As a sports medicine orthopedic surgeon, one of my primary tasks with an athlete recovering from surgery or injury is to make sure the patient gets the best possible outcome. Traditionally, from the orthopedic surgeon’s viewpoint that means achieving things like full range of motion, normal strength, and joint stability.
But from the athlete’s perspective the “outcome” encompasses much more, such as successful return to sport.
One of the perplexing things about orthopedic outcomes that’s become evident as we study things more from the patient’s viewpoint is that there is a gap between what a patient can do and what we (surgeons) think they can do.
For example, after ACL reconstruction we typically quote “success” rates of about 95% when judged by knee stability, muscle strength, and range of motion. But studies focusing on return to pre-injury sport levels show a very different picture. Published studies show effective return to sport closer to the 60% range, and I’ve even seen recent presentations showing a dismal 33% return to pre-injury sport levels.
So what’s up with that? Why the difference? Why is it that injured athletes often don’t get back to the level of play that the orthopedic surgeon thinks they should? There are likely many factors, but a big one is fear of re-injury. Essentially, if you go back to the same activity that got you injured in the first place, why do it?
I often refer to this fear as “the voice in the back of your head.” It’s real, and you should listen to it, but don’t let it conquer you. A recent review article in the journal Sports Health suggests that rehabilitation professionals should incorporate psychological rehabilitation where appropriate in injury recovery. Another study in the American Journal of Sports Medicine states that the 6-month time point is a key time to measure fear of re-injury after ACL reconstruction, and can be used to identify individuals at risk for poor outcomes.
If you find yourself with a loud voice in your head that’s causing you to be fearful after injury or surgery recovery there are definitely steps you can take to improve your outcome. In working with athletes over the past 23 years of my practice there are some consistent principles that I’ve seen used by athletes to successfully overcome fear:
• Get rid of the timeline and take it as slow as your body needs. Each person responds differently to recovery, try not to compare yourself to someone else (especially avoid comparing yourself to a professional athlete …)
• Keep track of your recovery by writing it down. Some folks like spreadsheets, others write progress down in a calendar. Whatever you choose, you’ll often be surprised by how much progress you’re actually making when you see it written down.
• Golfers are famous for visualizing their shots, and there is power in using visualization to “see” the right outcome from any activity.
• If you’re stuck, get help. Discuss the situation with your doctor or physical therapist. There are times when it will be necessary to see a psychologist, who is particularly skilled in recovery techniques to address fear. Your doctor or physical therapist will likely have professionals they can refer you to for assistance.
• Fear of re-injury after a sports related injury can be a powerful influence in return to sport.
• This often causes an athlete to reduce playing levels, even though their recovery may be seen as a “success” from the doctor’s viewpoint.
• There are a number of techniques that can be used successfully to overcome fear of re-injury and allow for a higher level of return to sports activity after injury or surgery.
(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the
creator of the SidelineSportsDoc.com online injury-recognition course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared.