Princeton, New Jersey, USA
Sunday 16th February 2014

Over the years I have attended many of the National Athletic Trainers Association annual conventions, which I scheduled alongside other clinical visits to facilities in the United States.

The events always fascinate me as you get to meet some great characters & professional's whose paths you may not otherwise have the fortune to cross.

One of those people, Leah Washington, has been involved in some fascinating work looking at the psychology of injury & over the years we have kept in touch updating each other on our latest career progressions. 

A doctoral student in Sport Psychology at University of North Carolina, Greensboro, Leah is now combining her 15 years of experience as an athletic trainer, 5 years in the field as a sports psychology consultant & her academic research to educate sports physiotherapists, sports medics, athletic trainers & coaches in the influence that injury can have on the mental health of athletes.

An area that is often overlooked or underestimated, I think the psychology of injury actually can make or break the sporting careers of those that struggle to cope with the impact that injury can have on their lives.  

My previous research into goal setting & motivation raised some challenging thoughts, so when Leah agreed to answer a few questions, I was delighted that the answers were so informative.

Given that long articles often get skimmed over, I have decided to split Leah's interview into a two-part blog as I really feel that it is one of the most insightful contributions I've had on the website.  I certainly gained a lot from it.

OF:  Please introduce yourself in ten words

LW:  Athletic trainer, sport psychology consultant, mental health advocate, LGBTQ ally

OF:  Please explain the basis of the PhD that you have spent the last years reading

LW:  My PhD is in sport psychology.  Due to my background in sports medicine, I am particularly interested in the psychological recovery of injured athletes. 

I am also interested in how athletic trainers & physios can use mental skills throughout the rehabilitation process to help their athletes recover faster & with more success.

OF:  Do you think the current focus in sports psychology is appropriate or should we put more on emphasis on educating the coaches, ATs, physios & docs than we currently do?

LW:  I will always encourage more education!  We definitely don’t do enough. 

There is still a stigma against seeking help & it isn’t something ATs or physios readily think of as another option.  

There is definitely more acceptance of using sport psych services - professional athletes are more public about using us, several universities are employing licensed psychologists with a sport psychology specialty, etc.  However, the prevalence is for sport performance enhancement & not enough on injury recovery. 

I still consider what I do performance enhancement, it’s just that my athletes’ performance is in the rehab clinic instead of the court/field/pool/pitch.


OF:  Where do you think the biggest progress has been made in your current field over the last 10 years?

LW:  I think one of the biggest signs of progress is the inclusion of psychosocial competencies in athletic training education. 

We (as a profession) still struggle with how best to incorporate the competencies into the education and practice, but really, the fact that our governing body has recognized the importance of this knowledge makes a big difference.  

There has also been more of a push for general awareness of clinical mental health issues.  More athletes are getting help with their anxiety or depression, which is great because they aren’t just better athletes, but healthier people.

OF:  What are the biggest challenges you encounter when working with teams?

LW:  One of the biggest challenges is that many athletes think they should be able to figure it out on their own & it’s not always that easy.  If you don’t know the process of how to increase your motivation, you will just spin your wheels & get frustrated. 

Things like concentration, motivation, positive thinking, etc, are not inherent- they are skills that can be improved with practice. Working on your mental skills doesn’t mean you are weak, it just means you are maximizing your potential for success.

The other challenge is that the psychology side of the game is often deemed not important enough to devote significant time to improve.  Athletes are already doing so much, it’s hard to get them to think about doing yet another thing.  

On the other hand, when I ask athletes, “How much of your game is ‘mental’?”, I will invariably get a response suggesting around 80% is.  So then I ask, “How much time to you spend working on your skills/at practice/in the weight room?”, which usually gets a response of around 20-30 hrs/wk.  Subsequently, when I ask, “How much time do you spend practicing the mental part of your game?”, I often get responses of 0-2 hours/wk. 

So most athletes are spending 2 hours (at best) per week on 80% of their game & 20-30 hours on 20% of their game.  That doesn’t make any sense to me & this often gets athletes thinking about where they can improve.  

It’s not about training more, just to train more; it’s about training smarter, & being more efficient with your energy.

My biggest challenge with athletic trainers is to help them realize that incorporating these skills isn’t as challenging as they might think & it can make their job so much easier. 

Athletic trainers (& sports physiotherapists) are so busy, that we often don’t stop to think about the bigger picture of the athlete’s experience.  

