Posts Tagged ‘rehabilitation’

Utilization of Sport Psychology in the Rehabilitation Process

Monday, January 9th, 2017

Posted January 9, 2017

Beth Druvenga

By Beth Druvenga, M.S. Ed, LAT, ATC

“Sports are 10% physical, 90% mental,” this common phrase used in sports is easily transferred into the world of injury rehabilitation. Sport psychology has started to be incorporated into the sports medicine realm.  Athletic Trainers (ATs) are required to participate in some type of psychological or behavioral classes as part of an athletic training program curriculum. Many people have heard of collegiate or professional athletes using psychological techniques such as imagery, stress reduction and positive self-talk as part of their pre-game regimen. They have credited these techniques as helping their game excel, but what if we transferred these techniques into the athletic training facility?

There are some athletes who still feel the stigma of psychosocial help and may not see it as the ATs “place” to employ sport psychology theories into the rehabilitation program.1 However, these interventions have been shown to have positive effects on athlete compliance to rehabilitation programs, better rates of recovery and may help alleviate stress or anxiety.4,3

As ATs, we are put into the unique role, which allows us to control many aspects of the rehabilitation process such as; creating a positive atmosphere, maintaining athlete compliance and providing social support for the injured athlete. We can easily facilitate the discussion with the athlete about how they feel regarding their injury, refer them to another healthcare professional or help them cope with their injury. ATs are on the front lines of student-athlete wellness. Having awareness and knowledge about the psychosocial aspects of the sport allows ATs to take greater care of the athlete, which will hopefully reduce injury recovery time.

Use your tools of the trade! As a professional, it is intrinsic to give our athletes feedback and cues on how to do their exercises correctly. We help set achievable goals in their rehabilitation and lift them up when they’re having a rough day in rehab. All athletes have some part of their identity associated with being an athlete. Being aware of any changes in this identity can be useful for an AT to help in identifying any issue that may appear. These are all subtle psychological interventions!1 Though subtle is sometimes best, there are some more direct ways that can be beneficial to the athlete.

Start by having the athlete write down goals for each week in a journal or on a rehab sheet. The ability to see these goals daily during rehab will ingrain in the athlete’s mind about what they have set out to do for the week and will motivate them to make progress.2 They can acknowledge their goals while doing specific exercises and visibly see their progress written out. Talking with the athlete about their motivation for recovery can also be helpful. By understanding the athletes “why” early in the recovery process, you can help remind them of this “why” during the difficult days.

Add imagery into their program. Imagery is a process which involves three steps: vividness, controllability and self-perception.5 Especially with post-surgical cases and prior to the exercise, have the athlete imagine the muscles they use to do a specific exercise (vividness). After they have done this for a few minutes, have them move on to imagining going through the exercise and completing it successfully and pain free (controllability). Then, after doing this step for a few minutes, finally have the athlete think about a time where they were performing at their best, what emotions they had and what it took for them to feel that way.5 Imagery can be used in pain management as well. Having the athlete view the pain as a “hot” color like red and change it to a “cool” color like blue, which can help reduce pain.6

Teach them positive self-talk. Athletes are quick to get down on themselves if they aren’t performing the task perfectly. Have the athlete use “I can”, or “I will” statements before tackling a tough exercise. This practice will positively engage the brain and give the athlete the boost to achieve their goal. Another way to enhance confidence is to view the setback or injury as a challenge and obstacle to overcome rather than a threat to athletic identity. Changing the perception will help the athlete remain optimistic during a potentially difficult period of life.

Create a peer to peer group.2 A peer to peer group can be led by a sport psychologist or qualified mental skills coach, which can meet to discuss the “boo’s and yay’s” of that day’s session. Athletes need to know they’re not the only one struggling with certain things. When they can dialogue with others in a controlled setting, they may find it beneficial to talk with others going through similar situations. They can also share techniques which have helped them and may  help other athletes.

Many ATs do not feel adequately equipped to walk athletes through the psychological aspects of return from injury. If this is the case, search for local sports psychologist or qualified mental skills coach, who work with adolescents or young adults. A great resource is the Association for Applied Sport Psychology, they have information for consultants in your area, as well are plenty of resources on injury/rehabilitation.

In the college/university setting, seek out your psychology or kinesiology professors. They may have an interest in the area of sport psychology and would be willing to provide guidance and expertise. Seek out workshops, lectures and continuing education that touch upon applying psychology into the athletic training facility. As ATs, we are uniquely taught and equipped to handle many different and difficult facets of injury, rehabilitation and return to play. We have an overflowing toolbox, but adding sport psychology training may prove to be a welcome addition.

