Sample Essay on Practitioner Strategies For Enhancing Recovery Outcomes

Return To Sport Concerns Following Injury Rehabilitation: Practitioner Strategies For Enhancing Recovery Outcomes

Introduction

Sports injuries are a major threat to an athlete’s career and success. While some injuries are negligible due to little or no impact they pose on the athlete’s career, others are serious with the potential of ending the athlete’s career as well as have significant costs on the athlete’s quality of life (Podlog and Eklund 20). Even more of concern for the injuries is the medical cost and time loss associated with the treatment of the injuries: a major concern for not only the athletes but the sports organization as well. Although injuries may be inevitable for athletes, the amount of time spent on training increases the risk of injuries for the athletes in comparison with regular exercisers (Brewer 84). For instance, while amateur windsurfers have a 0.22 probability of injuries for every 1000 hours of practice, the chances are graver at 13 injuries for the same practice period for professional performers (Perez-Turpin et al. 87). Further, Santi and Pietrantoni inform that about 70-80 percent of female gymnasts get injuries in their training, while 75 percent of professional football players are also treated for injuries every season (1030).

Studies continue to indicate a difference in the risk of injury with regard to different sports. According to Santi and Pietrantoni, skiing and snowboarding present 2-4 chances of injury for every 1000 hour of practice (1030). Indoor climbing presents lesser risk with 1-3 chances of injuries for the same time. Non-competitive windsurfing presents even lower risk with only one chance of injury for every 1000 hours of practice (Santi and Pietrantoni 1030).

Differences additionally exist between the genders in the propensity to injury. Data by NEISS indicate that men are more prone to injuries than women are. For instance, male professionals in basketball have four times as many injuries as women, while in baseball; males have twice as many injuries as females (NEISS 10). There are, however, exceptions in the frequency of injury in some sports such as horse riding and wind surfing where females are more prone to injuries than males are (Perez-Turpin et al. 87; Santi and Pietrantoni 1030).

Among the sports with higher chance of injury include track, football and rugby. Of the aforementioned, hamstring strain injuries are the most common, largely due to the sprinting demands of these sports (Heiderscheit et al. 67). Dancers similarly are vulnerable to hamstring injuries, largely due to the stretching demands on the hamstring muscles. As one of the most common injuries, hamstring strains are only second to knee sprains, with a consequential 8-25 days in lost time, dependent on the severity and location of the injury (Heiderscheit et al. 67). Alarming for the injuries, especially hamstring injuries, is the fact that about a third of them recur, a few weeks (2) after return to sports (Orchard 438).

Perhaps the recurrence of the injuries has more of a psychological than a physiological cause. According to Podlog and Eklund, some athletes returning to sports after injury find the process difficult. This is largely due to the fear of reinjury, anxiety over the ability to perform to levels before the injury as well as the need to meet set deadlines for return to active sports (Crossman 164; 334; Gould et al. 370; Podlog and Eklund 20). Moreover, the risk of reinjury heightens, as the returning athletes feel acquire even more competitive anxiety, put too much focus on the injury, in addition to struggling to regain technical skills and abilities. Such adverse thoughts and experiences thus escalate the chances of reoccurrence of the injuries, with potential injurious effect on the confidence and performance of the athlete, thus the need for an effective rehabilitation program for enhanced recovery outcomes.

Literature review

In a study by Podlog, Dimmock and Miller, findings indicated the competitive athletes making a return to competitive sports after rehabilitation experience a diverse array of psychosocial concerns. These concerns, while warranted, may have a negative effect on the returning athletes’ performance and overall adjustment to active sports. Furthermore, these concerns put the athletes at a vulnerable position for the reoccurrence of the injuries, with potential hazardous effects on the athletes’ career.

Podlog and Eklund contend that athletes returning to active sports after an injury harbor negative thoughts. These thoughts are largely a result of concerns over performance and the pressure to meet set return deadlines (20). Additionally, competitive anxiety and the need to regain technical skills and abilities put even more pressure on the recuperating athletes, putting them at risk of reoccurrence of injuries. The fear of losing to opponents an athlete easily beat before injury is a cause of concern after injury (Heiderscheit et al. 67; Podlog and Eklund 21). While these concerns are warranted, they have an adverse effect on the performance and future career of the athlete, in addition to increasing the risk of reinjury.

