VIEWS ON POST-INJURY

RECOVERY PROCEDURES
By Dr. Kuulo Kutsar

The author, who is the Medical Director of the Physical Education Department of
the Pedagogical Institute of Tallinn, Estonian SSR, discusses physiological and
psychological methods used in the post-injury recovery period and stresses the
value of mental rehearsal techniques, based on exact mental perceptions of the
performances, to speed up rehabilitation. Re-printed with permission from
Modern Athlete and Coach.

Athletes involved in frequent injuries are often suffering from fear that can
impede the technical aspects of their performances. This situation can occur in
every event but is most common in the pole vault, the high jump, the hurdles and
the throws. The results of sporting injuries, that the athletes complain about, are
often psychological by nature. Fear from chronic injuries, apparent pain and a
deteriorated general psychological condition (nervousness, easily upset)
consequently create insecurity and uncertainty.

THE PHYSIOLOGICAL SIDE

Athletes, as the result of continuous training, develop a fixed movement

stereotype on which the established optimal technique of an event has been
based. Immediately after an injury an athlete could sometimes be completely
immobilized. Even during the recovery period it is common to observe how
athletes subconsciously protect the injured limb and therefore prolong the period
of inactivity. This, in turn, is responsible for a mental deformation of the
previously established movement stereotype. It can be said that the athlete
simpl yhas“ f
orgot ten”t het echnique.

In an effort to spare the injured limb, athletes sometimes fail to pay adequate
attention to it and could feel imaginary pain wher eitactuallydoesn’ texi
st.This
can develop into a negative motor condition where the limb required for a certain
function fails to respond to the command from the nervous system. In contrast to
a healthy limb, that reacts to a demonstrated or even imaginary movement order,
there is no preparedness for the action created in the injured limb.

It is not sufficient to depend on the perception of muscles in performing

movements during the recovery from a trauma after medical advice has been
received to begin to exercise the injured limb. Depending on muscular perception
only can develop serious co-ordination disturbances. To avoid this the athlete
must perform visually controlled purposeful and spatial movements.
A good example of this is to participate in games where an athlete is involuntarily
forced to react on the travel of a ball. This allows the athlete to forget the often
only apparent injury pain when making the required movements. Doctors
occasionally recommend such ball exercises even when a limb is still
immobilized.

The functions of an injured limb are restored step by step. Active movements can
in the beginning be performed only as part movements that are supported by the
healthy sections of the limb. This is followed by a period during which the injured
limb has acquired sufficient mobility for the athlete to presume that increasingly
larger loads can be tolerated. This period requires extra care to prevent a
reoccurrence of the injury.

The athlete and the coach must therefore be aware that it is the movement co-
ordination that is first restored after a trauma. Muscular strength is next, followed
finally by the restoration of full mobility. To start this sequence, co-ordination
responds best to a large number of repetitions of the same exercise, performed
in frequent small volumes.

THE PSYCHOLOGICAL SIDE

The injured athlete, after movement coordination, strength and mobility have
been rehabilitated, has to make psychological adjustments in order to restore his
technical skills. It is necessary to overcome the problems meanwhile created by
the deterioration of the pre-trauma technical images, responsible for performance
hindering uncertainty. A psychologist, in addition to a doctor and physiotherapist,
can here be most helpful.

The psychological rehabilitation can take place by using ideo-motor or

hypnotherapy methods. The first of the two is usually preferable because it can
be successfully performed, after initial guidance, by an athlete without
supervision.

Let us look at the use of the ideo-motor training in the psychological rehabilitation
of a high jumper as a typical example. The athlete has suffered back and head
injuries as the result of a poor landing. After the physical recovery the athlete still
has problems with the performance of full effort jumps. He is simply frightened of
the bar prior to the take-off.

The ideo-motor training in this case begins with relaxation techniques and the
development of positive self-confidence by imagery. In the last it is advisable that
the psychologist, assisted by the coach, compiles a verbal set of instructions of
how the jump should be correctly performed. Most important technique elements
are emphasized. The instructions are then read out to the athlete at the same
speed and rhythm as the actions take place in the performance of the actual
jump.
The imaginary performance in t heat hl
et e’smi ndmustnotf orestallorbebehind
the structure of the movement tempo in the real jump. In order that the athlete
handles the imaginary jumps similarly to the real jumps it is advisable to begin
the training by deciding how many imaginary jumps the athlete will visualize in a
session. In order to prevent fatigue sufficient recoveries for relaxation are
allocated between the imaginary jumps.

It is important for an athlete to master the complete relaxation and self-affirmation

techniques before ideo-motor training without supervision can be attempted.
Keeping in mind that complete relaxation is an important prerequisite for the
development of self-affirmation, the athlete begins by memorizing the verbal
instructions used by the psychologist to guide the performance of a correct jump.
Thei maginaryj umpsar enow pr acti
cedment al
l
y ,guidedbyt heathlete’sownl ow
voice instructions. Finally the complete mental rehearsal of the jump is
introduced.

The mental rehearsal of the jump must in the ideo-motor training be performed
as the whole, emphasizing the beginning as well as the end. After this skill has
been acquired it is advisable to introduce gradually the mental rehearsal factors
that have a distracting influence on the performance in training and competitions.
Such factors include noise, the behavior of spectators and the presence of other
athletes.

It is a known fact that an athlete is unable to accomplish well something that he

can’ tclear
lyimagi neandf ull
yper ceive.Anex actment alper ception, on the other
hand, allows executing correctly even technically complicated movement
elements already in the first attempt. It must be kept in mind here that a repetitive
performance of technically incorrect movements, even in mental rehearsal, can
leave a fixed negative imprint that will be rather difficult to correct later.

To avoid this problem athletes should during the post-injury period attempt to
perform every movement correctly right from the start. Athletes, who first of all
consciously examine mentally all the instructions given by the coach until they
fully comprehend what they have to do and how to do it, are therefore likely to
succeed.

Hypnosis can be employed during the post-injury recovery, as well as during

normal training, when it is possible to use over a longer time period the help of a
psychologist or hypnotherapist. The use of hypnosis must in each case be
decided by the hypnotherapist, who, above all, has to take into consideration the
t
ypeoft heat hlete’
sner v oussy stem and,i nparticular, the balance between
mental arousal and negative emotional processes.

The duration of hypnotherapy sessions is about 30 minutes every day during a

desired period. The athlete can in the hypnotic state receive a variety of
suggestions, including, for example:
  How to execute certain technical elements of the performance.

 How to relax completely certain muscle groups.

 What is the desired rate and tempo of certain movements.

 How to correct technical faults and shortcomings.

In addition, it is also possible to use hypnotherapy to make changes to the

already established stereotypes. As the short and long term memory of an
athlete is improved by hypnotherapy, this method is in certain circumstances
even more efficient than ideomotor training.