How Emotions Improve Return to Sport After Knee Injury

Knee injuries are common in sports and unfortunately many athletes don’t return to the game. A new study, “Psychological, social and contextual factors across recovery stages following a sport-related knee injury: a scoping review,” published online in the British Journal of Sports Medicine on February 14, 2020 suggests that recognizing the psychological and social factors can improve recovery.

The researchers analyzed studies from six databases that identified or described psychological, social or contextual factors of recovery from a sport-related knee injury.

Overall, they reviewed 77 studies involving 5,540 participants, aged 14 to 60 years. Eighty-four percent of the injuries were anterior cruciate ligament (ACL) tears. All the studies analyzed reported on psychological factors, but less than half reported on social (39%) and contextual (21%) factors. Almost half of them were conducted during rehabilitation of the injury.

The researchers identified several psychological and emotional barriers to recovery including fear, frustration and anxiety. While fear was a common theme, only 20% to 45% of the athletes said that was the main reason for not returning to their sport. The athletes also reported psychological readiness, knee and sport confidence and motivation as barriers to returning to their sport.

The researchers wrote, “Injured athletes value playing an active role in their recovery. Immediately after injury, athletes reported wanting strategies that help them understand their injury and diagnosis, manage emotions and deal with athletic identity loss.”

Lack of coping strategies was associated with depression, failed return to sport and negative coping behaviors like substance abuse. The injured athletes also reported a desire to have more control over their rehabilitation and to be given realistic expectations about their rehabilitation and recovery.

The need for more social support was also a major theme, both educational and emotional. In these studies, social support was linked to greater resilience, confidence and self-motivation. Athletes were more likely to adhere to rehabilitation if they received social support.

The researchers added, “Injured athletes valued health care providers who engaged and involved them in their care through strategies such as goal setting. A strong therapeutic alliance, where individual goals and values of athletes were respected led to positive rehabilitation experiences and improved trust in healthcare providers.”