Influences of the Mind and Body

Objectives

During the past two decades, sport psychology has received significant and increasing attention from athletes, coaches, parents, and the media. A growing number of elite, amateur, and professional athletes acknowledge working with sport psychology professionals.

Exercise specialists, athletic trainers, youth sport directors, corporations, and psychologists are using knowledge and techniques developed by sport psychology professionals to assist with improving exercise compliance, conducting rehabilitation programs, educating coaches, building self-esteem, teaching group dynamics, and increasing performance effectiveness.

Almost all sports are based on competition. Striving to reach peak performance is appropriate until athletes push themselves beyond their capacity. Exercise is very helpful in alleviating stress, releasing tensions, and producing a relaxing kind of fatigue. However, some people go far beyond this normal response and become overly dependent on daily exercise.

One of the by-products of exercise is the production of naturally occurring brain chemicals that influence mood. Endorphins are morphine-like substances that produce a sense of well-being and relaxation and are responsible for the “runner’s high.” Some people become addicted to daily exercise through production of these chemicals. If they don’t exercise, they become depressed and irritable, and they may actually have withdrawal symptoms. If they become injured, they will make life miserable for everyone around them until they can get back to exercising daily. Many athletes refuse to take time off because of their drive to keep pushing themselves. It can be difficult to get the message across that an injury, like a hamstring pull, may take 3 or more months to heal. This mental outlook often interferes with even the best treatment because the athlete will try to play before he or she is ready.

Muscles may be held in sustained tension owing to overuse, poor posture, and/or psychological or emotional stress. States of anxiety and anger, for example, can create sustained muscular hypertonicity. Emotional stress, such as depression, can also cause decreased muscular tone and loss of sensory motor communication (Figure 8-1).

Appropriate massage can support the work of the sport psychologist by calming anxiety, reducing increased motor tone of muscles, and, to a lesser extent, addressing mild depression. Massage affects the same mood-altering neurochemicals as exercise.

Objective

Studies of athletes, artists, and others have shown that being “in the zone” generally means being in a state in which mind and body are working in harmony. When in the zone, an individual is calm yet energized, challenged yet confident, focused yet instinctive. Different parts of the brain are working together smoothly to automate the movement or skill. This is comparable with the massage practitioner’s being “centered.”

Training the mind is an important step toward getting in the zone. Aspects of mental training for some sports and positions include increasing concentration and focus, controlling emotions, feeling relaxed but energized, being calm and positive, and aiming to feel challenged and confident. A person who is in the zone is free of worries and is confident and relaxed, so that the best performance occurs automatically.

Getting in the zone combines physical and mental training. When the body is conditioned, skills are well practiced, or habituated, and mental conditioning is congruent; a zone experience is then possible.

The implications for massage supporting “zone” functions are vast. Physical sensations of relaxation can help relieve anxiety and tension and improve concentration and focus. Various progressive relaxation methods that involve contracting and releasing the tension in large muscles are used. Massage can induce deep relaxation and support zone functions.

Guided imagery can help reduce anxiety and increase concentration and confidence, and can serve as mental practice or rehearsal. Imagery techniques work well in conjunction with relaxation techniques such as massage because relaxation can help the client better imagine performing the skill required. During massage or other induced relaxation states, the athlete can mentally picture himself or herself performing a specific sport or activity. He or she can visualize being dressed, getting ready to perform, hearing the sounds and smells—feeling the muscles and emotions and envisioning doing the activity, practicing skills, running the race—whatever it might be.

Negative thoughts can get in the way of concentration and confidence. The massage therapist must not be negative during the massage and must support positive and productive thought processes.

Although training the mind and body can lead to more skillful and enjoyable play, it is important to understand that the athlete might not get in the zone all the time. The zone experience does not happen nearly as often as people like to think it does. Do not overfocus on the zone experience during the massage.

Several names may be used for states of being similar to the zone. Each is slightly different, but the basic concepts are the same.

Objectives

Whether the athlete is a competitive or a recreational exerciser, recovering from an injury can present a challenge. How the athlete understands and responds to pain and limitation is a very individual experience based on many factors. However, certain responses and psychological skills can help most people take an active role in their own recovery.

