Psychological readiness is defined as “the presence of confidence and lack of fear”. This is crucial to safely returning to sport after injury. Various ACL research studies have concluded that fear of re-injury and lack of confidence is a barrier to return to sport. Athletes who experienced an ACL tear had to undergo surgery, adjust their daily life, and rehab in physical therapy for several months. They’ve often built the strength capacity and plyometric capabilities to return to their sport, but often are being held back by the anxiety and fear of re-injuring themselves.
Many sports teams and organizations are great at measuring physical performance metrics, but not as great at taking a holistic view of an athlete. The fear that athletes feel after an ACL injury may cause them to remain tense in their muscles, to have ruminating and obsessive thoughts, and to quit their sport prematurely. The more they avoid playing, the bigger that imaginary boulder of fear becomes, and the more anxious they feel. There is often a mental health stigma in sports. The elite athletes of the world are thought to have a “tough” and “unbreakable” mind. The truth is that athletes need to develop the tools needed to build mental resilience.
How to Build Psychological Readiness When Returning to Sport Post ACL Injury
Who Should an ACL Athlete Speak to When Returning to Sport?
The first step to building psychological readiness is to address those anxious and tense feelings. It’s important to remember that you’re not alone, and that your care team is there to provide support. This includes your teammates, coaches, physical therapists, athletic trainers, and mental health therapists. It’s most ideal to speak with a mental health therapist who has sports psychology training. It’s important to note that team culture is a critical piece of psychological readiness. If teammates aren’t encouraging when mistakes are made, this will negatively impact the entire team.
Which ACL Athletes Would Benefit Most from Speaking with a Mental Health Therapist?
Physical therapists will administer a survey called the Anterior Cruciate Ligament Return to Sport After Surgery (ACL-RSI) when they feel like an athlete is physically getting close to returning to their sport. This survey is a 12-item patient-reported questionnaire designed to measure an athlete’s psychological readiness. It includes questions about performance confidence and fear avoidance.
Research suggests that the optimal ACL-RSI score threshold is >/= 65. Other research suggests that a score of 60 is considered a Patient Acceptable Symptom State (PASS). Athletes scoring lower than 60 have “low readiness”, suggesting low performance confidence and high fear of reinjury. These are the athletes who would benefit most from speaking with a mental health therapist.
ACL Athlete Identity Outside of Sports
Who are you outside of your sport? Discussing your identity outside of athletics can be helpful. Many times athletes tie their ego strongly to their sport. When your identity becomes too rigidly attached to any single endeavor, you’ll be faced with distress. The distress you feel takes the pleasure away from participating in your sport. Engaging in other interests or hobbies you enjoy can allow you to step away and to have a clear and relaxed mind. This can help you to find joy in playing the sport you’ve always loved.
How Do Elite Athletes Think When Training and Competing?
Having self compassion for yourself during this transition of returning to sport will be most helpful. Do your best to avoid being overly critical of yourself, and don’t compare yourself to how you performed before your injury or surgery. You will slowly expose yourself to playing and/or competing again, and your confidence will build based on your increasing exposure.
Making mistakes and errors is necessary in order to learn and adapt. This is a field of study called motor learning. Be kind to yourself when these errors inevitably happen. The more mistakes you make, the greater the learning and the stronger the neural networks develop. You may be back on the court/field after a serious injury and you're thinking, “I suck now.” Ask yourself, what else could be true? Perhaps you simply need to allow yourself some time to practice, shake off the rust, and rebuild confidence. You're allowed to make mistakes along the way.
Conclusion
There is absolutely nothing wrong with feeling anxious and fearful about returning to sport. The important thing is that you talk about it and not try to shove it away. Speaking with a mental health therapist can help you to understand your feelings, express them, and find solutions on how to cope with this new reality.
If you or someone you know could benefit from speaking with a mental health therapist after an ACL injury, you can contact Taylor Rosenblum Therapy by clicking the button below.
Disclaimer: This is not intended to be formal medical advice. Your individual needs should be met by the appropriate health care practitioner. Please consult with a trusted provider.
Taylor Rosenblum, LMHC
Licensed Mental Health Counselor in NY and NJ
Level 1 USA Track & Field Coach
Former Division 1 Track and Field Athlete (Sprints)
Dr. Paul Nasri, PT, DPT, OCS, COMT
Doctor of Physical Therapy
Orthopedic Clinical Specialist
Certified Orthopedic Manual Therapist
