November 30, 2021

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The hidden battle Wales’ top rugby stars must fight when returning from long-term injuries and how they come out on top

The hidden battle Wales’ top rugby stars must fight when returning from long-term injuries and how they come out on top
It is generally accepted that injuries are an unfortunate inevitability in professional sport. Lists of injured players at Wales’ four professional rugby sides are consistently in the double figures, with some of the nation’s brightest stars currently battling their way back. Leigh Halfpenny, George North and Dan Lydiate are rehabilitating from long-term knee ligament injuries…

It is generally accepted that injuries are an unfortunate inevitability in professional sport.

Lists of injured players at Wales’ four professional rugby sides are consistently in the double figures, with some of the nation’s brightest stars currently battling their way back.

Leigh Halfpenny, George North and Dan Lydiate are rehabilitating from long-term knee ligament injuries and Josh Navidi has just had shoulder surgery.

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Justin Tipuric is dealing with a fractured shoulder and James Davies is out with concussion-related issues, while Rhys Patchell hasn’t played in more than a year after encountering a number of problems including concussion, hamstring and calf issues.

As well as those mentioned above, Gareth Anscombe and Ellis Jenkins have recently returned from more than two years out of the game and are about to reacquaint themselves with the Test arena in the coming month.

Clearly, there are physical obstacles to overcome in the rehabilitation of almost all injuries and most would have a decent grasp of what they entail.

But what is often lost on those of us sitting outside elite environments is the psychological impact that a long-term injury has on a rugby player, and the mental barriers they must break to return to their stage.

To gain a greater appreciation of this often overlooked aspect of returning to action, WalesOnline spoke to Professor Stephen Mellalieu, who has lectured in sports psychology for the last 21 years and worked within Welsh rugby for 16 of them.

He explains that there are typically three phases players will experience when dealing with long term injury – and the first one involves coming to terms with it.

This is the phase that players such as Navidi may find themselves in at the moment, having only recently had the injury.

“The first stage is the initial processing of the injury itself,” said Professor Mellalieu. “Sustaining a long-term injury is usually pretty painful and at this initial stage of the injury it’s about processing that traumatic event itself and come to terms with it.

“When we get trauma in life, the typical response is one of distress. So it’s about trying to support the athlete around that.

“For the professional athletes, once they start to come to terms with being injured, thoughts may turn what this means for their careers. All professional athletes will have a range of detailed goals and targets they set for themselves.

“If you’re an international rugby player, there will likely be a block of Test matches coming up, a Lions tour or a European Cup competition – there will always be something that they are working towards.

“There is likely to be some realisation that they’re not going to get to that goal or target and subsequently initial frustration, disappointment and anger can set in quite quickly.

“Players have to process the trauma and then the feelings of disappointment and upset that they may miss out on some big events in their sporting calendars.”

Josh Navidi recently suffered a shoulder injury

The middle phase of dealing with the psychological effects of being injured is the long haul.

It is the period after the athlete comes to terms with what has happened but before a return to the playing arena has appeared on the horizon.

This is where the likes of current injured players such Halfpenny, North and Lydiate find themselves. Locked in the monotony of performing mundane and relatively remedial rehabilitation exercises to rebuild injured joints away from the limelight of the game, while their fellow team-mates operate at full capacity.

This phase brings about a number of challenges and how players respond to them is often determined by their experience of dealing with previous injuries. It is a time riddled with potential setbacks and that can be tough.

“There will be some stage when you start to get back in the gym to put an empty barbell on your back or take some other small step,” explained Professor Mellalieu.

“That can either go well or the injured limb could react and set the player back.

“Along the journey of returning to play, there are lots of ups and downs and lots of critical moments and transitions as the player becomes able to do more physically and progresses in their rehabilitation.

“At each one of those stages a setback can occur and that can cause potential emotional challenges.”

He added: “Looking at the bigger picture, a lot of players will also endure a challenge to their own identity during the time out from the game.

“Imagine not being able to go and do your job day in, day out. Not being able to do what you love, what makes you feel good about yourself, what reinforces your sense of worth.

“For some of the younger or more inexperienced players, that can lead to a loss of their identity and question their worth. If all a younger player does is train and play rugby, then suddenly they’re not able to do that because of a long-term injury, that can be very frustrating. Often termed the ‘hero’ to ‘zero’ effect.

“Some athletes that don’t cope as well, are more susceptible to an identity crisis, and can go on to suffer from bouts of depression.

Ellis Jenkins has recently returned from a serious knee injury

“The athletes who cope better with long-term injuries tend to have a little bit more balance in their lives. They have lives or identities outside of sport – families, children, business interests or education – to keep the balance.

“They have other things that they can pour their energy into and gain reinforcement about who they are as a person. So they are not just a rugby player, they are a partner, a parent, a businessman and so on.

“Athletes that are solely wrapped up in their sport can be more susceptible to challenges to their mental health during the rehab process.”

To combat this potential identity loss, one strategy is encouraging the player to draw upon the support network around them.

The club’s player development managers, for example, often become involved in this process by providing options around things like education and training courses so that a player can look to fill their time and develop interests outside of the game.

Remaining part of the group is also important. Some players undertake analysis tasks for the team, providing reports on the opposition and then brief their team-mates in the lead up to matches.

“Good practice is to try and encourage the players to think about the other things they can do to become a better person during that time away from the field, which will help them become a better player on it,” says Professor Mellalieu.

