Is Confidence the Missing Link in Athlete’s Return to Play Post Injury?

I had the absolute pleasure of hosting Dr. Clare Ardern on the Rehab and Performance Lab podcast. Clare is a true expert in assessing mental readiness for return to sport, and our conversation was packed with practical insights that I know you can implement right away in your practice. If you missed the episode, don't worry – you can catch the full thing over on MedBridge (and even snag some CEUs!). But for now, let's dive into some of the key takeaways that really resonated with me.

One of the central themes we explored was the critical role of the athlete's mental readiness in their successful return to sport after injury. We all know that physical capacity – strength, power, range of motion – is essential. But as Clare pointed out, having all the physical tools doesn't automatically translate to a confident and successful return. The mind matters just as much as the body when it comes to getting athletes back in the game.

One of the first areas we tackled was the use of questionnaires to assess psychological readiness. This is something I know many of you are curious about, and a question that often comes up is:

What is the passing score or cut point of psychological readiness questionnaires?

I think this was one of my biggest take aways: there isn't a specific cutpoint on psychological readiness questionnaires, like the ACL Return to Sport after Injury (ACL-RSI) scale, that definitively tells you if an athlete is "ready" or not. This was a crucial point Clare emphasized. Instead of chasing a magic number, the real value lies in monitoring both physical readiness and psychological readiness over time. Think of it like this: your physical testing (strength, vertical jump, etc.) should ideally track with how the athlete feels about returning.

Mismatches are key: If an athlete's psychological readiness significantly exceeds their physical function, it might indicate overconfidence. This opens the door for important conversations about the objective physical testing results.

Conversely, if their physical testing looks good, but their psychological questionnaires don't match, we need to dig deeper. What's holding them back? This is where open dialogue and truly listening to the athlete's concerns become paramount. Sometimes, this is also where referral to an appropriate mental health provider might be the most supportive step.

So, if there's no magic cutpoint, what's the point of these questionnaires?

Clare highlighted that the primary purpose of psychological readiness questionnaires isn't to provide a definitive "yes" or "no" for return to sport. Instead, they serve as a fantastic tool to facilitate communication.

Opening the door: Questionnaires can help you identify specific areas of concern for the athlete, such as fear of re-injury, confidence in their abilities, or emotional readiness. Instead of awkwardly asking "So, are you feeling confident?", you can point to their responses on the questionnaire and say, "I noticed you indicated some concern about lateral movements. Can you tell me more about that?". Understanding the nuances: By looking at the individual questions and subscales, you can gain a better understanding of the specific aspects of mental readiness that might be influencing the athlete.

The Pitfalls of Too Much Positivity

As rehab professionals, we're often naturally positive and encouraging. However, Clare raised an important point: too much unwavering positivity can actually be detrimental.

Closing the door to concerns: If we're always saying "You're going to be 100%!" and "Everything looks great!", we might inadvertently create an environment where athletes don't feel safe to express their genuine fears and anxieties. Rehabilitation is rarely a perfectly smooth journey; there are ups and downs. Note: Check out the the ACL Rehab Live Patient Case Series where Kyle Matsel and I worked with a patient for 18 months. This definitely shows the ups and downs of rehab.

Authenticity matters: Being authentic and acknowledging the challenges of rehab allows athletes to bring their "real authentic selves" to the interaction, fostering a more meaningful dialogue.

Labeling: A Powerful Communication Technique

We also touched upon a communication technique called labeling, which I is one of my favorite communication facilitators. 

It is empathy in action: Labeling involves verbalizing a potential feeling or concern that the athlete might be experiencing. For example, in the case of an athlete who has had multiple ACL reconstructions, you might say, "Wow, I can't imagine you seem hesitant to go back?".

This approach gives the athlete permission to acknowledge those feelings without feeling like they're being negative. It can also open the door for them to say, "No, actually, I feel really confident!", which can provide valuable information in itself.

Main Takeaways 

Clare provided some fantastic actionable takeaways that you can start implementing today:

Get Comfortable Practicing Shared Decision-Making

This isn't just about asking the athlete what they want to do. It's about you sharing your expertise and the evidence, supporting them to explore all reasonable options, and ultimately empowering them to make a decision that feels right for them.

Decide which questionnaire(s) you prefer using to assess psychological readiness. Whether it's the ACL-RSI or other generic measures of confidence or fear of re-injury, find a tool that you feel comfortable with and that provides meaningful information for your patient population. Remember, it's a starting point for conversation.

Create time and space to listen with a flexible mindset. Truly listen to what the athlete is saying they're struggling with, both physically and emotionally, and then act accordingly. Rushing through sessions doesn't create a productive environment for them to share their concerns.

It's a Continuous Process

Remember, assessing psychological readiness isn't a one-time thing. Just like we continuously monitor physical progress through testing and observation, we need to make regular check-ins on the mental side. Simple visual analog scales for confidence before or after challenging tasks can provide valuable insights.

A Crucial Distinction: Mental Readiness vs. Mental Health Diagnosis

Finally, Clare made a very important point: we are talking about psychological readiness for return to sport, not diagnosing mental health conditions. While anxiety and depression can certainly impact an athlete's recovery, our role as rehab professionals is to identify potential concerns and make appropriate referrals to mental health professionals when needed. We're looking at how their mental state is influencing their ability and willingness to return to their sport.

Want to hear the whole conversation? Head over to Medbridge to check out the full podcast episode, "Rehab & Performance Lab 13: Is Confidence the Missing Link in Athletes’ Return to Play Post Injury?" where you can earn CEUs and access bonus resources.

You can also listen to the episode at the links below. If you'd like CEUs, make sure to use the MedBridge link.