An exclusive doctors insight into how injuries can impact an athletes mental health and performance

Unfortunately, injuries are part and parcel of sport especially at the elite level, and with the vast majority of them being unavoidable it often triggers a psychological response from the athlete.

Whilst some minor problems can be treated with little to no disturbance on performance, others cause extended periods away from sport while inflicting significant impact on not only the players physical health, but their mental state as well. The affects can reveal more serious mental health issues including: depression, anxiety, disordered eating, and substance use or abuse if sufficient support isn’t available.

Everybody’s reaction to being injured is different, as some find it extremely difficult not competing on a regular basis, whereas others are able to cope with the setback and focus all their attention into returning to the sport they love. The manner in which the situation is approached can play a major factor into not only their recovery, but how quickly they are able to move past it, to reach the peak levels of fitness shown beforehand.

Some of the problems that can hinder performance include concerns over re-injury, regaining status on a team, and failing to perform at pre-injury levels which are all common and can affect the rate of recovery through overuse, avoidance, and other compliance issues.

With the matter of mental health prevalent in society at the moment, with one in four people experiencing problems each year, it leads to questions about why coverage of this topic isn’t at the forefront of the sporting world.

To help give an insight from a professional point of view into some of the problems athletes can face, I reached out to Dr Rajpal Brar, DPT, a physical therapist, sports scientist and data analyst who also specialises in sports medicine and mindfulness.

When athletes first return to competitive action, it takes them time to get back to the level of performance which they showed prior, due to a multitude of different reasons. More often than not, their bodies are ready to pick up where they left off, however the mental barrier can be far more challenging to overcome.

Many footballers have expressed how nervous they felt to make their first tackle following a long-term injury, therefore I asked Brar to evaluate the impact that fear of being injured again has on performance:

“It’s significant. You’re naturally going to be cautious or hesitant following an injury – especially a long-term ACL injury – because that’s an experienced trauma and the brain remembers that episode. Like anything else, it’s going to take time to regain that confidence and the research increasingly shows that kinesiophobia (fear or movement or reinjury) is one of the last things to return following long-term injury, especially ACL ruptures.”

As more research is carried out, studies show that the mental side of the recovery should be considered just as important as the physical, therefore clubs have been focusing on improving this part for the players as there can be many benefits by doing so:

“It depends on the injury with longer-term or recurring injuries potentially requiring more help on the mental side but I think it needs to be a critical piece of recovery,” Brar explained. “The physical side will certainly be the priority but there’s more and more research showing that taking care of the mental side further expedites physical healing, which can create a virtuous cycle.”

From the incident to full recovery, rehabilitation programmes can feel like groundhog day for players, draining them due to their repetitive nature. Therefore, keeping their spirits high throughout can play a pivotal role in the process and one of the ways of doing this is by the player spending more time around their families for support.

“I’d always advise any patient to have a strong social support system when going through a major injury, especially when it’s an athlete who is so used to being active, may not be used to failing, and often have much of their identity tied into playing that sport.” Brar said when asked about what advice he would give to one his patients.

In recent times, many professional athletes have made the same decision with the likes of Hector Bellerin moving back to his hometown in Barcelona, in order to be around people who can keep him motivated through some of the most difficult stages on his road to full fitness.

Despite the attempts for a new European Super League falling through over the last week, it’s safe to say that football is constantly looking to evolve, and with that comes even more coverage on the sport. The turning point for this could be looked on when the Premier League was introduced in 1992, as sponsorship and TV deals sky rocketed, which almost single-handily enforced an environment where success was solely measured on results.

Inevitably, pressure on managers increased as well due to the financial implications on missing out on certain targets, thus when their star players are injured the first thought on everyone’s mind is when can they get back on the pitch to contribute.

Even when they pass all the necessary medical checks, often when returning after extended periods on the sidelines, players tend to pick up smaller problems after. This could be down to the fact that it takes time to get back up to speed, but the consideration into idea that they aren’t mentally fit continues to be left in the dark.

With the slightest part of doubt in an athletes mind, it could completely change their running style or the way they approach certain scenarios during a game, and as a result further problems could occur down the line. Away from the distress it can cause on the body, the physiological impact it can have on performance is massive, and is something that supporters fail to understand due to them not having any physical defects.

It’s an issue that seems to be becoming more frequent and leads to speculation about whether players long-term health and wellbeing is being compromised to get results. Brar suggested that these type of situations are arising more often nowadays:

“Absolutely – there’s a constant push-pull between player’s absolute health and safety and having them out on the pitch to contribute, it’s a constant risk-reward tightrope.”

Research also indicates that footballers could be more susceptible to becoming addicted to gambling or painkillers after an injury, as they use it as a coping method or another way recreate the thrill that playing football in front of thousands gives them. However, Brar isn’t convinced that athletes are more likely to struggle with addiction due to their completive nature:

 “Honestly I can’t say because there are so many nuances to personality type. Someone can be extremely competitive and committed but not have any addictive tendencies. Generally, clubs are offering more and more social and psychological support.”

Some of the examples used above are only scratching the surface into the affects injuries have on an athletes health and performance, however they continue to be forgotten when a player is struggling to find their form following time in the treatment room.

With their mental wellbeing being so important and even helping to the extent of physical rehabilitation, the stigma surrounding mental health needs to be abolished and put at the forefront of all sports.

Not only the sports, but the fans can play their part by being more patient, not taking to social media so quickly to criticise and abuse, without taking into consideration the mental barriers that player may be facing.

Follow us on Twitter @ProstInt