Even more risk of reinjury among the athletes occurs during injury rehabilitation. While trainers expect athletes to adhere to a set itinerary during the rehabilitation process, personal and organizational pressure sometimes push athletes beyond the set limits. Podlog et al inform that while adherence to a set rehabilitation program broadly relates to improved clinical and functional rehabilitation outcomes, many of the athletes under rehabilitation do not adhere to the practitioner-recommended guidelines. The failure to adhere to the guidelines, however, occurs in two ways. While some athletes my fail to follow the set treatment protocols, others may overindulge, attempting to do too much too quickly (Podlog et al. 372). Such athletes, therefore, work on their rehabilitation even in the face of harmful pain symptoms. By such engagement, athletes put themselves at risk of reinjury and fresh injury.

Even more risky is the return of the athletes to active sports before the completion of the recommended program. According to Podlog et al. “the quest for athletic excellence and
the ‘‘win-at-all costs’’ environment of elite sports may encourage athletes to risk a premature return to sport” (372). This is especially true for the overzealous athletes keen on achieving their athletic goals. Such athletes therefore may be willing to return prematurely to active sports regardless of functional and clinical indicators advising the contrary (Podlog et al. 373). By so doing, most of these athletes set themselves for failure due to recurrence of the injuries in addition to the possibility of fresh injuries.

In a bid to return to active sports, most athletes overindulge in the rehabilitation and eventually return prematurely to active sports. Wiese-Bjornstal et al. contend that self-preservation concerns and athletic identity are the culprits in instances of overindulgence and premature return to active sports. Here, self-preservation refers to the need to control the perception or evaluation by other as a means of creating a desired impression by an individual (Podlog et al. 373). Individuals with high self-preservation tendencies, therefore, engage in risky behavior with the assumption that such acts will give them a better impression. For that matter, injured athletes with self-preservation tendencies may thus overdo the rehabilitation process, or better yet adapt maladaptive beliefs such as the need to do away or expedite the rehabilitation process,  with the perception that doing so will earn them favor and approval among teammates, coaches and fans (Podlog et al. 373).

On the other hand, athletic identity refers to the level of identity of an individual with the athlete role. Wiese-Bjornstal et al. inform that a controlled level of identification with the athlete role is beneficial. However, they warn that a high athletic identity, especially among injured athletes is dangerous as it is likely to lead to overindulgence in the rehabilitation as well as risk the athletes’ early return to sports from the overbearing need to restart the sporting activity that defines them (Podlog et al. 373; Wiese-Bjornstal et al. 52). Moreover, athletes with a high athletic identity tend to overindulge in the rehabilitation program because of the feeling for the need to indulge in actions that are in tandem with their role as athletes. These actions include pushing through pain and avoiding any mentions/reports of pain while performing (Podlog et al. 373)

Perhaps the need to overindulge and prematurely return to active sports stems from the very effects of injury on the athlete. Having given their lives to the sports, and with the sports being an extension of them, athletes see injuries as a feeling of losing part of themselves (Klenk 2). Consequently, while there is indeed the physical pain of an injury, psychological strain among the athletes have far adverse effect and influence the recovery process. Additionally, there is a wide difference in the response of athletes to injury; thus, while some athletes struggle emotionally during the injury period, others are more relaxed and take the injury “in stride” (Klenk 2).

Athletes’ response to injury range from anger to frustration, others struggle with depression and tension over their inability to take part in their favorite sport (Klenk 2). The response to the injury is even worse for athletes in elite sport who have a higher measured of negativity, depression, anxiety and lower self-esteem. Curiously, injured athletes elicit reactions largely related to trauma victims such as fear, anxiety, anger, grief, depression and irritability (Klenk 3).

