MODULE 6 PSYCHOLOGY 310: SPORT & INJURY PSYCHOLOGY UNIVERSITY OF MARY INSTRUCTOR: DR. THERESA MAGELKY SPRING 2016 Imagery in Sport Injury Rehabilitation

Research indicates imagery is one of most popular performance-enhancement techniques in sport Elite, high-level, successful athletes use significantly more imagery than novice, lower-level, less successful athletes However, imagery during sport rehab process is underutilized, perhaps due to lack of understanding regarding how imagery works in rehab setting

Rehabilitation Imagery: Concept Definitions Definitions of Imagery in rehabilitation “cognitively reproducing or visualizing an object, scene or sensation as though it were occurring in overt, physical reality. It evokes the physical characteristics of an absent object, event or activity that has been perceived in the past, or may take place in the future (Dent [1985] cited in Driediger, Hall, & Callow, 2006) In ‘lay terms,’ imagery is an activity which involves creating a clear mental picture of the sporting situations, which can mean the venue, performance, conditions, people, emotions, and feelings involved

Rehabilitation Imagery: Benefits to the Athlete Benefits of Imagery in Rehabilitation: Facilitates athletes’ ability to better cope with injuries Helps athletes manage emotions, anxiety, worry, and stressors associated with their injuries and the rehab process Helps injured athletes deal with pain of injuries Assists athletes in eliminating counterproductive thoughts and aid in development of a “positive self” Increases injured athletes’ rehabilitation motivation and, as a result, adherence and compliance with rehab Prepares athletes for successful return back to pre-injury level of performance, both physically & psychologically

How to Use Imagery Relax (take a few deep breaths before beginning) Close your eyes and create a vivid and convincing image Maintain a positive attitude Have realistic expectations (imagery can help, but don’t expect a miraculous or immediate recovery) Use all of your senses to make the image as realistic as possible If your imagery session is not going the way you want it to, stop and start over… always be in control Dworsky & Krane, 2015

Imagery Some clips on using imagery in sport (watch as many as you would like):      

Types of Imagery Types of Imagery in Rehabilitation: Healing Imagery Pain Management Imagery Rehabilitation Process Imagery Performance Imagery

Healing Imagery Healing imagery involves visualizing and feeling the injured body part healing Can be used to envision internal processes and anatomical healing that take place during rehab Athlete must possess full understanding of their injury and have ability to recreate a realistic picture of the injured area Athlete must have awareness of anatomical healing process and knowledge of treatment modalities employed during rehab Athlete should know what injured body part should look like once healed Dworsky & Krane, 2015

Healing Imagery (cont.) Examples of Healing Images include: Broken bone: cement filling in a break in a bone Torn muscle: muscle fibers braiding together Swollen body part: “bad stuff” draining out of the body Injured ligaments: ligaments getting thicker and stronger or tight muscles lengthening, stretching Dworsky & Krane, 2015

Healing Imagery (cont.) A healing image is one that symbolizes recovery It is an image that creates a mindset for healthy healing To develop healing images, ask yourself:  What images do you associate with injury and/or pain?  What images do you associate with being strong, mobile, or healthy?  What images remind you of healing? These images can be silly; remember that the image only needs to be meaningful to you.

Pain Management Imagery Pain management imagery involves assisting athlete to cope with pain associated with injury Requires athlete to create images of themselves free of pain Examples include:  Pleasant imagining – visualizing yourself in a comfortable and relaxed setting such as lying on a beach  Pain acknowledgement – assigning physical properties to the pain, such as color, size, shape, sounds, and feelings  Dramatized coping – viewing pain as part of a challenge and reframing it as a motivational tool

Sample Healing Imagery Script Take a few deep breaths … Concentrate on your breathing, feel the movements of your body … Just relax, sink into the chair/couch Now focus your attention on your hurt knee … Notice what it feels like … See what it looks like, the swelling, bruising … Concentrate on reducing the swelling … Imagine a leak in your knee and see some of the fluid drain out … Concentrate on the swelling going down … See your knee returning the its normal size … Concentrate on the swelling going down … As your swelling reduces, notice your knee feeling more normal Now turn your attention to feeling the knee getting stronger … See the ligaments coming together … Feel the ligaments getting tighter, growing together … Concentrate on the fibers getting bigger, stronger, tighter … Feel your knee getting stronger Scan the muscles around the knee … Begin concentrating on your quad … Relax the muscle … Feel the muscle become loose and relaxed … To further relax the muscle imagine your quad being massaged … Feel the muscles being kneaded … Notice the relaxed feeling in your quad and all around your knee Notice how your knee feels … concentrate on feeling relaxed … feeling stronger … You are getting better … enjoy the feeling Dworsky & Krane, 2015

Healing Imagery (cont). Clip of Healing Imagery for pain, injury, and disease: 

Pain Management Imagery (cont.) When our muscles are tense, pain often increases. So one way to reduce pain is to become more relaxed. Examples of relaxing images include: imagine tight muscles getting massaged see muscle fibers separating concentrate on feelings of warmth Sometimes it is helpful to distract yourself from thinking about pain. Some distracting images include:  being on the beach or floating in a pool  rehearsing sport skills Dworsky & Krane, 2015

