Overcoming Psychological Barriers

May 23, 2019 by Beth Sitzler

In honor of Mental Health Month, NATA is conducting a mental health blog series throughout May to examine different facets of this topic and how they impact athletic trainers and their patients. This post focuses on the NATA 2019 Best Practice Forum “Enhancing Rehabilitation Outcomes Following Knee Injury: Overcoming Psychological Barriers.”


The May NATA News article, “The Psychology of Injury,” takes a look at how injuries impact not only the physical well-being of athletes, but their mental well-being, as well. Holistic, lifelong care has become a focus of the athletic training profession with many wondering how to best care for an injured athlete physically and psychologically.

Mental health will be a hot topic during the 70th NATA Clinical Symposia & AT Expo this June in Las Vegas. One session taking a closer look at athlete psychology is the Best Practice Forum, “Enhancing Rehabilitation Outcomes Following Knee Injury: Overcoming Psychological Barriers,” presented by Neal Glaviano, PhD, ATC, and Grant Norte, PhD, ATC, at 10 a.m. June 27.

As researchers at the University of Toledo, Norte and Glaviano have studied the psychological barriers associated with knee injuries, specifically ACL injuries and patellofemoral pain. Nonphysical psychological barriers, such as anxiety, depression, fear of movement and avoidance, are common in athletes after such severe injuries. These psychological factors can hinder successful patient outcomes, lead to a decrease in physical activity and increase the patient’s risk for subsequent injuries.

“What we know in 2019 is [these injuries are] much more than musculoskeletal – they affect the whole body and have a psychological impact and burden on the patient,” Norte said. “There are a lot of domains in psychological function. They’re each unique and can be treated in different ways. It’s important to recognize that, No. 1, there is a psychological impact after a variety of injuries.”

Glaviano and Norte said the first step is understanding that these psychological barriers exist. The next step is to identify them. This can be done in several ways, such as the use of patient-reported outcome measures, including questionnaires.

“If we can’t identify and assess these barriers, we’re not going to be able to effectively address them and intervene,” Norte said.

During the Best Practice Forum, the duo will identify the psychological barriers that can impact an athlete after a knee injury, illustrate the relationship of these barriers to functional impairments and identify patient-reported outcomes measures to assess these barriers.

“We’re [also] interested in hearing about what attendees are already doing and what their perceived barriers are in intervening [when a patient is facing a psychological barrier],” Glaviano said. 

Ultimately, Norte and Glaviano want attendees to leave with the tools needed to identify and assess these psychological barriers in order to connect athletes and patients to the treatment they need.

“It can be uncomfortable, but these are important things we need to be asking,” Glaviano said. “We need to have an open dialog with our athletes about these things. ATs need to have a game plan to identify these things and how to start talking about them.

“We have to think about the athlete as a whole and what’s best for them. And we have to think about them over their lifespan.”

Learn more about “Enhancing Rehabilitation Outcomes Following Knee Injury: Overcoming Psychological Barriers” and view the entire NATA 2019 schedule on the NATA convention website.