Athletes elicit such responses, perhaps due to the significance of sports in the lives of the athletes. As aforementioned, these athletes see sports as an extension of them and their very identity. The fact that sports require so much commitment, passion and determination from the athletes makes injuries unwanted adversaries (Klenk 3). Moreover, for professional athletes, the benefits that come with participation in the sport as well as the social support that the sport brings to the athlete is ideally threatened at any time of injury (Klenk 3). This is perhaps the reason for overindulgence, premature return to active sports, the feelings of anxiety, fear and irritability because of the potential loss of their identity and livelihood (Klenk 3; Podlog et al. 373; Wiese-Bjornstal et al. 52). With such knowledge, it is imperative that rehabilitation interventions for athletes do not only cater for the physical aspect, but also heavily look into the emotional and psychological recovery of the athlete during the rehabilitation process.

Rehabilitation interventions

The type of intervention assigned to an athlete greatly affects the athlete’s response to the rehabilitation, and the re-entry period into active sports. While the physical aspect is important, the psychological dimension and effects of the injury need addressing. Consequently, rehabilitation personnel can use several intervention models throughout the intervention process. A combination of these models is more effective than a singular approach during the process. The intervention therefore can use cognitive review through self-talk, while at the same time supplying biological information and feedback on the progress of their recovery (Santi and Pietrantoni 1036). Further, it is possible to manage the athletes’ emotions through education and imagery, while motivating the athletes through either goal setting or providing social support (Santi and Pietrantoni 1036).

As an intervention model, education aims at informing athletes of their situation. Francis, Andersen and Maley contend that most athletes lack a clear picture of the rehabilitation process, a factor that contributes to the negative emotion and demotivation. The purpose of information through education of the athletes during the intervention process is therefore to allow the athletes to get a better picture of their situation, and thus reduce anxiety (Francis, Andersen and Maley 20). It is especially important that the intervention come in the early stages of intervention to have maximum effect (Santi and Pietrantoni 1036).

In providing education about the injury to the athlete, a structural description of the injury is necessary, along with the recovery schedule. Moreover, this information to the athlete must also inform the athlete of the recovery process, especially as it regards muscle soreness and stasis (Santi and Pietrantoni 1037). Even more education to the athletes should include the awareness of the positive pain during the intervention process, which is very different from the negative injury pain. In so doing, the athlete should also learn the proper use of painkillers and not excessive indulgence of the painkillers at any point during the intervention. The importance of education intervention is the fact that it restrains and attitudes associated with different phases of injury such as denial, anxiety and loss of self-confidence. Education therefore reduces these phases replacing them with a more solemn and coping attitude (Taylor and Wilson 188).

Goal setting is another intervention for injured athletes. According to Santi and Pietrantoni, goal setting is a great determinant to the level of motivation and commitment of an athlete to an intervention program, given that if set the direction for the optimization of recovery. Goal setting finds wide acceptance among sports and medical professions, both of who see it as a necessity for both athletes and coaches (Santi and Pietrantoni 1037). Besides, many physiotherapists consider goal setting as one of the most important intervention measures for injuries.

In setting the goals, however, it is important that the athlete, through the help of the physiotherapist, psychologist or coach, ensure that the goals set are realistic, measureable, specific, stimulating and time-based (Podlog and Eklund 22). The goals set must take into consideration both the long and short-term achievements that the athlete desires to maintain high motivation. Accordingly, an effective goal-setting intervention helps in the reduction of the athlete’s anxiety, while boosting the athlete’s self-confidence. This further helps the athlete to adhere to the intervention program given that he/she perceives the treatment as more effective (Podlog et al. 379).

Self-talk intervention as an intervention procedure involves the restructuring of the athletes’ cognitive thinking, positive thinking and self-monitoring. This is especially important as through it athletes recognize their negative thought and work towards changing these negative thoughts (Podlog et al. 379). Self-talk involves a laid down framework that involves the expression of feelings and thoughts; identification of the negative thought; focusing on the positive; selection of a statement; reading of the statement and maintaining by constantly reading the statement and monitoring their personal progress.

Another intervention procedure is biofeedback that uses computerized systems for monitoring athletes’ progress. Through sensors or professionals mediating the computerized information, athletes’ vitals are monitored. These include heart rate or blood pressure, which the computer records and with the help of the professional, the athlete gets feedback on his/her progress (Santi and Pietrantoni 1037). Such progress reports are essential for athletes as they boost their self-confidence and act as a source of psychological support, especially when they are making progress.

