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Understanding the Traumatic Nature of ACL Injuries

March 11, 2023 by Robert Andrews Leave a Comment

Robert B. Andrews MA, LMFT

For many athletes coming back from a serious sports related injury is a terrifying ordeal. They have been cleared to play physically, but their fear of suffering another injury can be debilitating. These fears can cause complications with their return to play. Many suffer from confusion, anxiety, anger, shame and guilt. If they have been “cleared to play”, then why do they feel so bad? Many feel that something is wrong with them if they can’t come back confident and in a good frame of mind.Sports Injury

I was talking with a soccer player about a teammate who suffered a strained ACL. The injured athlete took time off for the injury to heal. When they returned to play they were terrified. They were afraid of injuring their knee again and played with anxiety, fear, and apprehension. They did not play all out and their hesitancy was apparent. It grew worse with each game. As their anxiety and fear grew they became more emotional during the games. It was apparent to everyone watching that something was wrong.

I began to get excited at the thought of helping this athlete overcome their sports injury trauma. As I reached for a business card for the parent of the struggling athlete I was told that during their last game the athlete had torn their ACL completely. The field was in really bad condition and their fear of re-injury was amplified. They were crying while trying to play soccer. They ended up in a fight for the ball and injured their knee. I felt my heart sink when they told me this part of the story.

Too Many Sad Stories

I was on the sidelines of a football game watching a running back who had torn his ACL the year before. He was hesitating as he ran and favoring the injured knee. After the game I told his coach that he was going to suffer an ACL injury to the other knee if he didn’t get some help with the trauma from the first injury. The next week he tore his other ACL.

I was watching a game on television and I observed hesitation and apprehension in an offensive lineman who had injured his left knee the year before. I turned the game off at half time. A few days later I called his athletic trainer and mentioned to him that I believed that this lineman was heading towards an injury on his other knee. He asked me why I felt this way. I told him what I observed watching the game. He said that was interesting and that the lineman had torn his other ACL in the fourth quarter of that game.Overcoming Sports Injuries

Is the Wrong Message Being Sent?

An athlete I helped overcome a horrific injury was interviewed about his “miracle comeback”. When they asked this athlete what they did to make such a profound come back they said they just had a “really strong attitude and mind set”. They didn’t mention all the hard work they did mentally and emotionally to overcome the trauma they suffered while injured and unable to compete. I believe this athlete did a disservice to other athletes who are trying to overcome the trauma and the mental and emotional blocks that stand in the way of a full “100%” recovery. They sent a message to other injured athletes that all you have to do is have a strong mindset and everything will be o.k.

This message can have a profoundly negative impact on the athlete who is struggling to get back mentally and emotionally. It can create doubt and confusion, and erode self confidence. Many athletes never find their way back from injury because they can’t overcome this cauldron of powerful emotions.

The New Way Back From Injury

I was watching a game on TV recently. An athlete I helped overcome a serious injury was having a great game. It was apparent that they were confident, in command, and had no fear of re-injury. The commentator said it was apparent that this athlete was back physically, but that they were back mentally too. My wife asked me to replay his comment. We listened to it again and she said “someone gets it”. This commentator could see from the way this athlete was playing that they have experienced a complete psychological recovery from their injury too.

I wish I could have helped the young soccer player before they suffered a completely torn ACL. I wish I could help every injured athlete. Treating the traumatic nature of sports related injuries puts the athlete back in charge and rids them of fear, anxiety, apprehension, depression and self doubt. They return to play mentally stronger and tougher. Not only does their attitude and outlook get better, they come back wiser and more mature. This wisdom and maturity permeates all areas of their lives. They learn a lot in the process of coming back.  Download a pdf version of this post

Filed Under: ACL Injury Recovery, Athletes mental health, Mental Aspects of Sports Injuries, Mental Health in Sports, Sports Injuries and Trauma, Sports Injury Recovery Tagged With: ACL Injuries, Athletes Mental Health, Mental impact of injuries

Pre-Surgery Treatment of Mental and Emotional Aspects of Sports Related Injuries

April 24, 2016 by Robert Andrews Leave a Comment

Working with an injured athlete prior to surgery has proven to be a game changer when it comes to the athlete’s approach to surgery, pain management, and the rehab process.

