Reducing Fear of Reinjury and Pain Perception in Athletes With First-Time Anterior Cruciate Ligament Reconstructions by Implementing Imagery Training

Abstract

Clinical Scenario: The anterior cruciate ligament is one of the major stabilizing ligaments of the knee joint by preventing anterior translation of the femur in the closed kinetic chain. A ruptured anterior cruciate ligament may require reconstructive surgery for patients who wish to return to physical activity. For the most part, surgeries are successful at repairing the ruptured ligament and restoring ligamentous function; the percentage of athletes that return to a competitive level of physical activity is only 44%, and 24% of patients report a main factor of preventing their return is fear of reinjury and pain. Most physiotherapy and rehabilitation research has focused on the physical treatment and is limited on the psychological aspects of recovery. Imagery has been suggested to be effective at reducing anxiety, tension, and pain, while promoting and encouraging healing after an injury. Imagery is defined as a process of performing a skill in one's mind using the senses (touch, feel, smell, vision, etc) without any overt actions. Clinical Question: In athletes who are first-time anterior cruciate ligament reconstruction patients, does imagery training in combination with standard physical therapy reduce the fear of reinjury and pain perception? Summary of Key Findings: Previous research has primarily looked at the physical treatment aspect, and few studies have focused on the psychological factors affecting recovery. Researchers concluded that fear of reinjury was the unique predictor of return to sport even in a sample of participants that reported very little or almost no pain at all. Imagery as a therapy is an effective intervention in reducing fear of reinjury and confidence building. Furthermore, mental imagery is suggested to assist with a reduction in anxiety, pain, and tension, while promoting healing. Clinical Bottom Line: Based on the strength of recommendation taxonomy, there is a combination of level A and B evidence proposing that imagery, in combination with traditional physical therapy, can be effective at reducing psychological distress such as fear of reinjury and pain perception in first-time anterior cruciate ligament reconstruction patients.Keywords: knee joint, psychology, rehabilitation, sport psychology Clinical ScenarioInjuries are an inevitable part of competitive sports as well as recreational activities. Research shows that one of the most common musculoskeletal complaints that accounts for approximately 48 out of 1000 patients is knee-related injury. 1 As noted, approximately 9% of these knee complaints are related to anterior cruciate ligament (ACL) injuries. 2,3 The ACL is commonly injured in contact sports by a noncontact action, such as planting, cutting, landing on a hyperextended knee, or pivoting and sudden deceleration. 4 Typically, athletes report feeling immediate pain and hearing a pop, resulting in progressive knee swelling and difficulty ambulating. The ACL is one of the major ligaments that provides stability to the knee joint by preventing anterior translation of t...

Influence of Imagery Training on Adjusting the Pressure of Fin Swimmers, Improving Sports Performance and Stabilizing Psychological Quality

“…Because scientific research needs to be conducted with adequate theoretical support, rarity or novel research areas are relatively weak in terms of the theoretical foundation. Adopting a complex research approach, complementing the breadth of research with quantitative research methods [64,65], and increasing the depth of research with qualitative research [66] can compensate for research methodological or theoretical shortcomings [67].…”

The Effectiveness and Recommendation of Motor Imagery Techniques for Rehabilitation after Anterior Cruciate Ligament Reconstruction: A Systematic Review

“…A previous systematic review by Rodriguez et al [ 18 ] concluded that MI techniques are effective as a psychological intervention, which could reduce post-injury consequences with positive functional and mental outcomes with scarce and no clear evidence. ACL injury has led to numerous different research techniques and therapeutic approaches and has gained an important boom in recent decades.…”

“…Fear and pain are the factors that most limit recovery from injuries in athletes, and these factors are quite stressful and frustrating, as well as conditioning physical performance. It would, therefore, be crucial to address these factors during rehabilitation [ 17 , 18 , 19 ]. Physiotherapy and rehabilitation research has not focused on this aspect and the influence on the recovery process [ 19 , 20 ].…”

Is Fear of Harm (FoH) in Sports-Related Activities a Latent Trait? The Item Response Model Applied to the Photographic Series of Sports Activities for Anterior Cruciate Ligament Rupture (PHOSA-ACLR)

“…Such engagement can be either real or imagined. Imagery exposure (motor imagery) can potentially reduce the fear of (re)injury and pain in ACLR patients [36].…”