Psychology of Injury and Rehabilitation

Injuries happen, fact. It is estimated that 29.7 million sports injuries alone occur annually in England
and Wales.

Commonly, the first things that springs to people’s mind when an injury occurs are “how badly am I
injured” and “when will I be fit to play again”. The first thought is always concerning their physical
state and how long it will take for their body to recover. We don’t often think about how we may be
affected psychologically.

No matter the extent of an injury, whether it be a pulled muscle or ligament rupture, everyone goes
through the same psychological phases:

1. DENIAL – When you first experience the shock of an injury you immediately begin an internal
dialogue in which you try to convince yourself the extent of the injury in only minor. You
carry on telling yourself it will ease off in the next few days and perhaps you even continue
to train.

2. ANGER – This phase is often fuelled by thoughts of “why me?” or “why now?”. This occurs
when you begin to process your injury. Sometimes the anger may be directed at family or
friends if you believe they don’t understand the sense of loss you are feeling from training
changes.

3. BARGAINING – You may not fully understand what is best for your body regarding rest and
adapt your training to minimise pain, however, sacrificing your performance quality.

4. UNMOTIVATED – Not being able to meet your training goals as a result of injury can be
difficult to process and negative thoughts about future goals come flooding in. A lack of
motivation is experienced during this phase.

5. ACCEPTANCE – For rehabilitation to be effective you need to fully understand your injury
and what it will take to make a quick but effective recovery. This phase is the most
important, if you achieve acceptance early, the rehabilitation process can start right away.

The hurdles you may face through injury can be frustrating, sometimes feeling as if you are taking
one step forwards and then two steps back. In order to start the physical rehabilitation process, a
psychological appreciation for your journey to recovery must take place.
A strong emphasis is therefore, placed upon cognitive appraisal which depicts how you perceive
your injury rather than the physiological components of the injury. An appraisal is a process in which
a potentially stressful situation (injury) is assessed and the individual’s evaluation of the stress
extent.

PRIMARY APPRAISALS – involves an assessment of what is at stake and whether the injury is a
challenge, benefit, threat or harmful.

SECONDARY APPRAISALS – involves an assessment of the coping options available to manage with
the psychological effects of injury.

This proposes that two people with the same injury could appraise the injury in different ways; one
perceiving it as a disaster and the other as an opportunity to have a break from intense training. The
person who acknowledges their injury as a challenge or potential benefit will reach acceptance
sooner than those who feel at a loss or threatened, allowing for their rehabilitation journey to occur
much sooner.

If you are ever unsure about an injury or need advice on what actions you should take next, our
physiotherapists here at Carter & George are happy to help. Our highly experienced physios can
support you and instil a positive mental attitude towards your injury and future recovery.