An examination of changes in psychological status across four phases of injury recovery and return to sport: A prospective weekly study of competitive athletes from acute care to return to sport.

While ample research has shown that sport injuries are associated with poor psychological status, scant attention has been given to changes in injured athletes' psychological status over the full course of recovery and return to sport. The aim of the present study was to prospectively investigate potential changes in injured athletes' psychological status across four phases of recovery and return to sport. A total of 38 severely injured adult competitive athletes (58% female; mean age 24.1 ± 7.18 years) participated in this prospective weekly investigation (n = 319 observations). Athletes' were asked to indicate their current phase of recovery or return to sport (acute care, rehabilitation, adapted training, or full return to sport) after which they responded to visual analog scales assessing post-injury psychological status, including: perceived pain (frequency and intensity), emotions (positive and negative), anxiety (cognitive and physiological), motivation, self-efficacy, and satisfaction. During the acute care phase, participants showed higher scores of perceived pain, and physiological anxiety compared to the other phases. During the adapted training phase, amotivation was higher than in the acute care phase, and self-efficacy was lower than in other phases. At full return to sport, athletes showed less perceived pain, cognitive anxiety, and more satisfaction than during other phases. The present study provides a deeper prospective understanding of changes in athlete's psychological status over the course of injury recovery and return to sport and highlight the importance of monitoring psychological status.

Examination of the validity of the Injury-Psychological Readiness to Return to Sport (I-PRRS) scale in male professional football players: A worldwide study of 29 professional teams.

Perceived confidence is an important dimension of an athlete's psychological readiness to return-to-play. However, there is no established and validated tool to evaluate confidence in professional football. This study aimed to provide preliminary evaluation of the internal structure of the Injury-Psychological Readiness to Return-to-Sport scale (I-PRRS) in a cohort of injured male professional footballers. Over an 18-month period, 29 teams from 17 leagues participated. Players sustaining injuries eliciting ≥ 3 weeks' time-loss were recruited. Cross culturally adapted to 4 further languages, the I-PRRS was administered on two occasions: 1) day before returning-to-training and 2) day before returning-to-match-play. In total, 113 injuries were recorded with 96 completed I-PRRS data sets collected. Confirmatory factor analysis indicated the I-PRRS was a unidimensional scale, with all items measuring the same construct. The scale demonstrated good internal consistency (ω = .88). When examining longitudinal invariance of the I-PRRS across administration time-points, indices of model fit supported scalar invariance. There was preliminary evidence of good internal structure for the I-PRRS in professional male footballers. However, before further research involving the I-PRRS can be endorsed, efforts to confirm or refute empirical developments pertaining to psychological readiness are necessary.

Exploring the Factors Involved in Being "Ready" to Return to Sport Following a Concussion.

OBJECTIVE: To explore the factors involved in athletes being ready (or not) to return to sport (RTS) after sport-related concussion (SRC). DESIGN: Qualitative, semistructured interviews.Setting: Videoconference.Participants: Twenty-two sport-injury stakeholders involved in contact and collision sports at various levels of competition (high school, university, professional), including: formerly concussed athletes (n = 4), coaches (n = 5), athletic therapists (n = 5), physiotherapists (n = 4), nurse practitioner (n = 1), and sports medicine physicians (n = 3). INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: We included questions in the interview guide regarding factors participants believed were involved in athletes being ready (or not ready) to RTS after a concussion. RESULTS: Participants described physical (concussion symptoms, return to pre-injury fitness), behavioral (changes in behavior, avoidance, malingering), psychological (individual factors, cognitive appraisals, mental health), and social (isolation, social support, communication, pressure) factors that they believed were involved in athletes being ready to RTS after SRC. CONCLUSIONS: The graduated RTS strategy outlined in the most recent Concussion in Sport Group consensus statement focuses on physical aspects involved in being ready to RTS, which does not address behavioral, psychological, and social factors, which were identified by participants as being related to returning to sport post-SRC. More research is needed to determine whether the additional factors outlined in this study are relevant among larger samples of athletes, coaches, and healthcare professionals.

Not All Promotion Is Good Promotion: The Pitfalls of Overexaggerated Claims and Controlling Language in Exercise Messaging.

Across 2 studies, the authors explored reactance effects to overexaggerated claims and controlling language in exercise messaging. In Study 1, participants received either a message exaggerating the benefits of an upcoming exercise session or no message. They subsequently undertook a mundane exercise session led by an instructor, which was either need supportive or "realistically controlling." Relative to no-message participants, those who had read the message reported less positive evaluations of the session. These results were observed despite participants in the message condition holding more positive presession expectations, and the effect was apparent even for those who received need-supportive instruction. In Study 2, participants read an advertisement that was written in either autonomy-supportive language or controlling language. Despite reporting comparable expectations, participants who received a controlling-language message reported significantly greater anger and freedom threat-factors commonly linked to contrast effects. These studies highlight the operation of message-driven contrast effects in exercise.

School-based physical activity interventions and physical activity enjoyment: A meta-analysis.

The purpose of this meta-analysis was to examine the effectiveness of school-based physical activity interventions on increasing students' physical activity enjoyment. An internet search with several databases using the keywords "Adolescents", "Children", "Enjoyment", "Physical Activity", and "Schools" was performed yielding over 200 published studies. Studies were eliminated based on the lack of experimental manipulation (i.e., non-intervention studies), no assessment of physical activity enjoyment as an outcome variable, a lack of a control or comparison group, and no reporting of the effect estimate's variability (i.e., standard deviation, standard error, etc.). This procedure resulted in 10 studies being examined in the meta-analysis. Data were analyzed in the state of Utah, USA in 2017. The Hartung-Knapp-Sidak-Jonkman method for a random effects meta-analysis was employed with studies being weighted by inverse variance. The pooled Standardized Mean Difference=0.38 (95% C.I. [0.10-0.65], p=0.011). Cochran's Q test showed statistical significance (p<0.001) and the I2=76.6%, suggesting large heterogeneity across the 10 studies. Egger's regression model yielded an intercept coefficient that was statistically significant (bias=3.28, 95% C.I. [0.21-6.36], p=0.039), indicating the presence of small-study effects. This meta-analysis provides evidence that school-based physical activity interventions can be effective in increasing physical activity enjoyment in children and adolescents. However, the magnitude of the pooled effect was small-to-moderate and there was evidence for publication bias and large between-study heterogeneity.

Examining elementary school children's level of enjoyment of traditional tag games vs. interactive dance games.

Enjoyment has been implicated as a determinant of physical activity among children and adolescents. However, the effect of different sport activities on children's enjoyment remains largely unexplored. This study examined whether children's enjoyment in physical education (PE) varied as a function of learning activities. Participants were 210 third- through sixth-grade children who had a 30 min PE class every week. Participants responded to a standardized self-report enjoyment survey measuring their enjoyment level in a PE class during which they participated in tag games. Students completed the same questionnaire when involved in interactive dance games in PE. The results revealed that children reported significantly higher scores in enjoyment toward interactive dance games than they did toward traditional games (p < .01). Also, girls exhibited higher enjoyment toward interactive dance games than boys did (p < .05). However, no gender difference emerged on enjoyment toward traditional games. In conclusion, it is practical and meaningful to integrate interactive dance games into PE.

Certified athletic trainers' perspectives on rehabilitation adherence in collegiate athletic training settings.

