Keeping your head in the game: sport-specific imagery and anxiety among injured athletes.

CONTEXT The use of sport-specific imagery during rehabilitation is sparse. Athletes who used imagery (either facilitative or debilitative) during injury rehabilitation were compared with injured athletes who did not use imagery. Return-to-practice anxiety in the groups was investigated also. OBJECTIVE To (1) explore debilitative images used during rehabilitation, (2) examine athlete and injury characteristics in relation to variations in imagery content and return-to-practice anxiety, (3) compare the frequency of imagery use early in injury rehabilitation with that just before return to practice, and (4) examine the relationship between image use and return-to-practice anxiety. DESIGN Observational design. SETTING Athletic training facilities. PATIENTS OR OTHER PARTICIPANTS Thirty-six injured National Collegiate Athletic Association Division I collegiate athletes sustaining at least an 8-day practice suspension due to injury. MAIN OUTCOME MEASURE(S) Sport Imagery Questionnaire, Sport Anxiety Scale. RESULTS Athletes used both facilitative and debilitative images during different phases of rehabilitation. Men used more sport skill, strategy, and excitement imagery content than did women, who reported higher scores for worry and concentration disruption than did men. Athletes used fewer images related to their sport skills and strategies early in rehabilitation than just before they returned to practice. Additionally, athletes who used more arousal and less strategic imagery experienced more somatic anxiety. CONCLUSIONS Similar to research findings on healthy athletes, sport-specific image content in injured athletes is related to return-to-practice anxiety during rehabilitation, and some of the images were perceived as debilitative. Practitioners should advise injured athletes to use sport-specific imagery, especially that related to sport skills and strategies, but they should caution athletes against using arousal imagery, because it may elevate somatic anxiety before return to practice. Image content recommendations should encompass the cognitive and motivational functions of imagery, and the practitioner should assess if any image used by the athlete is debilitative.