Developing a Sensitivity to Traumatic Sports Injury
William Sefick, Ph.D., B.C.E.T.S.
Member, The American Academy of Experts in Traumatic Stress'
Board of Scientific and Professional Advisors



One weekend during the summer you are playing a pick up game of basketball or a quick set of tennis. Suddenly you turn the wrong way and you feel something pop in a knee or tear in your ankle. A trip to the emergency room reveals that you have done some serious damage and need surgery to repair the problem and that you will be in a cast and on crutches for the next several weeks. You are annoyed over this course of events and are quite inconvenienced for the next few months. Now imagine for a moment you are not a weekend warrior but rather a top athlete perhaps of late high school or early college age and you suffer the same injury. We are no longer talking about a subtle shift in life style. The essence of who you are may be about to change. Certainly your thinking about yourself will be brought into question. Top athletes generally spend more time working at their sport than at any other activity. Even athletes as young as high school age have already invested up to 10 years playing and working at their craft. These young athletes may be forced to deal with the trauma of a serious injury that may change their view of themselves for an extended period of time.

When we talk of traumatic events we generally refer to them as emotional, cognitive and behavioral experiences of individuals who have been exposed to or who have witnessed events that are extreme or life threatening. Volpe (1997), in giving an overview of traumatic stress, views it as "an unexpected and uncontrollable event that can overwhelm an individual's sense of safety and security and leave a person feeling vulnerable and insecure in his or her environment." When an athlete experiences a season ending or possibly a career ending injury we are talking about the possible loss of self. When interviewed, athletes will often define who they are and their level of self-worth through their sport. The friends that they have and most of their support groups are, after a time, related to their sport.

In a study by Gould et al. (1997) examining season ending ski injuries, it was found that a number of factors contributed to the difficulty of the experience. The areas addressed by athletes were in the areas of psychological concerns, social concerns, physical concerns and financial concerns. Gould reports that the largest source of stress was in the areas of psychological and social concerns and that although a good physical diagnosis and rehabilitation information is necessary, it may not be enough. If we look at this issue from the view of a traumatic event - one that affects all areas of life - we can see or at least sense what the athlete is dealing with. In his article on athletic burnout, Raedeke (1997) addresses burnout from a commitment perspective. He suggests that beyond the simple stress of working too hard burnout can better be explained when athletes do not get the rewards they are used to getting from their sport. The athletes are no longer getting the rewards and successes that their hard work requires and seem to now justify being committed to "just being athletes." They begin to doubt the value of their sport, are feeling trapped and are making little gain or improvement.

One can quickly see the value of looking at a severe sports injury from a traumatic model. The young athlete, used to getting rewards in a number of areas (psychologically, socially, physically) is suddenly thrust into the position of self-doubt with long periods of time without any noticeable rewards for their efforts. The commitment changes from rewards to just work and the trauma of the injury leads the athlete on a downward path toward possible burnout. Thotis (1995), in an article examining stress from health-related difficulties, identified three major stressors: 1) major life events; 2) chronic stress; and 3) daily hassles. All of these could be related to a severe sports injury and the first two clearly are consistent with the definition of a traumatic stressor.

When a young athlete goes to a physician about a serious injury it is clear that they will need a good deal more than just being told that they will be able to resume normal daily activities in a couple of months. When they ask if everything will be OK they are asking about much more than functioning for the average person. They are asking "will I be able to resume my life?" Can they perform and compete at the level that made them special and in some cases even defined them? A recent report at the Goodwill Games underscores this issue. In 1996, Alexander Popov won two gold medals in swimming at the Olympics. Upon his return to Russia he was stabbed and severely wounded. After regaining consciousness, it was reported the first question he asked was, "will I be able to swim again?" The report suggested it was clear he was not talking about recreational swimming. The question was whether he could compete at the highest levels of his sport.

I would suggest that members of the helping professions, from physicians and nurses who will generally make the initial contact with the injured athletes to others (i.e., psychologists or social workers) consider dealing with the wide range of issues from a traumatic stress perspective. Rather than focusing on one symptom or another, it will be important to recognize that elite young athletes are, along with their physical injury, possibly experiencing traumatic stress and the variety of symptoms that go with it. Helping the young athlete to identify some of what he or she is experiencing and having a respected professional provide an empathetic response will allow the athlete to at least feel that someone understands what they are feeling.

The physical problems of an injured athlete are clearly the most obvious, but the emotional trauma experienced by an adolescent or young adult athlete may also be particularly troubling. The fear of losing all that they have worked for is quite frightening. Research suggests that even adult athletes, when they are ready to retire from their sport, often need support to deal with the myriad of changes in their life and life style.

To help a young athlete identify and understand some of what they are feeling, that these feelings are normal, and that they will not be abandoned during this period, is extremely important. The physical process of recovery is often a long one and may or may not be completely successful. Psychological issues dealt with along the way vary from athlete to athlete, but I believe that looking at the problem from a trauma model will allow all the professionals concerned to provide the emotional support and direction necessary while the physical issues are addressed. Should the young athlete need more psychological support there are obviously a host of strategies and techniques that can be presented over time but they are, at this time, beyond the scope of this article.

References

 

Gould, D., Udry, E., Bridges, D.,& Beck, L. (1997). Stress sources encountered when rehabilitating from season-ending sports injury. The Sport Psychologist, 11, 361-378.

Raedeke, T.D. (1997). Is athlete burnout more than just stress? A sport commitment perspective. Journal of Sport and Exercise Psychology, 19, 369-417.

Thotis, P.A. (1995). Stress coping and social support processes. Where are we? What next? Journal of Health and Social Behavior, (Extra Issue), 53-79.

Volpe, J.S. (1997). Traumatic stress: An overview. Trauma Response, 3, 8-9.

©1998 by The American Academy of Experts in Traumatic Stress, Inc.