Ask Mike Reinold Show

How to Help Athletes with the Psychological Aspect of Injury

On this episode of the #AskMikeReinold show we talk about some of the psychological struggles of being an athlete dealing with an injury. There are a lot of things that can feed into the mental health of an athlete after an injury. Here are some of our tips on helping as best we can as physical therapists. To view more episodes, subscribe, and ask your questions, go to mikereinold.com/askmikereinold.

#AskMikeReinold Episode 196: How to Help Athletes with the Psychological Aspect of Injury

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Transcript

Mike Reinold: On this episode of the Ask Mike Reinold Show, we talk about how you can help athletes dealing with the psychological aspect of being injured.

(Intro)

Joe: Jennifer from Massachusetts says, “Hey guys, I was curious on how you handle the psychological aspect of injury at Champion. I see many physical therapists who are great at physically helping athletes return to their sport, but lack the knowledge when it comes to mentally preparing them as well. I see so many athletes come through the doors who are upset, regretful, have fears of reinjury and become really burnt out in the rehab process. So how do you guys handle these situations?”

Dave Tilley: Great question.

Mike Reinold: Yeah, it’s a good question. We actually haven’t tackled this much on the show. We’ve talked a little bit about some professional burnout, a little bit, with some of the podcasts and we had some good guest posts in the past on my website. But from the athlete perspective, I think this is a pretty cool topic. So heck, I don’t know, I don’t want to just throw it at somebody, but what do you think Dave? You feel like you… I guess I’m throwing it at you.

Lenny Macrina: Boom.

Mike Reinold: I mean so Dave works…

Dave Tilley: It’s the closest I’ll ever be to baseball so…

Mike Reinold: …Dave works with younger female athletes. So you have a different kind of perspective a little bit. I know that probably a lot of our athletes probably hide their feelings on our end a little bit more, kind of more the collegiate or pro level male athlete. So maybe we start with that because I think obviously you have some interesting perspectives. But I actually think learning from you for example, may actually help us work with some of our other people that are probably just putting on a fake smile sometimes. So what do you think, Dave? Where do you want to start with this?

Dave Tilley: Yeah, I think that I’ve learned from my experiences, again working in this population, that you have to remember that, what matters to them, you have kind of get from their point of view. It takes a lot of empathy I think to have a really good understanding of this. And I think that on the younger athlete side for sure, you always have to get back to… A big thing for them is social acceptance. And it’s being part of a community and their team. And half their life, if not more, is part of their team and their community. And so that’s a big part of who they are when they’re younger especially.

Dave Tilley: So I think always recognizing that that’s a big driver of why they may be nervous or have something like that. I think that the fear of social judgment from their peers or their coach or their parent about why they’re injured or they’re kind of the outcast a little bit, they’re kind of usually off to the side in training, they’re not involved. I think that’s a huge barrier to making sure that someone doesn’t spiral into a negative thought process.

Dave Tilley: So I always think about that but also allude to the question, fears are always at the root of a lot of these things. Like fear of reinjury, the fear of, again, social judgment, the fear of “will I get back, is this going to derail me a lot?” And so I think that obviously on the physical side we have a lot of tools to pick those things up. But you always have to be thinking about from their point of view, what are they most scared about or what are they most nervous about? And it’s usually a conversation about fear, insecurity or social judgment. One of those three things has pretty much always been involved in… A younger athlete that I’ve worked with especially… In a high pressure sport like gymnastics where it feels very cut throat. It is. But sometimes when you can intercept some of those things about… Don’t catastrophize, this isn’t the end of the world. You heal, you’ll get better. This doesn’t mean all of your life is falling apart. Just like this area of gymnastics is maybe struggling a little bit.

Dave Tilley: And then educating coaches and parents about how can you keep them involved in training. Can you give them a program where they can go for an hour and kind of still be involved? The rehab process itself is sometimes a little bit more isolating. So that’s kind of my advice.

Mike Reinold: Yeah, no, I like where you went with that here because there’s a lot of different things that can be going on in the head of an athlete. So, you brought up a couple of points. I’m just going to try to get it out of my head a little bit from hearing you. But I heard a couple of things. One was obviously, there’s that fear of reinjury. And man I actually wonder, the more I learn about this and the more I work with it, I wonder if that’s the least effective one. The fear of reinjury, that’s probably the one we go to the most. Sometimes there’s lack of confidence in their limb or their injured body part or whatever, or there’s a fear of getting reinjured again. Those are the ones that I think we do a better job in our environment, like the service base industry of fitness and wellness and rehab, those types of things. I think we do well with that because we can do things like graduated exercises and slowly increasing the demands to get them to have some more confidence in their limb and their extremities.