Pain Management Imagery (cont.) Some people associate a certain image with pain (e.g., the color red, sparks or bolts of light). Use imagery to reverse these images.  If red is associated with pain, image the sore body part turning a soothing pale blue  Focus on the bright light getting dimmer Additional examples of pain control images include:  Feel heat/ice on sore body part  Imagine swelling draining out of the body  Imagine pain flowing out of the injured body part  If you have throbbing pain, imagine “pain bubbles” leaving the body with each beat Dworsky & Krane, 2015

Rehabilitation Process Imagery Rehabilitation process imagery allows athletes to create images of the many different aspects of the rehabilitation process that they could potentially experience  E.g., completing exercises, adhering to rehabilitation program, overcoming setbacks and obstacles, maintaining a positive attitude, and staying focused Can assist athletes in dealing with challenges they may encounter during course of rehabilitation Self-efficacy – rehabilitation imagery facilitates recovery through self-efficacy  If an athlete believes and is able to visualize their ability to successfully complete a rehab task or exercise, he or she is more likely to be able to perform well and succeed

Performance Imagery Performance imagery involves the athlete practicing physical skills and imagining themselves performing successfully and injury free Can increase injured athletes’ confidence in their ability to return to sport Imagining themselves back playing the sport may correlate with a decrease in stress and anxiety that many athletes experience when returning to play Can help athletes achieve major performance gains in areas that may not receive priority during regular training Can be useful in allowing athletes to recognize performance gains likely to increase their motivation and potentially improve rehabilitation process

Functions of Imagery in Sport Injury Rehabilitation Three-functional approach to imagery:  Imagery can serve the following functions:  Motivational  Cognitive  Healing

Considerations Regarding Using Imagery Before selecting a specific type of imagery, sport professionals who are interested in introducing imagery to injured athletes need to consider:  Athlete’s rehabilitation situation – to ensure desired outcomes are realistic & purposeful for the phase of recovery  Athlete’s imagery ability  Imagery function – is the purpose of the imagery motivational, cognitive, or healing?  Potential outcome

Using Imagery in Rehabilitation: The Process The incorporation of imagery into injury rehab should follow a systematic & organized sequence of events to increase its effectiveness Two phases of incorporating imagery: 1. Using a theoretical approach to determine type of imagery to be used 2. Following a step-by-step program to integrate imagery into injury rehab

Using Theoretical Approach to Determine Appropriate Type of Imagery At this point, no clear theoretical framework for integrating imagery into rehab exists Applied Model of Imagery Use in Sport (AMIUS) – one of the most prominent frameworks for imagery use in sport AMIUS is centered around imagery type, which acts as a determinant to the possible cognitive, affective, and behavioral outcomes of imagery use AMIUS also proposes that:  Type of imagery used is dependent on the situation in which imagery use occurs  Athletes’ imaging ability can act as a moderating factor affecting the imagery outcomes

5-Step Program to Integrate Imagery into Injury Rehabilitation 5-Step Program for Integrating Imagery into Rehab: 1. Introduce imagery to the athlete with intention of educating him/her about practical application and potential benefits of imagery  “Imagery works the best when the athlete believes it will be beneficial to the healing process” (Richardton & Latuda, 1995, p. 11).

5-Step Program to Integrate Imagery into Injury Rehabilitation 2. Informally assess the athlete’s ability to use imagery  The following questions can be used:  What is your current use of imagery?  Describe your previous history with imagery.  How often have you used imagery and in what context?  How effective has your past use of imagery been? This information can then be used to develop and incorporate an imagery program into the athlete’s rehabilitation.

5-Step Program to Integrate Imagery into Injury Rehabilitation 3. Assist athlete in the development of basic imagery skills (depends on athlete’s history & experience with imagery)  Richardson & Latuda (1995) suggest 15-minute training sessions two times daily:  1 st five minutes: Focus on imagery vividness (ability to create images that are vivid, clear, and realistic in addition to incorporating all senses)  2 nd five minutes: Switch focus to image controllability (the ability to manipulate the image, making it do what athlete wants it to do)  3 rd five minutes: Expose athlete to self-perception of the image (e.g., imagining their best ever performance, if relevant, also for five minutes

5-Step Program to Integrate Imagery into Injury Rehabilitation 4. Once athlete has a basic understanding of skills introduced in Step 3, he/she needs to commit to practice using this skills until it becomes automatic.  Encourage practice in a variety of settings such as before, during, and after rehab-related activities as well as during athlete’s personal time 5. Once athlete has put in the necessary time practicing their use of imagery, it can be incorporated into their rehab program.  Make sure to keep the process as simple and concise as possible.

Guidelines on Maximizing Rehabilitation Imagery Usefulness (Taylor & Taylor, 1997) Specific tips on how to maximize the usefulness of rehabilitation imagery:  Choose the imagery perspective (internal/external) most natural to the athlete and then experiment with the other perspective  Reproduce total performances – using all physical & psychological aspects of injury rehabilitation experience  Combine imagery with relaxation  The most important part of imagery is to feel the effects both physically and emotionally  This can only be achieved if your body is relaxed and you mind is calm  Use imagery to facilitate physical and emotional well-being and feeling good

References Arvinen-Barrow, M., & Walker, N. (2013). The Psychology of Sport Injury and Rehabilitation (1 st ed.). Routledege. Dworsky& Krane, 2015 Kremer, J., Moran, A., Walker, G., & Craig. C. (2012). Key Concepts in Sport Psychology. Sage Publishing.