“That’s particularly in the middle phases.

“We know scientifically that social support, in all walks of life, is a great buffer of stress. So making sure players have a good support network around them inside and outside of the sport is a healthy mechanism to cope with the ups and downs of the rehab process.

“Another part of coping with the injury process is feeling that you belong. So being kept in the loop and being part of team activity as much as possible can help to boost an injured player’s drive and motivation, which can be a tough thing to maintain when a player is faced with such a long time away from the sport.

“All the injured players will also be training together, supporting each other. That’s all part of the support process, and helps to add to the sense of belonging, and of course rugby being rugby, humour is a good part of that as well.”

The final phase of the psychology of rehabilitation from a long-term injury is helping an athlete prepare for a successful return to the field of play.

There are two elements to this which athletes are often faced with. One is dealing with the fear of re-injury and the other is potential concerns around performing to reach pre-injury levels – will my injured limb hold out? Am I still the same player I was?

This is the phase that players such as Anscombe and Jenkins may have recently had to come through as they head back into the Test arena, possibly against New Zealand on Saturday.

“We all take confidence from doing our jobs day to day and if a player hasn’t been able to do their job for nine months due to injury, then it’s perfectly natural they may have concerns around their ability to fit back in and perform to expectations,” explained Professor Mellalieu.

“If you’re a professional player, there can added worries – for example, will I be able to perform to keep my place in the team? Earn my next contract? Or earn selection for my country again?

“There are a lot of anxieties around that. A lot of it comes down to confidence management.

“International players are often very mentally tough, they’ve had years of competing at the top level so they have the mental skillset to cope with the transition to performing successfully at the elite level again.

“Often it’s just about tweaking those mental skills to build and protect their confidence going into that last phase of the return to play process.

“One of the biggest predictors of confidence in performing a task is having done the task successfully before. How do you make someone confident about making a tackle if they’ve hurt their shoulder? Well, making a tackle will give them the most confidence, but how do you know when a player is physically and mentally ready to take that step?

“A club’s rehab team will structure activities and exercises to help build a player’s confidence in testing out the injured limb in a gradual manner through to going back into full contact.

“From a mental preparation side, athletes often use a lot of visualisation. Players can visualise themselves making the hit, making the cutting movement off one leg and the other and so on. Also, players will watch previous footage of themselves doing those things successfully.

“As well as programming the body through the movements to build confidence, we can also get them to mentally prime the body and the limbs by mentally rehearsing the different actions.

“Ultimately, a player will tell you that you only know if the injured limb is okay when you’re in the first five minutes of that first game.

“But the aim is to try to make sure they’re as confident as can be going into that first tackle, carry or sprint.”

Then, after all the rehabilitation – mental and physical – a player will eventually return to the field.

There is little more that a physio, doctor or psychologist can do at that point.

Given the work that goes in, with no stone left unturned, do the support staff get nervous when a player makes their comeback?

“That’s a rhetorical question, right?” laughs Mellalieu.

“Any member of staff – from the kit man through to the head coach – all of us have emotional bonds and investments in the players.

“It’s someone’s livelihood and you want them to come back safe and well and stronger than before.

Gareth Anscombe speaking to attack coach Stephen Jones

“As much as injury rehabilitation is a science, there is still an element of unpredictability. There are some things you can’t control when returning injured players.

“You can prepare an athlete as much as possible, physically and mentally, but sometimes re-injury does occur.

“It’s not an exact science. You work to get everything right to give the player the best possible chance to come through successfully.

“As soon as they get back on the field, there’s a lot of anxiety on the support staff side of things until they have come through that first game.”

Concussion has become a well-documented part of rugby in recent years, having gone largely under the radar for years.

Players can endure extended periods out of the game with an injury which they cannot see and that has no timeline for a return, which brings about a fresh set of psychological challenges.

“That’s a very frustrating one because the nature of the injury itself means you can experience lots of psychological symptoms such as feel confused, anxious or frustrated,” explained Professor Mellalieu.

“That can have an impact on your day to day mindset and overall mental health and wellbeing.

“It’s not like a knee ligament injury, for example, where you can predict roughly nine months of rehab. Recovery from concussion can range from as little as a few to 14 days to a number of months or longer.

“It’s a real challenge, supporting concussed players. Physically and mentally.

“When players face persistent challenges to their mental health and wellbeing during their injury rehabilitation, it can often be helpful to refer a player to a clinical psychologist so they can get treatment for potential clinical symptoms experienced.

“There’s a common phenomenon in relation to head injuries called post-concussion syndrome, where your anxieties aren’t caused by the concussion itself, they’re caused by your view of the injury… you become frustrated or anxious about the symptoms you are experiencing.

“You’re not angry or upset because of the concussion, you’re angry and upset about being concussed.

“If you’re a professional athlete, you’re likely to be a perfectionist because that’s what makes you good at your sport. You’re obsessive about things, your training, your performance, your recovery, you leave no stone unturned, and if you pick up a head injury (or any long-term injury) that doesn’t settle down, that obsessive side of you can almost be an Achilles heel. You can become frustrated and over analytical which can impact upon your mental health and wellbeing.”

What those of us who observe professional sport often forget is that those in the thick of the action are also human beings.

They are not superhuman.

They have frailties and vulnerabilities.

They are not inanimate objects that simply need to be put together again when they break. It runs much deeper.

Every player overcoming a long-term injury will be fighting a battle that onlookers cannot see.

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