Mike Reinold: So we see those sorts of things. But yeah, I think some of the other ones that you started hitting on, and maybe this is what you guys can think about if anybody else has any more feedback, but the other stuff. So now it’s, man I’m letting my team down.

Dave Tilley: Yeah.

Mike Reinold: Cause that actually happens quite a bit, especially…

Dave Tilley: College setting for sure.

Mike Reinold: Oh man. And then imagine getting up to the pro level where I’m letting my team down, I’m letting my coach down, I’m letting the owner down, I’m letting the city of Boston down. People feel this way when they get a big professional injury. I’m getting paid $75,000 to play tonight and I’m not in the lineup. There’s a lot of guilt. You just signed a big contract, something like that. So it’s fear of being out of it a little bit too that I think some people miss, but I don’t know, who wants to jump in? Anybody else got anything?

Dan Pope:I don’t know, you already alluded to this. But for the people we see, athletes, especially for you Mike, all the professional guys, their entire sense of self is completely wrapped up in the sport or their activity that they have. And once you get hurt, that’s an enormous threat to that. And you start to have all sorts of crazy emotions that pop up as a result of that. So there’s so much you can do, I think, as a physical therapist. But I think the first and most important thing to do is just to realize that it’s probably going on, more or less depending on the athletes in front of you, and just accept that and let them know that it’s okay and we’ll work with them. I think where physical therapists go awry a little bit is belittling that.

Mike Reinold: Right.

Dan Pope: And I think it’s a fine line because one thing is, I think we do really well at Champion, is having this really fun environment where people are kind of hurt, they’re getting better, it’s not a big deal. And we create that environment. We’re not actively telling people “dude, your problems aren’t that bad. You’ll get better.” In some ways we are, but it’s a fine line. Again, it depends on the athlete. You don’t want to belittle what they’re going through, but at the same time you want to make sure that they understand that it will be okay.

Mike Reinold: Yeah, I’ve actually seen that backfire too. And that’s kind of interesting where, if you take the approach—and maybe you’re doing this intentionally—that hey it seems like they’re overreacting to the threat, the environment that they have, they’re overreacting to that. Sometimes what we do is we make a mistake of that and we actually try to go the other thing, and you said belittle and I think that’s actually a good word.

Mike Reinold: Sometimes it’s unintentional but sometimes we try to minimize it. I think we do it accidentally. We’re not trying to minimize their injury, but we’re saying, man they seem really freaked out for… This is just a grade one ankle sprain. This shouldn’t be that bad so you try to minimize it. Sometimes I have actually seen that backfire. And then the person has to say, well, I don’t feel good, I don’t feel like I have a place. And now I almost have to pretend it’s worse. And then that delays them getting back because they’re worried about the social anxiety of… Oh especially, you get to the pro level, what’s the media think? The media is going to rip me apart or all these things. So these are all the things on the big stage with pros, but I think they’re happening more at the high school, middle school level than we probably get. So I don’t know. What do you guys have, anything on your guys’ end?

Lenny Macrina: I don’t know. When I have somebody in front of me, whether it’s a kid, a college athlete or a professional, I just try to put myself in their shoes. What would I want to know? What information would help me to figure out a game plan and give me guidance? So I try to just reverse the seat and pretend like I’m the athlete and what information would help me the best. Am I progressing? Am I normal? Where am I going wrong? What can help me? Just little things like that I think would be…

Lenny Macrina: If you just kind of flip the roles, what would you want to know? You know what I mean? What would help them better understand their situation? I kind of keep that in that simple frame. I try to just kind of figure out what information would help them better make a decision on how they feel like they’re failing. Because you’re trying to interpret their generalisms that they’ve given you and not all the time they’re giving you information. But I think if you can weave through some of the complexity, especially some of the guys that we see that really don’t want to talk about it, I think it kind of helps as well.

Mike Reinold: Another strategy I’ve kind of tried sometimes with this. So it sounds like empathy is number one, right? Dave kind of brought that up a little bit. Belittling them is number two. Oh wait, no, sorry, not belittling them.

Mike Scaduto: Don’t do that.

Mike Reinold: But empathizing then just be careful with how you articulate things. Sometimes we unintentionally try to minimize it because we think we’re trying to help. We’re trying to decrease their stress, when sometimes that’s not necessarily what they want to hear. So the other thing that I think I would add to this is, how do we keep them, especially as an athlete, how do we keep them part of their team somehow? And I’ve seen some people really succeed with this and some people really fail with this and make it worse. Some people love staying part of it. So in baseball, just for an example, I don’t know, I’m sure we can think of other sports. But in baseball, like the catchers, if a catcher gets hurt… I’ve seen most catchers they do double the work. They’re doing double analysis of the upcoming pitchers. They’re getting in on the meetings. They still want to provide value to their team. So I’ve seen that a little bit.

