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Physical Therapy: Mind, Body, and Sport

The time was January of 2021. I was laying in bed, trying to decide what classes I should

take for my junior year of high school. I had already solidified my required classes such as

English, math, and history, but I could not decide what to take for my electives. I knew I wanted

to take some sort of science class, but outside of that, I had limited knowledge of the classes

available. The only thing I knew was that many juniors took physiology, and I had heard good

things about Northgate sports medicine. Truth be told, I barely even knew what the terms “sports

medicine” and “physiology” meant. However, I did not know at the time that this decision to

take those two classes established my goals for the future.

I ended up really enjoying those classes my junior year, and fell in love with those

subjects. I was enthralled by the content of the classes, and thoroughly enjoyed learning about

anatomy, how body functions work, and how to treat basic injuries. I even ended up taking some

sports medicine classes through Diablo Valley College, to enhance my knowledge in the field.

Beyond this, I decided to become a football trainer for the Northgate program, a position that had

to be auditioned for as the highest-ranking student position in the sports medicine program. I

ended up getting the spot, and was excited for football season my senior year.

The other thing that senior year brought was college applications. I honestly had no idea

what I wanted to study in college up until the beginning of the year. As I started scrolling

through the majors, kinesiology, or the study of the movement of the human body, caught my

attention. I had enjoyed sports medicine and physiology, so why not pursue a career in that field.

In my mind, it made perfect sense. Once college applications were done, the senior project rolled

around, but I was already prepared, and knew what I wanted to focus on: sports medicine. After

learning more about the jobs under the “sports medicine” umbrella, physical therapy was the one

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that caught my attention. Being able to help out injured athletes and get them back to their sports

sounded very rewarding and satisfying to me, and is something that I want to pursue later in life.

All of my life, I have played sports, but have never been significantly injured, and never

had to go through any serious rehabilitation. However, I had some friends who had, and I always

wondered if they knew what was going on with their treatment. I also thought about whether

athletes had any knowledge about the injuries that were occurring to them. Being a

student-athlete myself, and taking sports medicine, allowed me to learn about injury prevention,

and proper rehab techniques. But I am willing to bet that many other athletes do not. This led me

to focus on the question: What are the benefits of physical therapy on an athlete's mental and

physical health, and how can an athlete learn from their treatment to protect against future

injury?

First of all, it is important to understand what happens to an athlete when they are injured,

and the effects on their overall health, not just physical health. Injuries can be as small as some

shoulder pain, or as detrimental as a torn ACL, but both of them still cause an athlete distress and

pain. When facing these two feelings, it is often very easy for athletes to develop a negative

mindset about recovery, their sport, or even their life. Specifically, “Athletes who are injured

often struggle with fear, frustration, anger, and other emotions that distract them from focusing

on their rehab. Social support for injured athletes is one of the keys to keeping positive

psychological health” (Robbins). When an athlete gets hurt, it rocks their whole world, especially

if it is something traumatic that could cause them to miss their whole season. Rehabilitation is

often the last thing on their mind, and seeing physical therapy can help put them back in the right

mindset. Physical therapists are there to help an athlete with their rehab, and can help an athlete

get back into the right mindset about their recovery, and themselves as an athlete. In addition,

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“Injured student-athletes who are having a problematic psychological response to injury may be

reluctant to seek treatment. They may be afraid to reveal their symptoms, may see seeking

counseling as a sign of weakness, may be accustomed to working through pain, may have a sense

of entitlement and never had to struggle, and may not have developed healthy coping

mechanisms to deal with failure” (Putukian). As previously stated, athletes do not always know

what to do when they are hurt, and can view being injured as something that would single them

out, or be judged for not being able to play. An athlete has a reputation of being able to perform

at a high level for their team, and if they become injured, the worst thing that they could do is not

treat it, or try and play through the pain. An example of physical therapy helping an athlete with

their identity comes from physical therapist Robert Walters, who reflects on his own experience

of being injured during his high school athletic career. Walters has always been involved in the

medical field, as a director of John Muir Health’s rehabilitation department, as a hospital CEO,

and now as a private practice owner. Walters stated, “ A lot of times identity is wrapped up in

being an athlete, and who you are as an athlete. So for me, going through physical therapy and

getting healthy again, helped me reidentify being an athlete, because I had missed it for so long.”

Walters notes that for athletes, identity is a huge part of their reputation and how they see

themselves as an athlete. Especially, for more hard contact sports, such as football, players can

definitely believe that they show weakness walking around in a boot or with crutches. However,

when this injury is treated, the individual is able to get their reputation back, and come back

stronger than ever. And typically, physical therapy is the best way to get someone out back onto

the field after traumatic injury, or prolonged pain.

