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Psychological Intervention in Sport Injury Rehabilitation Intervention

post-injury psychological evaluation

have to assess the following:

• injury and scope
• The emotional impact of injury and its aftermath
• Pain Variables important in the rehabilitation process variables
• sports during the period of injury
• The tendency to avoid or escape

Evaluation of the injury and its extent

physician's role is to assess the severity and consequences, but the psychologist has to have this information in two areas: Knowledge

• description, prognosis, therapy lesion and its interaction with the normal operation of the athlete
• The type of injury, understanding biophysical
• The existence of pain location, intensity, activities to be determined, and if require pharmacotherapy for disposal or relief
• Mode and extent to which their activities interfere injury normal, discontinue the sport, how long and possible limitations
• take immediate therapeutic measures (hospitalization, surgery, etc..), time, risk, etc.
• therapeutic impact of these measures in normal operation (sleep, wandering, degree of disability, etc.).
• At what point will you know the final extent of the injury, prognosis, degree of recovery and final yield at the end rehabilitation.
• Knowledge about the impact of injury in sports performance
• Income before injury (major, lower, as expected), history of performance in recent months, pressures he was subjected to (family, professional, etc.).
• losses which can result from sports injuries (loss of role in his team at major competitions ), need to change lenses for the season, his contract
impact on earnings that can bring
• injury (avoidance or escape from stressful situations or competitions, the end of a particularly bad season, the possibility of switching to a desired lifestyle .. .)
• possibility to use the downtime to improve other aspects of the sport

emotional impact assessment of the injury and its consequences

To evaluate the emotional state can be used questionnaires Derogatis SCL-90 (especially the scales of anxiety, depression, hostility and stress) or MMPI (useful for detecting athletes and grief Somatic recognized). Due to its length, and low sensitivity for detecting transient emotional fluctuations is only recommended use in selected cases (beginning and end of the process), but as it is necessary to make these assessments more frequently, we recommend using Profile of Mood State (POMS), the Anxiety and Depression scales of Leeds, the Visual Analogue Scales Tyrer or Symptom List Lubin.

The POMS is sensitive to emotional changes, has six dimensions: tension-anxiety, depression-dejection, anger-hostility, vigor-activity, fatigue-inertia and confusion-bewilderment. A positive emotional state would indicated by a profile with high values \u200b\u200bin the dimension vigor-activity and low in all other (shown as the time we manage, control the negative impact after injury, adherence to treatment during rehabilitation, mentally prepared for the imminent reappearance). Profiles with high scores on all or some of the scales except vigor-activity, suggest adverse emotional reactions.

The other scales (Leeds, Tyler, Lubin) have hardly been used within this policy area, however they are recommended by their high sensitivity to emotional changes and speed of application (in the same line as the POMS). They are also very useful thermometric scale in which the player has to be placed on a scale (0-10) the presence and intensity of certain emotions.

The possible reluctance of athletes to the use of psychological assessment instruments can be eliminated by establishing a relationship of trust informing and explaining the usefulness of each and reducing fears about the significance of their responses. Through the interview

can meet potential personal cognitions that can affect the process (also used self-reports) to intervene more directly on them with behavioral techniques and / or cognitive adequate.

Pain Assessment

is necessary for all professionals involved in rehabilitation, to know as precisely as possible the characteristics of pain that could pose (location, type, intensity). This is especially useful for drawing the body human head and back in the athlete indicated by dots and signs (or colors) its exact location, modality (pricking, tingling, itching, etc.) and intensity (numerical scale of 0-10 or 0-20).

The distribution of trigger points can tell us about the degree of emotional adjustment of the athlete. According to Heil, an overestimation of points (greater than might be expected given the severity of the injury), an unusual distribution of points, inappropriate locations (outside the body), comments, additions or inclusion of other symbols, suggest an emotional maladjustment and a somatization that could interfere with the rehabilitation process (always and where, after medical analysis, these elements not to cause inadvertent physiological problems at first.)

is useful for assessing pain intensity Thermometers and VAS. The first is to indicate a numeric value of the entire range directed-and the second mark a point on the horizontal line joining the ends of the scale (no pain-worst pain possible), the numerical value is obtained measuring the stretch of line from the end of freedom to the extent indicated. You can also use direct observation, evaluating verbal and motor behavior, and complaints etc.

also be considered background, those stimuli to which pain is maximum or minimum which help to better control the pain. On the other hand, the consequences of that pain, the negative: if it prevents sleep, interference with normal functioning, and positive, avoiding stress, greater attention of others, reinforcing unwanted behaviors, etc.

