Returning to Sport after injury – The Mind Matters – by Clare Ardern

Today we have a first for RunningPhysio – our first guest blog by a published researcher! Clare Ardern has very kindly agreed to share her thoughts on psychological factors in returning to sport after injury. Clare completed a systematic review on this topic which we discussed in our previous piece on return to sport. You can follow Clare on Twitter via @Clare_Ardern. To find out more about her research on this and other topics please see her ResearchGate Profile.


My day job involves trying to understand the factors that influence whether athletes return to sport after injury. For many years, the primary focus of sports medicine research has been on finding out how well athletes physically recover from injury. The psychological aspect of recovery and returning to sport has always been acknowledged as being important, but curiously has not garnered the same research focus as physical recovery. Earlier this year, my colleagues at La Trobe University and I published a review of the psychological factors associated with returning to sport after an athletic injury. The main findings of our review were that for athletes who had a more positive psychological response to injury and during recovery, there was a greater chance of returning to their previous level of sport. These athletes also made a faster return to sport.

There were some interesting questions that arose from our review, like: “Are there differences between men and women?” and “Do people of different ages have different psychological responses to injury?” So, like all researchers worth their proverbial salt, we took some of these questions and ran with them as inspiration for further investigation.

Women respond differently to men when faced with many different situations, including injury and recovery from injury. But it may come as a surprise that there really is very little research looking at differences between men and women in terms of returning to sport after injury. We have shown in amateur athletes, that women have higher levels of fear about getting injured again when compared to men. Women had more worry about the type of playing surface contributing to injury, which might reflect differences in the types of sports women and men typically play.

In our most recent work, there were some indicators that younger people had greater levels of mood and emotional distress before they had surgery for a knee ligament injury. This might reflect the fact that younger people feel more strongly that playing sport defines who they are. Young people probably have more opportunities to play sport, either through school and university; or have fewer outside commitments like work and family, so have more time for sport. This might also mean that young people's friendship and support networks are also linked to their participation in sport, so they feel a greater sense of social isolation when they are injured and can't play their sport.

In our recent work we have also shown that athletes' psychological responses before treatment begins, and early after knee ligament surgery predicts whether they will get back to sport. This was despite the fact that all of these athletes had excellent physical recovery after their surgery. For clinicians, it seems that there is the possibility to screen athletes very early in their recovery, to help identify those who may be at risk of not returning to sport. This is critical, because often the main reason why the athlete has sought you out for treatment in the first place is because they want to return to their sport! Sticking at it, for the length of time if takes to completely recover from a serious injury, can be a tough ask. So early identification of athletes who may be more likely to have problems returning to sport means you have more time to help them through what can be a tough period from both a physical and mental perspective. In our work with athletes who'd had a knee reconstruction, we used a specific questionnaire developed to assess athletes' fear, confidence and perceptions of risk about returning to sport after knee reconstruction, and this questionnaire showed real promise as an easy-to-use, and relevant screening tool.

There are many factors, both physical and non-physical that are likely to influence returning to sport. Examples include psychological responses, age, the type of sport an athlete played, and lifestyle and work commitments. Some of these factors we may be able to influence, and others we may not. What is certain, is that encouraging life-long participation in sport from any age is critical for both physical and mental health; and understanding more about the multitude of factors that may influence returning to sport after injury will help achieve this.



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4 Responses to Returning to Sport after injury – The Mind Matters – by Clare Ardern

  1. Joy August 6, 2013 at 7:45 pm #

    Great article! I am not an athlete, more a light runner. I ruptured my Achilles playing netball in February and am a few weeks away from starting to run again. I have great support from my running club who will help me which is great. But mentally I am really, scared that I will reinjure myself and I just can’t get over that block. I think I am starting to slow down my recovery because of this, any advice?


    • Clare Ardern August 6, 2013 at 11:25 pm #

      Hi Joy,
      Thanks for reading, and for your comments. You raise a really important point – getting over the mental hurdle of injury is a big part of recovery. I will preface this reply by saying that I’m not a sport psychologist, I’m a physiotherapist with an interest in sport psychology!

      Research shows us that somewhere between one in ten and one in twenty people will get another ACL injury, and the younger you are, the more likely you are to have another injury. There is also research showing that the more you worry about getting injured again, the more likely you are to get injured. The fact that you have good support from your running club is a real positive. People who are supported by their team mates and fellow club members are more likely to get back to sport.

      Ask yourself why it is that you play sport? For most of us, playing sport is about having fun, keeping fit, and challenging ourselves physically. Remind yourself of the positive things about playing sport. Remember there is always inherent risk of injury when playing sport, just as there is risk of injury when driving a car – we still drive the car! Keep at it with your physical rehabilitation, and talk to your physiotherapist about setting some goals around playing netball again. By working together on these goals it can also help you both identify what you need to work on to make sure you’re physically ready to return to sport, and ticking these off will help reinforce that your body is ready to cope with the demands of playing netball again. It’s ok to take things a little slower – remember, many people take up to two years before they get back to their previous level of sport.

      Getting back to regular sport and/or physical activity is so important from both a mental and physical health perspective – best wishes for your recovery.

      • Clare Ardern August 6, 2013 at 11:37 pm #

        Correction: I gave statistics on re-injury rates for ACL injury. For the achilles, somewhere between one in twenty and one in fifty people who have surgery for their achilles rupture will re-injure their achilles. For people who don’t have surgery for their original achilles injury, the chances of getting another injury are a bit higher.


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