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KGB Vol 9: Fear & Concern; Two very different emotions on the way back from an injury

“Rub some dirt on it.” 

This seems to be one of the all-time great sports cliches. The phrase really is just  a metaphor for the fact that toughness is a part of all sports whether it be mental, physical or both. 

There is, however, a legitimate performance concern when fear creeps into the mind of an athlete. “Fear Avoidance Behavior” is the official term applied to this concept and it is in no way new. 

Who usually sees and recognizes this phenomenon in an athlete? Most of the time, it is not the doctors or therapists on the support staff. It is something that will likely be noted by the coaching staff and, on rare occasion, by the players themselves. 

In the general population, this type of fear is not uncommon. A person who has dealt with pain for a long time will naturally develop an avoidance of that pain. But, in sport, avoiding pain can mean avoiding certain aspects of the game, possibly critical performance aspects. For instance, in the game of hockey, a player who has suffered from a major shoulder injury may find that they naturally avoid physical contact when possible.

As I treat clients in the rehabilitation process, I like to convince my athletes that fear and concern are two very different things. Concern leads to discovery; fear leads to avoidance. To be concerned is natural; to be fearful is unnatural and becomes life-altering. 

I have long believed that the final stage of return-to-play is the athlete’s perception of the ability to compete. This phase is last and is always tempered and informed by previous milestones. Using this approach has helped me avoid the temptation to reactivate an overzealous athlete but, more importantly, has helped me communicate to an athlete that it is okay to work the stages of recovery and be patient enough for the body to come along for the ride. 

All athletes must trust their bodies to perform; if they lose that connection, it can be difficult to reestablish. Something as simple as working the “well” limb can be a powerful reminder to the athlete that they still have amazing physical capabilities and gives them something with which to compare the injured/recovering limb.

When an athlete starts to get paid for their services or is on scholarship, these stresses can go either way. The atmosphere may be safe and allow for maximal mental and physical recovery, or the environment can be an added stress and hinder the recovery process. Communication is the key! 

As the bench boss, most of the time you control the identity of the team and establish the environment in which that identity is fostered. How you bring a player back into the fold can drive fear up or down and, to my knowledge, there is no absolute right way. We have, however, identified plenty of wrong ways. (And, yes, this sounds a lot like parenting!)

To establish a fear-free environment, avoid:

  • Threatening conversations that discuss timetables for return
  • A heightened focus on symptomsand ,
  • Alienating the player from the team

Try, as much as possible, to include:

  • Positive sport-related interactions
  • Continued high-quality connections to the team, and
  • Use of reassuring language that still encourages accountability

If you suspect you are working with an athlete who is developing some fear avoidance behaviors, try consulting with their rehab provider and potentially a sport psychologist. If you personally have some experience in overcoming injury, it may be a great time to relate to your player and have a very human conversation. 

You know your culture and have a good idea what motivates your player. This final stage of the return-to-play dynamic is one in which the coaching staff can have a huge impact on the quality of this crucial last step.

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