Physical therapy is important for athletes to receive because it is the quickest way to

return to activity, and will restore them to their previous condition before injury, typically

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through rebuilded strength and endurance. Sometimes, if an injury is serious enough, an athlete

will require surgery on that ligament, or tendon, or whatever structure it may be. If this should

occur, more often than not they will see physical therapy. However, “Not all of these injuries

require surgery, but it is important to treat them in order to reduce pain, increase strength, and

help an athlete get back to competition as quickly as possible” (Lindberg). This shows that even

if an injury is not surgery-worthy, physical therapy is still very beneficial and important. One of

the greatest hardships of being injured is loss of strength, which is something that every athlete

needs to perform at their highest level. Specifically, “Scientific literature generally agrees the

biggest changes in the musculature occur soon after injury.In fact, the most drastic reduction in

muscle strength occurs during the first week of immobilization…Another way to think about it:

Imagine that a person is going to lose 30 percent of their muscle size and strength while

recovering from an injury” (Carroll). This shows that strength loss is a huge issue for an athlete

to deal with when they are hurt, and regaining that strength is crucial for the athlete. Kathy

Lawrence, physical therapist who has 26 years of clinical experience, and current therapist for

Luna Physical Therapy, explains: “I find that I do a lot of retraining, so figuring out where the

weaknesses are, and retraining those muscles. It can be through manual therapy techniques or,

through exercise”. Here, Lawrence states that in order to rebuild muscle mass, it is important for

the muscle to be retrained, typically using therapy techniques, and then strengthened, through

various exercises. Injuries are often associated with pain and weakness within muscles, but there

is so much more to an injury that cannot be seen or felt. It is the same thing as not participating

in an activity for a prolonged period of time; it takes a while for someone to get back into the

groove, and reestablish that muscle memory. The same goes for injuries, and physical therapy is

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able to target muscle memory, and begin to establish those connections before full participation

in the activity.

Physical therapists approach rehabilitation in a different way than many other

professions. They are able to provide a specialized and personal treatment plan for each patient

that they see, as no two injuries are always exactly alike. As stated in “Physical Therapy’s Role

in Injury and Wellness Prevention”, “This typically focuses on building strength, flexibility,

balance and endurance. Many therapists utilize a whole body approach to heal an individual

patient’s unique orthopedic or neuromuscular condition and improve their functional capacity for

daily tasks, work and fitness/athletic activities” (Spencer). Physical therapists are experts on how

the body moves, and know the anatomy of the body inside and out. However, the muscular

system only goes so far in an individual’s treatment. Lawrence states that: “The main effect is the

retraining of those connections from your brain to your body. Some people say strength, but it is

more about the connection from the nervous system.” When most people consider physical

therapy, they only really think about muscles, strength, and how therapy will help them regain

strength. But as stated above, another very important physiological benefit of physical therapy is

retraining muscles to perform properly, especially if they have been in disuse for a prolonged

period of time. The physiological benefits of physical therapy definitely include strengthening

muscles and reducing pain in the area, but a subtle, crucial part of the treatment is working on the

nervous system to reestablish those “brain-to-muscle” connections.

Besides just the physical benefits of physical therapy, it has many effects on mental

health, and often helps athletes get back into the right mindset, restore confidence, and set goals

for their recovery. First of all, when someone gets hurt, it is vital that they understand the

recovery is a process, and the injury does not heal at the flip of a switch. For example,

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“Cultivating a positive future perspective on the recovery process fosters confidence in athletes’

ability to cope with adversity and endure rehabilitation. The full path to recovery comes in

stages, each with its own challenges and uncertainties'' (Heil et al.). There are going to be

hardships, whether they go to therapy or not. However, physical therapy can help an athlete

tremendously on this road to recovery, and as they are experts in the field of rehabilitation. In

addition, they also specialize in creating emotional relationships with an athlete. As previously

stated, a hurt athlete is a completely different person with a completely different mind, compared

to when they are on the field. Walters expanded on the fact of creating a relationship with his

patients, and how important that concept of physical therapy is. Walters stated, “Honestly, that is

90% of it. I cannot overestimate how important understanding and developing a relationship, like

an emotional relationship, is…when patients come to you and are hurt, they are really really

vulnerable. And they’re giving you their injured body part for you to fix.” This shows that

physical therapists want and need to create relationships with their patients. As previously

mentioned, an injury significantly affects mental health and reputation; physical therapy is

designed to reverse these effects. In short, it is a win-win, as athletes feel a connection and have a

safe space to express their feelings about the injury, and in return, can receive guidance and

treatment to get them back into a positive mindset.

