With Injury comes a loss of confidence (Doran, 1984). Whilst low confidence can be a result of injury, it can also cause injury e.g. not fully committing when going in for a rugby tackle. Magyor & Chase (1996) conducted a study looking at the consequences of having low self-confidence pre- and post-injury in gymnasts and found negative relationships between

  • Fear of injury and confidence in avoiding injury
  • Fear of injury and confidence in own ability to perform successfully
  • Probability of injury and confidence in avoiding injury

When working with an injured athlete I suggest that Sport Psychologists adopt the following rehabilitation guideline (Heil, 1993). I have successfully used this framework with a Premier League Academy footballer.

  1. Pre-injury
  2. Immediate Post-injury Period
  3. Treatment Decision & Implementation
  4. Early Rehabilitation Period
  5. Late Rehabilitation Period
  6. Specificity Period
  7. Return To Play

Firstly, (pre-injury) when dealing with an injured athlete you should identify the factors that created the environment in which the injury occurred. These can be addressed later on in the rehabilitation process.

Having done this, you then have to understand how the athlete is feeling (immediate post-injury period). Bearing in mind that so much of his/her life revolved around playing sport. All of a sudden it has been taken away from them. Consequently the athlete is likely to be experiencing emotions such as, depression, anger and guilt. It is vital you gain the athlete’s trust, otherwise the rehabilitation process will fail. Trust can be achieved by simply giving an accurate diagnosis, and proposing a course of treatment, with a realistic estimation of the duration of treatment.

Having gained their trust, attention turns to treatment (treatment and implementation). It is important to prevent the athlete from making any rash decisions regarding treatment, as they may not have thought about the long term consequences. At this point you must listen to the opinions from the athlete, coach and medical staff, and stress that they all must be in agreement before any treatment begins. The athlete needs reassuring that the final decision was made in his/her best interests and not the managements’.

Having set out the rehabilitation process the athlete then begins the long or short journey back to full fitness (early rehabilitation stage). Before any treatment begins the athlete and yourself should agree on early rehabilitation goals. Goals give the athlete something substantial to aim for and get actively involved in. These early goals should be short-term, relatively easy to achieve and not too strenuous (Brewer et al., 1994). Pain levels will be high so an emphasis should be placed on goals being more psychologically based rather than physical. At this stage of the process, levels of physical practice are limited therefore an emphasis is placed on mental practice. Fortunately the brain does not differentiate between real and imagined events, making it a formidable tool if used regularly. The following can all lead to an increase in confidence; Mental Imagery, Relaxation Training, Positive Self-talk and Biofeedback (Rose & Jevne, 1993; Cupal & Brewer, 2001).

As physical practice steadily increases the athlete then sets late rehabilitation goals (late rehabilitation stage). These should be long and short-term, challenging but realistic and involve both physical and mental practices. Having a sustained input from the athlete is vital, so they constantly feel in control maintaining self-confidence. At this point you should slowly introduce the athlete back into the team set-up, e.g. team meetings and practices so they realise they have not been forgotten about or replaced. Eventually, the athlete will partake in regular physical training.

The end is in sight (specificity period). Although he/she will require less mental training they still need constant reassurance that they will return to pre-injury form and achieve success again. The athlete may still want to discuss parts of their rehabilitation process.

Finally, once the athlete, coach, medical staff and yourself are all in agreement, the athlete will return to competitive action (return to play). If rushed back too early the athlete could experience low levels of self-confidence which not only increases the risk of re-injury, but could also lead to receiving a negative public perception. This could potentially destroy all the psychological healing achieved during the rehabilitation process.

An emphasis should be placed on carrying out follow up tests once he/she returns to action to hopefully identify signs of high self-confidence e.g. willing take risks, but also for any signs of low-confidence e.g. playing overly cautious. Some athletes successfully go through the injury rehabilitation process e.g. Petr Cech. In 2006, he suffered a depressed skull fracture from a tackle by Stephen Hunt. He returned wearing a scrum hat. The coaches did not mind the hat as it seemed to boost Cech’s confidence. In his first game back, Chelsea lost 0-2 to Liverpool. However, Cech then went 810 minutes in the English Premiership without conceding and was the first goalkeeper since Tim Flowers in 2000 to receive player of the month.

Some athletes however, begin the injury rehabilitation process and never return to their pre-injury form e.g. Alan Smith. In 2006, he suffered a dislocated ankle and broken leg after blocking a shot from John Arne Riise. Speaking to the Daily Mail he is quoted saying “I’ve never been the same player since my Antonio Valencia – style injury”. Although physically healed, he admits there are mental scars such as fear that have subconsciously altered the way he plays.

To conclude, low levels of self-confidence can occur pre- and/or post-injury. When making decisions regarding the athlete’s treatment you should always ask for their input to maintain their confidence levels. However, remember before deciding on treatment, all parties involved should be in agreement. Goal setting and mental training methods are effective in maintaining confidence levels, especially when physical practice is limited. Finally, once an athlete returns to competitive action, follow-up tests must be carried out measuring confidence levels to eliminate any chance of re-injury.