Maybe our athlete is late every day (or doesn’t show up) because the athletic training room reminds them too much of their injury event, or they feel overly scrutinized by other athletes, or they are reminded of the disappointment of not finishing a season. 

If we can recognize WHY they are behaving a certain way, we can intervene & improve the recovery experience, which will mitigate any delays in healing.  

I like to think about it in a similar manner as to how athletic trainers think about the kinetic chain - maybe we have an issue at the hip that is ultimately a result of something going on in the foot.  We can keep treating the hip symptoms, but until we address the foot nothing will improve.  

Psychological issues are the same way; too often we just get irritated because we focus on the behavior (stop being late!) & not the cause. 

The other issue is that athletic trainers don’t want to get into an athlete’s “personal business”.  This is completely understandable, but if the athlete is struggling, we are in a great position to help. 

We don’t need to know their whole story to provide resources or refer them to a mental health professional.

OF:  What has been the most successful outcome you have seen in your practice?

LW:  One of my most satisfying athletes to work with was a cross country runner.  He had terrible performance anxiety, to the point where he would finish races in last place. 

It was truly paradoxical- he was so terrified of failing that he sabotaged any chance for success.  He was committed to changing though & I was able to help him rediscover why he started running in the first place & what he loved about it. 

After that, the competing came naturally because it was no longer the focus.  He could just run because he wanted to & that translated into success in races.  

I ended up working with him for most of his collegiate running career; he was always looking to improve & wasn’t hesitant about reaching out for help when he felt he needed it.

One of my most memorable injury recovery clients was a baseball player with a chronic shoulder injury.  He was frustrated that his recovery was going slowly & he had had a few setbacks.  He was losing some determination & missing playing the game he loved.  

One day he mentioned that he had been working with his batting coach because he kept hitting pop-flys, so I asked if I could go to batting practice with him.  

It was then that I realized his hitting technique was contributing to his pain & this was why his shoulder wasn’t improving.  He wasn’t using his legs or his core for power, so his arms were doing all of the work, leading to fatigue & over use.  

Working with his batting coach & his athletic trainer, we were able to work as a team to improve his technique, treat his pain & get him back on the field. 

I worked with him to develop specific “cues” to help him remember the new techniques he was learning (while unlearning bad habits), as well as keep him motivated & excited to play again. 

This was a great example of when I was able to use my knowledge from sports medicine & biomechanics & it was awesome to be able to use my complete skill set with one athlete.

OF:  What has been the most difficult case you have worked on & how did you overcome the challenges it presented?

LW:  My most challenging client was a wrestler who had shoulder surgery.  He was very angry, & had gotten into a lot of trouble both on & off campus.  He had a short fuse & was prone to fighting (which, by the way, is difficult with your arm in a sling).  

Everyone was frustrated with him & he wasn’t doing himself any favors. At first we worked a lot on simply how to recognize his emotions, beyond “fine” or “pissed”.  Then we were able to work on regulating those emotions & what triggered his outbursts.  

I really had to adjust my expectations, since he was so unaware of himself, or what set him off & he had no idea how his environment affected him.  Working with him took every ounce of my patience, but I had to remind myself that, ultimately, he needed someone who had faith in him, who wouldn’t give up like everyone else. 

It sounds so cliché, but it was true. I decided that I would become his advocate & keep reminding him that I knew he could do better, that he may have burned bridges, but he could repair them.  I had to constantly remind myself to look for the small successes (because that’s all there were at first) & frankly, to look past all the bullshit. 

I also worked with his athletic trainer to keep her from getting too frustrated during his rehab.  It took a while, but he was so much more calm at the end of the process & we were then able to translate those skills he learned into being a better wrestler who didn’t lose his head & give up a point.  

He was a frustrating client, but it was ultimately very rewarding to see him come out the other side a different person.

Please check back next week for the conclusion of Leah’s interview.  In the meantime, Leah recommends the following articles to provide further insight into the research that has been conducted concerning the influence of addressing psychological factors on the treatment of injury.

Clement, D. et al (2013).  Psychosocial Aspects of Athletic Injuries as Perceived by Athletic Trainers.  J Athl Training; 48(4): pp512-521

Marshall, A. et al (2012).  An Exploration of Athletes’ Views on Their Adherence to Physiotherapy Rehabilitation After Sport Injury.  J Sport Rehab; 21: pp18-25

Thanks Leah!

blog comments powered by Disqus