Reading material on improving patient communication

Reaction to injury 

It is difficult to predict what an athlete’s reaction to an injury will be. It depends on many factors: related to the injury itself (its type and severity), the situation in which the injury occurred (e.g. injury shortly after winning the gold medal in the world championships or just before the Olympic Games, at the beginning or end of the season, etc.), temperament and personality of the athlete (tendency to anxiety, depression and catastrophizing the situation or a positive attitude and assessment of the injury as a challenge that needs to be overcome), family and financial situation, internal pressure (strong need to compete and win) and external pressure (fear of losing position in team, being forced to return to the game quickly). 

The reaction to injury is a dynamic process. It can range from shock, disbelief, denial, anger, and disapproval (“Why me?”, “How could this have happened?”), depression and self-blame (“If only I had prepared better…”, ” If only I hadn’t neglected the warm-up…”), blaming others (for a poorly prepared stadium, defective equipment, imposed too burdensome training plan, insufficient care of a physiotherapist) usually to acceptance. Of course, this pattern is not permanent and each athlete experiences his injury differently. 

Depending on the coexistence of internal and external factors, the trauma may ultimately be perceived only negatively, it may be a contribution to reflection and the search for positive sides, or it may be underestimated. 

Negative emotions related to the trauma may manifest themselves in the evaluation of the trauma as: 

– a misfortune and unnecessary suffering, 

– an enemy and an obstacle to achieving a goal, 

– an irreversible obstacle to achieving one’s dreamed success, 

– a cause of isolation and loneliness, 

– a source of anxiety and low mood, 

– loss of motivation to act, 

– sources of anger and jealousy towards other athletes who can train and improve their performance, 

– a source of family problems, including financial ones, 

– a sign of weakness, 

– an invitation to manipulate the environment. 

Among the positive emotions associated with the injury, the following can be noted: 

– reflection and looking for positive sides (e.g., more time to spend with family), 

– revaluation of one’s life plans and goals (e.g., finding an alternative hobby, or activities), 

– building work motivation, 

– training humility and patience, 

– strengthening mental resistance, 

– overcoming an unexpected challenge and strengthening self-confidence, 

– greater empathy for other athletes struggling with injuries. 

The downplaying attitude is characterized by the perception of an injury as: 

– an accidental event that will happen to every athlete someday, 

– a normal event in sport that will soon be forgotten, 

– events that are not of major importance for health and sports career, 

– an excuse to rest from sport and carefree laziness, 

– excuses from all duties. 

Of course, the best prognosis is cooperation with an athlete whose attitude can be described as a reflective optimist. One of the tasks of the therapeutic team is to support the athlete in achieving such an attitude towards the injury. 

Ways to deal with injury-related stress 

In order to reduce the stress associated with the injury, it is important for the athlete to understand his own condition (the nature and consequences of the injury, the purpose and course of therapy), accept it, regain a sense of control, and take responsibility for their actions. It seems crucial to focus attention on positive emotions, which can be achieved using the athlete’s internal resources (self-efficacy, internal locus of control, positive self-esteem, independence, consistency in action reinforced by relaxation techniques, prayer, meditation) or external resources (support from the environment). The athlete should actively cooperate with the therapeutic team, communicate their concerns (e.g., ask about disturbing symptoms), talk about difficulties, and not hesitate to ask for help. 

The basic recommendations for an athlete after an injury are: 

– use pharmacological treatment and perform follow-up examinations as prescribed by the doctor, 

– work systematically with a physiotherapist, 

– perform the recommended exercises between appointments with the physiotherapist, 

– apply recommendations for modification of daily physical activity, diet, sleep, and rest. 

– cooperate with a sports psychologist. 

Factors interfering with rehabilitation 

The main factor interfering with the rehabilitation process and constituting the greatest obstacle to its effectiveness is pain. Thus, one of the most important tasks of medical personnel is to help relieve pain. 

Other difficulties interfering with the course of rehabilitation can be divided into:  

Emotional problems 

Examples: negative emotions, emotional suppression, depressiveness, sleep problems, and in extreme cases suicidal thoughts 

Support that can be provided: presence, showing interest and concern, talking, listening, creating opportunities to express concerns and release negative feelings 

Consequences of lack of support: deterioration of well-being and increasing tension associated with suppressing emotions 

Cognitive problems 

Examples: a distorted or incomplete understanding of the nature of the injury, the purpose and course of treatment, misconceptions about the consequences of the injury, the time needed for recovery and fitness, misconceptions about the prognosis, incorrect implementation of the doctor’s and physiotherapist’s recommendations 

Support that can be given: giving information in a clear and comprehensible way, giving the opportunity to talk to someone who has had similar experiences, making a note of how to take medication when appointments and check-ups are scheduled, detailed instruction on how to do exercises (e.g. making short videos with a mobile phone) 

Consequences of lack of support: Anxiety and pessimistic attitude to therapy or belittling of the problem, lack of motivation to actively participate in the rehabilitation process, lack of progress in rehabilitation, discouragement. 

Material problems 

Examples: financial problems related to the lack of earning opportunities, lack of access to specialist treatment 

Support that can be provided: assistance in obtaining financial support, assistance in obtaining access to specialist treatment 

Consequences of lack of support: lack of therapy progress, permanent loss of health and fitness, emotional and family problems 

Kinesiophobia and fear of re-injury 

One common reaction to an injury is fear of movement and re-injury. In the initial phase after the injury, this fear is justified and is a protective factor. As the athlete recovers and returns to fitness, the fear of movement should decrease. It happens, however, that despite effective treatment and the lack of medical contraindications to physical activity, the fear of movement and re-injury remains high. This situation is very unfavorable and is regarded as a factor increasing the risk of re-injury. Even if, from the point of view of medical and fitness assessment, the athlete is ready to return to sport, but still has a fear of movement, the return to sport should be postponed and the athlete should be provided with support, e.g., a session with a sports psychologist. 

One of the most commonly used tools to assess fear of movement is the Tampa Scale of Kinesiophobia. This scale consists of 17 statements, examples of which are: “I am afraid that I may hurt myself if I exercise”, “Pain always means that I have damaged my body”, “No one should exercise when in pain”. Statements are scored on a Likert scale from 1 to 4: 1 – strongly disagree / 2 – disagree / 3 – agree / 4 – strongly agree (higher scores indicate greater severity of kinesiophobia). The respondent can receive from 17 to 68 points, with a score of 37 or more indicating kinesiophobia. Free access to the electronic scale calculator in English can be found at: https://www.physiotutors.com/questionnaires/tampa-scale-kinesiophobia/ (access: 03/09/2023) 

Additionally available in the e-manual: Description of other scales and questionnaires useful in the RTS decision-making process.