The Mind of an Athlete:

A Lesson in Sports Psychology for Physical Therapists

Introduction:
It is one thing to tell an athlete what to do in regards to treating and preventing injury, however; having
them actually do what they are told is another issue entirely. In the world of physical therapy, the aspect
of the psychology of an athlete and how it affects their training, rehabilitation, and physical fitness as a
whole is often overlooked. When treating an athlete, a certain range of psychological tendencies such as
the culture of elite athletes, their motivation, and their stress are too often overlooked even while they
are important for how to give treatment. The purpose of this paper is to teach physical therapists about
how to work with an athlete for injury prevention and treatment in while keeping in mind their
psychology in order to best treat them.
Athletic Culture:
When it comes to understanding how an athlete thinks, the first thing to look at is the culture they are
immersed in. The athletic mindset is one that praises hard work and courage and emphasizes such
adages as no pain, no gain, hurt is temporary, pride is forever, and you cant make the club while
sitting in the tub. (Shuer & Dietrich). While these phrases are positive in terms of pushing yourself in
training for a sport, they also have an adverse effect upon how athletes view injuries. Athletes are in fact
taught to work through pain and discomfort in what is known as the grind. This idea can even be seen
in the professional medical community where a PhD certified psychologist expressed in an article: The
Grind is what separates successful athletes from those who don't achieve their goals (Taylor). While all
of these ideas do make good athletes who are willing to push themselves to be the best that they can
be, a secondary result of injury neglect forms. The well-meaning drive instilled in the culture causes
pain [to be] ignoredunaccepted, (Shuer & Dietrich) and injuries to be seen as weakness. An athlete
who steps out of a practice in order to manage an unusual pain is seen as a quitter or someone who is
not willing to push themselves hard enough. As a result injuries (especially chronic injuries) are often left
untreated to become much worse where they are not adequately cared for until it is too late and the
injury is more debilitating. Statistically this denial of the athletes own injuries can be seen in a study on
NCAA Division I athletes where participants with chronic injuries scored higher in avoidance tests which
is suggestive of the athletes continued difficulty with processing injuries (Shuer & Dietrich). This study
helps demonstrate how athletic culture is conducive towards athletes ignoring their injuries. As a result
physicians must know to repeatedly inquire their patients as to any injury they have no matter how
small or
unsubstantial the athlete may think it is. Also the therapist must explain the difference between pushing
through fatigue and aggravating injury to the athlete in order to counteract the grind.
Stress:
In addition to giving physical exercises to an injured athlete, a physical therapist needs to give
psychological exercises in order to manage one of the leading factors to injury: stress. Athletes routinely
undergo far more stress than the average person for a variety of reasons. Stress can stem from pressure
to win a game, to succeed, to not let down the team, their parents, their friends and fans, and
themselves, and countless more external and internal factors that raises the stress in an athlete. This

already high level of stress is compounded when an athlete is injured and they can no longer even
perform or practice what they are both expected and used to. One of the effects of this stress can be a
downhill spiral as Stress has been shown to cause increased muscle tension and coordination
difficulties which increase the athlete`s risk of injury, (Coppel, Herring, & Putukian) which further injury
then adds more stress and so on. Another risk to elevated stress from injury comes from the normal
coping skills of an athlete being taking away. For many athletes how they cope with stress is running,
working out, or doing their sport of choice, however; when an athlete is injured and unable to use their
normal coping strategies the bottom can seemingly be pulled out from them as they do not know how
to manage their stress. Additionally, not only is the sport a coping mechanism, but too many athletes is
a definition of the athlete themselves. When an athlete is injured they cannot perform that part of
themselves which adds even more stress compared to an injury for a non-athlete. Dr. Aimee Kimball
explains in the article Mind over Matter that a lot of times the sport is so important to the athletes, it
is like they are losing a significant part of themselves (Ross). Some helpful coping tools that have been
proven effect that can be given to patients are Thought stopping, slow, deep
or centered breathing, goal setting, thought replacement and imagery, progressive muscle relaxation
stress management training, positive self-talk, and biofeedback training (Coppel, Herring, & Putukian).
This way the athletes can for new coping mechanisms that they can use without having to exercise on an
injury or invoking a new one from the stress of not being able to work out.
Trust: For all patients, forming a trusting relationship between the patient and the physical therapist is
always important, but with athletes that fact becomes even more imperative. Athletes have a complex
trust system where they have a relationship with their team and themselves. As a team member, an
athlete learns how trust means knowing the other person will do their job and support you. Then at the
same time an athlete needs to trust in themselves to be able to perform at their top level. As a result the
value of trust is trust is extremely important, however; for an injured athlete that trust is fractured.
When an athlete gets hurt the thoughts that something went wrong shakes their trust in themselves,
their coaches, or even their sport that got them injured as [the injury] places an athlete in a world with
no guarantees or predictable outcomes (Shuer & Dietrich). For this reason physical therapist need to
make sure that they build trust and rapport with the injured athlete (Coppel, Herring & Putukian). This
trust ca be formed by making sure to give the athlete support and listen to what they have to say,
however; one of the most important things to do is to be honest. If an athlete is told they will be out
from injury for 4 weeks and that time is overestimated and turns out to be more, the trust with the
athlete listening to the physical therapist is shattered. Athletes want above all else to be back on the
field and place their trust in the physical therapist to get them there. As a result the athlete expects the
physical therapist to act like a teammate to build trust through doing their job well for the better of the
team, which in this case, is the athlete.
Over-Motivation:
As discussed with the culture of athletes, motivation to push through the grind can lead to injuries or
lack of treatment where they could have been avoided. This over-motivation can also be problematic in
athletes coming back off of injury too early. Athletes often have good intentions when they come off an
injury early such as trying to help their team or get back to training, however; coming off of an injury too
early can extend the time in which the athlete is unable to perform at their maximum potential and
delay their actual recovery time. A good example of an injury that is trained on too early after injury is