Mike Reinold: Then I’ve seen other ones where people, they isolate themselves because they’re anxious and I think that sometimes makes it worse. So things we can do I think just on that note, is how do we incorporate them with the team? So we did this in spring training this year with some of our baseball players, but the beginning of spring trainings, we’re crazy busy, there’s tons of people around, but you still have some guys that are rehabbing. Even some high level guys that are rehabbing. It’s very easy to try to push them off to the side and have the pitchers go play catch over there that are injured and then the healthy guys go over here. But then they start feeling like, well, I’m by myself, nobody’s here with me, the coaches aren’t even there. You got to make them part of the team.

Mike Reinold: And that was one big thing we did is everybody’s out on the line and stretch at the same time, including the injured guys, because you got to be part of the team. And then what happens is they get around, they fool around with their friends again, they start doing the same old things that they were doing and they feel part of the team and then they can tell that their teammates I should say, not their athletes, their teammates are still accepting them, they’re not mad at them. Those things like that. So have some empathy. Try to put yourself in their shoes a little bit. Watch your words. Don’t accidentally minimize or maximize their symptoms. And then I think this is really important is, somehow figure out a way to keep them part of the team. I think that’s a big one all the time.

Dan Pope: I don’t want to speak too much because we already talked about this. But I think the other thing that really helps people with the fear is that… The question had kind of two major parts. The fear of reinjury. I think as physical therapists, we have to do a really good job getting people prepared for whatever they want to try to get back to. So if you’re an athlete in say like a field sport, I don’t know, let’s say you keep on straining your hamstring as a soccer player. If you never do really advanced drills, never pushed them to their peak and then give them some sort of plan after they’ve rehabbed to stay healthy, over the course of time, then of course they’re going to be fearful because they’ve never actually experienced that stress. They don’t feel like they have a good plan or a good process.

Dan Pope: So actually going through with a good plan of care and showing people they can do it, is not only you believing as a physical therapist they can get better, but the athletes starting to see that they can make that progress and starting to change in their own head.

Mike Reinold: Absolutely. Absolutely. I think that’s good advice. And then don’t forget, we oftentimes need to get them some help. They probably don’t want to talk to us. We’re probably actually okay. But if you’re in an environment like this, there’s lots of people around, sometimes that’s awkward. They probably don’t want to talk to their coach. They probably don’t want to talk to their teammates or their parents. So they need these outside people. So I always tell a story. Bob Mangine, a friend of ours, he’s the head athletic trainer at Cincinnati, but he told us a story. He was telling how they changed the name to mental skills and all of a sudden people would go to it, but they weren’t going to the…

Mike Scaduto: Mental health.

Mike Reinold: … mental Health, that’s what it said. They said they started this mental health wing for their athletes and nobody took advantage of it. But then they changed it to mental skills coaching and now all of a sudden everybody took advantage of it and then they started talking about it. So again, there’s a stigma, there’s a negative stigma there. That’s our fault as a society. But how do we get them to a mental skills coach to kind of help them in there? So awesome. Anybody else? Pretty good? Solid? No? Awesome. All right, well good.

Mike Reinold: I think that’s some good advice. That’s a start and I think that’s a good place right there because sometimes we’re not equipped. We didn’t learn this. So sometimes it’s just identifying some of these things. I’ll say the more injured athletes I work with, the more I can see these things. I remember… You start getting fringe players, minor leagues, NFL Europe back in the day, which is like the minor leagues, the NFL, those guys were always nervous of all time that their dream was going to be over. So we got to keep this in mind. This is a big deal. Like Dave said, this is a big deal to them. You have to keep that in mind. So hopefully that helps. From there I think sometimes just outsourcing and just like we always say it’s good to have good strength coaches, massage therapists, physicians, skills coaches, maybe you also need a good mental skills coach or somebody that they can talk to in your network as well. So, awesome.

Mike Reinold: Great question. We haven’t really tackled anything like that at all, I don’t think really. So maybe we probably should more. But great question. Hopefully that gave you a little bit of guidance and I get the apprehension with that because that’s not probably something we all learned in school. So good one. If you have a question like that, head to Mike Reinold.com, click on that podcast link and you can fill out the form to ask us anything related to PT, fitness, business, sports medicine type stuff. Anything you want to talk about it. And hopefully we’ll get to your question in a future episode. Thank you so much.