Methodology

This section discusses the research design, target population, sampling procedures, instruments for data collection and analysis.

Research Design

This research will use cross-sectional survey. The cross-sectional survey is appropriate for the research given its ability to determine the nature of prevailing conditions or relationships and practices that exist (Cohen, Manion and Keith 70). Additionally, cross-sectional surveys are appropriate for collection of information from a predetermined population, which the study hopes to use. Surveys additionally have the advantage of collecting information in a relatively short time, and help in the determination of significant association among variables at some point.

Target Population

This research will target professional athletes, coaches and rehabilitation center staff. These will be drawn from different sport disciplines and rehabilitation centers.

Sampling Procedure

Selection of Participants

In conducting the survey, athletes competing in state, national and international sports will be used. These will form the sample frame for the survey. Additionally, to ensure that sub-groups constituting the minority in the population are represented proportionately, Stratified Sampling Method will be used.

Sample Size

Large sample sizes are traditionally representative of population scores this is because the larger the sample, the more likely the research participant scores on the measured variables. While selecting the appropriate sample involves a trade-off between breadth and depth there is need for finding a middle ground for the two. In the view of this, a sample of six athletes, a coach and a rehabilitation staff will be selected for each sports discipline for the study.

Instrumentation

The study will use three instruments, which include athletes’ questionnaire, coaches’ questionnaire and interview schedule for rehabilitation center staff. While the questionnaires will have largely open-ended questions, some will require Yes and No answers from the respondents. By definition, an interview schedule is a set of questions an interviewer asks an interviewee. Interview schedules make it possible to obtain data required to meet the specific objectives of the study. Moreover, the interview schedule helps in the standardization of the interview in that the interviewer can then ask the same questions in the same manner. The interview schedule for the rehabilitation staff will be appropriate, therefore, in finding out the possible intervention programs available for injured athletes and the most appropriate programs for enhancing the recovery outcomes.

Validity and Reliability of Research Instruments

Validity refers to the degree to which results obtained from data analysis are representative of the phenomenon under study. Questionnaires are valid given that the researcher obtains first-hand information from the respondent. Moreover, the respondents will be interviewed, giving the researcher the opportunity to seek clarification where necessary. Observation during the interview will additionally enable the researcher to confirm the information obtained from the questionnaires. In testing the reliability of the instrument, the Cronbach coefficient alpha will be used. The Cronbach coefficient alpha is instrumental in occasions when items are not scored dichotomously. For instance, given that multiple-choice questions have different possible answers each with different weighting, the alpha is applicable as a measure of internal consistency among items. The alpha will provide therefore a coefficient of inter-item correlation and is used for multi-item scales (Cohen, Manion and Keith 74). A 0.7 reliability will thus be acceptable.

Data Collection Procedure

After the approval of the proposal, the research will visit the sampled individuals for collection of data. This will be done through the distribution of questionnaires and conducting of the interviews.  The researcher will then ask the respondent to fill the questionnaires, which the researcher will collect at the respondents’ completion.

Data Analysis and Presentation

The data collected will be both qualitative and quantitative. The researcher will code and enter the data into the computer for analysis using the statistical package for social sciences (SPSS). After the data processing, frequency tables, bar graphs and pie charts will be used for presentation of the data. This is largely because simple descriptive statistics such as percentage and frequency counts are easily understandable to the majority.

Work cited

Brewer, B. W. “Injury prevention and rehabilitation.” Sport Psychology, Chichester: Wiley-Blackwell

Cohen, Louis., Manion Lawrence and Keith, Morrison. Research Methods in Education. New York: Routledge, 2007

Crossman, Jane. “Psychological rehabilitation from sports injuries.” Sports Med., 23(1997):333-339

Crossman, Jane. Coping with Sports Injuries: Psychological Strategies for Rehabilitation. New York: Oxford University Press, 2001

