Drew Brannon, Ph.D.Licensed Psychologist
Brief backgroundCase of MadiDiagnosis and managementReturn to play considerationsPrevention and protocolDiscussion
Public’s understanding vs. actual service delivery
Variability in training has created confusion
DepressionAnxietyGrief/lossSexual traumaEating disordersAnger
Performance AnxietyBurnoutFocusInjuryConfidenceRole changesCareer transitionGoal setting Motivation
Collegiate student-athlete
High level soccer player
Key team contributor
Sister: diagnosed with ADHD
Mother: notable symptoms of anxiety
Madi: first collegiate student-athlete in family
Both parents busy/successful working professionals
One previous ACL tear during high school (11th grade)
Extensive physical therapy
Complicated rehab process
Slow recovery
Diagnosed with ADHD @ 7 y/o
Prescribed Focalin XR (20mg)
History of disruptive/risk taking behaviors
History of depressive episodes since age 14
Fall preseason camp prior to Sophomore year
Three-a-day practices
Day 9
MRI confirms tear
Surgery scheduled
Procedure performed
1. Denial2. Anger3. Bargaining4. Depression5. Acceptance
(Tracey, 2003; Leddy et. al.,. 1994; Udry, 1997; Heil, 1993)Greatest mood disturbance during initial phase
following injury
Early recovery process greatest period of emotionality
Critical point of psychological intervention occurs in first three weeks post-injury
Disengagement from team
Perceived lack of interest from coaching staff
Overly involved parents
Need for attention
Sense of helplessness
Absence of sport removes her only known coping mechanism
Now has more time on her hands
Peer group heavily involved in alcohol use/abuse
Disagreement regarding rehab
Poor compliance with rehab
Impatience from all parties
Initial consult mandated by team physician
Gathering of information difficult due to lack of cooperation
Was willing to discuss other things, which slowly built rapport
Madi becomes more willing to attend
Disclosure of family dynamics clarifies nature of several problem areas
Trusted information eventually shared
Onset of depressive symptoms
Poor self-care practices
Lack of regard for behavior
Effects of social choices
Inconsistent motivation
Unhappy with role on team
Lack of trust toward coaches
Identity confusion
Extensive clinical interviewing
Beck Depression Inventory
Collateral information
Psychiatric consult
Weekly counseling sessions
Medication management
Consults with sports medicine staff
Willing and motivated toward rehab
Improved sleep and dietary habits
Increased independence from parents
More engagement with support systems
Clearance from sports medicine staff
Psychological symptoms to benefit from return
Significant anxiety necessitated controlled return
Hesitation about return due to fear of regression
Cognitive-behavioral therapy
Self-talk affirmations
Guided imagery/visualization
Watched game tape
Read old press releases
Talked to high school and club coaches
Role of psychological services in long-term rehab
Sport psychology consult protocol (pre-op, post-op, monthly follow-up, PRN)
Comprehensive treatment team approach
Qualified team leaders
Life skills programming
Caring coaches
Power of the shared experience
Knowing you’re not alone
Receiving ideas for getting through adversity
Better use of time that other activities?
What could I have done differently in this case to improve the situation and/or outcome?
What are critical psychological factors for sports medicine professionals to consider in athletes during long-term rehab?
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