Over the past decade, I’ve either trained or physically rehabilitated athletes. And in each of these realms, it didn’t take long for me to realize that excelling in any of these pursuits requires more than studying the science behind these endeavors and going through formal academic training, mainly because it’s not entirely about the science itself.
Keeping all avenues of athlete development and wellbeing as science-based as possible is the backbone of my rehabilitation and performance coaching.
But let’s be very clear: there is also an art form woven into the fabric of working with athletes, and in no greater place within my clinical and coaching pursuits have I found this to be truer than when working with athletes dealing with injuries.
So, let’s talk about this beautiful art and why it matters.
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Injuries, while undesirable, are an inherent part of athletics. And no matter how significant or seemingly inconsequential an injury may be, there are always lessons to be learned from them — both for the athlete and the professional (coach, therapist, etc.) who works with the athlete. These lessons, if we allow them to, serve as opportunities to make us better at what we, as coaches and performance specialists, do.
Learning from injuries is vital for all of us because no matter one’s particular role with athletes — be it as a strength coach or a rehabilitative professional — you will be working with athletes who, in one capacity or another, will be looking to you for some form of guidance and support as they navigate the world of injury, pain, and emotionally challenging setbacks.
Of course, any of us working with athletes has a respective scope of practice to which we must adhere. And while imperative to do so, we must also realize that when helping athletes navigate the unsettling waters of physical setbacks, there are universal strategies each of us can implement that transcend individual scopes of practice. Most of which, I would contend, comes through the art of working with athletes and not strictly from the science.
What follows is a list of the most important lessons I’ve learned over the past decade of either training or rehabilitating athletes. Take what speaks to you and weave it into your own coaching or rehabilitative fabric. Feel free to leave the rest. I’m writing this on the presumption that we all want to continually grow and evolve in ways that allow us to better train, treat, and serve our athletes. The sharing of anecdotal experiences is one of those ways we can help each other evolve with and improve what we do.
Therapeutic alliance: Everything is built on trust
I’m not one for cliches, but there is a profound truth to the phrase, “People don’t care about how much you know until they know how much you care.” Athletes are, in fact, people, and people are more inclined to work with others who foster a sense of trust. Trus is where the therapeutic alliance officially starts.
Regardless of one’s role in working with athletes, all of us must remember that these athletes are humans and that emotions can run high when injuries arise. Despite our credentials or knowledge, we must remember that athletes navigating the world of injury don’t merely want to be impressed; they want to be heard and understood. They want you to know how hard they work, what their pursuits mean to them, and how unsettled they often feel when a physical issue is holding them back from their pursuits.
Keeping athlete development and well-being as science-based as possible should be the backbone of rehabilitation and performance-based training…but there is also an artform woven into the fabric of this process.
Often, we may feel this understanding is implied, but assuming such can be detrimental to the athlete; athletes all have different perceptions, personalities, and experiences they carry with them in their pursuits. As such, not all of them will inherently know how invested you are in their endeavors, no matter how much you love what you do.
Once an athlete feels heard, knows that their needs are understood, and that you are working in their best interests, only then will they make their absolute best efforts to adhere to any professional (coaching or clinical) insight you may be qualified to provide.
This is all about communication, often with more listening involved than speaking on our part. Questions such as “Where are you at with all of this,” and “Tell me more about that” not only provide me with valuable insight into the athlete’s well-being but also subtly reinforce to the athlete that their needs are being heard.
For anyone (particularly rehabilitative professionals) looking to further explore fostering the therapeutic alliance and the outcomes it generates, I would highly recommend you check out the book Compassionomics: Evidence That Caring Makes a Difference by Anthony Mazzarelli and Stephen Trzeciak. There is some seriously cool research and science within its pages.
Ultimately, it comes down to providing athletes with an indwelling sense of hope, which research shows can make a profound difference in athlete recovery following injury. Check out the journal article below to learn more:
Fostering a sense of relatedness with the athlete
In the world of psychology, the model of self-determinism provides a theoretical construct for how human beings (in this case, injured athletes) attain maximal motivation in a given pursuit. The model attests that humans require three particular criteria to be achieved to become motivated to the greatest extent possible.
These criteria are:
1. A sense of autonomy
2. A sense of competency
3. A sense of relatedness
Autonomy simply means the individual feels they have a say or input to the task at hand. Competency refers to the individual feeling they are effective with and have mastery in their activity. Relatedness is all about the individual/athlete feeling a sense of connectedness or belonging with others.
While I encourage all strength coaches and healthcare professionals working with athletes to fully appreciate and incorporate each of these three principles in their own respective ways for their athletes, fostering a sense of relatedness is the focus of this article, mainly due to the avenues of trust it opens up between the coach or rehabilitative specialist and the athlete.
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This relatedness can perhaps be thought of as a branch of the therapeutic alliance, and it is a powerful way to create buy-in with the athlete regarding their willingness to adhere to the path any of us are helping them to navigate in the gym, in the clinic, or on the track.
As strength coaches and rehabilitation professionals, we often make intense, deliberate efforts to maximize an athlete’s motivation toward their desire to succeed in their sport (i.e., when not injured). While this is indeed a worthy cause, we must also make the same intense effort with their desire to succeed in their rehabilitation, be it from minor or extensive injuries.
In the athlete’s eyes, the only thing better than working with a professional whom they trust is working with a professional they can relate to, and there’s always at least some capacity to which this can be achieved. You can put their mind at ease when they make the connection that you’re someone who appreciates, identifies with, and finds value in their endeavours.
During the trust-building phase, making the rationale explicitly clear for your plan of action for the athlete is crucial.
