The Body is Ready but is the Athlete

Exploring Psychological Readiness for Return to Play

Introduction

The world of sports medicine and rehabilitation has evolved significantly over the years, with a growing recognition that an athlete's recovery is not just about physical healing but also about psychological and social factors. The holistic approach, known as the biopsychosocial model, emphasizes the interconnectedness of biology, psychology, and social influences on an athlete's journey to recovery and return to play. In this piece, we’ll delve into the crucial aspect of psychological readiness for athletes to return to play after injury. We’ll explore why it's essential to consider the psychological dimension of recovery, what psychological readiness means, how to assess it, and what health professionals can do to support athletes in this process.

The Evolution of Athletic Injury Recovery

Traditionally, athletic injury recovery primarily focused on physical aspects, following a structured path of diagnosis, intervention, rehabilitation, conditioning, measurement, and ultimately, return to play. The assumption was that once an athlete demonstrated physical capability, they were ready to return to competition. However, it has become evident that some athletes struggle with their recovery and return to play due to a complex interplay of biological, psychological, and social factors.

The Psychological Dimension

Psychologically, an athlete's thoughts and emotions during the rehabilitation process play a pivotal role in their successful return to play. This piece of writing will focus on the psychological elements that impact an athlete's readiness to return to play, highlighting the significance of confidence, focus, realistic expectations, and sustained motivation.

Psychological Readiness to Return to Play (PRRP)

Psychological readiness to return to play can be defined as, “a dynamic psychosocial state in which an athlete has the confidence, focus, and motivation to meet realistic expectations in the competitive environment before and/or after return to competition." This readiness can be experienced at various stages throughout the return-to-sport process and is characterized by:

1. Confidence: Athletes must have confidence in their physical recovery and their ability to give their full effort. This includes trust in their physical condition and the belief that their abilities will match those of their peers.

• Focus: Returning athletes should be able to focus on controllable actions, concentrating on the present rather than dwelling on the past. They should have the ability to detach from their injury, while experiencing minimal fear of re-injury and being able to pay attention to performance tasks rather than recovery movements.

• Realistic Expectations: Athletes need to hold realistic expectations of both their abilities and the competitive environment. This involves making realistic decisions, emotional readiness to adapt, and a balanced assessment of their readiness, e.g. an acceptance that injuries can happen.

• Motivation: Good psychological readiness comprises athletes exhibiting a high level of motivation to return to playing or competing in their sport. Although levels might fluctuate, there will be some consistency shown throughout their convalescence.

What Psychological Readiness Looks Like

Athletes who are psychologically ready to return to play exhibit a physical willingness to test their body within the context of their sport. They assess their abilities without excessive fear of re-injury. They also express a positive but realistic outlook, focusing on improvement rather than dwelling on limitations. These athletes demonstrate a concentration on performance rather than rehabilitation, actively engaging in performance-related movements.

Assessing Psychological Readiness

Assessing an athlete's psychological readiness to return to play is crucial for preventing excess stress, re-injury, poor performance, and the onset of common mental health disorders. Psychotherapists with experience working with injured athletes can assess psychological readiness by observing markers such as confidence, motivation, focus, and realistic expectations.

For those without psychological training, psychometric assessments like the Psychological Readiness of an Injured Athlete to Return to Sport (PRIA-RS) questionnaire can provide valuable insights. Athletes scoring low on these assessments should be referred to a psychologist for intervention, while those scoring high can derive confidence from seeing their progress.

Psychometric Tools for Assessment

Several psychometrics can be used to assess psychological readiness for return to play. These include:

1. Psychological Readiness of Injured Athlete to return to Sport (PRIA-RS)-Questionnaire
2. Injury-Psychological Readiness to Return to Sport Scale (IPRRS)
3. ACL-Return to Sport after Injury Inventory (ACL-RSI)
4. Re-Injury Anxiety Inventory (RIAI)

In my experience, an athlete's motivation, confidence, insight into the risks of re-injury and future performance (realistic expectations) are crucial indicators of psychological readiness.

Supporting Psychological Readiness

Health professionals can play a vital role in supporting an athlete's psychological readiness for return to play. Some strategies include:

1. Providing accurate diagnostic and prognostic information: Accurate information helps athletes regain a sense of predictability and control over their future.

• Encouraging social support: Athletes should be encouraged to activate the available social support networks, as this can significantly impact their psychological readiness.

• Promoting self-awareness and relaxation: Athletes can benefit from techniques such as meditation, visualization, and keeping a recovery journal to enhance self-awareness and stress management.

• Assisting in realistic goal setting: Setting achievable goals throughout rehabilitation helps athletes track progress and maintain motivation.

Incorporating Psychotherapy and The Comeback Programme

Finally, psychotherapy has shown positive effects on an athlete's psychological readiness for return to competition. Consistent, non-judgmental, and non-performative interactions can help athletes develop motivation, confidence, focus, and realistic expectations.

In addition to the above, I work with athletes through a programme called Comeback (in-person or online) that incorporates the above tactics including information processing, journaling, meditations, visualisations, social connection, progress tracking, and the PRIA-RS psychometric. These daily tasks over six weeks are supplemented with weekly ‘therapy’ check-ins to keep the athlete supported.

The primary motivation behind Comeback is to diminish stress associated with injury recovery, while helping the athlete process the experience and to use the time to develop emotional maturity and self-awareness – all aspects needed for a positive psychological readiness to return to play. 

In Conclusion

The journey of an athlete's recovery and return to play is not solely about physical healing but also about psychological readiness. Understanding and assessing an athlete's psychological state are vital for preventing re-injury, ensuring peak performance, and safeguarding their mental well-being. Health professionals have a crucial role in supporting athletes on this psychological journey, using a combination of clinical judgment, psychometric assessments, and effective interventions to help athletes reach their full potential.

Resources List

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