It was only five months before the 2014 Winter Olympics when Team GB snowboarder Billy Morgan ruptured his anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in his right knee during practice. He was medically advised that the injury required an operation, but with the recovery time for an ACL op lasting a minimum of six to nine months this would rule him out of competing in the Sochi Olympics. With the determination of an elite athlete and a positive mindset to rival the most observant Buddhist monk, Billy powered his way through months of intensive physiotherapy to be back on the slopes competing in the Aspen X Games in January; and then placing an incredible 10th overall in the first ever Olympic slopestyle event in Sochi a month later.
What gives athletes the strength of mind to battle through the setbacks caused by a serious injury and stick with a rehabilitation programme?
This has been a question of much debate and fascination among sports professionals, and has been the focus of a growing number of research papers (Duda et al., 1989; Fisher et al., 1992). When an athlete suffers a serious (or even minor) injury, the physical implications are immediately clear and the recovery time can be quickly assessed through medical prognosis. However, what is less clear is the psychological impact of an injury for the athlete both during and post-rehabilitation. An athlete must quickly learn to accept their injury and the temporary limitations, and focus solely on the gradual process of rehabilitation. When this involves a complete lifestyle change from training every day and competing every week (for example) to a painful and more sedentary lifestyle, which could involve learning to walk or run again, it can be extremely hard to adjust. In the first place athletes have to struggle with the loss of ego from feeling weak or feelings of isolation from not being with the team. Secondly they also have to overcome the mental setbacks when returning to their sport after a long hiatus and regain the confidence to compete at a high level again.
Early researchers in this field sought to develop a “stage approach” theory that would define the psychological process experienced by an athlete following a serious injury. Kiibler-Ross (1969) created her “loss of health” or “grief” model, which, although developed as a result of her clinical experience with terminally ill patients, is still widely cited in the current literature. The model suggests that a grieving individual passes through five sequential stages: denial, anger, bargaining, depression, and acceptance. While it has not been supported that all injured athletes progress through these emotions in the exact order, Kibler-Ross’ theory has provided a solid framework for sports scientists to further investigate this complex psychological process. Recent research findings include tension, anger, depression, frustration and boredom as typical emotional responses to athletic injury (McDonald and Hardy, 1990); with frustration and boredom being reported as the primary responses when athletes are asked to rank their emotional responses post injury (Pearson and Jones, 1992). The groundbreaking research by Weiss and Troxel (1986) highlighted the psychophysiological effect an injury can have on an athlete, and follows the stress-response model originally developed by Selye (1976). This posits that the cognitive-appraisals of an injury can greatly influence the emotional response of an athlete both positively and negatively. The emotional response in turn can precipitate a host of physical and psychological reactions, ranging from severe anxiety, depression, and anger to increased muscle tension, blood pressure, and heart rate.
Now that sports practitioners understand the consequences of negative appraisals following an injury, it is important to provide the right psychological support for athletes in order for them to accept their situation and adhere to a rehabilitation programme. Gordon et al. (1991) and Pearson and Jones (1992) explain that the physiotherapist is in an ideal position to apply psychological principles because of the close relationship that exists with an athelete under their care during rehabilitation. However, it is still debated as to whether it is within the professional limits of a physiotherapist to help restore the psychological wellbeing of an injured athlete. Brewer et al. (1994) suggest that interventions of a psychological nature should always be incorporated in the physical rehabilitation programme, so that they are not interpreted as separate or extra. Further evidence for the positive impact of emotional support came from Bianco’s (2001) study into elite skiers and their experience of social support from coaches, team mates, friends, and family during the rehabilitation process. The study involved in-depth interviews with athletes who had experienced career-ending injuries and a selection of their close social support network. Given the significance of emotional responses to injury and the short time frame with which to begin effective rehabilitation, it seems almost ineluctable that psychological interventions will be increasingly provided to athletes following a severe injury.
Snowboarding is an extreme sport by its nature, and participation in the sport (much like other extreme sports) carries with it a high risk of injury (Kim et al., 2012). Elite competitors often have a catalogue of previous injuries from their progression from novice to elite level, and these tend towards serious injuries due to the extreme nature of the sport. Therefore, these athletes must learn to expect and to deal with the psychological effects of serious injuries, to ensure a rapid recovery and psychological harmony. However, sometimes it is almost impossible to comprehend the emotional response when faced with the prospect of a career- or even life-threatening injury. In such cases not only must your lifestyle change dramatically, but your whole outlook on life. This can be no better highlighted than in the pure grit and determination of the ex-pro snowboarder Kevin Pierce. Following a severe brain injury during practice for the 2010 Winter Olympics, Kevin showed that through strength of mind it is possible to reinvent yourself (in his case as an inspirational survivor, sports commentator, motivational speaker and advocate for brain injury and Down syndrome) and become a positive force in the world, even for the elite athlete who has only known their sport as their main motivator. The commitment and compassion of his friends and family are a testament to the power of social support and its influence on adherence to rehabilitation.