Mental Health Performance - Athlete Psychology, Sports Injuries & Chronic Pain
About the Author
Ben Foodman is a licensed psychotherapist & performance specialist. He owns his private practice located in Charlotte North Carolina where he specializes in working with athletes to help them overcome mental blocks (the yips), PTSD, ADD / ADHD and achieve flow states through the techniques of Brainspotting & Neurofeedback. If you are interested in services, use the link here! Enjoy the article below!
Introduction: Athletes, Sports-Related Injuries & The Yips (AKA Mental Blocks)
Athletes know that acquiring sport related injuries is not a matter of if, but when. The vast amount of sport related injuries are usually fairly mild, but as the intensity of competition increases so does both the likelihood of an injury occurring along with the severity of one. Understandably when athletes experience an injury one of the first places they will be referred to and evaluated is through either a doctor or a physical therapist. While this is a necessary first step, the vast majority of these professionals (doctors, physical therapists, athletic trainers, etc.) usually only include a mental health professional when the athlete continues to report physical pain despite the perceived ‘absence’ of a physical injury after the completion of physical rehabilitation. Even then, many professionals will continue to just prescribe more physical therapy interventions.
This is incredibly problematic but also representative of the way the vast majority of professionals within the healthcare industry view the psychology of sport related injuries. Most of these professionals either minimize the psychological component of pain, or assume that the issue isn’t ‘real’ if they determine that there is no ‘physical problem’. I want to use this Training Report to debunk these myths and present a strong case for why the psychological component of injuries and pain must be taken just as seriously as the ‘physical’ component. I will start off by reviewing the neuroscience of sport injuries, followed by the relationship between the mind & traumatic injuries. Finally I review a new and exciting treatment method that can address the psychological component of sports injuries. First let’s review the neuroscience of sports injuries.
Part I. Neuropsychology Of Sport-Related Trauma & Pain
Many people place very little focus on how human psychology can influence chronic pain and injuries. If you were to ask most doctors, physical therapists and athletic trainers how much emphasis they place on incorporating psychological interventions when treating chronic pain and sports injuries, you would be hard pressed to find any significant number of individuals that simultaneously include mental health interventions as a part of the treatment process. This is in large part due to their lack of understanding on the neuropsychological mechanisms that occur during a trauma event. Because of this, a significant percentage of athletes and individuals who suffer from chronic pain and sports injuries are destined to re-injure themselves and never solve the riddle of their chronic pain. So how is it exactly that our individual neuropsychology affects pain and re-injury rates?
When we experience a traumatic event (such as a sport-related injury) that surpasses our individual stress threshold, our reptilian brain becomes highly responsive to the stress event. In the book The Body Keeps The Score, author Dr. Bessel Van Der Kolk beautifully illustrates how the brain functions during a trauma event, ‘the emotional brain has first dibs on interpreting incoming information. Sensory information about the environment and body state received by the eyes, ears, touch, kinesthetic sense, etc. converges on the thalamus where it is processed and then passed on to the amygdala to interpret its emotional significance. This occurs with lightning speed. If a threat is detected the amygdala sends messages to the hypothalamus to secrete stress hormones to defend against that threat. The neuroscientist Joseph LeDoux calls this the low road. The second neural pathway, the high road, runs from the thalamus via the hippocampus and anterior cingulate, to the prefrontal cortex, the rational brain, for a conscious and much more refined interpretation. This takes several microseconds longer. If the interpretation of threat by the amygdala is too intense, and/or the filtering system from the higher areas of the brain are too weak, as often happens in PTSD, people lose control over automatic emergency response, like prolonged startle or aggressive outbursts.’
The author continues with this critical and final point, “In PTSD, the critical balance between the amygdala and the medial pre-frontal cortex shifts radically, which makes it much harder to control emotions and impulses. Neuroimaging studies of human beings in highly emotional states reveal that intense fear, sadness, and anger all increase the activation of subcortical brain regions involved in emotions and significantly reduce the activity in various areas in the frontal lobe, particularly the medial prefrontal cortex. When that occurs the inhibitory capacities of the frontal lobe break down and people “take leave of their senses”: they may startle in response to any loud sound, become enraged by small frustrations or freeze when somebody touches them. Psychologists usually try to help people use insight and understanding to manage their behavior. However, neuroscience research shows that very few psychological problems are the result of defects in understanding; most originate in pressures from deeper regions in the brain that drive our perception and attention. When the alarm bell of the emotional brain keeps signaling that you are in danger, no amount of insight will silence it. When our emotional and rational brains are in conflict, a tug of war ensues. This war is largely played out in the theater of visceral experience, your gut, your heart, your lungs will lead to both physical discomfort and psychological misery”.
