Anterior cruciate ligament (ACL) injury is a common injury in multi – directional field sports and is a highly devastating injury (Robinson et al, 2019) (Chan et. al, 2017) (Montalvo et. al, 2019) resulting in a long time loss from sport (Murphy et. al, 2012). Kneading et. al (2017) reported that more than 120,000 ACL injuries occur every year in the USA and are more common during high school and college years. They suggest that ACL reconstructions account for 50% of all sport related surgeries performed. The Murphy et al, (2012) tracked 851 Gaelic football players over a four-year period. They found that ACL injuries accounted for 13% of knee injuries and 1.5% of all injuries sustained. Additionally, an ACL injury was the most severe injury sustained in terms of time loss. Female athletes sustain ACL injuries at a significantly higher rate than their male counterparts. (Montalvo et. al, 2019) (Keading et. al, 2017). Keading et. al (2017) state that the overall incidence of ACL injuries in females is 0.081 injuries per 1000exposures for all sports combined.
The relationship between mental health and injury has been widely reported. Injury is part and parcel of sports participation. Aside from the obvious effects of injury on an athlete’s physical well – being, there are also effects on their mental health (Chan et. al, 2017) (Meredith et. al, 2020) (Gervis et. al, 2020) (Covassin et. al, 2015). The International Olympic Committee (IOC) stressed that mental health is a vital component of athlete well – being and cannot be separated from physical health, in their consensus statement on mental health in athletes (2019).
Athletes regularly suffer psychologically, as a consequence of long-term injury. Physical injury can be a source of stress, and athletes often experience feelings of tension, confusion, hostility, loneliness, fear, irritability, and anxiety (Covassin et. al, 2015) as they work through the entire injury and rehabilitation process. Additionally, these issues can persist beyond physical recovery (Gervis et. al, 2020). In their 2019 report, the IOC stated that cognitive, emotional and behavioural responses to injury are important factors in injury outcomes and mental health disorders may complicate recovery. Meredith et. al (2020) referenced a systematic review that found 65% of athletes did not return to play citing a psychological reason. Fear of re – injury, lack of confidence in the knee and depression were most cited. Specifically, Covassin et. al (2015) reported that 52% of high school athletes and 50% of collegiate athletes who had anterior cruciate ligament (ACL) reconstructive surgery did not return to sport participation because of fear of reinjury.
Anxiety and depression were the most common clinical mental health issues reported in the literature. Injured athletes reported higher levels of anxiety and depression compared with non - injured patients at immediate postinjury assessment and at 2 months (Covassin et. al, 2015).
Often, sports medicine professionals focus on the physical aspect of the injury while the psychological aspect goes untreated. Gervis et. al (2020) conducted a survey of the psychological supports available to professional football players in the UK. They found that physiotherapy staff were almost entirely responsible for providing psychological support during rehabilitation, of which only 37% were trained in the psychology of injury. This may be part of the reason why although, psychological interventions have been shown to be affective, their implementation is limited This study highlighted that most sports medical staff are aware of the psychological challenges faced by long – term injured players but were not trained to provide adequate support to these players. (Gervis et. al, 2020)
Although medical staff may not have psychological training, an awareness of the psychosocial response to an injury helps professionals to empathise with and help patients to cope effectively to prevent adverse responses to injury that may disrupt the healing and recovery process (Covassin et. al, 2015)
A large body of research supports the implementation of psychological elements in rehabilitation programmes to facilitate a holistic recovery and prevent further injury. (Meredith et. al, 2020) (Gervis et. al, 2020) (Covassin et. al, 2015) (Robinson et. al, 2019) Introducing psychological screening for presenting athletes will help to flag athletes who have mental health needs. Even without introducing psychological strategies to rehabilitation protocols, screening will identify athletes who may need referral to a mental health physician. (Gervis et. al, 2020)
Many psychological interventions have been suggested in the literature to promote healing ang encourage athletes to return to their pre – injury level of sport. (Robinson et. al, 2019) (Covassin et. al, 2015). Effective communication , relaxation techniques, and positive self – talk have been recommended in treatment of injury – related anxiety and stress.
Goal – setting is one of the most used psychological strategies during injury rehabilitation. Involving the athlete in the goal – setting process has been seen to increase their adherence to the rehabilitation programme as the athlete believes that their thoughts, feelings and ideas are being taken into consideration. (Covassin et. al, 2015). Goal – setting is also considered a form of social support provided by health care professionals.
Effective patient – physician communication has been shown to improve health outcomes for patients. Covassin et. al, 2015 suggests utilising the 4E’s of the Bayer educational model (engage, empathise, educate, enlist) along with the basic 2Fs of biomedical tasks (find the problem, fix the problem) in order to enhance communication in an athletic training setting
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