ACL REHABILITATION:HOW TO SUPPORT HIGH MOTIVATION IN FOOTBALL PLAYERS AFTER INJURY AND SURGERY

Introduction Rehabilitation and full sport recovery after Anterior Cruciate Ligament (ACL) injury and reconstructive surgery need perseverance and willpower. The difficulties normally experienced by patients after injury can be overcome with high motivation during the recovery period (1, 2). Patient’s motivation is essential to achieve full sport recovery but needs full support of physiotherapists and of medical staff. It is thus is essential to assess and analyse psychological aspects as much as negative moments, fears, expectations occurring during rehabilitation, in order to better manage these and to customise motivational strategies for each patient. The aim of our study was to explore which motivational factors are linked to a good compliance of a rehabilitation path, in order to better understand how the staff could support patients in coping with difficulties (physical, emotional and psychological). Methods Five male football players (aged 13 to 38 years) ranging from recreational to competitive athletes, previously undergone ACL surgical reconstruction followed by knee rehabilitation were recruited for this explorative and qualitative study. We conducted semi-structured interviews, specifically focusing on: 1) relationship with football (story, past and future goals, personal needs that find an answer in sport activities); 2) the injury (how it happened, if it has been a psychological trauma, physical sensations, thoughts and emotions); 3) the recovery process with particular attention to surgery and rehabilitation. The interviews were conducted by a psychologist in Isokinetic Centre of Milan, in winter 2014-15. We were interested in understanding their decision to opt for surgery, what information they had, what were their expectations and if they encountered any unexpected event. The aim was not to measuring the incidence of different motivations supporting rehabilitation, but better understand which strategies the staff could use (customizing the intervention) during the rehab process in order to obtain better results working together with the patients. Moreover, we wanted to know how the rehabilitation period was. We applied a semi projective tool (fill in a graphic line that represents their feeling in the main steps of the path, starting from before the injury and arriving to the present, few months after the end of the rehabilitation). Results The five patients started playing football since they were a child and they never stopped it until the injury. They loved that spots, especially for the social and the competitive needs. Nowadays, they are not sure to playing football again for different reasons (linked – they said – to changes in their life), except the youngest one. The injury was a different experience for them, in some cases has been a trauma (big pain, feeling in danger, something broken), in other cases instead they didn’t understand its seriousness. When the injury is a traumatic experience, it seems more probable that the player will have more fear about “broken himself” again. From the graphics we could understand that the injury (or when they realize the seriousness of it) was the worst moment, but actually they feel almost as before. They had good information about the surgery, but the days just followed were very hard (they felt blocked and starting the rehab had a good effect (they felt active and not passive). From the five patients point of views, the physiotherapist had a core role during the rehabilitation process. In particular, the football players we interviewed reported that the physiotherapist had two important functions: to guide them during exercise (professional function) and encourage them to face difficulties using “the carrot and the stick” (motivational function). The Doctor is perceived as a supervisor who gives feedback on the results and anticipates the following steps. The patients could verify the progressive achievements of the goals throughout the rehabilitation (this is a good reinforcement) and improve self-efficacy (feeling able to face the situation). Besides they recognize the role of their compliance, so they feel able to control of the process and of its goal. They were quite worried about undergoing rehabilitation post the surgery but their will to return to play football was the main helping factor. Finally, the five football players said that this experience (the injury and the care process) was been a very formative moment of their life which also gave a good contribution to their self-esteem (how they evaluate themselves). Conclusion The interviews clearly show how important is to know the patient, his experience, his targets and his needs in order to better support him during the rehabilitation process and to obtain full recovery. In particular, the relationship with the physiotherapist together with the supervision of the doctor, playing the role of case manager, represent good motivational dispositive, both for professional aspects and relational/emotive factors. Moreover, giving patients verifiable information about the rehabilitation phases supports their self-efficacy. A motivational speech before starting the rehabilitation process of ACL injured football players could be useful to better know the patient and his needs. Therefore particular attention by the staff to communicative aspects seems helpful. References 1. Langford JL, Webster KE, Feller JA. A prospective longitudinal study to assess psychological changes following anterior cruciate ligament reconstruction surgery. Br J Sports Med 2009; 43: 377-378 2. Podlog L, Eklund RC. The psychological aspects of a return to sport following serious injury: A review of the literature from a self-determination perspective. Psychology Sport Exerc 2007; 8: 535-56