Sports medicine

JOHN DOHERTY: For ACL recovery, the mind matters

2013-03-18T17:24:00Z 2013-03-18T21:08:05Z JOHN DOHERTY: For ACL recovery, the mind mattersBy John Doherty Times Correspondent
March 18, 2013 5:24 pm  • 

I have long said an athlete tearing his or her ACL is much like a death in the family. Certainly not the same, but “much like" in that the athlete and his or her family experience genuine grief — with all its stages.

However, thanks to modern medicine, the injury need not be fatal to a career, like it once was.

As good as the surgery and rehabilitation have become, though, there are times when they don't work as well as wanted. And even if they do succeed, a career may not be lost but the better part of a year is.

So during that time, the mind can't help but weigh on the victim.

A case study in the January/February 2010 issue of the medical journal Sports Health focused on just that. For those wondering why Derrick Rose isn't playing yet, the article may provide some answers.

According to author Siobhan McArdle, Ph.D., “Physical and psychological trauma are not mutually exclusive but often occur together. Research has shown that some of the more common psychological responses to injury (i.e., depression, anger, anxiety) are amplified in cases of more severe injury, such as traumatic ACL injury.”

Faced with the unexpected and then prolonged interruption or end to a career, it would be surprising if there were NO psychological issues for the victim.

“Athletes who strongly identify with their athletic role have been shown to be more likely to suffer negative mood disturbances when injured as compared to athletes whose sport participation is not integral to their identity,” McArdle wrote. “Research has shown moderate to severe post-injury depression rates ranging from 5 percent to 21 percent.”

Anger regarding the injury and anxiety about the outcome of the subsequent operation take their tolls, too.

“Negative psychological response to injury,” McArdle wrote, “has been linked to to less-than-optimal adherence and rehabilitation outcomes.”

Still, more often than not, the rehabilitation process is successful. From that point, it is a matter of getting back on the field, the ice, or — as is the case with Rose — the floor. Naturally, there may be a fear of failure, but that is something that rarely afflicts the best athletes. Confidence is a part of their game.

Nonetheless, there is one final fear to overcome and there is no avoiding it because it is entirely rational: fear of re-injury. For the ACL victim, the odds of it happening again are extraordinarily high. Over the course of five years, there is roughly a six percent chance of re-injuring the knee. Worse, the odds of suffering the same injury to the other knee in that time span are twice as great.

That rational fear then has some seemingly irrational consequences.

“Fear elicits elevated levels of physiological arousal leading to increased muscle tension, fatigue, and decreased coordination, thus escalating the individual's susceptibility to injury,” McArdle wrote.

“Fear of injury may also elicit muscular guarding, which affects body symmetry, also increasing vulnerability to injury.”

In that case, the prophesy becomes self-fulfilled, an outcome neither the Bulls, nor Rose, nor their fans are in a hurry to see.

John Doherty is a certified athletic trainer and licensed physical therapist. This column reflects solely his opinion. Reach him at Follow him on Twitter @JDohertyATCPT.

Copyright 2014 All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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