CONTEXT: Adherence to sport-injury rehabilitation protocols may be pivotal in ensuring successful rehabilitation and return-to-play outcomes. OBJECTIVES: To investigate athletic trainers' perspectives related to the degree to which rehabilitation adherence is an issue in collegiate athletic training settings, gain insight from certified athletic trainers regarding the factors contributing to rehabilitation nonadherence (underadherence and overadherence), and ascertain views on the most effective means for promoting adherence. DESIGN: Cross-sectional, mixed methods. SETTING: Collegiate athletic training in the United States. PARTICIPANTS: Certified athletic trainers (n = 479; 234 male, 245 female). MAIN OUTCOME MEASURES: Online survey consisting of 3 questions regarding rehabilitation adherence, each followed by an open-ended comments section. Descriptive statistics were calculated for quantitative items; hierarchical content analyses were conducted for qualitative items. RESULTS: Most (98.3%) participants reported poor rehabilitation adherence to be a problem (1.7% = no problem, 29.2% = minor problem, 49.7% = problem, 19.4% = major problem), while most (98.96%) participants reported that they had athletes who exhibited poor rehabilitation adherence (1% = never, 71.4% = occasionally, 22.5% = often, 5% = always). In addition, the majority (97.91%) of participants reported that overadherence (eg, doing too much, failing to comply with activity restrictions, etc) was at least an occasional occurrence (2.1% = never, 69.3% = occasionally, 26.3% = often, 1.9% = always). Hierarchical content analyses regarding the constructs of poor adherence and overadherence revealed 4 major themes: the motivation to adhere, the development of good athletic trainer-athlete rapport and effective communication, athletic trainers' perception of the coaches' role in fostering adherence, and the influence of injury- or individual- (eg, injury severity, sport type, gender) specific characteristics on rehabilitation adherence. CONCLUSIONS: These results suggest that participants believe that underadherence (and to a lesser extent overadherence) is a frequent occurrence in collegiate athletic training settings. Strategies for enhancing rehabilitation adherence rates and preventing overadherence may therefore be important for optimizing rehabilitation outcomes.

50 Years of Research on the Psychology of Sport Injury: A Consensus Statement.

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

Experiences participating in a telehealth exercise program among older adults with cancer: a qualitative study.

PURPOSE: Telehealth delivery of exercise programs has rapidly increased in recent years; yet, little is known regarding older cancer survivors' (OCS) experiences participating in telehealth exercise. The purpose of this study was to determine OCS barriers and facilitators to participation in telehealth-delivered exercise. METHODS: OCS who participated in a 12-week, one-on-one telehealth exercise program were recruited to participate in one of three focus groups. Focus groups were conducted virtually using a semi-structured interview guide. Focus groups were audio recorded, transcribed verbatim, and analyzed utilizing thematic analysis with Atlas.ti. RESULTS: Fourteen OCS (age range 65-79 years) participated in the focus groups, five (35.7%) of which had not completed a telehealth follow-up assessment. The most common cancer type was breast (n = 6, 42.9%), and all cancer stages were represented. Three overall themes were identified: having adequate space to exercise, meeting OCS physical and psychosocial needs, and OCS learning throughout the exercise program. Within these themes, five facilitators and two barriers were identified. Facilitators included the individualization of the exercise program, no travel, accountability, learning to exercise, and support from staff and family. The barriers identified were having limited space to exercise and a learning curve with technology. CONCLUSION: OCS viewed telehealth exercise positively. Identified barriers aligned with those in younger cancer survivors (≥18 years), indicating that OCS are able to engage with telehealth exercise programs alongside their younger counterparts. IMPLICATIONS FOR CANCER SURVIVORS: Telehealth exercise mitigates exercise barriers in OCS and should be used as a strategy to support exercise participation among cancer survivors, regardless of age.

The impact of increased blood lactate on serum S100B and prolactin concentrations in male adult athletes.