Also useful are self-reports, in which the athlete may indicate pain location, intensity, antecedents, consequences, and if you modify the pain sensation. Assessment

relevant variables in the rehabilitation process

be evaluated following variables:

Adherence to the rehabilitation . It has three components:

• Attendance at meetings
• Compliance
• Performing tasks required physical effort required in each of the tasks

The assessment of the assistance and compliance tasks can be performed using objective measures , to evaluate physical effort, or using a computerized dynamometer (isokinetic) or a subjective scale (self-registration record and score on a scale 1-5) to which you can add measures of emotion and pain.

also be assessed psychological variables (interview and scales) of the athletic goals you have, confidence in achieving its current status, motivation, etc. If an athlete tells ambitious, if you have a good motivation, adherence to rehabilitation will be good, however there may be a danger that the athlete intends to obtain in a period of time than possible or desirable, and displayed anger or despair; ambitious targets with low motivation, stress can cause seriously affect the rehabilitation process (should be modified objectives and strengthen self-reliance). If there are no targets, there will be low motivation and poor adherence to treatment.

An important variable is trust in the rehabilitation treatment, which will be assessed (scale 0-10) in case intervention is needed in this direction. Performance

athlete rehabilitation work. The performance increase self-perception of the task, success will increase the motivation impacting positively on adherence. This performance evaluation can be made first by observing the behavior of effort, and then turn to objective measures (degree of stretch of the leg, number of lifts with weight of 20 kg), always in reference to the expected level according to severity and stage of the process rehabilitation. The knowledge of this performance data, allows to increase the perception of dominance, motivation and confidence that ultimately will benefit from adherence to treatment.

therapeutic progress to determine if evolution is correct or not . If progress is not adequate, by setbacks or slow progress, the self-reports allow us to determine the circumstances that have produced or fostered (as opposed to sensing). The lack of progress is disappointing for an athlete, but this effect can be reduced with the use of measures of progress and performance, while allowing you to increase your perception of control

Variables

sports during the injury. Inactivity is a source of stress, it should reduce it, and also enhance self-confidence. Concerned that the athlete is the most active as possible throughout the rehabilitation in order to maintain high motivation. In this sense, it is necessary to determine the activities you can do (taking into account its limitations) and adherence and progress in sports tasks are allocated.

tendency avoidance or escape. Provisions can be taken as favorable to the avoidance or escape, the following situations:

• excessively positive emotional states (to know the severity of the injury, for example)
• Somatization, especially if the return is very close
• overly pessimistic attitude on the recovery (sometimes denying or questioning evidence)
• Attitude negative toward rehabilitative tasks and poor adherence to treatment (low willingness to recover)
• excessive attention from others (especially in athletes who usually do not stand)

post-injury psychological intervention

will focus on the following general objectives:

• control emotional responses associated with the injury
• motivation and self-development with respect to the rehabilitation program
• Performance Optimization in the rehabilitation
• time optimization Preparation
• inactivity recurrence
• specific intervention to prevent recovery athletes
• Intervention injured athletes must compete
• specific intervention with athletes to be withdrawn as a result of the injury

control emotional responses associated with the injury
Get

• accept the reality of the situation. Cognitive intervention can be used to re-evaluate, reinforce or amend
• Control of expectations about the extent and duration of injury, recovery rate (a trend is positive, optimistic and realistic)
• Achieving social support of family, rehabilitation team. Care that there are no negative effects (excessive attention, excessive support ...)
• Prepare the athlete for hospitalization and surgery: information, relaxation training, stress inoculation, cognitive restructuring, etc.
• plating recovery as a new challenge, perceived control rather than helplessness
• Develop a realistic plan to achieve greater use of duration of the injury. In addition to their own rehabilitation, others related to the sport or outside the sport. No overloading of tasks, but to avoid inactivity and the emergence and subsequent thoughts difunctional negative emotional states.
• To help increase their perception of control over treatment. Know and participate in the choice of treatment, anticipate problems, provide solutions. Adaptation
• as quickly as possible to their new life. Acceptance of reality, real problem solving immediate ... Acquisition
• coping skills that help control adverse emotional responses. Relaxation, self-instruction, thought stopping, re-evaluation of the seriousness of the situation.
• In cases of very pronounced emotional reactions, appropriate therapies.