medial tibial stress syndrome (MTSS) or, as they are commonly known as, shin splints. MTSS is also a
good example because it effects 50% of collegiate cross country runnersover the course of a
competitive season (Dana & Smith). Research for treatment of MTSS ranges from therapeutic rubber
insoles for running shoes to low impact training, and yet; one suggestion all studies have in common is
the urge for athletes to rest. Suggesting 7 to 10 days of rest from painful activities to treat MTSS [and
that] patients should return to running gradually, (Carr & Sevetson) an athlete needs to cut down on
their training in order to recover from the chronic MTSS. This can be hard because as athletes are wired
to push themselves beyond their limits, they often have a hard time not working out. Ways to prevent
this from physical therapists is to make sure to explain to long term benefits of resting and the serious
consequences of training on an injury even if the athlete thinks it feels mild. Additionally finding
alternative ways to exercise such as water resistant and low impact pool workouts allow both the
athlete to remain training while at the same time minimalizing strain on their injuries.
Treatments:
Above all, the job of the physical therapist is to [protect] the athlete from further injury and this
sometimes means making the tough decision to tell the athlete to stop his or her activity (Peebles). An
athlete wants to continue to train and work their hardest, and yet; they also understand long term
goals. The entire basis of training is a long term goal where hard work now pays off later when the
athlete needs it to. As a result, physical therapists should present the hard work of recovery and having
to rest the injury as being just as important as the training itself. That being said, athletes usually are not
fully disabled when they are injured. While they cannot do the exact same drills as a non-injured athlete,
recovering athletes can still do a wide range of low impact and low injury active rest (Peebles) training
such as swimming, using an elliptical trainer, deep water running, and cycling or spinning (Peebles). To
help an athlete recognize that recovery does not have to equate to doing nothing can be the first step
into getting them on the right track. Above all, treating an injury is only half of the battle. When a
physical therapist ignores the psychology of the athlete and does not give them the proper direction to
focus their motivation, they are missing the other half of what makes up the recovery process.
Conclusion:
Physical therapy is by definition a physical field where body dynamics are the main elements, however;
to leave out psychology of athletes would be to take out nearly the entire human aspect of the field.
Because athletes tend to have both similar psychology among each other but a unique psyche compared
to other people physical therapists need to understand the specificities that come with working with
them. Physical therapists both need to join the culture of athletes by forming trust and helping create
coping skills for the athletes while at the same time work against the culture to remove the equivocation
of injury with weakness. A physical
therapist that is uneducated about this field would not know to look immediately at factors such as
stress and over-motivation leading to overtraining. Additionally, knowing more about an athlete can
help form a relationship in general between the patient and the therapist by showing to the patient they
are not simply a client to be treated as if everyone was the same. Instead by focusing on the specific
needs of the athlete the patient will be more accepting to treatment and trust of the therapist. In the
same way a teammate that does their job well earns the respect of the team, a therapist that knows
what they are doing earns the respect of their patient. By knowing what is going on in an athletes head,
physical therapists can better predict what an athlete will do and how to make them cooperate with a

therapy, therefore; having a better understanding of sports psychology is essential for a physical
therapist.
Bibliography:
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Injury in Athletes and the Team Physician: A Consensus Statement." The American College of Sports
Medicine (2006): 2030-034. Web. 21 Oct. 2014.
Marjorie, Shuer L., MD, and Dietrich S. Mary, PhD. "Psychological Effecs of Chronic Injury in Elite
Athletes." WJM 166.2 (1997): 104-09. Web. 21 Oct. 2014.
Newlin, Dana, and Darla S. Smith. "Shin Splints 101: Explaining Shin Splints to Young Runners." Taylor &
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(2010). Podiatry Today. Web. 6 Nov. 2014. <http://www.podiatrytoday.com/key-insights-on-returningathletes-to-sport-after-injur>
Ross, S. (2006, January 29). Mind over matter. Pittsburgh Tribune Review. Retrieved February
12, 2006, from LexisNexis database.