Sports injuries pose arguably the biggest trials for aspiring performers, challenging not only the body but also the mind. How the performer and those around them approach and handle the process that follows an injury can prove to be pivotal, especially with more severe injuries. What mindset those involved bring to the task of dealing with injury is hugely influential in shaping the route this takes. A performance mindset goes a long way when contemplating the path forward following an injury. Indeed belief alone plays a role in shaping the eventual outcome. There is evidence that those who express high expectations of making a successful return as they enter the process (such as prior to surgery) are ultimately more likely to achieve that outcome in reality.
I came across a true proponent of a performance mindset when dealing with injuries early in my career and it has stayed with me. I met the athlete in question (his name is Kieron Dawson) during my time working in professional rugby. Rugby is a game of violent bodily contact and Kieron played in a position that exposed him to a lot of collisions and compromising positions as he contested for the ball. As such, Kieron suffered various injuries during his time, yet he nevertheless managed to have a long and highly successful career at the top-level for both club and country. One of the things that was striking about Kieron which helped him to achieve this feat was his unique response after suffering an injury. No matter how serious the injury Kieron never contemplated anything other than a successful outcome, but more than that he viewed the time on the sidelines as an opportunity to come back better (his mantra was faster, higher, stronger).
ENLISTING THE RIGHT SUPPORT
Bringing a performance mindset to the endeavour begins with seeking out the best support. As Kieron’s story illustrates, the role of the performer is critical and they should remain a central player in the process, but enlisting the right pit crew to support and inform the process is nevertheless crucial. Knowing that they have the right support goes a long way to ensuring that the performer has high expectations of making a successful return. Having the right people involved is also key for the performer to remain positive throughout the process and ensuring a high degree of confidence once they contemplate making their return.
Clearly an important first step is to enlist a practitioner with the expertise to provide clarity on what we are dealing with. Beyond an accurate diagnosis of the injury, this calls for a forensic approach to shine a torch on what factors might have contributed to the injury occurring.
Clearly if we want to be systematic we need to know what problems we need to solve. This begins with the injury itself but also encompasses the knock-on effects that are secondary to the injury as well as any contributory factors that might have predisposed the performer to the injury in the first place. The treating practitioner must of course also have the therapy skills to provide the best treatment (or a referral network to enable the performer to access the best provider for the treatment required).
Beyond an accurate diagnosis and effective treatment, making a successful return requires a comprehensive rehabilitation and reconditioning plan. The plan should place an onus on safeguarding the performer against future injury risk once they make their return. Success is largely contingent upon the quality and delivery of rehabilitation exercise and other training provided. Something that is often overlooked below the elite level is the need to engage a specialist in rehabilitation and return to sport training to provide for these critical elements.
LESSONS FROM ELITE SPORT…
If we are seeking a template for a performance-oriented injury rehabilitation and return to sport process it makes sense that we should look to elite and professional sport for examples of best practice and cutting edge approaches.
Professional and elite sport has essentially served as the proving ground for the merits of taking a performance approach to dealing with sports injuries. The impressive recovery times reported with common injuries in professional sports are testimony to the success of the progressive and innovative approaches presently employed at the elite level.
Given the dedicated support that is made available to professional and funded athletes it could be argued that this is all rather unsurprising. What is less easy to dismiss is that athletes at the top level show a far higher likelihood of making a successful return to their pre-injury level following severe sports injuries such as ACL rupture. Injured performers below the elite level fare considerably worse in this regard, with a substantial number failing to return to the same grade of competition following the injury.
Whilst there might not be the dedicated support, such a discrepancy in outcomes is nevertheless hard to justify. For one thing, there are not the same time pressures, which means we have more time to get it right and make sure they are ready. The level of intensity and associated stresses are also less below the elite level. So why are the outcomes so much worse on average?