S100B is an astroglial protein that is increased in the peripheral bloodstream after traumatic brain injury (TBI). Elevated serum levels of S100B have been shown to be predictive of mild TBI. Furthermore, physical activity (PA) can affect S100B levels. Interestingly, increased serum S100B concentrations have been detected in athletes without apparent TBI. Such increases could be attributed to tissue hypoperfusion reflected by blood lactate concentrations [BLa(-)] and/or increased serotonergic activity reflected by prolactin (PRL). The impact of increased blood lactates on peripheral S100B levels per se are yet unknown. The purpose of our study was to investigate if increased blood lactate induced by sodium lactate infusion, without the "side effects" of PA, resulted in changes in serum S100B and PRL. Twelve male adults were given a sodium lactate infusion for a period of 24 min by a perfusor with an infusion rate of 0.01 mL kg(-1) min(-1), increased every 3 min. The main outcome measures showed no increase in serum S100B (p > 0.05). Prolactin increased significantly (p < 0.05) after [BLa(-)] exceeded a concentration of 4 mmol L(-1). Furthermore, the expected values of blood lactate achieved peak values ranging from 11 to 15 mmol L(-1). We conclude that neither increased blood lactate nor serum PRL play an exclusive role in the regulation of S100B. Nevertheless, PA should be surveyed in medical history and critically assessed in determining the severity of TBI, especially in sports. Further studies are needed to clarify the impact of PA on the biomarker S100B.

Psychological predictors of injury occurrence: a prospective investigation of professional Swedish soccer players.

CONTEXT: Athletes participating in sport are exposed to a high injury risk. Previous research has found a great number of risk factors (both physiological and psychological) that could increase injury risk. One limitation in previous studies is that few have considered the complex interaction between psychological factors in their research design. OBJECTIVE: To study whether personality, stress, and coping predicted injury occurrence in an elite soccer population based on a hypothesized model. DESIGN: Prospective. PARTICIPANTS: 56 (n = 38 male, n = 18 female) Swedish Premiere League soccer players were selected based on convenience sampling. INTERVENTION: Participants completed 4 questionnaires including the Swedish Universities Scales of Personality, Life Events Survey for Collegiate Athletes, and Brief COPE during the initial questionnaire administration. Subsequent to the first meeting, participants also completed the Hassle and Uplift Scale5 once per wk for a 13-wk period throughout the competitive season. MAIN OUTCOME MEASURES: A path analysis was conducted examining the influence of personality traits (ie, trait anxiety), state-level stressors (ie, negative-life-event stress and daily hassles), and coping on injury frequency. RESULTS: Results of the path analysis indicated that trait anxiety, negative-life-event stress, and daily hassle were significant predictors of injury among professional soccer players, accounting for 24% of the variance. CONCLUSION: The findings highlight the need for athletes, coaches, and medical practitioners to attempt to reduce state-level stressors, especially daily hassles, in minimizing injury risk. Educating and training athletes and coaches in proactive stress-management techniques appears warranted.

Enjoyment Mediates Associations of the Physical and Family Environment With Adolescent Physical Activity: A Structural Equation Modeling Approach.

PURPOSE: The purpose of this study was to examine the direct effects and mediating effect of physical activity (PA) enjoyment on the associations of the physical environment and family environment with adolescent PA behavior. METHODS: Participants were US high school students who participated in the National Youth Physical Activity and Nutrition Study (N = 11,429; 49.4% female). The dependent variable was a latent variable from 3 survey items indicating adolescent PA behavior. One set of independent variables were items of the physical environment and a second set of independent variables were items of the family environment. A latent PA enjoyment mediating variable was constructed within a weighted structural equation model to examine the standardized direct and indirect effects (IEs) of the physical and family environment variables with adolescent PA controlling for demographic covariates. RESULTS: Significant PA enjoyment mediating effects on adolescent PA were observed for the physical environment variables (IE range = 0.015-0.040) and adult transportation (IE = 0.013, 95% confidence interval [CI]: 0.006-0.020). The strongest direct effects were the associations between the family environment variables of adult PA encouragement (ß = 0.11, 95% CI: 0.08-0.14), transportation (ß = 0.14, 95% CI: 0.10-0.17), and watching (ß = 0.12, 95% CI: 0.09-0.15) with adolescent PA. DISCUSSION: Stronger PA enjoyment mediating effects on adolescent PA were observed for variables of the physical environment compared to the family environment but the strongest direct effects on adolescent PA were observed for family environment variables. Interventions that provide equipment, improve neighborhood safety, and educate parents on how to support PA may both indirectly and directly improve adolescent PA.

Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program.

OBJECTIVE: Despite the numerous benefits of regular exercise participation for cancer survivors, nearly 60% of survivors do not meet current guidelines. Hospital-based exercise oncology programs may be one strategy to promote exercise engagement as survivors have expressed a preference for exercise programs associated with a cancer hospital. However, follow-up rates in hospital-based exercise oncology programs can be low. Follow-up assessments are a critical component of exercise oncology programs as they determine survivor progress, allow for revision of exercise prescriptions, and demonstrate the effectiveness of the exercise program. Therefore, the purpose of this study was to identify clinical and demographic factors associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. METHODS: We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman Cancer Institute's hospital-based exercise oncology program, the Personal Optimism with Exercise Recovery (POWER) program. Cancer survivors completed an assessment at the start of POWER and were encouraged to attend a 12-week follow-up assessment. Factors associated with not attending a 12-week follow-up assessment were identified using logistic regression. RESULTS: Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09, 4.98) to not attend a 12-week follow-up assessment, whereas endometrial cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI: 1.61, 3.49) were associated with not attending a 12-week follow-up assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference (OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR 1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were associated with an increased likelihood of not attending a 12-week follow-up assessment. Survivors with a higher baseline quality of life (OR 0.96; 95% CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were less likely not to attend a 12-week follow-up assessment. CONCLUSIONS: Both clinical and demographic factors were associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. Understanding factors related to follow-up assessment attendance in exercise oncology programs can inform the development of targeted interventions to improve follow-up rate thus maximizing exercise support for cancer survivors.

Patient and practitioner perspectives of psychological need support in physical therapy.

PURPOSE: To examine strategies utilized by physical therapists that contributed to patient perceptions of basic psychological needs support articulated within Self-Determination Theory (SDT). METHODS: Semi-structured interviews were conducted with physical therapists (n = 9) and physical therapy patients (n = 9) undergoing rehabilitation for a variety of musculoskeletal injuries. RESULTS: Both patients and practitioners articulated the value of specific competence (e.g. matching rehabilitation challenges with patient abilities) and autonomy support strategies (e.g. active decision-making). Interestingly, both patients and therapists emphasized the salience of relatedness need support, a finding indicative of the potential importance of this need in a rehabilitation environment. The possibility that relatedness need support may be of equal - or potentially greater - importance than the other two needs in a rehabilitation setting, is however, antithetical to SDT contentions. Whether the primacy of relatedness need support is an artifact of the sample used in the current study or a reflection of a broader rehabilitation trend, is uncertain and remains a topic for further investigation. CONCLUSIONS: Understanding the strategies physical therapists use to support patients' psychological needs may have substantial implications for patient motivation and rehabilitation adherence, such as, improved psychological well-being, enhanced function, and increased adherence to physical therapists' recommendations.

Self-efficacy as a mediator of children's achievement motivation and in-class physical activity.

The present study was designed to examine the mediating effect of self-efficacy on relations of middle school students' four achievement goals with their perceptions of two motivational climates and in-class physical activity in physical education. The four achievement goals (mastery-approach, mastery-avoidance, performance-approach, and performance-avoidance), perceptions of the motivational climate (mastery- and performance-involving climates), and self-efficacy were measured in a sample of 194 students (93 boys, 101 girls) in a public school. Students' in-class physical activity was assessed using Actical Accelerometers. A series of multiple-regression analyses supported the mediating effect of self-efficacy on the relationships among students' mastery-approach goal, perceived mastery-involving climate, and physical activity.

Does motivation mediate the relationship between competence perceptions and patient outcomes among individuals with chronic low back pain? A multiple mediation analysis.

