Written by Ambika Nair

Injuries suck. 

They suck especially when you’re about to score a buzzer-beating goal, but then in a blink of an eye, you hear a snap in your knee and collapse to the ground. That’s it, “she’s out for the season,” is a phrase we hear all too often.

 Sports injuries can be devastating not only for the individual, but also for their team, family and friends. Especially for young adults, what if sports is that one outlet where they are able to discover and fine-tune their athleticism, build enriching long-lasting social networks, and grow their identity? 

We so often seem to forget the mental blows that sports injuries can incur, especially in developing minds. An article written by Boston Children’s Hospital highlights how sports injuries and having to be “benched” for extended periods of time in many instances trigger anxiety, eating disorders, irritability, and depression. At the crossroads of adolescence, young adults begin to form a sense of self through identification with communities and peers, and being a part of sports teams is no different. A study conducted in the Netherlands highlights how “incidental stressful life-events” can be incredibly consequential in the development of identity for adolescents, leading to overall identity diffusion. Especially for young adults experiencing sports injuries in teams and communities where they begin to develop a sense of solidarity among, it is evident how injury stunting development with peers in these circles can leave one feeling anxious, depressed, or even suicidal. 

A 2024 study conducted by the University of Dublin highlights how the holistic review of psychological readiness for return to sports thoroughly documented in adult athletes is much more lacking in adolescent populations. By failing to understand the dynamic relationship between pubertal changes and physical and psychosocial wellbeing of young athletes, we fail to acknowledge how pain perception, evolving identity, and lived experience is altered during injury recovery for this population. Clinical Psychologist Andrew Ahrendt Phd at Nebraska Medicine mentions how sports injuries can greatly impact athletes’ mental health, no matter at what level they play.  “The more your identity is tied to being an athlete, the greater the impact. Suddenly, you feel like you’re no longer whole,” Ahrendt said.

When deciding whether to momentarily pause their sports journey or leave a sport entirely following an injury, young adults may begin to develop anxieties over whether this sport or community is still a vibrant part of their identity, whether they will be able to make a full recovery, whether they might let their teammates down, or whether they will experience a reinjury later on down the road. As recovery is usually a long and arduous process which cannot provide immediate gratification, it seems normal for young athletes to be frustrated and demotivated by the somewhat mundane repetitions of exercises prescribed for an inching recovery. The thrilling nature of shooting a basket or winning a match is quickly replaced by tedious physical therapy and social isolation. For a young athlete experiencing isolating conditions in recovery, it is likely they may begin to develop depression and a sense of lack of purpose, without even realizing it. 

A 2023 study conducted by Boston Children’s Hospital found that athletes with anterior cruciate ligament (ACL) injuries reported having seven times higher levels of depression compared to uninjured athletes, eleven days post injury. Similarly, those with concussion injuries reported having three times higher rates of depression compared to non concussed counterparts at the four-day mark. And many times we see all severity levels of these injuries having lasting impacts on cognitive, emotional, and social life of particularly youth patients years later.

In addition to the onset of identity diffusion and the frustrations that come with pausing activities for an injury, mental health recovery can be an even steeper hill to climb when actually returning to the field. Kinesophobia (the fear of physical activity) and fear of re-injury are noted to be the two most common psychological barriers in re-entering a sport post-recovery. Such psychological barriers can negatively impact a young athlete’s ability to return to their postoperative levels of performance, perceived levels of functional ability, and consequent self confidence.

Initiatives in addressing mental health recovery post-injury are starting to take hold in sports treatment protocols here in the US. However, there exists no mandated protocol for young athletes to receive psychological help post-operation, and very limited literature exists on the accessibility of mental health care for children and adolescents at the time of recovery. A qualitative study found that particularly male adolescents had a higher difficulty opening up to peers about psychological struggles during injury recovery compared to their female counterparts. Additionally, a major barrier to receiving psychological help in this age group is the stigma that surrounds it.

So, what are some ways we can attempt to make mental health just as pertinent as physical recovery for children, adolescents and young adults?

The initial step to assessing whether or not an individual recovering from a sports injury requires psychological support is screening. Screening tools can help to identify levels of self-efficacy, return to sports psychological readiness, kinesophobia, anxiety over re-injuries, and changes in identity perception. However, the caveat lies in the fact that psychological screening tests are not a universal protocol for patients, especially for young patients post-operation. Guidance by interdisciplinary healthcare professionals along the way – physicians, surgeons, physical therapists, and trainers, just to name a few – may suggest to them that a psychological screening is a necessary step for their patient or client. Yet, many times we see that building a rapport with patients or clients and asking initial questions about anxieties can be a challenging feat, particularly with youth and adolescence. 

Psychological treatments that have seen benefit include goal setting, meditation, and cognitive behavioral therapies (CBT) in adult athletes. However, the majority of these tests and treatments are focused for professional athletes returning to the field, and are scarcely utilized or explored in younger populations. 

A key factor to improving psychological health and readiness in recovering youth and young adults is strong social support networks from family, peers, and mentors. This includes being in the presence of teammates and coaches despite not being able to play, thereby mitigating moments of isolation and improving motivation for rehabilitation. One student participating in a qualitative study conducted by Burland et. al stated how “ a lot of people who have similar injuries and stuff so it made me more relatable.”

Being around teammates may also help young athletes to come to terms with healthy adjustments and what this injury may mean in the growth of their identity. It also ensures that recovering athletes have access and open communication with their coaches and teammates, especially those who may have endured similar injuries in the past. Hearing similar stories from familiar faces provides reassurance and guidance throughout the recovery process.

It’s easy to put our mental health needs on the back burner. It’s hard to visualize the importance of what we need mentally, when an ACL tear or a broken wrist is for the most part quite visually identified. A lot of times, we might not be able to immediately identify what the mental health need is. For a pre-teen or teenager, this gets even more difficult to navigate with rapidly changing hormone levels, friendship dynamics, and a changing sense of identity and self taking place. Hence, it is all the more important that we advocate towards ensuring that our youth’s mental health needs are being met with equal importance. While an injury may be a temporary physical set-back, it may have the unintentional ability to redirect psychological discovery of self.