It appears that the more passive, conservative and protective approach that is typical below the elite level paradoxically leads to worse outcomes. What helps explain this paradox is that our urge to protect and limit their exposure to load and challenge during the weeks and months that follow injury have the ultimate effect of failing to return the performer to a state of readiness to return to the rigours of participating in sport at the same level. Another irony is that failing to expose the injured performer to the stress and challenge of the sport during the rehabilitation and return to sport process also renders those who do return more susceptible to future injury.
A performance approach not only means that performers are better prepared once they make their return, but more importantly leads to a more successful outcome on average.
PRINCIPLES AND PROCESS…
Earlier we mentioned the need for a rehabilitation specialist to help guide the reconditioning and return to sport process following injury. Dedicated performance rehabilitation roles have become an established part of the support staff at professional teams and within elite sport over recent years. In my previous role with a commercial sports science and medicine facility I oversaw a team of performance rehabilitation coaches and this role was established to fill what is typically a void outside of sport at the professional and senior elite level. Indeed, part of the motivation for starting the Prepared ATH initiative was to bring this type of specialist support to injured youth sports athletes and serious recreational athletes, in collaboration with sport injury clinics in the local region.
When approaching injury rehabilitation the element of risk should be acknowledged from the outset. Equally, it is important that all parties understand that there is inevitably some element of risk whichever path is taken. The only way to eliminate risk entirely is to remain on the sidelines. But even then there are serious long-term health risks associated with a sedentary lifestyle if we do opt out of participating in sport and regular physical activity! Our task therefore is to be proactive and systematic in managing and mitigating the risks involved as far as possible to future-proof the performer and enable them to come back stronger and more resilient.
Professional sport has demonstrated what is possible when we push the boundaries during the injury rehabilitation process and we have made some important discoveries as a result. For instance, we have discovered that early mobilisation and a more progressive approach including training more normally associated with performance can lead to a superior outcomes following injury. The trick with youth sports athletes and those below elite level is to leverage the good parts without taking undue risks and forcing the timeline. There are not the same pressures, so we can adopt a long-term perspective rather than rushing the performer back. Equally we can retain the proactive and performance-oriented perspective to avoid the perils and pitfalls of lapsing into being too passive and overprotective.
STRIKING THE RIGHT BALANCE…
From the outset, successful performance rehabilitation is about striking a balance. Initially the balance to be struck is between protecting the injured area and avoiding prolonged unloading that slows healing and regeneration. Similarly the need for rest to permit healing and regeneration needs to be balanced against detraining and disuse-related changes the compromise integrity of tissues, function and fitness.
Later in the rehabilitation process more progressive types of training have great efficacy in supporting the remodelling of healing tissues, restoring function and rebuilding capacity and capability. Equally these tools will need to be modified to fit the purpose and delivery will need to be adapted to the performer’s present level of function and tolerance, which fluctuate over time. Once again, successful application and delivery is all about striking the right balance as we go along. Enlisting a rehabilitation specialist who brings expertise with these ‘advanced’ training modalities and how to apply them to sports injuries is crucial from this perspective. Having somebody other than the treating practitioner undertake this process with the performer in itself also helps to reduce any dependency and restore confidence.
Our ultimate objective is to return the athlete stronger and better equipped than prior to the injury, not least to offset the risk factor of previous injury. Coaching is a key element to not only restore but improve athletic movement skills alongside reintroducing sport skills and competition-related work. Preparing the performer for the rigours of the sport they are returning to also requires us to push the envelope during the later stages. Essentially this is a process of stress inoculation, comprising graduated exposure to more intense and less controlled conditions that increasingly replicate ‘live’ competition. To come full circle, the overarching objective is to restore the performer’s confidence so that they feel fully prepared and remove any doubts that they are ready when they ultimately make their return.
Those interested in finding out more can enquire about the options for support and coaching provision for those local to Vancouver, as well as remote coaching options for those further afield. For more, including how to arrange an initial assessment, see the ‘Enquire’ link at the top of the page or email us direct at PreparedATH@gmail.com.
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Thanks also to all those who have shared feedback on the recent release Prepared: Unlocking Human Performance with Lessons from Elite Sport (click on the image below for details).