PURPOSE: The aim of this study was to examine: (1) motivations of patients with chronic low back pain to attend physical therapy; (2) relationships between competence perceptions, motivational regulations, and pain/disability; and (3) whether patient motivations to attend physical therapy mediate the relationship between competence perceptions and pain/disability. METHODS: A sample of 64 participants completed baseline assessment (1-week prior to initiation of physical therapy) and 6-week follow-up assessment. Differences between motivation variables at baseline were examined using one-way within-person ANOVA. Relationships between competence perceptions, motivation subscales, and pain/disability were calculated using bivariate correlations and multiple mediation analyses. RESULTS: Participants reported significantly higher levels of autonomous versus controlled motivation (mean difference = 3.5, p < 0.001, d = 2.3) and amotivation (mean difference = 3.6, p < 0.001, d = 2.4). Competence was positively associated with autonomous motivation (r = 0.45, p ≤ 0.05) and negatively associated with controlled motivation (r = -0.26, p ≤ 0.05), amotivation (r = -0.57, p ≤ 0.05), pain (r = -0.35, p ≤ 0.05), and disability (r = -0.34, p ≤ 0.05). Amotivation significantly mediated the competence-pain relationship (Amotivation IE = -0.19, 95% CI (-0.44, -0.06), p < 0.05) and the competence-disability relationship (Amotivation IE = -0.07, 95% CI (-0.17, -0.01), p < 0.05). CONCLUSION: Findings highlight the role of competence perceptions in mitigating amotivation for physical therapy and the deleterious implications of amotivation for patient-centered outcomes.Implications for rehabilitationWhile it is normal for patients to experience periods where they lack motivation for rehabilitation exercises, practitioners can encourage patients to assume responsibility for their recovery by informing them that amotivated states may increase the likelihood of increased pain perceptions and disability.Health-care practitioners should seek to foster competence perceptions in patients about to undergo physical therapy.Competence building strategies such as patient education, goal setting, and role modeling may be valuable in facilitating autonomous motivation and reducing amotivation for physical therapy.

The basic psychological need support in physical therapy questionnaire.

Given the limitations of current inventories of basic psychological need measurement, and the importance of psychological need support within an injury rehabilitation context, there is an evident need to develop the present inventory. Utilizing Self-Determination Theory (SDT) as a theoretical framework, two studies were conducted to develop and psychometrically test a measure of patients' perceptions of basic psychological needs support in physical therapy: The Basic Psychological Needs Support in Physical Therapy Questionnaire (BPNS-PT). In study 1, a panel of Self-Determination Theory academics assessed a pool of items for content relevance, representativeness, and item clarity. In study 2, responses from 199 physical therapy patients were used to identify the best fitting model through confirmatory factor analysis. A 3-factor 10-item measure displayed good fit to the data and illustrated evidence of internal consistency. Findings from these studies provide initial psychometric support (i.e. internal consistency and evidence of construct validity) for the BPNSPT as a measure of patient perceptions of basic psychological needs support in a physical therapy context.

Coach strategies for addressing psychosocial challenges during the return to sport from injury.

The purpose of this study was to examine coach strategies for addressing athletes' psychosocial challenges in returning to sport following injury rehabilitation. Qualitative interviews with eight elite coaches from the Western Australian Institute of Sport (WAIS) in Perth, Australia revealed that coaches facilitated athletes' return to sport from injury through a variety of means, but did not typically provide systematic forms of assistance. Coaches commented that the idiosyncratic nature of the injury experience meant that they needed to apply strategies consistent with athletes' particular psychosocial needs. Such strategies included: (a) coordination of a "team approach" to rehabilitation; (b) fostering open communication with athletes and treatment team members; (c) social support; (d) positive thinking and goal setting; and (e) role models. Analysis of these strategies revealed that coaches attempted to address competence, autonomy, and relatedness needs in facilitating athletes' return from injury. These findings suggest that self-determination theory may be a valuable approach for examining coach forms of assistance regarding athletes' return to competition following injury. Findings are discussed in relation to injury literature and self-determination theory. Suggestions for future research are also presented.