**Huge thank you to my brother Joel Druvenga, a Master Resilience Trainer-Performance Expert with Comprehensive Soldier and Family Fitness at Fort Riley Army Base. He has a Bachelor of Arts in Psychology, Master of Education in Counseling with an emphasis in Sport Psychology.  He is also working toward a Doctor of Education in Kinesiology. He provided me with valuable insight into the realm of sport psychology and utilizing it in the sports medicine world, and added some great edits to this blog post.**


1. Arvinen-Barrow, M., Massey, W. V., & Hemmings, B. (2014). Role of Sport Medicine Professionals in Addressing Psychosocial Aspects of Sport-Injury Rehabilitation: Professional Athletes' Views. Journal of Athletic Training, 764-772.

2. Granito, V. J., Hogan, J. B., & Varnum, L. K. (1995). The Performance Enhancement Group Program: Integrating Sport Psychology and Rehabilitation. Journal of Athletic Training, 328-331.

3. Hamson-Utley, J. J., Martin, S., & Walters, J. (2008). Athletic Trainers' and Physical Therapists' Perceptions of the Effectiveness of Psychological Skills Within Sport Injury Rehabilitation Programs. Journal of Athletic Training, 258-264.

4. Heaney, C. A. (2006). Recommendations for Successfully Integrating Sport Psychology Into Athletic Therapy. Sport Psychology & Counseling, 60-62.

5. Richardson, P. A., & Latuda, L. M. (1995). Therapeutic Imagery and Athletic Injuries. Journal of Athletic Training , 10-12.

6. Taylor, J., & Taylor, S. (1997). Psychological approaches to sports injury rehabilitation. Gaithersburg: Aspen Publishers.

About the Author

Beth Druvenga is an Athletic Trainer currently living in northern Virginia. She has experience working in both a collegiate and high school setting. Druvenga is originally from Iowa where she earned her Bachelor of Arts degree in Athletic Training from Central College in 2012. She graduated from Old Dominion University in 2014 with a Master of Science in Education. Her professional interests include patient-reported outcomes, psychology of injury and rehabilitation as well as using yoga to increase flexibility.





Return to Sport Post ACL Reconstruction

Wednesday, September 21st, 2016

Posted September 21, 2016

Tim Koba, MS, ATC
Twitter: @timkoba

By Tim Koba, MS, ATC

ACL injuries continue to be a hot topic in the sport world. A big reason is that even though they are still not very common, percentage wise, they have a large impact on long term joint health, recovery, cost and ability to return. As reconstruction techniques continue to evolve, athletes are able to return to play, but how successfully?

After surgery, the treatment consists of rehabilitation to regain motion, function, proprioception strength and control. Once athletes have completed about 6-9 months of rehab, they return to sport. Here’s the sobering news: Of those who suffer an ACL reconstruction, only 65% return to their pre-injury level of sport, with only 55% returning to competitive play. Even more discouraging is the fact that of those who return to sport, up to 1 in 5 will suffer a tear to their reconstructed knee, or the ACL on the non-reconstructed side.

In order to determine what risk factors existed, and ways to modify them, researchers looked at elite soccer players who had their ACL reconstructed and then followed them. They looked at the type of surgery they had, their rehabilitation process and their return to sport. What they discovered was that athletes who did not meet certain bench marks in rehab were 4 times more likely to have another ACL injury. The following table shows the exercises and the discharge criteria that were deemed successful.

Discharge tests and criteria used during the study period

6 part return to sport tests Discharge permitted when criteria was met
Isokinetic test at 60, 180 and 300 degrees/sec Quadriceps deficit <10% at 60 degrees/sec
Single leg hop Limb symmetry index >90%
Triple hop Limb symmetry index >90%
Triple crossover hop Limb symmetry index >90%
On field sport specific rehab Fully completed
T test <11 sec

In addition to the tests above, athletes who had lower hamstring-to-quadriceps strength ratios were also more likely to injure their ACL. Since strong hamstrings act as an assistant to the ACL, weakness there can mean more stress on the ligament.


This study highlights a couple of key points when rehabilitating ACL injuries.

- Prior to return to play, athletes should be fully recovered with equal strength bilaterally

- They should be able to seamlessly perform multidirectional drills

- Athletes should have adequate hamstring strength. Most of us do not have access to isokinetic testing, but spending time having athletes perform hamstring strengthening during their rehabilitation is essential.


Kyritsis, P. et. al. (2016). Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50.

About the Author

Tim Koba is an Athletic Trainer, strength coach and sport business professional based in Ithaca, New York. He is passionate about helping others reach their personal and professional potential by researching topics of interest and sharing it with others. He contributes articles on injury prevention, management, rehabilitation, athletic development and leadership.


Celebrate National Rehabilitation Awareness Week

Tuesday, September 17th, 2013

Since 1976, National Rehabilitation Awareness Week has been celebrated annually across the United States. This observance, falling on the third week of every September, promotes the value of rehabilitation, highlights the capabilities of people with disabilities, salutes the professionals who provide services to this community and renews our commitment to meet the needs of people with disabilities.

