Performance, Pain & Fear

Is Dealing with Fear, After an Injury, Important?
by: Dr. Raymond J. Petras
Elite Sports Performance & Injury Mgmt Specialist
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Most athletes experience some pain, whether it is physical or psychological, during a season. Sports medicine has focused on helping the body heal and getting many athletes get back onto the playing field quickly, after a physical injury. But are we overlooking some need? Is fear a factor in the speed and completeness of recovery?

Critical Emotion, Neglected?
In last month’s article: Injury: A Mind/Body & Spirit Relationship? I reported how two fullbacks and a middle linebacker returned to play, more quickly than expected, using only mental techniques.

The fullback, diagnosed with a partial right shoulder a/c separation, was scheduled to start the game on Saturday. The prognosis was that he could play, but that it was his call based on his pain and range of motion. The game plan was for him to block off his right, injured shoulder. Because of his pain and limited range of motion, he had not practiced all week and was not planning to play Saturday. However, after working with a “mental” coach on Friday evening, his pain was gone and his range of motion returned to 100 per cent.

When the “mental” coach saw him Saturday morning, he was still pain free, at full strength and full range of motion. That morning, the team physician and trainer had again given him the go ahead to play. He wanted too, but he was concerned that by playing he might injure himself again or cause greater damage.

The Facts
“Our (the team’s) ‘mental’ coach,” the fullback said, “sat me down and we went over the facts:”

1. I had no pain.
2. I had full range of motion.
3. I had full strength.
4. And I had been checked by the trainer and team physician and had been given the go ahead to play, if I wished.

“Although reviewing the facts helped some,” the fullback said, “I was still fearful of further injury.” So, the “mental” coach had him vocalize his fears and concerns completely. Afterwards, the “mental” coach had him practice some relaxation and focusing techniques that he had taught the entire team during two-a-day practice sessions.

Results
After the athlete voiced his concerns completely and practiced the relaxation and focusing techniques, the “mental” coach noted that, “the athlete was visibly calmer and spoke more confidently.” The athlete said that he felt “good to go.” He checked one final time with the trainer and team physician released him to play.

Early in the game, he caught a pass over his previously injured shoulder, ran for a touchdown, and, as he crossed the goal line, was clipped causing him to land on his right shoulder. He immediately arose to his feet, thrust up his arms, indicating touchdown. He played the entire game, blocking off his right shoulder. The team doctors and trainer observed him for the season. He said that he never experienced any further pain or discomfort.

Healing the Body is Important; But Dealing with Fear is Critical?
One of the most neglected emotions that accompany pain and injury is fear. It appears, at times, to be more important than the healing of the actual physical injury. Once injured, depending on the injury, the athlete begins focusing on worst-case scenarios. Fear can cause an injury to drag on, dramatically decreasing per¬formance and increasing the risk of further re-injury.

You learn how important fear is when you see debilitating pain from injuries go to practically zero by dealing with fear alone. The injury still has to heal, but the athlete need not suffer debilitating pain while it heals. From this experience, the athlete generally learns how important dealing with, not ignoring, emotions are. In most cases, the athlete can be taught how to deal with fear and negative emotions in a session or two.

Place-Kicker: Neck Spasms
Another example is about a place-kicker ranked fifth in the nation. He was diagnosed with neck muscle spasms the Wednesday before a game. Since the spasms started, he followed standard training procedures to relieve the spasms, but there was no improvement. He indicated that he was in a great deal of pain, and that he had lost 60-70 percent of the range of motion in his neck. He did not kick in Friday's practice because of the pain. He indicated that he was very concerned that the spasms would prevent him from playing in Saturday's game. But even more so, he was concerned that it would “wreck his form,” and that he would not be able to perform for the rest of the year. He confided that it was his hope to eventually kick in the NFL.

Since the standard training procedures were not helping, he asked his coach for suggestions. His coach referred him to the team’s “mental” trainer. He said that the problem was not in his head. The coach agreed and added that the “mental” trainer had worked with some of the other players for their physical pain and gave examples. The kicker was now excited to see the “mental” coach.

