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THE HUNGRY LISTENER Every athlete, no matter what level of competition, will someday sustain an injury. While a break in training can be devastating for a professional or someone preparing for a possible once-in-a-lifetime event such as the Olympics, injury can challenge the self-efficacy of even a recreational runner. Just this past week in my office I saw one athlete, hoping to make the US Ski team, tear his patella tendon. I also saw a nineteen year old sustaining her second ACL injury in two years, a 31 year old teacher with a meniscus tear that has used running to lose over 100 pounds, and a 50 year old business man who has been playing in the same basketball league “with the young kids” for over 20 years now out for the season. For all of these patients, fitness and athletics are a huge part of their lives. Thus, when they sustain an injury, there will always be a psychological component that effects how they deal with both the injury and, perhaps more importantly, their recovery. (Heil 2000).My skier does not want to hear “well, just go to college and forget about being a professional” any more than the business man wants to ride the couch into old age. The question is, how do we help these folks mentally since we know that is connected to their physical healing? (Brewer 2000) The psychological component of injury is often overlooked because it can be ethereal. Despite degrees in sports medicine and sport psychology, even I find it difficult to wear both hats at once. In A survey of sports medicine physicians regarding psychological issues in patient-athletes to be published in the American Journal of Sports Medicine in the coming year (Mann 2007), sports medicine doctors were asked a range of questions regarding who they believe most often deals with the psychological component of injury. The answers were wide ranging, supporting the concept that, as a rule, there is little communication (or consensus!) between sports medicine and sport psychology personnel. A large number of these doctors felt athletic trainers and physical therapists were best positioned to effectively deal with psychological issues of their patients. As a result, a working of knowledge of some sport psychology principles, or perhaps more germane, knowing when the patient places you in the role of a “sport psychologist”, becomes an important aspect of returning athletes to their pre-injury level. The most difficult part of dealing with an athlete’s psychological stress, particularly for the young trainer or therapist, is where to start. While most of you have taken at least one lecture class in sport psychology, this hardly gives you the background or comfort to deal with such issues. (Of note, orthopaedic surgeons, who most commonly serve as team physicians, receive NO training in this discipline!) Luckily, when you are thrust into the role of sport psychologist or locker room confidante, many things come naturally. Most of us played some competitive athletics in the past giving us significant insight. More importantly, most of us have chosen our careers because we are in the business of helping people. In other words, caring, concentrating on the physical aspects you can control and were trained to do, and simply being interested in your patient’s health doing are big steps toward both anatomical and psychological healing. With that in mind, what I would suggest for those of you who are already overwhelmed by the physical issues your patients face, is not to get bogged down by too much sport psychology theory. One simple concept you might consider however, is practicing “hungry listening”. Hungry listening is a phrase attributed to Zora Neale Hurston (Hurston 1937) and is basically what it sounds like: listening with interest and concern. While listening sounds easy and is something that you already do, when you stop and think about it, neither is probably the case. Therapy areas can be pretty busy places. Weights are crashing, balls are being tossed, and phones are ringing. Your energies are engaged in the task at hand (make that two or three tasks at hand!) which leaves little time for what the patient is saying, or, more often the case, not saying. The best trainers, therapists and doctors are the ones who take that extra moment to listen to the patient. First, they will give you a lot of practical physical information, and here perhaps can be primed with a few questions. Do they think the therapy is a waste of time? Are they doing their exercises at home? Do they understand what you want them to do between visits? Have they substituted some “soft” work-outs they are allowed during their recovery? Are they worried about time off work or getting back to their starting position on the team? This level of listening should be part of every therapy visit, though often goes overlooked. The next level of listening is what we are calling “hungry listening”. Hungry listening involves being alert to the meaning of the words and the space between the words. Some people can listen hungrily in the course of a massage or other treatment, while others might have to designate a specific time during the patient encounter or even make a separate time later. At this level we are trying to go deeper than just the physical strategies of recovery you are employing, and touch on some psychological components. What are they saying about their coping strategies? (Udry 1997) Are they depressed, even suicidal? For a hungry listener these questions will usually be answered without any prodding on your part. In fact, in the training room or medical office visit, I have not found posing specific questions to be particularly effective; I try to just give the patient room to talk. Remember, you are not making a diagnosis nor doing therapy, you are simply making sure nothing is standing in the way of complete healing. Certainly in the thankfully rare instance where serious psychological issues arise from such communication, the appropriate consultation should be obtained. Return from injury does not always follow a straight line path. Someone can be doing great one day and show up disconsolate the next. Once athletics are eliminated from a person’s life, they do not automatically spend that new-found time on healthy things such as family or work. They often perceive that everything in their life “falls apart”. This is especially true for student athletes, where the team often functions as their family and support structure. Are they getting to all of their classes? Have they talked to their academic adviser? These are questions students will usually answer and can give an indication of their mental state. I did a study with one of my student-athletes a number of years ago where we looked at grades the semester after a season-ending injury. Contrary to our hypothesis, despite the extra time to study, grades actually decreased. One more personal example if I may. Last week I had an elderly patient and her husband making a fuss in the waiting room because they had gone to the wrong office for their appointment. They blamed my secretary and were vocal and somewhat inappropriate in the waiting area. When I saw her in the exam room she told me that her husband was just given a diagnosis of inoperable cancer and was not expected to live more than a few months. If I had scolded her before listening, I would have felt not only silly, but like a terrible doctor. You might not have any answers or the power to change their circumstances, but hungry listening can often lead to tangible actions that can lead to better results. Imagine if communication with a coach, a case worker, or parents could improve an outcome by relieving anxiety during recovery. This is a phone call you always want to make. When my patients apologize to me for taking my time by expressing concerns not directly attributable to their physical state, I quickly point out that my job is to care for them. My time is supposed to be spent answering their questions, calling their boss, chatting with their therapist, anything that will speed recovery. If I don’t listen, if I don’t take that extra minute to listen to their questions and concerns, I might not get potentially useful information and thus, not as good a result. Hungry listening does not come naturally to Americans. As your reputation gathers steam, there will be more claims made on your time. Do not give up this quality that will make you more successful. You will never know if what you are doing is working unless you listen with ears wide open. In future articles, we will discuss how you can use sport psychology principles such as goal setting, imagery, self-talk, etc. to make you better at your profession. These can be effective modalities but not something you need to be thinking about in the course of taking care of the patient’s physical needs. For now, leave specific psychological modalities to the sport psychologists and coaches. In the meantime, becoming a hungry listener will make you an even more valuable asset to your patient’s recovery. References Brewer, B.W., Van Raalte, J.L., & Cornelius, A.E. (2000). Psychological factors, rehabilitation adherence, and rehabilitation outcome following anterior cruciate ligament reconstruction. Rehabilitation Psychology, 45, 20-37. Heil, J. (2000). The Injured Athlete. Emotions in Sport, 245-265. Klimkiewicz, T.J.(2002). Meniscal Surgery Update. Arthroscopy,18, 14-25. Udry, E. (1997). Coping and Social Support Among Injured Athletes Following Surgery. Journal of Sport & Exercise Psychology, 19, 71-90. Mann, B.J., Grana, W.A., Indelicato, P.A., & O’Neill, D.F. A Survey of Sports Medicine Physicians Regarding Psychological Issues in Patient-Athletes. American Journal of Sports Medicine, Publication pending. Hurston, Zora N. Their Eyes Were Watching God. J.B. Lippincott Company, 1937. |
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