Utilizing Imagery to Enhance Injury Rehabilitation

Author: Marty Durden

Marty Durden, Ed. D., United States Sports Academy
M. Ed., Troy University

Athletic Director
Presbyterian School
5300 Main Street
Houston, TX
mdurden@pshouston.org
(706) 681-5904

Marty Durden is the Director of Athletics and Director of the Presbyterian Outdoor Education Center in Houston, TX. He serves as adjunct professor in Sports Management for Concordia University, Austin TX. He also serves as adjunct professor in Educational Leadership at Bellhaven University in Jackson, MS.

UTILIZING IMAGERY TO ENHANCE INJURY REHABILITATION

ABSTRACT
Recovering from injury is an unfortunate byproduct of athletic participation. The rehabilitation process can be an arduous experience full of discouragement. The athlete who approaches rehab with a positive attitude and a goal-oriented plan can turn the tough task of recovery into an affirmative experience. Therapy can result in the athlete being better prepared for future obstacles and in a better position to succeed. The athlete who takes charge of the rehabilitation process in a proactive manner has an improved chance to overcome the debilitating effects of injury.

A proven method that enhances the rehabilitation process is the utilization of mental imagery. Wise use of imagery techniques streamlines the recovery period and minimizes the psychological damage to the athlete. Imagery allows the athlete to participate actively in the progression and assume ownership for recovery. Utilizing imagery techniques allows a locus of control that lends hope for a timely return to competition. Visual imagery allows the athlete to see the movements that lead to restoration. Emotive imagery allows the athlete to see the possibilities that lead to recuperation. Healing imagery allows the athlete to sense and see the transformational process of recovery as the body responds via the natural effects of the healing. Utilization of imagery allows the athlete to be stronger than before, armed with a positive self-image, and satisfied with the efforts that brought them through this tough struggle.

Keywords: anxiety, emotive imagery, healing, healing imagery, imagery, injury, rehabilitation, visual imagery

INTRODUCTION
Injury is inherent in sports. Athletes encounter a higher exposure to the possibility of injuries. Anxiety toward the possibility of injury has been found to create a higher predisposition to this risk (Ivarsson, Johnson, & Podlog, 2013). Athletes who possess diminished ability to cope with the stressors of sport have a higher risk of injury, and face greater difficulty during rehabilitation (Scherzer &Williams 2010). People who have the cognitive ability to view stress in a more positive light are able to create more positive “eustress” and less “distress” (Scherzer & Williams, 2010). The sports programs that treat the entire person–and not just the injury–are more likely to help the athlete overcome the physical, and psychological stress that results. Three effective mental imagery techniques that positively promote the healing process for injured athletes are visual imagery, emotive imagery, and healing imagery.

Visual Imagery
Visual imagery is one effective method to help athletes recover more quickly. By utilizing imagery, athletes see themselves performing the movements of their sport. The ability to see the sport by utilizing the imagination creates a sense of motivation to return to the game. Athletes who consider negative visual metaphors are taught to redirect their thinking to positive images through the technique of self-talk. Athletes who experience difficulty visualizing can use video performances to augment their thinking process (Williams, Scherzer, 2010). Relaxation prior to the attempt to visualize helps the athlete recall the movements more vividly. Bassett, Hall, Foley, Maddison, Prappavessis and Wesch (2011) stated that positive visual imagery: (1) enhanced the coping skills of injured athletes and, (2) allowed them to more readily adhere to the rehabilitation regimen (Bassett, et al., 2011). Utilizing visualization as a practice technique, or rehearsal movement helps injured athletes to maintain their fundamental skills. If an athlete can first see it, then she can do it—this is the essence of visualization.

An example of proper visualization to enhance rehabilitation is the instance of a golfer who has incurred an injury that prevents him from gripping the club. To initiate the process of rehabilitation, the injured golfer views videos of skillful swings. The golfer also studies archived personal swings. Golf is a game of visualization, as golfers are taught to see the swing before executing it. Mental rehearsal during the beginning phases of rehab is particularly beneficial as it allows the player to retain vivid mental images of recent performances. The combination of seeing swing demonstrations (modeling) with mental imagery (remembering) is proven to aid in the retention of motor skills (Landers, McCullagh, Nilam, Riggs & Skaling, 2006). Some research indicates a relationship between the neural paths that are recruited in visualization as well as motor responses (Duhamel & Sirigu, 2001). Visualizing the movement during rehabilitation is helpful for injured athletes.