Helping athletes work through rational and irrational fears about surgery, processing concerns about the impact the injury will have on their performance, calming their anxiety about the rehab process, and gaining clarity about their identity as an athlete all help the athlete approach surgery with less fear and anxiety.

imagesA calm brain produces fewer stress related hormones so the mind and body have a remarkably different experience of surgery than the athlete who goes into surgery tense, scared, and filled with anxiety.

Recently I had the pleasure of working with an athlete as she was preparing to return to play after ACL surgery. This is an athlete that I saw a few days before surgery and a few more times as she worked her way through the rehab process.

The surgery/recovery process has gone so well for this athlete I decided to request an interview to capture and share the power and significance that pre-surgery treatment can have on an injured athlete facing surgery.

I have kept the athlete’s name private to maintain confidentiality. I will say that this athlete is a female high school soccer player who tore her ACL.

Question: How long ago was your surgery and how did the injury happen?

Athlete: About 8 months ago. I was going after a 50/50 ball on the soccer field. We collided and I tore the ACL in my left knee.

Question: How did you feel immediately after the injury?

Athlete: I felt “crappy”, devastated, scared, mad, upset, and sad. I wished it had not happened. I immediately started having all of these questions run through my mind. Questions about my future…Will I be able to come back? How long will it take to come back? Why did this happen?

Question: How did you find your way to The Institute of Sports Performance?

Athlete: My mother wanted me to have every kind of support I could have. She new I was suffering and upset so she started asking around. A therapist here in Houston told my mother about Robert Andrews, so we set up an appointment before my surgery.

Question: What was your reaction to your mother’s suggestion that you see someone to address the mental and emotional impact of your injury?

Athlete: At first I thought it was weird. I wasn’t excited. But she explained how it would help, and it made sense. Then Mr. Andrews explained everything in a way that just made more sense. After he explained how the brain works and how it handles high stress events, I was excited that I had this help going into surgery.

Question: How did you feel when you thought about having surgery?

Athlete: I was scared and anxious about the pain. I was really afraid of how painful it was going to be.

Question: Did you have any specific images in your mind about surgery, and how did you feel when you saw these images in your mind?

Athlete: Yes I did. I kept seeing images of the doctor opening my knee up and another image of me being surrounded by doctors in surgery. The images were there whenever I thought about going into surgery, and they made me feel scared and anxious.

Question: What work did you do with Mr. Andrews prior to surgery?

Athlete: We did some work with light, eye movement, and sound (EMDR) that focused on the scary images I had in my mind about surgery. By the time we finished with the first session those scary images were gone. I felt so much calmer. The fear and anxiety were gone. I was confident and ready for surgery.   I even had a new image in my mind of everything going well in surgery. The day of surgery I felt pretty calm.

Question: How did you feel after immediately after surgery?

Athlete: I felt great! I didn’t have a lot of pain. I was more concerned about the rehab process, but I saw Mr. Andrews again about that. We did some work that calmed my anxiety about rehab.  After that I was very confident and attacked my rehab process.

Author’s note– this process is not a guarantee that injured athletes will suffer less pain in surgery. There are many different types of ACL reconstruction surgeries, some more painful than others. Overall, I frequently hear reports from athlete’s saying they approach surgery calmer and with less anxiety. Many also report experiencing less pain.

Question: How do you feel now eight and a half months after the injury?

Athlete: I feel great! I continue to do my rehab with the goal of continuing to get stronger. I am back at practice, and I feel more confident. I have no pain and feel “normal”. I am definitely more confident than I thought I would have been at this stage of my recovery. Working with Mr. Andrews helped me be more patient about my rehab process. I have done great.

Question: When you think back to the point in time when you were injured, what do your think about and remember?

