This approach represents a physician's clinical perspective on the psychology of injury rehabilitation. The opportunities I have had to observe numerous world-class and dedicated recreational athletes have reinforced my appreciation for the role of psycholo gical factors in active rehabilitation. In some cases, patients intuitively apply the principles mentioned here. This ability to structure their rehabilitation effectively is probably a reflection of the way in which they achieved their preinjury success.
In treating many athletes, I have observed quite a number who have returned to their sports at higher levels than they had achieved at the time of injury. This can be partially explained by the possibility that they were in an ascending curve of performance at the time of the accident, but this cannot be the entire explanation. Nor can good surgery and rehabilitation account for such successful recoveries. A multifaceted approach to rehabilitation provides a learning opportunity and helps create the psychological momentum that accompanies the athlete beyond rehabilitation and back to competition.
The psychological rehabilitation program is summarized in Box 7-1. Although this program seems simple, it requires careful judgment calls by the rehabilitation team at each treatment stage. This approach to treatment is based on over 25 years of clinical experience with most of the major world-class competitive sports as well as work with many recreational athletes. The careful use of standardized treatment methods along with personal attention to the athlete's needs during his or her different rehabilitation stages have proven effective. Our treatment team has contributed to some outstanding postinjury success stories. The return of several of our patients to top world-class performance levels after career threatening accidents is eloquent testimony to the validity of this approach as well as to the intensity of the athletes' motivation.
Box 7-1 Rehabilitation Program Summary
The patient's psychological rehabilitation includes the following steps:
1. Complete understanding of the injury, the treatment, and the stages of treatment. This allows the patient to feel like a real part of the team guiding the recovery process.
2. Establishment of attainable goals at each stage in rehabilitation. These are realistic but demanding goals that provide an immediate focus but do not look too far ahead.
3. Prompt initiation of an aerobic program to help avoid the depression associated with the immediate postinjury period. In addition, the aerobic program counters other stress-related psychological changes that occur due to the abrupt transition from intense physical activity to no activity at all.
4. Psychological counseling, when necessary, to help the patient deal with his or her altered status as an athlete, especially during extended periods of inactivity.
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