1University of Primorska, Faculty of Health Sciences, Izola, Slovenia
2University of Primorska, Faculty of Education, Koper, Slovenia
3S2P, Science to Practice, Ltd., Laboratory for Motor Control and Motor Behaviour, Ljubljana, Slovenia
4University of Primorska, Andrej Marusic Institute, Izola, Slovenia
Psychological Aspect of Rehabilitation and Return to Sport Following Lower Limb Injuries
In addition to an athlete’s physical abilities, his or her mental state is also vital for optimal recovery and a successful return to sport after an injury. The purpose of the present review was to determine which psychological factors affect the success of rehabilitation and return to sport following the most frequent musculotendinous thigh injuries (hamstrings, hip adductors, knee extensors), and to present the main psychological screening tools and interventions that can aid the athlete’s rehabilitation and return to sport. A systematic review of the literature did not reveal any relevant results related to those injuries; therefore, the search was expanded to whole lower limb injuries, which showed that several different psychological factors could have a significant impact on an athlete’s rehabilitation and decision to return to sport. It can be presumed that these factors can similarly affect the post-injury process for thigh injuries, which should be considered when planning the rehabilitation programme. Systematically implementing psychological screening and psychological interventions (if needed) into the already established rehabilitation protocols would be reasonable for optimizing an athlete’s recovery and for helping with the decision to return to sport.
psychology, leg injuries, rehabilitation, return to sport
Ardern, C. L., Taylor, N. F., Feller, J. A., Whitehead, T. S., & Webster, K. E. (2013). Psychological responses matter in returning to preinjury level of sport after anterior cruciate ligament reconstruction surgery. American Journal of Sports Medicine, 41(7), 1549–1558. https://doi.org/10.1177/0363546513489284
Ardern, C. L., Webster, K. E., Taylor, N. F., & Feller, J. A. (2011). Return to sport following anterior cruciate ligament reconstruction surgery: A systematic review and meta-analysis of the state of play. British Journal of Sports Medicine, 45(7), 596–606. https://doi.org/10.1136/bjsm.2010.076364
Baez, S. E., Hoch, M. C., & Hoch, J. M. (2019). Psychological factors are associated with return to pre-injury levels of sport and physical activity after ACL reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. (2019). https://doi.org/10.1007/s00167-019-05696-9
Beijsterveldt, A. M. C. Van, Port, I. G. L. Van De, Vereijken, A. J., & Backx, F. J. G. (2012). Risk Factors for Hamstring Injuries in Male Soccer Players: 1–10. https://doi.org/10.1111/j.1600-0838.2012.01487.
Booth-Kewley, S., Schmied, E. A., Highfill-McRoy, R. M., Sander, T. C., Blivin, S. J., & Garland, C. F. (2014). A prospective study of factors affecting recovery from musculoskeletal injuries. Journal of Occupational Rehabilitation, 24(2), 287–296. https://doi.org/10.1007/s10926-013-9456-7
Briet, J. P., Houwert, R. M., Hageman, M. G. J. S., Hietbrink, F., Ring, D. C., & Verleisdonk, E. J. J. M. (2016). Factors associated with pain intensity and physical limitations after lateral ankle sprains. Injury, 47(11), 2565–2569. https://doi.org/10.1016/j.injury.2016.09.016
Brooks, J. H. M., Fuller, C. W., Kemp, S. P. T., & Reddin, D. B. (2005). Epidemiology of injuries in English professional rugby union: Part 1 match injuries. British Journal of Sports Medicine, 39(10), 757–766. https://doi.org/10.1136/bjsm.2005.018135
Burland, J. P., Toonstra, J., Werner, J. L., Mattacola, C. G., Howell, D. M., & Howard, J. S. (2018). Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction, Part I: A Qualitative Investigation of Psychosocial Factors. Journal of Athletic Training, 53(2), 1062-6050-313–316. https://doi.org/10.4085/1062-6050-313-16
Cupal, D. D., & Brewer, B. W. (2001). Effects of relaxation and guided imagery on knee strength, re-injury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabilitation Psychology, 46(1), 28–43. https://doi.org/10.1037/0090-55184.108.40.206
DiSanti, J., Lisee, C., Erickson, K., Bell, D., Shingles, M., & Kuenze, C. (2018). Perception of rehabilitation and return to sport among high school athletes with anterior cruciate ligament reconstruction: qualitative research study. Journal of Orthopaedic & Sports Physical Therapy, 48(12), 951–959. https://doi.org/10.1017/CBO9781107415324.004
Ekstrand, J., Hägglund, M., & Waldén, M. (2011). Epidemiology of muscle injuries in professional football (soccer). American Journal of Sports Medicine, 39(6), 1226–1232. https://doi.org/10.1177/0363546510395879
Everhart, J. S., Best, T. M., & Flanigan, D. C. (2015). Psychological predictors of anterior cruciate ligament reconstruction outcomes: a systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 23(3), 752–762. https://doi.org/10.1007/s00167-013-2699-1
Feeley, B. T., Kennelly, S., Barnes, R. P., Muller, M. S., Kelly, B. T., Rodeo, S. A., & Warren, R. F. (2008). Epidemiology of National Football League training camp injuries from 1998 to 2007. The American Journal of Sports Medicine, 36(8), 1597–1603. https://doi.org/10.1177/0363546508316021
Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce re-injury risk by 84% after ACL reconstruction: The Delaware-Oslo ACL cohort study. British Journal of Sports Medicine, 50(13), 804–808. https://doi.org/10.1136/bjsports-2016-096031
Harput, G., Ulusoy, B., Ozer, H., Baltaci, G., & Richards, J. (2016). External supports improve knee performance in anterior cruciate ligament reconstructed individuals with higher kinesiophobia levels. Knee, 23(5), 807–812. https://doi.org/10.1016/j.knee.2016.05.008
Houston, M., Hoch, J., & Hoch, M. (2017). Collegiate athletes with ankle sprain history exhibit increased fear-avoidance beliefs. Journal of sport rehabilitation, 27(5), 419-423.
Houston, M. N., Van Lunen, B. L., & Hoch, M. C. (2014). Health-related quality of life in individuals with chronic ankle instability. Journal of Athletic Training, 49(6), 758–763. https://doi.org/10.4085/1062-6050-49.3.54
Hsu, C. J., Meierbachtol, A., George, S. Z., & Chmielewski, T. L. (2017). Fear of re-injury in athletes: implications for rehabilitation. Sports health, 9(2), 162-167.
Kosy, J., Phillips, J., Edordu, A., Pankhania, R., Schranz, P., & Mandalia, V. (2019). Failure to return to preinjury activity level after hamstring anterior cruciate ligament reconstruction: Factors involved and considerations in goal setting. Indian Journal of Orthopaedics, 53(6), 714–720. https://doi.org/10.4103/ortho.IJOrtho_186_18
Kvist, J., Ek, A., Sporrstedt, K., & Good, L. (2005). Fear of re-injury: A hindrance for returning to sports after anterior cruciate ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy, 13(5), 393–397. https://doi.org/10.1007/s00167-004-0591-8
Lentz, T. A., Zeppieri, G., George, S. Z., Tillman, S. M., Moser, M. W., Farmer, K. W., & Chmielewski, T. L. (2015). Comparison of physical impairment, functional, and psychosocial measures based on fear of re-injury/lack of confidence and return-to-sport status after ACL reconstruction. American Journal of Sports Medicine, 43(2), 345–353. https://doi.org/10.1177/0363546514559707
Maddison, R., Prapavessis, H., & Clatworthy, M. (2006). Modeling and rehabilitation following anterior cruciate ligament reconstruction. Annals of Behavioral Medicine, (17).
Masten, R., Tušak, M., Stražar, K., Zupanc, O., Drobnič, M., Marinšek, M., & Kandare, M. (2014). Psychological Factors of Rehabilitation of Athletes After Knee Injury. Slovenian Journal of Public Health, 53(3), 226–236.
Miller, R., Kori, S., & Todd, D. (1991). The Tampa Scale for Kinesiophobia. The Clinical Journal of Pain, 7(1), 51.
Mosler, A. B., Weir, A., Serner, A., Agricola, R., Eirale, C., Farooq, A., … Crossley, K. M. (2018). Musculoskeletal Screening Tests and Bony Hip Morphology Cannot Identify Male Professional Soccer Players at Risk of Groin Injuries A 2-Year Prospective Cohort Study. The American journal of sports medicine, 46(6), 1294-1305.
Orchard, J., Seward, H., & Orchard, J. (2013). Results of 2 decades of injury surveillance and public release of data in the Australian Football League. American Journal of Sports Medicine, 41(4), 734–741. https://doi.org/10.1177/0363546513476270
Sonesson, S., Kvist, J., Ardern, C., Österberg, A., & Silbernagel, K. G. (2017). Psychological factors are important to return to pre-injury sport activity after anterior cruciate ligament reconstruction: expect and motivate to satisfy. Knee Surgery, Sports Traumatology, Arthroscopy, 25(5), 1375–1384. https://doi.org/10.1007/s00167-016-4294-8
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The Pain Catastrophizing Scale: Development and validation. Psychological Assessment,> 7(4), 524–532. https://doi.org/10.1037/1040-35220.127.116.114
Te Wierike, S. C. M., Van Der Sluis, A., Van Den Akker-Scheek, I., Elferink-Gemser, M. T., & Visscher, C. (2013). Psychosocial factors influencing the recovery of athletes with anterior cruciate ligament injury: A systematic review. Scandinavian Journal of Medicine and Science in Sports, 23(5), 527–540. https://doi.org/10.1111/sms.12010
Thomeé, P., Währborg, P., Börjesson, M., Thomeé, R., Eriksson, B. I., & Karlsson, J. (2006). A new instrument for measuring self-efficacy in patients with an anterior cruciate ligament injury. Scandinavian Journal of Medicine and Science in Sports, 16(3), 181–187. https://doi.org/10.1111/j.1600-0838.2005.00472.x
Vranceanu, A. M., Bachoura, A., Weening, A., Vrahas, M., Smith, R. M., & Ring, D. (2014). Psychological factors predict disability and pain intensity after skeletal trauma. Journal of Bone and Joint Surgery - Series A, 96(3), 1–6. https://doi.org/10.2106/JBJS.L.00479
Webster, K. E., McPherson, A. L., Hewett, T. E., & Feller, J. A. (2019). Factors Associated With a Return to Preinjury Level of Sport Performance After Anterior Cruciate Ligament Reconstruction Surgery. American Journal of Sports Medicine, 47(11), 2557–2562. https://doi.org/10.1177/0363546519865537
Werner, J. L., Burland, J. P., Mattacola, C. G., Toonstra, J., English, R. A., & Howard, J. S. (2018). Decision to Return to Sport Participation After Anterior Cruciate Ligament Reconstruction, Part II: Self-Reported and Functional Performance Outcomes. Journal of Athletic Training, 53(5), 464–474. https://doi.org/10.4085/1062-6050-328-16
Wiese-bjornstal, D. M., Smith, A. M., Shaffer, S. M., & Morrey, M. A. (1998). An integrated model of response to sport injury: Psychological and sociological dynamics. Journal of Applied Sport Psychology, 10(1), 46–69. https://doi.org/10.1080/10413209808406377