Athlete: I don’t really remember the injury. I see the rewritten version in my mind where I don’t get hurt. The old scary image of me getting hurt isn’t stuck in my brain anymore like it was when the injury first happened.

Question: Would you recommend this treatment process to other injured athletes?

Athlete: Yes I would, and I have. My mother tells everyone and I tell everyone. Seeing Mr. Andrews before surgery really made the difference for me. I thought I would be afraid when I came back, but I am not. I tell everyone how great I am doing. I am doing so much better than everyone thought.

Changing a Paradigm

I am grateful to this young athlete for sharing their process and experiences with me. It is important to get this information out. I believe we can dramatically alter the amount of fear, anxiety, anger, depression, and suffering injured athletes experience when injured.

After ten years of working with athletes I have seen thousands who have suffered serious injuries. These injuries include ACL injuries, Tommy John, broken ankles, legs, arms, and collarbones, shoulder injuries, and concussions. I have also seen baseball and softball players who have been hit by pitches, taken bad hops, and line drives back to the pitcher. Gymnasts and cheerleaders who have suffered bad falls and injuries, and pole vaulters who have broken ankles or suffered knee injuries also come to see me.

Savannah Jones (10) tries to shield the ball from a Lake Travis midfielder.Each of these injured athletes goes through an extremely high level of stress and possible trauma when injured. The part of the brain that is designed to protect them and keep them safe (the limbic system) is engaged. Calming this limbic system down before surgery is the key.

As a result, they approach surgery with less anxiety, less fear, and they attack the rehab process with more determination and confidence. These athletes return to play absent of the debilitating fear of re-injury.

Many athletes learn a lot about themselves during the injury/recovery process. They develop key parts of their personality. They learn to be tougher, more focused, resilient, and grateful. They reconnect with the love and passion they experienced before the injury.

Filed Under: ACL Injury Recovery, Mental Aspects of Sports Injuries, Sports Injury Recovery, Sports Shut Down and the Mental and Emotional Impact on Athletes Tagged With: ACL Injuries, EMDR, Injured Athlete, Soccer, Sports Recovery

Kobe Bryant, Derrick Rose, and Lindsey Vonn Injuries Reveal the Missing Link in Injury Recovery

January 2, 2014 by Robert Andrews Leave a Comment

Kobe Bryant breaking a bone in his knee after coming back from a torn Achilles tendon, Derrick Rose tearing a cartilage after returning to play after a torn ACL, and Lindsey Vonn partially tearing her ACL after returning from a complete ACL tear all reveal the gap in the recovery process for athletes returning to play after suffering serious sports related injuries.  Athletes return to competition after being cleared to play physically but their mental and emotional readiness is not part of the current treatment model for athletes returning to play. Addressing the mental and emotional impact of sports related injuries helps athletes face surgery with  a confident and positive mindset.  They handle surgery better.  They approach their recovery process with more focus and intensity.  They also return to play absent of the conscious or unconscious fear of re-injury.

AnkleKobe suffered a torn Achilles tendon last season and attempted to return to play at the beginning of this NBA season.  Kobe was cleared to play as “100%” by his Doctors and athletic training staff.  A few games into the season he tweaked his hamstring. A few games after that his comeback and his season ended when he broke a bone in his knee.

Chicago Bulls guard Derrick Rose suffered a similar fate.  He tore his ACL last NBA season. After a prolonged recovery process he returned to play at the start of this season. A few games in he tweaked his hamstring.  The following week he tore a cartilage in his other knee.  His return to play this season is questionable at best.

Olympic Gold Medalist Lindsey Vonn tore her ACL in a skiing practice training.  After surgery and an intense rehab process she returned to training only to partially tear the ligament again.  She is trying to make it through Olympic Trials without fully tearing the ligament.

Sports InjuryWhen an athlete suffers a serious injury a part of the brain called the limbic system is activated. The job of the limbic system is to keep the athlete safe. In the case of a serious sports related injury it means keeping the athlete safe from re-injury.  When the limbic system is engaged athletes will consciously and unconsciously make adjustments to protect the injured area. With these adjustments stress and torque move to other areas of the body. From the ankle to the knee, from the knee to the hamstring or back, from the elbow to the shoulder.

