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Road to recovery

ACL Study

During his 30 years of performing ACL surgery, Robert Clifford has seen his patients — many of whom suffered their injuries while playing sports — devastated when they realize that rehabilitation after the surgery may take six to nine months.

That’s why Clifford, the medical director at Fit N Wise Sports Medicine in Decatur, was excited to learn about Return to Sport, a study being conducted at UNT’s Center for Sport Psychology and Performance Excellence.

The study is being led by psychology doctoral students Kristina Clevinger and Shelly Sheinbein and Trent A. Petrie, professor of psychology and center director. The researchers are determining the effectiveness of different psychological interventions in improving athletes’ physical rehabilitation after ACL surgery and their psychological responses to injury, overall well-being and confidence in returning to their sport.

Sheinbein, Clevinger and Petrie plan to select at least 75 participants for the study. Those selected must be involved in at least six hours of athletics per week and be scheduled for ACL surgery. They will be randomly assigned to one of three psychological interventions and participate in eight 15- to 30-minute sessions for four months after their surgeries. They will meet with the researchers in person for the first four sessions and complete the final four sessions through web-based materials and phone calls with the researchers. The athletes will also complete four 15-minute surveys during the four months, and brief follow-up surveys six, nine and 12 months after their surgeries.

The anterior cruciate ligament, or ACL, connects bone to bone and is one of the two most significant stabilizers of the knee, Clifford says. Injuries to the ACL “take a high-functioning athlete and turn him or her into a benchwarmer for months after surgery,” says Clifford, who has already referred several of his patients to the UNT study.

Sheinbein, who is researching ACL surgery recovery for her dissertation, notes that most patients have “a traumatic reaction and feelings of disbelief, anxiety, isolation and depression” immediately after suffering their injuries.

“The first few weeks after surgery, they experience pain and loss of mobility, and they may start to lose their identities as athletes when they can’t do their workouts,” she says, adding that the slow physical recovery following surgery, combined with psychological distress that athletes may experience during rehabilitation, “make this population of athletes ideal for interventions targeting the psychological consequences of injury.”

Clifford says the first question his patients tend to ask is “Will I ever be an athlete again?” usually followed by “Will I be as good as I was before I was injured?”

“The orthopedic literature has very little about the psychology involved with making a full recovery,” he says, calling the Center for Sport Psychology and Performance Excellence “phenomenal.”

“I’m a big believer in psychology helping with anxiety and return to previous performance level,” Clifford says, adding that about 95 percent of those who have ACL surgery do eventually return to their sport.

Petrie says the amount of support an athlete receives after experiencing ACL injury from family members, friends and teammates largely contributes to psychological recovery, but adds that all participants in the study “should have decreases in perception of pain, depressive symptoms and anxiety about re-injury, and increased confidence in returning to their sport.”

“The skills that they learn will also enhance their athletic performance after they return to their sports full time,” he says.

Hunter Brandon, a patient of Clifford’s, volunteered for the study “to get more than just physical therapy.” A 17-year-old defensive end for Decatur High School’s football team, he underwent ACL surgery Oct. 15 and missed the last few games of the season.

He says the study’s researchers taught him how to set goals beyond his long-range goal of playing football again this fall.

“The goal setting helped me understand what was going on with my knee and healing and not sulk about my recovery,” he says.

Clifford says not one of his patients has declined to participate in the UNT study.

“They like the idea of having coping mechanisms to deal with their injuries and maximize their physical recovery,” he says.

-- Nancy Kolsti, News Promotions 

Photo Above, (from left to right) Trent Petrie, professor of psychology and director of the Center for Sport Psychology and Performance Excellence; Shelly Sheinbein, doctoral student in psychology; and Kristina Clevinger, doctoral student in psychology (Michael Clements, URCM).

Posted on: Mon 06 June 2016

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