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The Sport Information Resource Centre

An anterior cruciate ligament (ACL) injury is one of the most common and yet one of the most devastating injuries an athlete can sustain. There is plenty of research on ACL injuries and the methods for treatment are well documented; usually when an athlete sustains this type of injury, their physical recovery is addressed well and thoroughly, and many recover enough to return to their sport. While they may be physically able to play, the psychological and emotional impacts of an ACL injury are often overlooked and can have a detrimental effect on an athlete’s performance.

An anterior cruciate ligament (ACL) injury is usually caused by a sudden twisting motion in the knee when an athlete lands or steps. NIH MedlinePlus

Common psychological factors that contribute to an athlete’s reluctance to return to sport:

  • A fear of re-injury or further injury
  • Decreased confidence that negatively affects performance
  • Stress and anxiety regarding their physical condition
  • Feelings of depression

How can coaches and athletic trainers help their athlete combat these feelings and get them back to pre-injury levels?*

Goal setting – The injured athlete should focus on modified goals that they can accomplish on a daily or weekly basis. The new goals should be about performance, not outcome, and should be specific, measurable, realistic and individualized for the athlete. By keeping track of these goals and their subsequent achievements, a coach will be able to show them their progress and help relieve some of the stress an athlete feels towards their physical condition and increase confidence in their abilities.

Stress management – Learning to cope with stress and anxiety is an essential part of athletic training since they are regularly put in high pressure situations. The common coping mechanisms for these situations can be transferred to an athlete suffering from an injury. Learning different relaxation techniques, muscle, self-directed or deep breathing can prevent a fear of re-injury. Imagery is another avenue to explore as this involves the use of mental images and scenarios to relax the mind.

Social Support – A sports injury can have a traumatic effect on an athlete since sport is such a large part of their identity. Having a network of friends, teammates, coaches, trainers available for the injured athlete to connect with and share similar experiences can help the athlete understand the rehabilitation process they are going through, combat negative thoughts, and help them face the road ahead.

After injury and the following recovery, the goal for most athletes is to get back on the field as soon as possible; however returning to sport after an injury is not always a clear cut process and many factors need to be considered before the choice is made. The combination of both physical rehabilitation and psychological interventions working together helps to reduce recovery time, improve coping skills, and prevents re-injury anxiety. With this multifaceted approach there is a greater likelihood that an athlete will make a smoother and quicker transition from injury, recovery, and back to training and competition.

*If you are a coach or athletic trainer and feel you are not equipped to deal with the psychological aspects of recovery, it’s a good idea to refer your athlete to a professional that can help them get back on track.

References from the SIRC Collection:

Ardern C, Österberg A, Tagesson S, Gauffin H, Webster K, Kvist J. The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. British Journal Of Sports Medicine. December 2014;48(22):1613-1619.

Lentz T, Zeppieri G, Farmer K, et al. Comparison of Physical Impairment, Functional, and Psychosocial Measures Based on Fear of Reinjury/Lack of Confidence and Return-to-Sport Status After ACL Reconstruction. American Journal Of Sports Medicine. February 2015;43(2):345-353.

Petersen W, Taheri P, Forkel P, Zantop T. Return to play following ACL reconstruction: a systematic review about strength deficits. Archives Of Orthopaedic & Trauma Surgery. October 2014;134(10):1417-1428.

Podlog L, Hannon J, Banham S, Wadey R. Psychological Readiness to Return to Competitive Sport Following Injury: A Qualitative Study. Sport Psychologist. March 2015;29(1):1-14.

Tjong V, Murnaghan M, Nyhof-Young J, Ogilvie-Harris D. A Qualitative Investigation of the Decision to Return to Sport After Anterior Cruciate Ligament Reconstruction: To Play or Not to Play. American Journal Of Sports Medicine. February 2014;42(2):336-342.



The information presented in SIRC blogs and SIRCuit articles is accurate and reliable as of the date of publication. Developments that occur after the date of publication may impact the current accuracy of the information presented in a previously published blog or article.