Discursos verticales y horizontales

Despite the more favourable attitude towards psychology of athletic trainers compared to that of physiotherapists within North America (Hamson-Utley et al., 2008), the review of literature suggests that the perception of athletic trainers is mirrored by physiotherapists. As a helping profession, similar to both athletic training and strength and conditioning, physiotherapists are often considered best- placed to address the psychological aspect of an athlete‘s rehabilitation (Francis et al., 2000; Hemmings & Povey, 2002; Arvinen-Barrow et al., 2007; Arvinen- Barrow et al., 2010).

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Ninedek and Kolt (2000) conducted a questionnaire surveying the views of Australian physiotherapists. Similar to North American athletic trainers (Hamson- Utley et al., 2008), the physiotherapists perceived a range of psychological skills as important, such as appropriate goal-setting, motivational strategies and effective communication, however reported that particular skills were unimportant and underutilised, such as relaxation techniques and mental imagery. Similar to athletic trainers this is surprising, as the physiotherapists believed anxiety and stress to be common reactions to injury, for which imagery and relaxation strategies are appropriate alleviating psychological techniques. This may illustrate a potential lack of awareness of the benefits or the applications of particular techniques.

The perceptions towards psychology and the willingness to utilise such strategies were unaffected by the attendance of formal psychology training post certification, however it should be noted that owing to the Australian undergraduate curriculum all respondents would have been exposed to basic psychology instruction (Ninedek & Kolt, 2000). Nonetheless, this finding is interesting as in North American athletic trainers, participation in formal training was a factor contributing towards an increased positive perception of psychology (Hamson-Utley et al., 2008). In contrast, the physiotherapists felt their awareness of psychological strategies and applications was developed via experiential learning.

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Despite the negative perception towards particular strategies, physiotherapists value the role of psychology within their practice. In support of previous work (Ninedek & Kolt, 2000), Francis et al. (2000) surveyed physiotherapists working within an Australian city and similarly concluded that physiotherapists value psychology, however they perceive particular strategies such as imagery and relaxation to be ineffective. It was encouraging that there was evidence supporting the importance to understand conditions such as anxiety, however the physiotherapists believed that they did not need knowledge in strategies, for example mental imagery, to alleviate such conditions. It should be noted that the respondents‘ doubt of the effectiveness of such techniques may indicate a lack of familiarity, rather than a perception that they are ineffective (Francis et al., 2000).

Hemmings and Povey (2002) surveyed the views of 90 UK Physiotherapists. It was apparent that the respondents used a variety of psychological skills within patients‘ treatment, including the use of goal setting and encouraging positive self-talk. Nonetheless, as reflected in previous studies of sports medicine professionals (Wiese & Weiss, 1987; Wiese et al., 1991; Brewer et al., 1994; Ford & Gordon, 1998), the physiotherapists were keen to develop further awareness of the applications of psychology with regard to rehabilitation.

Jevon and Johnston (2003) examined the knowledge of physiotherapists working with British Olympic athletes with regard to the psychological aspect of their practice. The qualitative approach yielded findings indicating that physiotherapists lack formal training with regard to both the theory and practical

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application of psychology. This would align with previous conclusions that physiotherapists want further training (Hemmings & Povey, 2002), although only three of the 19 participants reported taking developmental courses in psychology. Of the courses attended, none were provided by recognised bodies such as the British Association of Sport and Exercise Sciences or the British Psychological Society (BPS).

Through qualitative analysis it was apparent that the participants who attended training courses valued psychology more than those that have not attended relevant training. It is important to emphasise that the descriptive analysis does not infer causation. It is possible that an increased prior interest in psychology may have guided physiotherapists towards attending further training rather than the training itself instilling the increased perceived importance of psychology.

An advantage of the interpretive nature of qualitative analysis is that the implicit use of psychological strategies can be observed. Despite varying perceptions of the importance of psychology, all practitioners described the implicit and informal use of psychology despite many not referring to formally recognised interventions. Such examples created themes such as dissociative techniques, healing imagery, and reflective listening, with the majority of the practitioners suggesting that the skills were developed experientially (Jevon & Johnston, 2003).

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Quantitative and qualitative studies conducted by Arvinen-Barrow and colleagues (Arvinen-Barrow et al., 2007; Arvinen-Barrow et al., 2010) suggest that practitioners are aware of knowledge gaps within their practice with reference to psychological strategies. Practitioners are typically capable at identifying symptoms of prevalent concepts such as stress and anxiety yet feel ill-equipped to provide applicable techniques, with decisions made based upon intuition gained through experience rather than formal education. Particular skills were utilised such as goal-setting and positive self-talk, conversely skills such as imagery and relaxation techniques were neglected. There was an apparent lack of perceived importance associated with imagery and relaxation. Such strategies were the exception to the widespread interest in wanting to learn more.