Rehabilitation helps minimize physical or cognitive disabilities and restore those affected by potentially disabling disease or traumatic injury to health and productivity. Rehabilitation is the single most effective treatment available to persons with brain injury.

In the athletic training profession, treatment and rehabilitation is one of the five practice domains. Athletic Trainers (ATs) are healthcare professionals who collaborate with physicians. The services provided by ATs comprise prevention, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.*

Why not take a moment this week to say "thanks" to your favorite ATs, rehabilitation researchers, counselors, therapists and technicians? The BOC thanks ATs for their dedication to the profession.

*This definition is approved by the NATA's nomenclature work group and the NATA Board of Directors, January 2013.

Written By:
Brittney Ryba


Who are you gonna call - Athletic Trainers

Wednesday, October 31st, 2012

Happy Halloween! Enjoy the following song sung to the tune of Ghostbusters theme song by Ray Parker Jr. in honor of the holiday and of Athletic Trainers.

Who are you gonna call - Athletic Trainers

If there's somethin' strange inside your head
Who ya gonna call? Athletic Trainers
If your feeling pain and it doesn’t look good
Who ya gonna call? Athletic Trainers

I ain't afraid of prevention
I ain't afraid of emergencies
If you're seein' things runnin' thru your head
Who can you call? Athletic Trainers
A weak athlete fallin' on your court
Oh who ya gonna call? Athletic Trainers
I ain't afraid of treatment
I ain't afraid of rehab
Who ya gonna call? Athletic Trainers
If you're all alone, pick up the phone
And call - Athletic Trainers

I ain't afraid of prevention
I hear it is a healthcare profession
I ain't afraid of emergencies
Who you gonna call (Athletic Trainers)
Mm…if you've had a dose
Of an illness, athlete
You better call an Athletic Trainer
Wellness makes me feel good
I ain't afraid of no evaluation

Don't try to fix it alone oh no… Athletic Trainers
When they come through to help
Even if you think it’s minor
I think you better call an Athletic Trainer
Ooh... who you gonna call (Athletic Trainers)
Who you gonna call (Athletic Trainers)
Ah, I think you better call (Athletic Trainers)

I can't hear you… Athletic Trainers
Who you gonna call (Athletic Trainers)
Louder Athletic Trainers
Who you gonna call (Athletic Trainers)

Who can you call? Athletic Trainers …(till fade)

Written By: Brittney Ryba

An In Depth Look with an Athletic Trainer with the Chicago Cubs

Friday, October 19th, 2012

An In Depth Look with… Chuck Baughman, MS, LAT, ATC

Describe your setting:
With the Chicago Cubs Organization, I design and implement rehabilitation programs for all players and staff who have suffered an injury that affects their on-field availability. I work out of the spring training facility in Mesa, Arizona and work 12 months out of the year.

How long have you worked in this setting?
I began the rehabilitation setting in the off-season of 2005.

Describe your typical day:
Depending on the time of year, I typically begin my day a couple of hours prior to the players arriving. The first part of my day is responding to e-mails and phone messages that I received from the following evening. I look over the rehab plans for the day and make any corrections that need to be made. Athletic training facility prep includes making ice towels (bags), rolling ace wraps and prepping the hot and cold whirlpools for use. After the athletic training facility is prepped, I meet with the Strength and Conditioning Coach to go over the day’s schedule and any other changes that were made to a rehab plan.

Once the players arrive for treatment, all hands are on deck. Players will begin with some type of active warm-up prior to treatments. If players are completing a throwing program that day, I observe or participate in the program as needed. I work alongside a pitching coach that specializes and works with the players on rehab to ensure proper throwing mechanics are being used. At some points of a throwing program we will utilize video to go over mechanics.

After throwing or conditioning programs, I work with the athletes on mechanics and corrective exercises in their rehab programs. Following the programs each player obtains post-treatment.

What do you like about your position?
My position allows me to work with many types of personalities. Some people just always keep you on your toes. We (patients and staff) have a lot of fun during the day and it breaks up the monotony that rehab sometimes gets. Satisfaction comes from taking an athlete pre-surgery all the way to the major leagues.

What do you dislike about your position?
This position often requires a lot of hours and time away from home and family. Your family needs to be understanding and accepting of your position. During the baseball season, it is not uncommon to work seven days a week for 10+ hours a day.

What advice do you have about your practice setting for a young Athletic Trainer looking at this setting?
I became a BOC Certified Athletic Trainer (AT) through the internship route. I spent a lot of hours in the athletic training facility and conversing with my mentor, Jeff Etherington. I also spent a lot of time working with other ATs and orthopedic surgeons. My advice to younger ATs is not to be afraid to put in more than is required. Eventually, your extra work and dedication will become noticed and rewarded, both professionally and mentally.