You can think of this mind-easing moment as the one when the athlete realizes why you’re so keen on ensuring they feel heard and why you are making an effort to validate their experiences; they realize you’re not merely listening because you’re a good person, but because there are common threads between your experiences and theirs that can be woven together into a sense of relatedness. The weaving of such relatedness helps athletes feel they’re in good hands and creates substantial buy-in with all avenues of the road back to full health.
Athletes appreciate brotherhood and sisterhood, and this extends beyond teammates; feeling connected to their network of coaches and clinicians is just as important to them.
Sharing your own experiences with the athlete regarding how agonizing it feels to be sidelined from competition or the frustration you’ve felt when an injury has seemingly stripped off months or years of training efforts are simplistic – yet highly effective – examples of how the professional can serve to strengthen the sense of relatedness with the athlete.
In doing so, it’s as if the athlete is reminded that the injury island they currently feel stranded on has been inhabited by others, such as yourself, and that getting off the island is entirely possible if they adhere to the return-to-play protocols we, as coaches and clinicians, provide.
Talking about your own love for being in the weight room or on the track, striving alongside teammates in past days, good memories of hard-fought victories — whatever YOU feel the athlete can relate to, attempt to share them with the athlete in a professional manner.
When you tap into the wavelength they operate on, you can almost see the moment when the therapeutic alliance is taken to the next level. It’s remarkable stuff.
Initiation of trust: Knowing the “why” behind your plan
Naturally, the fostering of a strong therapeutic alliance can take time to develop. As such, don’t expect athletes to blindly hand you their trust the moment you begin working with them (though expect it to develop quickly). Forcing an athlete to trust you is like forcing water to flow uphill — it just won’t happen.
During the trust-building phase, making the rationale explicitly clear for your plan of action for the athlete is crucial. To be clear, it’s always a good idea, but it’s essential when an athlete is still “feeling you out,” or you don’t know them all that well yourself. Blindly assuming an athlete will naturally understand the why behind the rehabilitative approach can be disastrous as it opens up many avenues for unintended setbacks.
As rehabilitative professionals, our tough love must be built upon the foundation of unconditional positive regard for the athlete, of which they must be made aware.
Very often, at the end of a session, I will ask the athlete to repeat back to me why I have made specific changes to their strength & conditioning program (if working with them in the gym) or have them tell me in their own words the basic nature of their injury (if working with them in the clinic). If they can’t do this, I can’t be confident they will adhere to the rehabilitative plan ( either knowingly or unknowingly) to the best extent possible.
However, if they can accurately give a general recap of why the plan has been implemented or why the return-to-play protocol looks the way it does, I have much greater assurance they will avoid unintended setbacks along the way.
To be clear, athletes will always benefit from understanding why you’re taking specific actions or approaches regarding their injury. However, it’s most crucial in the early stages when trust is being developed. As time goes on, they may be happy to blindly trust you, which, should this take place, is the hallmark of a strong therapeutic alliance.
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Injured athletes: They may hate you in the moment but will thank you in the long run
Any coach or performance specialist knows athletes don’t want to be on the sidelines. They will do all they can to stay in the normal athletic rhythms of training and working with their team or for their individual pursuit. Naturally, we need to expect blowback when we tell them things need to temporarily change; they don’t like hearing they need to pull back on specific aspects of their training, do rehab, sit the next competition out, or need medical clearance before returning to their activity.
They’re human. They often won’t like you for it. Don’t take it personally — it’s just the athletic spirit speaking within them when they encounter your tough love. But you must put your foot down as a means to protect them and think long term.
This is often easier to do when you make it explicitly clear to every athlete who needs to be sidelined for a specific duration of time that you never want to take them out of their sport any more than they want to pull themselves out.
Again, if the athlete trusts you, you can be confident that you can do this without negative repercussions and that your message will be taken to heart in the appropriate context. Try to do this with an athlete who isn’t aware you have their best interests, however, and they will likely shut down or ignore your message entirely.
It’s a delicate balance as our tough love must be built upon the foundation of unconditional positive regard for the athlete, of which they must be made aware. We don’t want our athletes to miss out on what they find meaning in; we always want the best for them, which often involves thinking long-term and beyond the emotions they feel in the present.
As coaches and practitioners, our respective specializations and qualifications help us understand physiologic nuances of which the athlete isn’t aware. This, in turn, guides us with our decision-making for the athlete’s training or rehabilitation in the gym, on the field, on the track, or in the clinic, even when it doesn’t make sense to them.
Ultimately, these specializations and qualifications allow us to put our foot down and pull them back (or out) from their training and competitive pursuits, even if the athlete feels their injury is inconsequential or that they’re fully healed.
As such, if you need to pull them back or temporarily take them out of their pursuits, give them permission to be upset with you, if needed. It’s actually not personal – it’s the athletic spirit shining through, which can be prone to failing to see the big picture in the heat of the moment.
Give them grace when this happens. You’re keeping them safe and prolonging their career, and they will ultimately thank you in the long run once they’ve made a safe return to sport.
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Final thoughts
Helping athletes experience the best possible game, season, and career relies heavily on science, but there is also an art in doing so. No matter how nuanced it may seem, this art is just as critical as the science itself. And, perhaps, in no other realm is the beauty of this art as evident as when helping athletes come back from their injuries.
Hi! I’m Jim Wittstrom, PT, DPT, CSCS, Pn1.
I am a physical therapist who is passionate about all things pertaining to strength & conditioning, human movement, injury prevention and rehabilitation. I created StrengthResurgence.com in order to help others become stronger and healthier. I also love helping aspiring students and therapists fulfill their dreams of becoming successful in school and within their clinical PT practice. Thanks for checking out my site!