Dealing with the Condition(s)
During he first meeting with the “mental” coach, the place-kicker related his condition and concerns. The “mental” coach confirmed his condition and concerns then discussed and reviewed some relaxation and visualization techniques that he had taught to the team. The kicker said that he was familiar with the techniques and practiced them regularly. The kicker and “mental” coach spent about 20 minutes after practice on Friday utilizing these relaxation and visualization techniques to reduce his pain. After the session, the kicker said that he felt the pain had been reduced approximately 50 percent, and his mobility had improved 50 percent. It was agreed that he would practice these techniques that evening and that they would get together before the game to see if anything else needed to be done.

After breakfast on Saturday, the kicker indicated that, although the pain and range of neck movement was greatly improved, he was still concerned about the remaining pain, his reduced range of motion and how he would perform. So, an hour and a half before the game, the “mental” trainer again took the kicker through the relaxation and visualiza¬tion techniques, but this time he focused specifically on his fear. After approxi¬mately 15 minutes, his pain was 99 percent gone and range of motion in his neck was “nearly normal.”

Results
After the game, the kicker reported that it was only after he had kicked 10 field goals in warm-ups that he realized that his pain was completely gone and he had full range of motion in his neck thanks to dealing with his fear.

He was on the field for all kick offs and went three-for-three kicking a field goal and two extra points.

Not Isolated Cases
These are not isolated cases. Many athletes have improved their performance, reduced their pain and improved their range of motion safely when they dealt with their fear. Most athletes, at some time, are fearful and most would benefit by acknowledging and dealing with their fears.

Keeping it Confidential
Athletes will generally tell their “mental” coach things that they will not tell their coaches, especially, about fear. The athletes feel that if they tell their coach that they are afraid, that the coach will berate them and maybe not play them. So, they keep this critical emotion from being acknowledged and addressed.

So, if an athlete is not progressing or performing as they should, check on how they feel or what they fear. You might consider having them talk to a sport psychologist or “mental” coach. You can usually find one locally through the local college psychology department or online. Extreme emotional conditions may require extensive psychotherapy from a licensed therapist or psychologist.

It is important in working with a “mental” coach that the athlete and coaches know one of the most important ground rules. It is: “What the athlete tells the ‘mental’ coach is confidential and will not be relayed to the coaches except in dangerous or life-threatening situations.”

Mental Trainer – Getting a Good One
It takes effort, to be good at anything. This also applies to finding a good “mental” coach. Some questions you may want to have answered before hiring or utilizing their talents:

1. What experience do they have? Are they professionals or students?

2. Do they have experience in your sport? They do not necessarily have to have experience in your sport, if they have the fundamentals for working with the mental training for performance enhancement.

3. Are they research based or do they have practical skills?

4. After you tell them what you are looking for, ask for a plan to accomplish those goals.

5. Are they a good fit for you and the team?

6. Do they have the skills to work with the team as a group or are they good working one-on-one. Can they do both?

7. What is their time commitment to you?

8. What are their fees, if any?

9. “Mental” coaching for injuries is very specialized and not many “mental” coaches are qualified or have experience in this area. The ones who do usually deal with the mental (psychological) changes that occur from injury and not the use of mental techniques to heal the injury more quickly.

Enhancing Performance
Finally, acknowledging and dealing with fear not only reduces pain quickly and sometimes permanently, it can quickly eliminate slumps, increase focus, improve alertness and concentration.

Question or Idea for an Article
Have an idea for an article or you would like more information on a particular subject. Send your request to: drpetras@reliefforyou.com

Next Month’s Article
Mental Techniques to Speed Injury Recovery. Although these techniques will never replace your trainer or team physician, they can safely help speed your player’s recovery.

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Dr. Raymond J. Petras is an elite sports performance & injury management specialist, international lecturer, author, professor, researcher and world cup team doctor. His work encompasses most sports from young amateur athletes, Olympic and professional, as well as the business and the medical communities. He is available for individual or team consultation and may be reached at 1.888.447.1429.
Email: drpetras@reliefforyou.com
More information is available on his website www.reliefforyou.

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