I worked with a team that had six athletes suffer serious knee injuries in a thirteen day period.  I was fortunate to be able to see three of these athletes before they had surgery.  I saw two athletes right after surgery. I was able to work with the sixth athlete as they were returning to play after being “cleared”.  Working with these six athletes during their process of returning to play was a remarkable experience. In a sense I had a small sample group to test this theory.

The three athletes I worked with prior to surgery were able to work through all of their fears about the surgical procedure they were about to face.  Some of these fears were rational.   Is it going to hurt? How long will I be out of competition? What if someone takes my place while I am out?  Some of their fears were irrational.  What if I wake up during surgery? What if they operate on the wrong knee? What if they cut something else during surgery and my career is over?

Many athletes have fear and anxiety before surgery but very few are able to talk about, process, and work through these fears before surgery.  They go into surgery with their brain on full alert and overstimulated.  By processing the fear and anxiety before surgery they approach surgery in a calmer and more relaxed state.  They are relaxed mentally and emotionally before they enter the operating room.

These three athletes had remarkably positive experiences of surgery.  One athlete said that a surgery room nurse asked if they had ever had surgery before because they seemed so calm and confident.  Their recovery process was very successful. They approached rehab with a high level of intensity and mental toughness.  They all returned to play the next season and suffered no further injuries.

The two athletes I worked with after surgery said that they approached surgery with a lot of fear and uncertainty.  They suffered a lot of pain after surgery.  Their rehab process was difficult.  After just a few sessions we worked through the injury and their rational and irrational fears about rehab and returning to play.  They made a great comeback the next season.  They played well and suffered no further injuries.

The last athlete went through surgery and extensive rehab.  They endured a lot of physical pain after surgery.  Rehab had been very tough.  There were resistant to their rehab and PT.  When they were cleared to play they had tremendous fear and anxiety about suffering another injury. At this time they asked to come see me and we started addressing the injury, the pain and suffering they endured, disconnection from their team, and their fear of being injured again. They made great progress quickly.  They went on to play that season.  They did very well and suffered no further injuries.

Working with these six athletes confirmed that treating the mental and emotional impact of the injury has a profound impact on the injured athlete.  I continue to confirm this treatment model with every inured athlete I am fortunate to be able to work with.

For CoachesI have also found that the sooner I am able to treat an athlete the better their recovery process and the better their return to play. Seeing the athlete before surgery is the real key.

When I hear about Kobe Bryant, RGIII, Derrick Rose, and Lindsey Vonn I know that there is another resource they can add to their recovery process.  Working with athletes before and after surgery helps the athlete return to play stronger, wiser, smarter, more confident, and absent of the fear of re-injury.

For professional teams and agents it helps restore their contractual value to their team.  If they play better they are worth more.

But most importantly they are happier and more confident.  They love the game or sport again.  They trust their bodies to perform at extremely high levels.  They are truly “100%” ready to play.

Filed Under: Sports Shut Down and the Mental and Emotional Impact on Athletes Tagged With: ACL Injuries, Derrick Rose, Kobe Bryany, Limbic System, Lindsey Vonn, Sports Injuries, sports injury recovery, sports related injuries

Robert Griffin III Causes for Concern

September 3, 2013 by Robert Andrews 3 Comments

The Washington Redskins decision to start Robert Griffin III next Monday night in the season opener raises serious red flags.  Redskins Coach Mike Shanahan has expressed “concerns” as recently as last Thursday.  His surgeon Dr. James Andrews has also expressed concerns over the last week as well.  Both signed off on his return today and as a result he will start against the Philadelphia Eagles.

Both cleared Robert to play after carefully evaluating his condition.  They are both experts in their respective fields.  Shanahan as an NFL coach, and Dr. Andrews as a national renowned surgeon for many elite athletes.   Their decision has to be respected given their experience, knowledge, credibility.

