Monthly Archives: August 2019

Why aren’t we educating those supporting injured players about mental health?

By Caroline Heaney

Photo by Fancy Crave on Unsplash

Recently, The Independent reported that professional football clubs are failing to provide injured players with the psychological support they need (Lovett, 2019). The psychological impact of sport injury is well documented – for example, the IOC consensus statement on mental health in elite athletes (Reardon et al., 2019) recognises that sport injury can have a significant impact on mental health, and several sportsmen and women (e.g. footballer Danny Rose) have cited injury as a trigger for mental health difficulties. So why is it that the psychological aspects of sport injury are being ignored in professional football?

The article in The Independent, which explored a study conducted by Dr Misia Gervis, pointed towards a lack of education and training amongst medical staff treating injured players – an area that I have researched extensively with my colleagues at The Open University. My early work in this area (Heaney, 2006) investigated the attitudes and perceptions of physiotherapists working in professional football and identified that whilst physiotherapists recognised that injury had a psychological impact they largely did not have the education or training to be able to respond effectively. This was supported by our 2012 investigation into physiotherapy education in the UK (Heaney et al., 2012) which revealed great diversity in the provision of psychology education in physiotherapy programmes and an inconsistency between the reported importance of psychology and the demonstrated importance of psychology through its visibility within the curriculum.

Photo by Jesper Aggergaard on Unsplash

These findings indicate that UK physiotherapy training does not adequately prepare sports medicine staff for dealing with the psychological aspects of sport injury and that training in this area would be beneficial, but is this the case? To answer this question we conducted two further studies. The first (Heaney et al., 2017a) examined the sport psychology related attitudes and behaviours of ninety-four qualified sports injury rehabilitation professionals (physiotherapists and sports therapists) working in sport. These professionals were split into two groups – those who had been exposed to education on the psychological aspects of sport injury as part of their undergraduate or postgraduate studies and those who had not. It was found that those who had studied the psychological aspects of sport injury integrated significantly more sport psychology into their practice and referred more athletes to sport psychologists for further support than those who had not.

Photo by Hussain Ibrahim on Unsplash

The findings of this study suggest that sport psychology education is beneficial to sport injury rehabilitation professionals and the athletes they treat, but what about the professionals who aren’t lucky enough to receive sport injury psychology education as part of their undergraduate or postgraduate training? How can they access the benefits of sport injury psychology education? We wanted to know whether post-qualification continuing professional development (CPD) training on the topic can derive the same benefits and so we conducted a further study (Heaney et al., 2017b) exploring the impact of an online sport injury psychology education module on the attitudes and behaviours of ninety-five physiotherapists working in sport who had not been exposed to sport psychology education as part of their undergraduate or postgraduate training. The physiotherapists were randomly assigned to either an intervention group who studied an online CPD module titled ‘sport psychology for physiotherapists’ or a control group who studied an equivalent online CPD module on strength and conditioning which had no psychology content. Physiotherapists working in sport tend to be busy professionals who work unsociable hours and travel a lot (e.g. traveling to competitions across the country or the world) and therefore it was important that the CPD module was flexible, accessible and of a duration that would promote adherence. Consequently, an online format was adopted with a study duration of approximately 12 hours. The ‘sport psychology for physiotherapists’ module covered three main areas – (1) understanding the psychological impact of sport injury, (2) psychological skills and techniques for injured athletes, and (3) referral and professional boundaries. Attitudes and behaviours towards sport psychology were measured before the module and at three points after the module had been completed (immediately, 3 months and 6 months after). It was found that those who had studied the sport psychology module demonstrated an improvement in their attitudes towards sport psychology immediately following its completion that was significantly higher than those who had studied the control module. Use of sport psychology also increased following the sport psychology module, with significant differences seen between the intervention and control group indicating that those who had studied the sport psychology module were integrating more sport psychology techniques into their practice than those who had studied the control module.

Photo by Jesper Aggergaard on Unsplash

The findings of this study indicated that CPD courses can address the limitations that some physiotherapists and other members of the sports medicine team have in their understanding of the psychological aspects of sport injury, but it also uncovered another issue – a distinct lack of CPD offerings in this area in the UK. We have sought to address this by developing a free Badged Open Course Exploring the psychological aspects of sport injury, which we hope will contribute to bridging the gap, but more still needs to be done to ensure that sport psychology is properly integrated into undergraduate and postgraduate training so that injured players get both the physical and psychological support they need during sport injury.