Development of motivation and confidence with respect to the rehabilitation program

• Expand your knowledge with regard to his injury and treatment
• Knowledge of costs and benefits in the short and medium / long term work with to perform. Raising
• appropriate targets, challenging but realistic. It first sets the ultimate objective of complete recovery, and when rehabilitation is long-term, intermediate targets are set (approach by the doctor and physio, psychologist and consultant suggests.) It is also interesting to make immediate objectives in each rehabilitation session, produce a greater motivation in the daily work and increase self-confidence. The objectives can be divided into performance objectives (to stretch the leg 90 degrees) and performance goals (go to meetings, do ten push-ups), the targets to be raised to motivate the athlete progress toward a goal, strengthen their confidence through success in their achievement, the embodiment prior to arise as the result, especially when it is difficult to draw close performance objectives over time, or are used to learn a specific technique or adherence or self-confidence are low.
• develop work plans to achieve goals. It is mainly a function of the doctor and physiotherapist, advised by the psychologist. It is desirable to develop the comprehensive plan, that covers all periods of rehabilitation, for on this build another more accurate and closer in time indicating the daily plans for each work session. Knowledge of these plans enhances the perception of control over the recovery process
• anticipate potential pitfalls and provide solutions for them. Increase the level of perception of control over the rehabilitation process and reduce the stressful impact on the case such problems arise.
• analyze relapses and rethink goals and plans. With the emergence of problems that may require rethinking, and possibly cognitive intervention necessary to replace rigid styles of analysis with more flexible. In any event, the athlete can not run out of targets, if the previous are to be changed and while not establishing a new, labeled others waiting time (to rest the affected area to establish a new goal next week, etc.) for motivation and perceived control does not decrease.
• Fostering self-rehabilitation. Through the involvement of the athlete in making decisions and completing the rehabilitation process control leaves (columns: objective, date approx.'s Achievement, plan to follow, possible difficulties, possible solutions).
• provide feedback of the completion and therapeutic progress.
• Using the modeling technique. Used as a model famous athletes who have suffered a similar injury (increases motivation and confidence in the rehabilitation plan), especially when progress is slow. If the self-confidence and self esteem is very low, presenting a very successful model can be counterproductive in the sense that it can make a bad comparison (in these cases it is better to present first a model closer to the athlete).

generally positive attitude should be the result of good motivation and confidence, and the latter are those that allow internal self-talk and optimistic comments useful. But the self-talk and optimistic comments per se will not produce motivation and confidence.

performance optimization in the rehabilitation

Strategies to improve communication . It is appropriate that health is a good listener, encouraging the athletes to express their emotions and feelings, and should have the following skills:

• Make eye contact
• Perform non-threatening nonverbal behavior that the athlete knows that he is understanding (nod ...)
• Using Motion to emphasize that it is understood the athlete (mov. hands, head, etc..) Issue
• sounds, monosyllabic words or words to support non-verbal communication (ya ya, yes, ahh ...) especially when the athlete is back to the caller
• Respect the silences when he / she is expressing something important to him
• and return the athlete Summarize the information received (from time to time) without challenging it or alleviate its impact.
• Wait turn to speak, try not to interrupt while you are

Other verbal and nonverbal skills useful are:

• Make eye contact with the athlete, especially when the information is important.
• Express as simple, clear and accurate as possible, avoid detours. Correctly use
• paraverbal components of the communication messages
• Fostering
appropriate verbal gestures
• In any verbal information complete with graphics, pictures or pointing directly. Biofeedback

. It can be used for the purpose:

• reduce the level of general or specific muscle tension in the injured area
• Increase, where muscle tension in the area of \u200b\u200binjury
• contribute to neuromuscular or motor rehabilitation
• foster the independent functioning of muscle groups that typically operate at a time, but that as a result of the injury should be trained differently Help
• proper execution of the research (Regulating their own efforts)

relaxation. Used to control some forms of stress, assist in technical feedback, improving blood circulation in the relaxed (which is associated with better recovery), and indirectly by facilitating the practical imagination. Intensity dependent relaxation of the situation, can be deep in a practice in imaginative, but a lot lighter between exercises rehabilitation in a single session (when it finishes a round of exercises, relax area and prepares for the next.) It is necessary that the athlete is trained in this skill, and is especially important that you own this domain before the injury, because it can selectively relax the injured area without the need to tighten the first to learn the method of Jacobson. A useful alternative is the relaxation of Schultz, which may be accompanied by hypnotic induction, an appropriate version of the technique of Schultz and Jacobson is the Method of Low Cost Home (Good and Buceta) that simplifies learning and increases the initial motivation. Finally, before applying a relaxation technique, you need to know in advance whether or not it is appropriate for the development of recovery, relax the injured area.

