Returning to your prior level of performance after ACLR rehabilitation is no easy task, and has multiple factors. On top of a clear, long-term plan to help restore your physical capacities (no reason to let your bench press or your conditioning take a dip!), the psychological challenges can be easily forgotten. To build on that, I want to say I’m no mental health professional, but I do think it’s important as coaches and health care providers, that we all look to have some mental health professionals in our corner to better serve our athletes. That being said, there are aspects of the psychological challenges that ACL rehab presents that we can be aware of to assist our athletes as much as possible. Coach Ravi has written a helpful blog with more on this topic so you can check that out here.
Psychological readiness is a multifactorial…
For this blog, we’re keeping the focus on motivation and doing what we can to meet the needs of our athletes during their rehab. To do this, we need to take a step back to establish what those needs are.
Self Determination Theory lists three basic needs in human motivation. Whether or not these needs are met MAY have implications for the health and well-being of the athlete returning to sport. These needs include:
- Autonomy – In this case, we want the individuals we work with to feel an internal locus of control. We want them to feel confident in knowing that they have a plan and they’re in control of aspects of their rehab and their actions are done for their own reasons. We are not the gatekeepers of their ability to return to play, we’re here to assist them.
- Competence – In this case, the athlete needs to know what the plan is! If we know what the goals are, they need to know how the plan being carried out is going to help them meet their goals.
- Relatedness- This could be making sure that they know what they CAN do at practice with their team and knowing how they can continue to contribute to themselves as an athlete and their team as a whole.
Doing our best to assist in meeting these needs can increase the chances of the athlete being intrinsically motivated. Failing to meet these needs increases the chances that the athlete can feel alienated, or forced to extrinsically motivate themselves to return to sport, or worse, find no motivation at all and feel like they’re going through the motions of rehab.
What do we mean when we say, intrinsic vs. extrinsic motivation?
Intrinsic motivation generally means that the athlete has their own internal agenda or motivation for working to return to sport after injury. This may show up as the athlete having their own goals to work toward to please themselves. Maybe they enjoy the exciting experiences that competition brings them. Sport could also allow them to discover new training techniques. For others, playing sports may allow them personal satisfaction when working to master specific skills, or even just allow them to stay active.
Extrinsic motivation can show up as a range of things. It may represent the need for other people’s positive feedback, or even just be ingrained in the culture of the sport. Some associate injury and playing through pain as part of the sport, which can lead to normalizing negative experiences in rehab and feeling like it’s just something they have to deal with when back on the court or field. Extrinsic motivation may show up as just wanting to get back to sport because they feel pressure from teammates or coaches and don’t want to let them down.
Like I mentioned earlier, having mental health professionals in your corner can help athletes find positive experiences to motivate themselves in rehab. I think that as healthcare providers and coaches, we need to communicate with and get to know the athletes we work with to help identify those in need. Having open ended questions and setting goals can certainly help, but there are also questionnaires that exist. One being the “SMS-28”, or the Sports Motivation Scale. The “SMS-28” can be a great tool to gain some objective insight into an athlete’s motivation and assist to identify those at risk for poor outcomes.
If you know of anyone going through this rehab process, just remember that outcomes have many factors, and we need to do the best we can to surround ourselves and athletes with the tools to not just have a positive physical outcome, but a positive psychological outcome.
Ardern CL, Kvist J, Webster K. Psychological Aspects of Anterior Cruciate Ligament Injuries, 2016, Operative techniques in sports medicine, (24), 1, 77-83. DOI: https://doi.org/10.1053/j.otsm.2015.09.006
Podlog L, Eklund R. Return to Sport After Serious Injury: A Retrospective Examination of Motivation and Psychological Outcomes. Journal of Sports Rehabilitation. 2005 Aug. 14(1). DOI:10.1123/jsr.14.1.20
Pelletier, L. G., Fortier, M. S., Vallerand, R. J., Tuson, K. M., Brière, N. M., & Blais, M. R. (1995). Toward a new measure of intrinsic motivation, extrinsic motivation, and amotivation in sports: The Sport Motivation Scale (SMS). Journal of Sport & Exercise Psychology, 17, 35-53.