People often initially feel overwhelmed by an injury. The ability to cope will greatly improve if the athlete works closely with the doctor and other health care providers to develop a clear plan for recovery.

Successful rehabilitation begins with becoming informed about the injury. It’s important to know the extent of the injury and anticipated recovery time, and to understand the rehabilitation plan required to recover safely and effectively.

It is important that the injured person considers himself or herself as an active participant in rehabilitation planning and treatment. An individual may not understand the scientific aspects of recovery, but he or she is the expert on his or her own experience—a reality that may help or hinder rehabilitation.

How the athlete responds to the injury is also very important. Although certain sports or activities present greater risk for injury than others, an injury usually is not expected or planned for. Athletes are rarely prepared for the emotional response to an injury.

Injuries have very different meaning for different people. For some, an injury might be life-threatening or career-ending. For others, an injury might take them away from a team or social structure that gives them a sense of identity and community. An injury can also interfere with a job or responsibilities at home. It’s important, therefore, that the athlete acquire the coping skills required to help him or her through the loss—with professional help if necessary.

Athletes should try to maintain a sense of identity and importance through activities that help them feel good. They should express their needs and concerns to the health care team. It is helpful to identify any negative mental responses to injury, then to reframe them to promote a positive approach to healing: be aware of the current level of function and of what function is lost, and then move beyond those limitations to envision the future level of function.

The athlete needs to ask for and receive help and to be surrounded by emotionally and physically supportive people. Interaction with those who hinder the healing process should be eliminated or minimized.

Athletes in today’s society have many problems to deal with, including multiple personal and professional demands, increased stress, and injury. Some athletes know how to successfully deal with injury, and others have a hard time coping with it. The athlete may need professional help to get through the injury healing process, and the massage therapist needs to be supportive.

Injury can negatively impact the mind, emotions, and body. Rehabilitation is often a time of emotional distress.

Injury rehabilitation affects a person in many ways, including the following:

Signs that an athlete is having some problems include these:

When these issues are recognized by the massage therapist, a referral is necessary. Avoid the tendency to try to fix them. Ultimately, therapeutic massage is secondary to, although supportive of, the medical team, including the sport psychologist. Respect for professional boundaries and honoring scope of practice are essential. However, because of the time that massage therapists spend with athletes and the compassionate quality of the professional interaction, we may be the first to notice difficulties. Athletes may share information with massage professionals that was not provided to others working with them.

As massage professionals interested in the sports massage career specialty, we want to understand and help an athlete through an injury. We need to understand the demands placed on the whole person while addressing the injury.

Sport psychology interventions can minimize negative experiences and maximize recovery from injury. Mental training enhances performance in rehabilitation and sport, improving the ability to return to play. Outcome of an injury, degree of pain, and expected performance are important factors in determining how fast rehabilitation should occur.

When coaches or trainers adopt an attitude that injured athletes are worthless, they create an environment in which athletes will continue to participate while hiding their injury, increasing the likelihood of further injury. Similarly, coaches who emphasize a strong will to compete and win, no matter what the athlete’s physical status, promote the idea of sacrificing one’s body for the team, which can cause players to take unhealthy risks and become injured.

All athletes should understand that the nature of participation in sports dictates that at some time, pain and injury are very likely to occur. However, instead of stressing the inherent risks associated with sport, the focus should be on doing those things that can minimize the chances of injury, such as making certain that the athlete is fit, is practicing safe sport techniques, and is learning to recognize when his or her body is saying that something is wrong. If athletes are confident that they have done as much as they can to reduce the likelihood of injury, perhaps their risk of injury will indeed be minimized. Teaching athletes how to distinguish between the “normal” pain and discomfort associated with training and “injury” pain is of vital importance. Athletes who do not learn to make this distinction often become seriously injured because they do not recognize the onset of minor injuries and do not modify their training regimens accordingly.

The individual’s current medical status must also be addressed. Conditions such as diabetes, asthma, and high blood pressure, as well as orthopedic concerns, must be factored into the exercise prescription for rehabilitation or fitness-based programs for performance.