imagination Practice . Is to imagine the physical and biological processes that should really occur in the injured area for it to recover (based on the assumption of control of mind over body processes). The images may be evoked are:

Related
• healing the injured party
Related
• physiotherapy treatment that is causing the recovery
Related
• injured party fully healed and working perfectly

These images can be used in combination with the rehabilitation process, using the first session when you are not doing the rehabilitation exercises the second during physical therapy exercises and the third at the end of the session. Naturally, the athlete can do these exercises in imagination needs to know the physiological processes and elements involved (no need for a high accuracy). The sessions should be regularly imagination, but should not be excessively long. A total of twenty minutes, including relaxation, for the total session, each scene of the imagination be maintained for a maximum of one minute, alternating with periods of mental rest (relaxed, effortless focusing on different parts of the lesion). Following the same procedure may induce imagination what will happen within the affected area when you start this exercise to be practiced.

Techniques pain control. Has to discriminate the type of pain, indicating that the activity has to stop, and the actual rehabilitation treatment to be tolerated. Heil offers a range of strategies to help control the pain to be borne. Attention Matrix of Pain and Activity attentional combines two dimensions: attention, distraction to the pain and rehabilitation to the task, four types of strategies emerged.
pain

	Care pain	Distraction
Care rehabilitation work Pain Association	performance and success in rehabilitation outpatient	focused on the rehabilitation
Distraction rehabilitation work Imagination	processes that control the pain. Transformation pain sensation	nice images Care Care neutral images rhythmic and monotonous mental activity

Examples of circumstances which may call one or another strategy for pain control:

	Care	pain pain distraction
Care rehabilitation work	When the athlete avoids pain or incorrect postures doing wrong When exercises can increase performance in the rehabilitation When allowed by the type of care should be directed to the task	during rehabilitation exercises , when the athlete must be aware of isokinetic feedback
Distraction rehabilitation work	In the breaks between periods or absence of rehabilitation work when you can not avoid perceiving pain or deemed advisable not to forget pain sensations	In the breaks between exercises. At night, when you try to sleep

generally considered also to control pain following attentional strategies, and to be attached to the matrix of Heil:

• Directing attention to external stimuli
• nice images
Attend Attend
• neutral images
• Make a monotonous mental activity
• imagine processes that control pain
• Transforming a nice feeling pain
Associate
• pain to achieve a significant

personal challenge is also effective stress inoculation as adapted to control the pain. Where there is fear of pain, may apply techniques such as systematic desensitization, programmed exposure and cognitive techniques.

self-affirmation and self-instruction . Can help overcome specific times of low morale, motivation and situational stress, however, whether these deficits are more or less permanent, we must use other strategies. The simple repetition of phrases is not enough, the repertoire selected sentences of the athlete, and there is a minimally stable conviction. The self-statements can be used to relieve the stress of certain situations such as the emotional impact of the onset of pain. Self-instructions are also self-statements that contain specific orders. These techniques have to be suitably trained in the sport before putting them into practice, you can use imagination and role-playing.

downtime optimization

psychologist coach suggest the desirability of raising the injured sporting objectives, must be incentivantes and perceived as useful for upon return. It is important that this period of inactivity will serve the athlete to increase certain psychological skills (personal goal setting, stress management techniques, cognitive techniques etc.) That allow better coping in his sporting life, regardless of the injury.

athlete preparation for the reappearance

The need to adapt to this new situation, performance expectations, uncertainty, the sport demands immediate and fear of re-injury are elements that can produce a high level of stress to the imminent reappearance. Psychological intervention in this case be sent to:

• progressive approach targets to increase their motivation and confidence. Targets are usually set off in the long, medium and short term, it is advisable to first dial long-term goal, moving to establish the average time from the farthest to the nearest in time. Once this is done setting performance goals, beginning in chronological order. In athletes with low self-confidence or uncertainty regarding your performance, you can set trial periods, delaying the establishment of performance objectives
Control
• performance expectations. Should use techniques designed to change beliefs that support unrealistic expectations (cognitive therapies of Ellis and Beck)
• Understanding, acceptance and adaptation to new roles. In many cases, after the injury, is to occupy other roles other than those previously performed. The athlete has to know what is expected of him, the period of time is going to be a substitute, and the actual plans the coach and the direction have for him. It should also be prepared to receive the views of others. To accept the new role can be useful decision matrix which combines advantages and disadvantages of "accepting the new role" and "not accept the new role."
• Development and testing of response plans. To prevent difficulties that might arise, and to advance possible solutions. Especially before the first competition after recovery. Plans can be tested in imagination or in vivo. In general, this strategy should be used immediately before competition, and that exposure could increase anxiety (you can imagine positive images)
• control emotional responses.
• Pain and treatment of fear of re-injury. It used the techniques described in the rehabilitation phase. With regard to fear of reinjury if it can increase the level of anxiety, specific techniques used (DS, stress inoculation, etc.).

specific intervention in athletes who must compete injured

The psychological intervention will focus on:

• Help you understand, accept and adapt to the competition with its limitations. You need to know that things can be done and what not. Cognitive techniques are used to change beliefs that may interfere with the acceptance and adaptation.
• promote adherence to rehabilitation measures that will help you perform your normal activity. The techniques are the same as to achieve adherence to rehabilitation. Keep in mind that in this case there may be an overload of work (rehabilitation + competition), must develop a reasonable program of activities.
• Treating fear to compete injured. The fear of re-injury can be treated with DS, in vivo exposure and cognitive restructuring (to remove the threatening nature), and thought stopping, stress inoculation to cope with stressful situations. Preparation
• to endure pain during training and competitions. Discrimination training in pain and strategies used to control during rehabilitation. Control
• previous expectations and self-performance in the competition. As you probably can not perform as you want, adjust your expectations to the real possibilities, is very useful in this case to establish realistic goals of achievement for each practice or competition
• prevent difficulties that may arise in training and competition in relation to injury. It avoid the experience of pain, attacks of other athletes (techniques used to deceive the opponent), and be trained in the application of techniques to control pain when it arises. Prepare
• conduct prior to the competition. Follow the chain of habitual routines (stretching, warmups, etc.).
Control
• attention athlete during training and competition. Ensure that the injury and its consequences do not waste attention to those stimuli relevant for competition sports. Check
• potential excesses of the athlete when well. Control impulsive behavior in the absence of symptoms, cognitive restructuring to change negative attitudes, and control of risk behaviors. Check
• possible impact of expectations and evaluations of others
• Check the emotional impact of the stressful situation by previous evaluations.

specific intervention that prevents the athlete recovery

• Evaluation and treatment of stress associated with sports. Includes the solution of real problems (sports and personal), behavior change significantly influential people for the sportsman, modified dysfunctional beliefs, self development, self-esteem regardless of success or failure and learn coping skills.
• increase the motivation for the sport. It is preferable not to set targets too ambitious, and make wise performance goals. We need to increase motivation and reduce stress.
• If lack of motivation is not due to a lack of self esteem, but by the very sport that has no incentive to look for other targets will be interesting to him.
• When the time of recurrence is near, we must evaluate potentially stressful situations. In such cases it is useful to "probation."
• The final comeback does not mean that has been finally resolved their tendency to avoid or escape. Are likely to emerge new lesions or relapses that allow the exhaust.
• When the avoidance of recurrence is used to attract the attention of others, have to implement the following measures to minimize the attention you get from the other, eliminating the threat of that attention will disappear upon return, assess and deal with stress, reduce excessive dependence on others, develop domestic sources of satisfaction, build self-esteem unrelated to the success or failure, the return must be provided much social support and allow use of rehabilitation techniques preventive level if you are rewarding. Intervention

specific athletes to be withdrawn as a result of the injury
The intervention will address:

• Allow expression of emotions in a timely fashion adverse
• eliminate or alleviate these emotional responses and prevent or treat disorders Getting more serious
accept
• their new situation, it helps reduce the emotional impact and understand the need to start a new life.
• Develop new interests. They are oriented towards other activities within the sports or other activities not as an individual and his injury.
• When predominate helplessness and low morale, achievable goals that will arise not threaten their self-esteem social support
• lot, especially close ones, advising them not to give overprotection. Prevent
• strengthen feelings of helplessness. Must be put in operation as soon as possible, tasks and objectives that addresses that can dominate increase their perception of control, and with it the self-esteem and motivation.
• All this without forgetting to be trying to rehabilitate the injury, although not allowed to compete, improve their quality of life. Has to understand that the absence of short-term (for what I go through that, but I can not play again / I will rehabilitate, because I will do things that make me feel good)

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