Emotive Imagery
Imagery is a poly-sensory technique (Scherzer & Williams, 2010). One of the strongest forms of sensation is emotive memory. Memories trigger emotions. Many athletes associate the playing of the national anthem with a vivid emotional reaction. This particular pre-game tradition affects the emotions of athletes (Scherzer & Williams, 2010). The common denominator for mastering emotive mental imagery is the ability to channel the imagination by association (Brewer & Gimbel, 2014). The cue that elicits this emotional response is triggered by the senses.

When an athlete associates a successful experience with one of the senses, it is easier to recall that event. For instance, an athlete has a great performance, and remembers that the pregame music contained a certain song. To stimulate another great performance, the athlete has only to replay this same song in his mind. Association with this song helps to duplicate the mental state that helped to create the heightened mental state. These same recollections can be generated kinesthetically (Brewer & Gimbel, 2014). Another example is a golfer who executes a great shot and afterward–as a cuing mechanism–rubs her palms together. To increase the chances of repeating this movement successfully, the golfer rubs her hands together again prior to the next shot. All of the senses can be used to stimulate vivid memories of prior successes by utilizing mental rehearsals of associative recall (Petitpas, 1999). Emotive imagery is a significant tool to create a sense of self-efficacy. Human emotions help athletes to transcend the despair that negatively affects the rehabilitation process.

Healing Imagery
Healing mental imagery is an effective technique that can decrease somatic anxiety, and enhance recovery from sport injuries. However, the imagery utilized should be relaxing in nature, as many athletes confuse it with performance based mental imagery. Incorrect imagery can actually heighten anxiety among recovering athletes (Farroll, Mensch & Monsma, 2009). A study by Hamson-Utley, Martin, and Walters (2008) reported positive mean ratings of 4.73 to 5.95 linking relaxing mental imagery techniques to better pain tolerance, and enhanced recovery (Hamson-Utley, Martin & Walters, 2008). Beneficial mental techniques are those that help the athlete to: (1) visualize the specific execution of a performance skill, (2) imagine the exuberant feeling of returning to competition, or (3) understand that other athletes have successfully endured similar rehabilitation. Athletes who journal their progress will benefit from the written record of progress. Journaling and goal setting serve as measurable steps culminating in a return to action. Accomplishing written goals is a motivational mechanism. Athletes that receive detailed information about the healing process, including color pictures of the injured area, are able to understand the reasoning behind their physical therapy prescription (Scherzer & Williams2010). This instruction allows the athlete to understand and visualize the healing process. Healing, relaxing imagery can be enhanced by the utilization of music. Playing soothing music and stimulating the auditory neurons also helps to recall former success (Brewer & Gimbel, 2014). Effective mental imagery is a heightened sense of imagination that fuels motivation for therapeutic rehabilitation.

Case Study
One example of mental imagery is the case study performed by Callow, Evans & Hare, 2008. This study followed the rehabilitation of a 28-year-old Olympic swimmer who was recovering from shoulder surgery (Callow, Evans & Hare, 2008). The therapy that he received included relaxing mental imagery. The respondent provided feedback at every phase of recovery via a questionnaire. The imagery provided hope for recovery to the athlete, and helped him to cope with the associated pain. The patient referred to the mental imagery as a “tool” that has a “positive effect …that made his recovery a lot smoother” (Hare, Evans, & Callow, 2008).

CONCLUSIONS
When an athlete suffers an injury she immediately fears the ultimate bad news–limited or no participation. At this vulnerable point in her athletic career, the injection of hope for a speedy recovery is a welcomed affirmation to lessen the negative psychological effects that often accompany the rehabilitation process. Imagery is an effective, positive, and useful method proven to encourage injured athletes during this tough phase. Imagery that incorporates visual, emotive, and healing techniques is a great way to help athletes on the road back to playing their sport.

REFERENCES
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