Learning stress management skills is important for athletes—both for enhancing performance and for reducing injury risk. Psychological stress has been shown to predict increases in injury. Stress is thought to increase the risk of injury because of the unwanted disruption in concentration or attention and the increased muscle tension associated with heightened stress. Athletes especially prone to injury seem to be those who experience considerable life stress. They have little social support from others, possess few psychological coping skills, and are apprehensive, detached, and overly sensitive.

Sport massage therapists should learn to treat the whole athlete, not just the injury. They must communicate effectively and factually without instilling fear or unrealistic expectations and with concern for the athlete’s feelings.

No one can work closely with human beings without becoming involved with their emotions and, at times, their personal problems. The sport massage therapist is placed in numerous daily situations in which close interpersonal relationships are important. Understanding an athlete’s fears, frustrations, and daily crises is essential, along with knowing when to refer individuals with emotional problems to the proper professionals. Injury prevention includes dealing with both psychological and physiologic attributes of the athlete. The athlete who competes while angry, frustrated, or discouraged, or while suffering from some other emotional disturbance, is more prone to injury than one who is better adjusted emotionally. Because of the emotional intensity surrounding competing athletes, the massage therapist working with this population needs to attend to his or her own mental health.

Objective

Generally speaking, injured athletes can experience feelings of vulnerability, isolation, and low self-worth. Denial of the reality of the injury also comes into play. All of these feelings can adversely affect the athlete and his rehabilitation. The injured athlete may experience a number of personal reactions besides a sense of loss. These may include physical, emotional, and social reactions. A fairly predictable response to injury often occurs in five sequential stages: (1) denial, (2) anger, (3) grief, (4) depression, and (5) reintegration. Athletes who fail to move through these five stages may suffer adverse psychological effects related to the injury. Such adverse effects are more likely to occur if the injury is season-ending or career-ending.

Some degree of psychological distress and discomfort accompanies most major athletic injuries. However, more serious problems of poor psychological adjustment to injury are often preceded by the following warning signs:

When these warning signs are detected, the athlete should be referred to a sport psychologist or another mental health professional.

Certain factors are commonly seen among athletes going through adjustment to injury and rehabilitation. Severity of injury usually determines length of rehabilitation. Regardless of length of rehabilitation, the injured athlete has to deal with three reactive phases of the injury and rehabilitation process:

Other factors that influence reactions to injury and rehabilitation include the athlete’s coping skills, past history of injury, social support, and personality traits. All athletes do not necessarily have all of these reactions, nor do all reactions fall into the suggested sequence.

Athletes who deal with their feelings and focus on the future rather than the past have a tendency to advance through rehabilitation at an accelerated rate. Those who have a high degree of hardiness, a well-developed self-concept, and good coping strategies and mental skills are more likely to recover rapidly and fully from injury than athletes who lack these qualities.

Athletes who lack motivation and are depressed or in denial have difficulty with the rehabilitation process.

After injury, particularly one that requires long-term rehabilitation, the athlete may have problems adjusting socially and may feel alienated from the rest of the team. The athlete may believe that there has been little support from coaches and teammates. The athletic trainer is responsible for rehabilitation and becomes the primary source of social support. The massage therapist can play an important part in this support process only if the professionals work together. Conflict among professionals can adversely affect this process.

One of the outcomes of an injury may be secondary gain. This can be a beneficial “time-out” (time to rest and refocus) with a decrease in pressures and expectations. Secondary gain can both support and interfere with the healing process.

Psychological strategies and communicative skills used by the sport psychologist help the athlete move successfully through the rehabilitation process. Care needs to be taken to maintain appropriate boundaries during this vulnerable time for the athlete.

The following strategies are used by the massage therapist to support the medical staff:

During injury rehabilitation, management of the emotional demands of treatment and rehabilitation consists of the following:

The massage therapist plays an important supportive role during this phase of rehabilitation and reinforces awareness of physical healing to support rehabilitation.

Objective

Stress is often associated with situations or events that are difficult to handle. How a person views things also affects the level of stress. Unrealistic or high expectations increase the stress response.

Stress may be linked to external factors, such as

Stress can also come from internal factors, such as

It is one thing to be aware of stress in daily life, but it is another to know how to change it. Stress is not just in the mind. It is a physical response to an undesirable situation, and it has the potential to control one’s life. Stress has many sources. Mild stress can result from being caught in a traffic jam, standing in line at a store, or getting a parking ticket. Stress also can be severe and cause major health problems. Divorce, family problems, and the death of a loved one can be devastating.