Francis, Susan, R., Andersen, Mark, B. & Maley, Paul. “Physiotherapists’ and male professional athletes’ views on psychological skills for rehabilitation.” Journal of Science and Medicine in Sport, 3.1(2000):17-29

Gould, Daniel, et al. “Stress sources encountered when rehabilitating from season-ending ski injuries.” Sport Psychol. 11(1997):361-378

Heiderscheit, Bryan, et al. “Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention.” Journal of Orthopaedic & Sports Physical Therapy, 40.2 (2010): 67-81

Klenk, Courtney. “Psychological Response to Injury, Recovery and Social Support: A Survey of Athletes at an NCAA Division I University.” Senior Honors Projects, 9(2006): 1-41

NEISS. NEISS data highlights 2010. US Consumer Product Safety Commission, 2010

Orchard, Best. “The management of muscle strain injuries: an early return versus the risk of recurrence.” Clinical Journal of Sport Medicine, 12(2012):3-5

Pérez-Turpin, J.A., et al.  “Lesiones en windsurfistas de élite masculinos.” Revista Internacional
de Medicina y Ciencias de la Actividad Física y el Deporte, 12.45(2012): 83-92

Podlog, Leslie and Eklund, Robert. “Return to sport after serious injury: a retrospective examination of motivation and psychological outcomes.” Journal of Sport Rehabilitation, 14(2005):20-34

Podlog, Leslie et al. “Injury Rehabilitation Overadherence: Preliminary Scale Validation and Relationships with Athletic Identity and Self-Presentation Concerns.” Journal of Athletic Training, 48.3(2013):372-381

Podlog, Leslie, Dimmock, J. and Miller, J. “A review of return to sport concerns following injury rehabilitation: practitioner strategies for enhancing recovery outcomes.”  Phys Ther Sport. 12.1(2011):36-42

Santi, Giampaolo and Pietrantoni, Luca. “Psychology of sport injury rehabilitation: a review of models and interventions.” Journal of Human Sport Exercise, 8.4(2013):1029-1044

Taylor, Jim and Wilson, Gregory. Applying Sport Psychology. Champaign, IL: Human Kinetics

Wiese-Bjornstal Diane, M, et al. “An integrated model of response to sport injury: psychological and sociological dynamics.” Journal of Applied Sport Psychology, 10.1(1998):46–69

Ethics Application

I hereby wish to apply for the ethical approval of the research titled Return to sport concerns following injury rehabilitation: Practitioner strategies for enhancing recovery outcomes. This research aims to highlight some of the concerns of athletes following injury rehabilitation. The objectives of the research therefore include:

1. Proposal of some strategies for practitioners for enhancing recovery outcomes
2. Highlighting athletes’ concerns following injury rehabilitation
3. Highlighting intervention programs for injured athletes

Given the nature of the research among athletes, the university provides approval. The Ethical Committee of the university must provide approval for conducting this research and therefore the application for the approval.

The research will use a cross-sectional survey design for the collection of information. This design is appropriate for the research, as it will enable the collection of data from a predetermined population, which the study hopes to use. In the collection of data, the study will use questionnaires and an interview schedule for the target population.

It is important to point out that the research will have minimal demands on the participants. Given that the researcher will travel to the location of the participants, there will be little inconvenience for the participants. A single interview will be enough for the rehabilitation staff, while filling out the questionnaires will take the minimum participants’ time. Additionally, the research poses no risks to participants apart from the little time inconvenience during the filling out of the questionnaires and interview.

Given the objective of the research, the participants for the research were identified as professional sports personnel in different disciplines. Their participation in the research is voluntary and the participants are entirely free to withdraw at their discretion. In the event of withdrawal, the participant’s data and information will also cease to be part of the research. However, if the participant provides consent, this data may be used as part of the research. The data collected from the participants will be entirely confidential, and for discretional purposes, no participants’ identifying information will be used for absolute anonymity.

This research has potential benefits on professional athletes. From the research, it is possible to propose better ways of managing athletes’ injuries, rehabilitating them and enabling them return to active sports without the risk of reinjury.

No known conflict of interest exists for this research. However, sports organization may be interested in the results of this research given its potential benefits on athletes.

Yours Faithfully,

 

 

 

 

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