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Psychosocial Aspects of Injury Rehabilitation in Division I Athletes

by Shanon Fronek

Working as the Resident Sports Physical Therapist at Saint Francis University has exposed me to a variety of challenges unique to managing Division I athletes. Of the multitude of factors influencing outcomes following injury, an athletes psychological responses can have a significant impact on the quality and speed of recovery. Developing a greater understanding for the psychosocial aspects of injury rehabilitation has been one of the most profound components of the recovery process that I have come to appreciate while in the sports residency program.

Learning from experience

For the majority of my life I have been fortunate to participate in competitive and recreational sports. Moreover, I had some fantastic coaches that were extremely influential in multiple facets of my life, including becoming a coach for young athletes. It is without a doubt that those past experiences played a major role in creating my passion for working with an athletic patient population and pursuing specialization in sports physical therapy. But even more valuable than those experiences shaping the path I have taken in life are the lessons I have learned along the way. Physical therapy school taught me knowledge. Coaching taught me how to relay information to my athletes/patients and that failure ensues when you are unable to relay the knowledge.

Empathy for the athlete

Early on in the residency I recall days when I would get so frustrated with some of the athletes. Why? Because I didn’t know my “team” yet. Once I started to understand my patient population, I realized the majority of reasons for non-compliance, poor effort/performance, and other behavioral issues stemmed from psychosocial factors. Some of these factors include college adjustment, athletic subculture, and athletic identity.

According to Melendez (2009), freshmen are particularly vulnerable to factors influencing their ability to meet the multifaceted demands of college. Identity development, socio-cultural factors, and social support all play a key role in this adjustment process. Additionally, the complexity of adjusting to college may be magnified for student-athletes due to the competing roles and time demands placed upon them by their academic and sport responsibilities. The subcultures that envelope student-athletes can be influenced by social experiences with peers, coaches, teachers, administrators, and teammates (Melendez, 2009). Finally, athlete identity is defined as the degree to which an individual identifies with the athlete role and is presumed to be a function of cognitive, affective, behavioral, and social factors (Murphy, Petitpas & Brewer, 1996). According to Brewer (1999), high levels of athletic identity have been reported in the literature to have both positive and negative consequences for athletes, thus potentially adding to the complexities of college adjustment.

Challenges for athletes

Unfortunately, rarely outside of professional sports do athletes have access to a range of allied health professionals, including a sport psychologist. This highlights the need for sports medicine professionals to develop competencies in the psychosocial aspects of injury rehabilitation. Books such as Applied Sport Psychology: Personal Growth to Peak Performance (Krane & Williams, 2014), The Psychology of Sport Injury and Rehabilitation (Arvinen-Barrow & Walker, 2013), and Psychological Approaches to Sports Injury Rehabilitation (Taylor & Taylor, 1997) are good sources of information for practitioners wishing to expand their understanding of injury and rehabilitation.

Working with college-aged athletes has reinforced my understanding of the importance of “knowing your athlete.” It has also pushed me to reach beyond my personality norms in order to strengthen the athlete-physical therapist relationship and provide advanced patient care. The level of this relationship is conducive to the athlete opening up about other psychosocial issues that may be impeding the recovery process. This ultimately allows for the implementation of counseling and psychological techniques. Moreover, this information enables the physical therapist to make appropriate adjustments in how to relay information, set goals, and employ motivational strategies. Lastly, sports medicine professionals must be aware of the boundaries of providing psychological assistance to athletes and identify when abnormal behavior warrants referral to a more qualified medical professional.

Brewer, B. W. (1999). Athletic identity revisited: A five-year update, Unpublished manuscript, Springfield College, Springfield, Massachusetts.

Melendez, M. C. (2010). Psychosocial influences on college adjustment in division I student-athletes: The role of athletic identity. Journal of College Student Retention, 11(3), 345-361.

Murphy, G. M., Petitpas, A. J., & Brewer, B. W. (1993). Identity foreclosure, athletic identity, and career maturity in intercollegiate athletics. The Sport Psychologist, 10, 239-246.


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