"This is the lowest I have ever been," admitted Utah Jazz guard John Stockton shortly after knee surgery.
If a veteran secure in his career can hit bottom, what happens to a young athlete who must adjust to life on the injured reserve? With his first season quickly approaching, Britton Johnsen, a highly touted first-year University Utah basketball player, found out.
Johnsen joined the University Basketball team as a high school All-American after graduating from Murray High School. He was hailed by many as the Second Coming of Keith Van Horn BS'97. However, before the season began, Johnsen developed tendonitis in his knee. No one listened to Coach Rick Majerus when he spoke of patience. All Johnsen needed, Majerus explained, was "a little time." Yet, that was not what Johnsen wanted to hear. "I couldn't handle not playing," he said. "It's been a dream of mine to play college basketball. Even though I learned something every game, it was very difficult to sit and watch my teammates play. It has been tough and extremely frustrating." After all, an injury can interrupt a player's goals, studies, training, competition, and social life.
Isolated from the team, the athlete must deal with an injury on his own. And often, despite proper rehabilitation, athletes are not psychologically equipped to return to the rigors of competition. While advances in sports medicine have led to remarkable recoveries, many observers of collegiate sports urge greater attention to the psychological aspects of treating injured athletes.
Initially, sports psychology was a vehicle to enhance performance in healthy individuals. Currently, however, there is a growing awareness of specific psychological risk factors that are a part of athletic performance. More frequently mental health professionals are summoned to assist coaches in helping an athlete adjust to injury or career termination.
Sports culture is guided by a unique set of principles. Risk of injury is said to be influenced by assumptions regarding pain tolerance. As illustrated by the often used motivational phrase "no pain, no gain," there is a rich tradition of pain and performance in sports. Still at the heart of some coaching strategies is the expectation, or sometimes encouragement, that an athlete continue to test his limits, even in the face of pain. In fact, Megan Marsden BS'84, women's gymnastic coach at the University of Utah, says that "pain and injuries are just part of sports, especially gymnastics. There is not a member on the team who has not been injured."
Feats of pain tolerance are lauded by fans, athletes, and coaches. At first, most athletes will not admit they might be hurt and continue to risk even greater injury. "It was something I thought would just go away," Johnsen said of the pain that started during the summer of 1997, "I kept playing on it, and waiting for it to go away." However, coaches are becoming more aware that pain can be serious and may signal permanent or debilitating injuries.
As many as 17 million sport injuries befall American athletes yearly. While many have the psychological tools necessary for recovery and adjustment following an injury, some do not. According to Keith Henschen, professor of exercise and sport science at the University of Utah, "Often, people forget that the mind is just as important as the body."
The psychological impact of athletic injury can vary, but the emotional reactions are common. Given the uniqueness of individual perceptions, it is critical that an athlete's reactions to his or her injury are individually assessed and monitored, perhaps before considering any other form of treatment. In addition, Henschen points out, it is now known that an athlete's mental response to an injury will affect how his body responds to physical rehabilitation.
"When people get down on themselves, that robs them of their ability to perform," Henschen says. Greg Shelley, a sports psychologist at the University of Utah, reports that injuries are a common source of diminished self-esteem. Athletes who have known nothing but success, for instance, frequently continue to have problems after their physical recovery from an injury. "While some athletes may have a high self-concept, which propels them to take 'additional' risk," Shelley says, "others with low self-concept may use an injury as a release from the pressure."
Although physically able to compete, athletes coming back from a traumatic injury may be psychologically compromised by a fear that their former style of play may again lead to injury. Most athletes find it difficult to admit to themselves, or a coach, that they are afraid of being hurt again, or that deep down, they even expect it. "When we anticipate that an event will occur," Shelley says, "this assumption actually increases the likelihood of the occurrence. Painful as this fear might be to accept, it is necessary if the athlete is to restore his self-concept in a positive fashion."
When student's enter the University of Utah athletic program, they receive a pamphlet that teaches them, before an injury, just what to expect if the unthinkable occurs. Bill Bean MS'79 BS'86, University of Utah athletic trainer says, "we try to give the athlete some ideas and strategies to use in dealing with injury, because most athletes do not know what to expect when they find themselves injured."
In the pamphlet compiled by Shelley, the process of dealing with an injury is described as similar to the five stages of grieving defined by Dr. Elisabeth Kubler-Ross. Grief occurs for an athlete whenever he suffers a sense of loss or loses some aspect of the self. Accordingly, the following reactions are shown.
The first stage is denial. Many perceive themselves as invincible, refusing to believe that they are vulnerable to injury. Therefore, this shock to an athlete's sense of strength leads to a denial of the reality and seriousness of the injury. Unfortunately, when an athlete realizes that the injury is "real," the response may be a feeling of self-blame and loneliness. Many will isolate themselves from family, friends, coaches, practices, and competitions.
The next stage is anger. Athletes may become irritated or frustrated with themselves for having allowed the injury to occur. Anger may result from the inability to perform optimally, if at all.
Most injured athletes will next go through a bargaining stage. This is usually the time athletes make promises to the medical staff, the coaches, or occasionally God, in the hopes of being able to return sooner than recommended.
The realization that they will not return when they want may lead to depression, which in turn may cause the athlete to withdraw, experience self-pity, or simply give up.
Hopefully, all athletes will eventually arrive at the final stage, acceptance. In time, the athlete begins to realize the importance of physical rehabilitation and focuses on a successful return to their sport.
University of Utah gymnast Jenny Schmidt recently experienced all of these emotional stages as she approached her third knee surgery. "The first time I was injured it was easier to deal with because I knew what was happening," Schmidt says, "this time though, I did not expect to be out for the season." She talked to Henschen about her injury and he offered her advice and support. "Even going once really helped with the frustration," she said. As Schmidt passed into the denial stage, her right knee became worse. "There was frustration, depression, and even anger when they told me I needed surgery. But, after going through all the stages, and getting the help I needed, I now accept the fact and am working for next year."
No matter how the stages and emotional responses are defined, the handling of individual athletes' rehabilitation programs becomes critical. "Some athletes prefer to go through rehabilitation alone," Marsden says, "while others need to remain a part of the team." Unfortunately, too often the psychological aspects are not part of the rehabilitation program. Sports psychology is a critical part of bringing any athlete back from an injury. Coaches and trainers alone cannot assess what works for each athlete. Both the psyche and the body must be examined, treated, and eventually mended.
As medical equipment and sports medicine become more sophisticated, athletes are more confident than ever that they will be physically ready to return to competition in a short time. But are they mentally ready to do so? Although no single strategy is all-encompassing, the "whole person" treatment is gaining approval and producing results. Athletes must realize that the "no pain, no gain" method is not necessarily valid. Consequently, a team approach with several physicians, psychologists, family, athletic trainers, friends, coaches, and teammates can make significant contributions to an injured athlete's recovery. As a result, the road to wellness will be enhanced and an athlete's chances of returning to competition, physically and mentally whole, are greatly increased.
--David Doermann BS'89 is a freelance writer in Salt Lake City.
Questions and Comments