Stress can be short-term (acute) or long-term (chronic). Acute stress is a reaction to an immediate or perceived threat. Everyday life sometimes poses situations that are not short-lived, such as relationship problems, loneliness, and financial or health worries. The pressures may seem unrelenting and can cause chronic stress.

When a person’s coping behavior is ineffective, a physical stress response occurs to meet the energy demands of the situation. First, the stress hormone adrenaline is released. Then, the heart beats faster, breathing quickens, and blood pressure rises. The liver increases its output of blood sugar, and blood flow is diverted to the brain and large muscles. The massage therapist should recognize signs and symptoms of nonproductive sympathetic dominance.

After the threat or anger passes, the body relaxes again. One may be able to handle an occasional stressful event, but when it happens repeatedly, such as with chronic stress, the effects multiply and are compounded over time.

For example, a football player endures week after week of hits in a season, or a source of pain, and may reach a point of not being able to handle it anymore.

It is evident that there is too much stress for a person to cope with when the following telltale signs appear:

Signs of chronic stress, which can damage overall health, include the following:

Coping with Stress

The following measures can help in coping with stress.

Massage is a major relaxation modality. It supports physical relaxation techniques such as deep breathing, progressive muscle relaxation, word repetition, and guided imagery.

Objectives

Restorative sleep is extremely important for anyone who is an athlete or in rehabilitation. Almost everyone has occasional sleepless nights, perhaps owing to stress, heartburn, or drinking too much caffeine or alcohol. How much sleep is enough varies for different individuals. Although hours of sleep is about average, some people feel fine on only 5 or 6 hours of sleep, and others need 9 or 10 hours a night.

Lack of restorative sleep can affect energy levels, and restorative sleep helps bolster the immune system, fighting off viruses and bacteria.

Insomnia is the most common of all sleep disorders. Insomnia includes difficulty going to sleep, staying asleep, or going back to sleep when awakened early. It may be temporary or chronic. About one out of three people have insomnia at some point in their lives. Simple changes in one’s daily routine, lifestyle, and habits may result in better sleep (Box 8-2).

Insomnia becomes more prevalent with age. As a person gets older, the following changes often occur that may affect sleep.

Between the ages of 50 and 70, more time is spent in stages 1 and 2 of non–rapid eye movement (NREM) sleep and less time in stages 3 and 4. Stage 1 is transitional sleep, stage 2 is light sleep, and stages 3 and 4 are deep (delta) sleep—the most restful kind. Because one is sleeping lighter in stages 1 and 2, one is more likely to wake up. With age, the internal clock often speeds up, and a person may get tired earlier in the evening and consequently wake up earlier in the morning.

A change in daily activity can disrupt sleep patterns regardless of whether the client is less or more physically or socially active. Consistent activity as part of daily activities helps promote a good night’s sleep. The retired client may have more free time and because of that may drink more caffeine or alcohol or take a daily nap. These things can interfere with sleep at night.

A change in health can affect sleep patterns. Chronic pain associated with conditions such as arthritis and back problems, as well as depression, anxiety, and stress, can interfere with sleep. Older men often develop noncancerous enlargement of the prostate gland (benign prostatic hyperplasia), which can cause the need to urinate frequently, interrupting sleep. In women, hot flashes and urinary urgency that accompany menopause can be equally disruptive. Other sleep-related disorders, such as sleep apnea and restless legs syndrome, become more common with age. Sleep apnea causes one to stop breathing periodically throughout the night and awaken. Restless legs syndrome causes an unpleasant sensation in the legs and an uncontrollable desire to move them, which may awaken one or prevent one from falling asleep. Nutritional depletions may be the reason for restless legs syndrome; therefore, nutritional supplements may help. A nutritionist or a physician can help by making recommendations.

The following strategies promote restorative sleep:

The training and competing athlete needs an appropriate amount of restorative sleep. This is typically 8 to 9 hours at night and a 1-hour nap. Playing schedules and travel to different time zones disrupt an athlete’s sleep patterns. Sleeping in a different bed when traveling can be a problem.

 Workbook

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