Its not all doom and gloom when it comes to this topic and its important to note that some professional football clubs do utilise sport injury protocols that integrate psychological factors and use multidisciplinary sports medicine teams that include sport psychologists to support the injured athlete. Indeed, The Independent article gives the example of Queens Park Rangers where sport psychology is firmly embedded within the treatment room. Dr Misia Gervis suggests that for this to become more commonplace “a cultural shift of practice is needed by medics, physios and coaches.” It is my belief that educating sports medicine professionals is the first and key step to enabling this cultural shift.

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Please watch the video to find out more about the free Badged Open Course (BOC) Exploring the Psychological Aspects of Sport Injury

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Bernal’s ‘amazing engine’: how do endurance athletes’ hearts differ?

By Nichola Kentzer

Many will remember the 2019 Tour de France for its premature finish caused by hailstorms and landslides, rather than the incredible achievements of the endurance athletes. To complete the 21 stages spanning 3,480 kilometres is an extraordinary feat – but what is it about these athletes that allows them to do it? The physiology of a Tour de France rider has been examined in depth by scientists (e.g. Santalla and colleagues in 2012), but in this short article we will be focusing on just one aspect, the heart.

The heart of the matter

Chris Froome described Egan Bernal, the 2019 Tour champion, as having ‘an amazing enginereferring to Bernal’s heart, the muscular pump, that drives blood around the body to perform essential functions. Located in the left-hand side of the chest and typically about the size of a clenched fist, Bernal’s heart’s ability to pump the required oxygen to his working muscles to complete the mountain climbs and long distances, is the key to his success.

We can make such statements because, on examination, as the athlete trains their hearts get bigger and stronger meaning they can pump more blood per beat. Indeed, athletes often have a larger than usual left ventricle, developed through conditioning the body to be as efficient as possible. Referring to these adaptations to training, Bradley Wiggins was described as have a heart ‘like a bucket’ after his 2012 Tour victory.

Because of this increased efficiency, and the trained heart’s ability to pump more blood per beat, a key indicator of an endurance athlete’s heart efficiency is their resting heart rate. Where an average adult’s resting heart rate might be between 60-90 beats per minute (bpm), a Tour de France cyclist can have readings of lower than 40 bpm. Physiological tests carried out on Chris Froome by Team Sky to quash doping allegations after his Tour successes, showed that his resting heart rate dropped as low as 29 bpm.

Cycling is not the only sport that produces these super athletes. Biathlon, combining cross country skiing with precision target shooting, is widely recognised as one of the most challenging winter endurance events. Indeed, the two activities seem unlikely partners with one requiring strength, speed and endurance and the other requiring concentration and a steady hand (while your heart is still thumping from the exertion!).

Top French biathlete, Martin Fourcade, winner of over 20 World Championship medals, over 120 World Cup medals and seven Olympic medals posted his own resting heart rate readings on his Instagram account in 2017. He reported an incredible 25 bpm. Although this reading is his own, and biathletes do specifically train to lower their heart beat to enable more accurate shooting, the value is incredible considering the lowest resting heart rate on record is 27 bpm.

This level of efficiency can also be examined through a second measure: cardiac output the amount of blood ejected from the left ventricle in one minute. It is calculated by multiplying the person’s heart rate by their stroke volume (amount of blood pumped from the left ventricle in a single heart beat). Therefore, with the trained endurance athlete’s larger left ventricle and lower resting heart rate, they can pump out more blood per beat and their heart needs to beat less frequently to achieve the same cardiac output.

And for those of us who are not elite endurance athletes?

Comfortingly for us mere mortals, and important knowledge for those working in the sport and fitness industry, regular exercise (not necessarily long-distance cycling!) improves heart health and increases cardiac output. This enables us to reduce our resting heart rates and for our bodies to become more efficient, even if not to the extreme levels of the athletes discussed above. So instead of sitting at your desk during your lunch break take a brisk walk, opt for the stairs, and park a few hundred metres further from the supermarket entrance, as these small changes can all improve your heart and most importantly your health.