The psychology of injury rehab: How to help patients through the process

Injuries don’t discriminate. All athletes – from kids to weekend warriors and elite professionals – can sustain the same injuries.

Successfully rehabilitating those injuries requires an effective partnership between the athlete and a team of professionals that may include doctors, physical therapists, performance coaches, and sport-specific coaches.

But it’s not just the practitioners that impact the success of rehabilitation. There’s the less-talked-about factor of patient mentality. Not surprisingly, rehab can be as much of a mental challenge as a physical one given the lengthy timetable, feelings of isolation, and concern that the process will not yield the desired results.

“Rehabbing is like a roller coaster with a lot of ups and downs,” says Cruz Romero, a performance physical therapist at EXOS. “Everyone involved has to trust the process and make sure we’re trending in the right direction.” Here are four ways to address what can be called the psychology of rehab.

1. Establish trust.

Athletes who sustain injuries that require surgery sometimes face yearlong rehabilitation programs. With such a long timetable for recovery, emotions are high and measuring progress on a daily or weekly basis can become frustrating. That’s why it’s important for therapists and coaches to first establish trust. “Compassion and communication are the keys,” says Brenton Hardy, a performance specialist at EXOS. “As coaches, we have to understand the phase they’re in — not just in the hour we see them but throughout the rest of their day,” he explains. “People aren't the same when they’re in pain because it rewires the brain. They need to be reassured that the process is working, and they aren't alone.”

2. Celebrate the small stuff.

Physical rehabilitation is about slow, steady progress toward the end goal. That’s why it’s important to celebrate small improvements such as a 10 percent improvement in strength or range of motion or completing an exercise without pain or injury-related symptoms. “These little wins each day mean a lot,” Romero says. “At the end of each session, I make sure to recap what we did and highlight improvements. Some days will be better than others, but you want to see that constant incremental progression.”

3. Set realistic goals.

Athletes’ competitive nature often drives them to rehab as hard as possible to return faster. And for elite athletes, there may be media coverage of the timetable for return, making them even more impatient. “If an athlete is progressing well, I won’t hold them back,” Romero says. “But if I see signs that they’re not ready, I’m going to say so. When I notice an athlete is feeling the pressure to beat the general timeline, I find that explaining what each activity is going to accomplish keeps people motivated.” To combat the pressure, Romero suggests athletes set SMART goals. Specific, measurable, agreed upon, realistic, and time-based goals help remind athletes of their goal — avoiding setbacks and coming back stronger than before.

4. Help clients embrace their athletic identity.

Athletes of all skill levels have a strong sense of identity that’s lost or diminished during a lengthy rehab. Some team sport athletes feel uncomfortable around teammates while injured and prefer to rehab elsewhere. Others find attending practices and games keeps them in the loop. The key to a successful rehabilitation is helping athletes keep that identity intact, and that means working with what they’ve got. Because injuries often prevent athletes from moving like they’re used to, it helps to think outside the box. Romero works balls into rehab movements during core or balance exercises. This not only adds fun and a degree of difficulty to the exercise, it helps athletes move like themselves. “An athlete’s greatest comebacks often come from setbacks,” Hardy said. “That perseverance is key, even if it’s a career-ending injury. As coaches, our job is to help them develop resilience through the rehab process and help them transition into everyday life.”

About the Author

Pete Williams

Florida-based writer Pete Williams is a longtime editorial contributor to EXOS.

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