When one considers this explanation about neuropsychological mechanisms that occur during trauma events, it becomes easier to question how the vast majority of healthcare professionals so easily ignore the impact our minds have on the experience of chronic pain and injury. Our brain is always the first part of our body that is involved in processing traumatic experiences by creating memory files of those events which directly influence central nervous system patterns, yet if mental health professionals and sport psychologists are involved at all, it will only occur at the very end of the physical rehabilitation process when athletes continue to report symptoms of pain and discomfort. Healthcare professionals need to rethink their treatment approach when working with individuals dealing with sports injuries and chronic pain if they want to have a lasting impact. So what are some of the ways in which we can change the physical rehabilitation process?
Part II. Disconnect Between Sports Medicine & Trauma Informed Mental Healthcare
When athletes go to see doctors and physical therapists to treat sport-related injuries or areas of chronic pain, healthcare professionals assess, diagnose, and prescribe physical treatment interventions to address the presenting problem (e.g. improve range of motion, stimulate blood flow to repair damaged tissue, reduce chronic pain, etc.). This is a necessary and fundamental process that must take place in order for the injured body part to regain optimal health and homeostasis. With that being said, this is only one half of the equation and in my professional opinion unless a licensed psychotherapist or a sport psychologist is a part of the treatment process, athletes will most likely continue to experience chronic pain and even worse risk re-injury. In the same way individuals who have experienced psychological trauma need to process their experiences in order to heal, rehabilitating injured body parts also need similar attention from mental health professionals. Why is this the case?
As previously mentioned, when an athlete sustains an injury or experiences chronic pain their brain creates a memory file associated with that experience. In the same way individuals with PTSD experience symptoms such as panic attacks when they are triggered with experiences that mimic their traumatic memories, our bodies have similar PTSD like reactions, but can come in the form of muscle guarding or extreme sensitivity to pain. The subcortical brain structures that were first in line to activate our internal alarm systems during traumatic events keep our autonomic nervous system responses active in order to ensure that we are safe and acting in accordance with our own survival needs. Many athletes who have undergone injuries have probably had the experience of completing physical therapy, but continue to experience weakness, chronic pain, feelings of fear associated with re-injury or even freeze responses. Unless mental health professionals or sport psychology experts are simultaneously involved with the treatment process, these alert systems and traumatic memories will remain in place and keep individuals in this negative crystalized state. So what methods can be used to help ameliorate this issue simultaneously with physical therapy and medical treatment?
Part III. Athletes, Brainspotting & Body PTSD Responses
A new psychotherapy has begun to make headlines within the field of trauma focused therapy known as Brainspotting. I have explored Brainspotting in previous Training Reports which I encourage you to read. Within Brainspotting there are different technical approaches that can be used to help individuals process trauma. One such method is known as Bodyspotting. Bodyspotting is a process where both the therapist and the client identify both the relevant memories along with specific eye reflexes that are associated with the chronic pain and origin of injury. Quite simply, this technique is meant to find the Brainspot for the specific injury or pain that the athlete has experienced within their career. I use this method extensively with the athletes I work with and have had athletes report significant improvement in both reduction of chronic pain symptoms as well as increase range of motion.
Ultimately, my hope is that both athletes and medical professionals that are working towards healing sport-related injuries and chronic pain begin to also incorporate mental health treatment simultaneously with physical rehabilitation. Individuals that choose to place an added emphasis on co-occurring mental health treatment do no necessarily need to exclusively use Brainspotting as a primary psychotherapy. However, it is critical that the mental health treatment intervention utilizes some component of somatic applications in the same way Brainspotting and EMDR use this approach. Athletes and professionals that are able to transcend the stigma associated with mental health treatment will ultimately find that incorporating ‘the other half’ of the body during rehabilitation will more than likely both increase the speed of healing and hopefully reduce the chances of possible re-injury!
Note To Reader:
If you are an athlete reading this segment of the TRAINING REPORT, hopefully this content was helpful! I put the Training Report together because I felt like many of the discussions on issues such as the Yips/mental blocks, strength training & other subject matter on athlete performance concepts were really missing the mark on these ideas (e.g. how trauma is the direct cause of the Yips). If you are interested in learning more, make sure to subscribe below for when I put out new content on issues related to sport psychology & athlete performance! Also, if you are looking to work with a mental performance specialist, you are in the right place! USE THIS LINK to reach out to me to see if my services are the right fit for your goals!
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