Paper title: Patellofemoral joint loading during the forward and backward lunge Publication: Physical Therapy in Sport. Jan 2021; Vol. 47, Pages 178-184 https://doi.org/10.1016/j.ptsp.2020.12.001 Publication date: Jan 2021 INTRODUCTION Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain in young athletes. It usually presents as anterior and retro-patellar knee pain made... MORE
Managing pain with meditation
In our series on pain in athletes, we’ve explained how pain perception effects an athlete’s potential to return to their previous level of play. If an athlete has a tendency toward catastrophizing, they will see only the negative aspects of their injury. In addition, they may tend to focus more intently on their pain, increasing their sensitivity to any stimulus and developing a pattern of behavior that avoids any activity or situation which could trigger their pain. This is known as fear avoidance behavior.
Our last newsletter outlined four strategies for handling fear avoidance in an athlete who is reluctant to advance their rehab. This reluctance may stem from the anxiety they feel with any pain sensation and the worry that discomfort means the progression or worsening of their injury. This level of anxiety is known to impede the rehabilitation process(1).
Mindfulness meditation, considered mainstream in the general population, not only promotes relaxation, but also acceptance of one’s current situation. By bringing one’s awareness to the present moment, the future concerns and past events fade in the consciousness. This mental break can reduce pain and anxiety(1). Mindfulness encourages one to view their present situation without judgment or worry.
Researchers at the University of Kent hypothesized that meditation could increase pain tolerance, decease pain perception, and improve the mood of injured athletes(1). Twenty athletes who had not participated in their sport for at least three to six months due to injury, were randomized into two groups. Both groups received physical therapy treatment as recommended for their injury, however, the intervention group received additional mindfulness meditation training. The meditation training consisted of guided instruction using the Mindfulness-Based Stress Reduction (MBSR) program for 90 minutes once a week, for eight weeks. They were also given a compact disc (CD) for home use and encouraged to meditate for 20 to 30 minutes each day.
Testing of pain tolerance using a Cold Pressor Test was conducted in both groups of athletes prior to and after the intervention period. Other tests evaluated mood, anxiety and stress before and after the intervention. The intervention group showed an increase in pain tolerance and awareness after the eight weeks of meditation. The researchers suggest that adding some component of mindfulness to a usual course of sports physical therapy may be beneficial in helping athletes handle pain, cope with an injury and return to previous level of play.
How might a physio incorporate mindfulness techniques into a rehab course? Technology can help (see box 1)! Firstly, educate injured athletes on the importance of mindfulness for peak mental health (see my article here). Direct athletes toward applications they can download on their phone and use daily for guided meditation practice. Charge for this instruction under patient education codes.
Box 1: Mindfulness apps
There are many apps that promote meditation. Here are a few suggestions to start with, or explore your app store to find one that’s right for your client.
With the tagline “Mind right, game tight” Lucid provides athlete-specific meditation training, similar to other online training tools athletes already use. The free introduction series teaches their particular method, with guided meditations to take an athlete through real sports situations. No unicorns and rainbows here. Subscription ($9.99 US / month) offers the ability to message a mental coach for more individualised guidance.
Developed by a former Buddhist monk, Headspace offers a free starter series for the beginner. You can connect with “buddies” to develop streaks and improve participation with accountability. Individually themed modules geared specifically toward athletes are available, with a subscription ($12.99 US / month).
Developed with the busy person in mind, Simple Habit believes you just need five minutes a day to benefit from meditation. With over 1000 meditation tracks (some available only with the premium upgrade (costing $11.99 US per month), Simple Habit offers meditations for every situation, including sports. It also offers connectivity with your training community and allows participation and competition in challenges with people all over the globe.
Smiling Mind’s mission is to provide accessible lifelong tools based on mindfulness meditation. The Australian based non-for-profit company provides free guided audio meditations for people of all ages and stages, including a sports module. You can access these 12 sports-specific sessions completely free of charge and if inclined, donate $10 to support the cause.
- Front Psychol.2018 May 15;9:722.