care professionals felt that taking time to talk to clients and to listen to them talk about their injury, the prognosis and treatment, and their fears can help injured athletes to be more confident as well as more motivated about their rehabilitation. Both of these factors, confidence and motivation, are essential for a successful recovery from injury.
Being a good listener, however, is only one component of the communication desired by the participants. With regard to the physical aspect of their injury, participants in the present study indicated wanting to be the ones who asked the questions or initiated. When it came to the psychological component of the injury, however, participants wanted the health care professionals to be the ones who asked the questions. This may be because there is a sigma associated with mental illness or distress (Rusch, Angermeyer, & Corrigan, 2005) and by having health care professionals broach the subject it may lessen this stigma and help to normalize what they athlete is feeling. This is contrary to what Mann et al. (2007) reported in regards to injured athletes broaching the subject of a poor psychological response to injury with their health care professionals. Mann et al. (2007) indicated that injured athletes trust their health care professionals enough to initiate a conversation about responses to major injuries with them. Despite the fact that based on the data it would be unlikely an injured athlete would initiate a conversation about the psychological
component of their injury with their health care professionals; trust may not be the limiting factor in initiating this conversation. Rather than a lack of trust it may be a lack of
understanding or embarrassment of the psychological response they are experiencing or an inability to know how to explain what they are feeling. Additionally, injured athletes may think that what they are experiencing is abnormal. Because of this uncertainty on thè part of the injured athletes as to what they are experiencing it is important that this subject is initiated by the health care professional, even if it is only to provide outside educational resources or referrals, because it seems unlikely that it would be the injured athlete who
initiates this conversation.
With respect to what may limit a health care professional in addressing the psychological aspect of injury, one factor may be time. As previously discussed, injured
athletes see the time spent with their health care professional as being important to the rapport they develop. The fact that participants saw their physiotherapists and athletic therapists as best addressing the psychological component of injury seems to make sense as they are the people who injury athletes would spend the most cumulative time with during their rehabilitation. One participant noted she had had over 100 appointments with her physiotherapist during her rehabilitation. This amount of time with someone clearly allows more opportunities for a strong rapport to be developed. Increased time spent together would allow participants to feel they are more important to their health care professional and that the health care professional has more of a vested interest in them making a successful recovery.
Another aspect of the rehabilitation environment that injured athletes seemed to find important was having their health care professionals be positive. Wiese et al. (1987) found that athletic trainers thought positive reinforcement for athletes was one of the nine most important psychological strategies that athletic trainers could use. Health care
professionals adopting a positive stance towards the athlete and the injury can be important in the athlete's appraisal of the injury. Researchers have found that an athlete's attitude and feelings towards their injury can be completely determined by how their health care
professional seems to appraise the injury. These feelings can extend well beyond the time of the appointment (Johnston & Carroll, 1998).
Finally, social support was indicated by athletes as being a important component of the role they see their health care professionals playing in addressing the psychological component of the injury. Athletes indicated a desire for social support in the form of the health care professional acting as a source of social support as well as the health care professional helping facilitate relationships for them with other injured athletes to be
sources of social support for each other. The importance of social support to the injured athletes in the present study is consistent with Bianco (2001) who found that injured athletes saw health care professionals as one of their sources of social support during their rehabilitation. Some even indicated that their physiotherapist was their key source of social support during their rehabilitation.
Niven (2006) found that those athletes, who had more social support and good relationships with their health care professionals, were more adherent to their rehabilitation program. Given that social support has been linked to both motivation and adherence, it would seem to be an important target of treatment with injured athletes. Having athletes adhere to their rehabilitation program and remain motivated to practice in rehabilitation activities so as to make a successful return to play is beneficial to athletes both physically and psychologically. Adherence to a rehabilitation program has been positively linked to rehabilitation outcome (Brewer, 2010). More specifically, athletes who were more (vs. less) adherent to their rehabilitation program, had fewer physical symptoms associated with their knee six months post-operatively (Brewer, et al., 2004). Participating in rehabilitation allows athletes to interact with others who have suffered an injury and are undergoing rehabilitation, which can facilitate their recovery. Wiese and Weiss (1987) found that social support groups improve injured athletes' motivation during rehabilitation.
Limitations
The findings of the present study must be considered in light of a number of limitations. First, the sample size of the study was quite small. Recruitment may have suffered because logistics precluded the primary investigator being in direct contact with