heal from a major injury. If an injured athlete brings

bad aura and attitude, it is not long until the behavior manifests in the team. Looking at what the

teammates can do to help support the recovering athlete is importance to build strong bonds;

teamwork. An author from Live Strong explains the importance by stating, “teams that often end

up on the winning end of the score in team sports are those that work well together. Learning to

cooperate with others towards a common goal in sports is what builds character, friendship and

important life skills for players and coaches. The friendships built within a team can last a

lifetime for some players, and the journey of a team throughout a season is often memorable.”

(Harle) Teammates that can learn to cooperate with each other will produce better success

towards goal.
 In addition, coaches can make a great impact on forming an effective team. Coaches must

act like professional educators and mentors especially among youth groups in order to teach

them efficient leadership and social tools. They also must understand individual athlete’s role on

the team and how each role is very different. For example, an athlete who starts may have

different social support needs than someone who has less playing time. (Gilbert, Lyon, and

Wahl). Coach who form connections with their players can more easily enforce teamwork and

bring the team to commit to the same objectives. Coaches can form a sharing a goal within the

team by helping form better teamwork, role clarity and acceptance, and making sure all the

athletes know they have a significant role on the team. Coaches must stress trust and cooperation

from the start of the season so that the team can believe their team is capable of success.

Effective coaches know that turning a group of individuals into an effective team takes a keen

understanding of team dynamics. By incorporating previously listed team characteristics into

coaching strategies, coaches will help guide individual players into adopting a team vision and

commitment. Every year the team must strive to accomplish a monumental task, effective teams

develop a shared sense of responsibility and accountability that maximizes success. (Nicki

Moore). Coaches and athletes must communicate with one another to fully succeed in teamwork.

Building an effective team involves a great impact of an injured athlete’s journey to

recovery. Bringing together the coaches, injured athlete, and teammates, will form a stronger

bond within the team and help them advance and win. The best teams are the ones with greater

chemistry and tighter bonds than other teams with no connection. During an injured athlete’s

recovery process, the athlete deeply relies on his/her teammates for greater moral support.

However, the teammates actions are deeply influenced under the tactics of the coaches and

parents. Thus, coaches and parents should also help support the injured athlete so that the effect
is passed on to the teammates. Building a effective team is a social factor that can strengthen

bonds between athletes and coaches; thus, coaches who exhibit strong leadership and teach

athletes ways to help their fellow injured teammates will successfully pull athletes to work

together.