The Institute of Sports Performance

Creating Breakthroughs with Athletic Performance and Sports Injury Recovery

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

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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.

Robert Griffin III Causes for Concern

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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.

What Kevin Ware’s Injury Can Teach Us About Sports Injury Trauma

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Kevin Ware‘s injury during the Duke/Louisville NCAA basketball game was the most horrific sports related injury I have seen. I cringed and looked away from the TV but I found myself drawn back to the images of teammates, coaches, trainers and fans agonizing over the shocking scene playing out before them.

Kevin suffered a compound fracture of his lower leg when he leaped to block a Duke players shot and landed awkwardly in front of his own bench.  His lower leg snapped and a bone tore through the skin.   His reaction to seeing his injury was tragic, but seeing the reaction of his teammates on the bench let me know that most in the arena were seeing something that the mind could not comprehend.  Players from both teams fell to the floor, cried, and held each other.  Coach Rick Patino’s face was white from the shock of seeing Kevin’s lower leg turned sideways and hanging in the air.

Fans in the stands were visibly shaken and many were crying.  Obviously traumatized by what they had seen.  The Louisville trainers were remarkable in the face of this tragedy.  They covered his leg so no one could see it, especially Kevin.  But for Kevin, those in attendance at the game, and those of us watching on TV the imprint in all of our minds had already been burned in.

Mental images of a traumatic injury like this are deeply burned into the mind of the injured athlete.  They are also burned into the minds of his teammates, Duke players, coaches, fans, media representatives, cheerleaders, and TV viewers.

These images or “holographic imprints” contain incredible amounts of information.  Kevin’s brain now carries the image of seeing his leg in that state.  That image or imprint also stores the intense physical pain he experienced, physical sensations of shock in his body, the sound of his bones snapping, the light in the arena, the gasp of those close to him on the court, the look of concern on the faces of trainers and other medical personnel caring for him,  and other significant sensory information.

The more of Kevin’s senses that were stimulated when suffering his injury, the more shocking or intense his emotional reaction, and the more intense his physical pain the deeper the neurological imprint in his brain and nervous system.

When a traumatic injury like Kevin’s occurs the Limbic System of Kevin’s brain takes over to help him survive the overwhelming shock and pain his system has suffered.  This information is now deeply imbedded in his brain.  Add surgery, the prospect of a monumental recovery process, the loss of a final Four experience as a player, disconnection from his role on the team, uncertainty about his future in basketball, and loss of his identity as a player, and the imprint and stored information is compounded.

Kevin’s long road to recovery will not be just physically in nature.  It will require specific mental and emotional processing to teach his brain and nervous system how to integrate this traumatic experience.  Addressing his injury from a psychological perspective can help him process the trauma related to the injury.  If he is able to return to play he can come back without the fear of re-injury.

With so many people witnessing his injury, and the frightening images the TV cameras provided all of us as viewers, we now have an inside look at the traumatic nature of sports related injuries.  We all experienced vivid holographic imagery, intense emotional reactions and physical sensations in our bodies.  In a sense we all might be traumatized to varying degrees by witnessing his injury.  Whether on the bench as a teammate, in the stands as a fan, or watching on the TV we all now have a shared traumatic experience that is related to a very intense sports related injury.

I know Kevin is receiving the physical care he needs from Doctors, nurses, PT’s, and trainers.  I hope Kevin and any of his teammates who might need support  receive the psychological care they might need to overcome this catastrophic injury.

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