“100%” Cleared to Play

Athletes want to play period.  Robert is a fierce competitor and is paid millions of dollars to be the “Face of the Redskins”.  He will present himself as ready to play because it is his nature as an athlete to be “ready to go” on opening day.

It has been said that after consulting with Robert all concerns have been addressed.  His clearance most likely follows the traditional “100%” ready to play requirement of injured athletes before coming back from a serious sports related injury. This addresses the stability of his knee, flexibility, range of motion, ability to run, cut, jump, back pedal, and all of the other things required of Robert in the Redskins up tempo offense.

This “100%” definition does not take into account the mental and emotional trauma Robert has suffered during each of his three knee injuries.  Robert suffered a torn ACL while at Baylor University, a strained ACL last regular season, and completely tore the ACL in a playoff game in January of this year.

With each injury Robert suffers intense physical pain, followed by the pain of surgery and rehab.  He also suffers mentally and emotionally.  The brain springs into action to compartmentalize this cauldron of physical pain, horrific mental images, and the intense emotions and sensations that are surging through his body, brain, and nervous system as he is injured.. This process continues while he is carried off the field, diagnosed, and prepares for surgery and works his way through the rehab process.

Where The Mind Leads The Body Follows

Elite athletes are conditioned to compartmentalize this information on a conscious level.  You see elite athletes return from serious injuries all the time and compete at a high level.  Look at what Adrian Peterson accomplished last season after returning from a torn ACL.

What is going on in the brain and body unconsciously is what concerns me.  Look at The Chicago Bull’s Derrick Rose.  He tore his ACL and has been cleared to play at “100%”.  He has not returned to a high level of play. Could Derrick’s mind be doing its job by unconsciously holding him back to prevent another injury? I feel confident in saying that this is exactly what is going on in this case.

With each injury the neo-cortex in Robert’s brain does it’s job to process as much of this neurological information as possible.  The overwhelming information surging through his brain and nervous system overwhelms the part of the brain (neo-cortex) that processes the normal incoming stimulus that an NFL Quarterback processes during a game. The limbic system take over and stores this overwhelming information.  Its job it to make sure that Robert is safe, stays alive, and suffers no further injuries. In a sense his brain goes on full alert and doesn’t calm down until this overload is addressed and processed.

Experiencing multiple injures creates a layering of stored information in Roberts limbic system. All of the anger, frustration, despair, fear, anxiety, confusion, loss and other intense emotion, imagery related to the injury, and sensation are held in the limbic system.

When Robert goes out to play Monday night his limbic system can spring into action and unconsciously attempt to keep him safe and free from suffering a fourth knee injury.  This sets his body up to favor his injured knee, put more weight, torque, and force on his other knee.   He might play cautiously or hesitate.

One might say that you will never see Robert Griffin play that way and I agree if his neo-cortex is running the show.  If his limbic system kicks in then we might see a change in the way he plays the game and there is a possibility that he might suffer another injury.

“The New Way Back’ from Sports Related Injuries

Teaching Robert’s brain, specifically his limbic system, to process this cauldron of stored information relating to his multiple knee injuries can lessen if not prevent another knee injury.  By addressing the mental, emotional, and psychological trauma he has suffered and endured during each of his three knee injuries Robert can return to play at a high level both consciously and unconsciously with no fear of re-injury.

I have seen athletes return to remarkable levels of play after suffering serious knee injuries, broken legs, crushed faces after being hit by 95 mph fastballs, horrific falls, concussions, and many other serious sports related injuries.

In Roberts case I hope that my experiences in working with injured athletes proves wrong.  He is an electrifying player and has done so much to help the Redskins, the NFL, and the game of football.  More than that he is  an intelligent, thoughtful, and humble young man.  He honors and respects the game.

I would like to see him in the league for a long time.

Filed Under: Sports Shut Down and the Mental and Emotional Impact on Athletes Tagged With: ACL Injuries, Dr. James Andrews, Limbic System, Mike Shanahan, Neo-Cortex, Return to Play, Robert Griffin III, Sports Injuries, Washington Redskins

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