In addition, although physical therapy is used for physical injuries, it has a strong effect

on mental health that goes along with and comes from the physical aspect. Common effects of an

injury are depression and anxiety, and it has been found that “During exercise, your brain

produces endorphins. Endorphins trigger the release of dopamine. Researchers believe that these

factors provide a natural way to reduce mental disorders like depression” (CORA Development

Team). Consequently, “By participating in physical therapy, you’re simultaneously improving

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your physical and mental health” (CORA Development Team). Mental health is something that

is often overlooked in athletes, but being locked in and having positivity and confidence goes

hand in hand with performance. Physical therapists always strive for mental health benefits, and

want athletes to feel that they are cared about.. Finally, confidence is key for an athlete, and

injuries disrupt and ruin this confidence. Athletes need to be confident to play, and to stay safe:

“So that when they are ready to return to sport, they are 100% confident that their injury is

healed, that they feel good about it. Because, if you’ve gone back, and you don't feel 100 percent,

you’re playing guarded, protective, and it's a lot easier to get hurt when you don’t go 100%, and

then you risk yourself to a whole host of other injuries” (Walters). This shows that injuries can

stockpile if an athlete isn’t confident that they are fully healthy. Due to the expertise of a physical

therapist, they will make sure that the athlete feels confident, and not just have them return

because their injury has healed. So building up confidence and allowing the athlete to feel

confident in themselves is a vital part of physical therapy.

Oftentimes, there is a bridge between the physical health and the mental health benefits

that come from physical therapy. When patients start to feel better, the stigma of being injured

begins to go away. Lawrence notes that, “They are both really important. But the mental part

comes from the physical a little bit, so I would lean towards physical a bit more, but it is very

close. But the mental, such as anxiety, can be huge as well. Pain is also a huge area of study, like

currently, the neuroscience of pain, and the psychology of trying to figure out how to deal with

different people’s perceptions of pain”. Here, Lawrence explains but both mental issues, such as

anxiety, and physical issues, such as pain, are treated simultaneously. When pain begins to

subside, that will obviously have an affect on the patient's perception of the pain that they are

feeling. Adding on, therapists often have strategies that can target the two sides of health. One

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such strategy is creating a routine, which goes along with a physical therapist office being a safe

and structured space for a patient: “With a regularly scheduled exercise routine, your brain learns

your body’s limits, helps retrain your muscles and reinforces movement patterns that will enable

you to be more active with less pain. As you get stronger, your nervous system will trust what

movements are safe and which actions may cause harm”(“How physical therapy…”). Here, it is

shown that a significant part of an athlete or patient’s treatment doesn’t even come from

exercises and therapy. Rather, it just comes from the structure and requirement of putting a time

commitment towards getting better. Seeing physical therapy allows someone else to put together

a schedule that can easily be followed for recovery. Lastly, there are other strategies used in order

to strengthen an athlete's mental health. One of these strategies is making the rehab a

competition, as many athletes enjoy being able to participate in competition as quickly as

possible. This allows for a sense of enjoyment out of the treatment, and it works simultaneously

on mental and physical health. Therapists also can reach out to coaches and parents, and describe

to them how well their client is doing in therapy. When the athlete hears this from someone else,

it continues to build their confidence, and an increased will to get better (Walters). While mental

and physical health may seem unrelated, physical therapy, and looking at the body as a whole,

unites the two for optimal recovery.

Physical therapy is a vital part of recovery, especially after serious injury, and is like no

other form of treatment of rehabilitation. Physical therapy is a unique profession, and physical

therapists are experts at what they do, regarding movement and injury. An example of this is,

“Physical therapists are experts in the way the human body moves. They are able to provide a

unique perspective on purposeful, precise and efficient movement across the lifespan by

evaluating the movement system through their expertise in mobility and locomotion” (Spencer).

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Physical therapists look at the whole body, and use their anatomy knowledge of the whole body,

to figure out what’s wrong, and develop a personalized plan for recovery. Physical therapist

Kathy Lawrence stated that: “We are known as the movement specialists, so we really analyze

movement…so really being able to break down the components of a movement and the joint

mechanics of a movement and the muscle dynamics of a movement”. Both Lawrence and

Walters also agree that other professions do not find the root cause of the injury, and just manage

symptoms to make the patients feel better: “Not just treat the symptoms but improve the overall

mechanics of the joint and the surrounding body parts…. In fact, I know other professions don’t

do that” (Walters). When a physical therapist finds the root cause of the injury, and instills the

confidence in the athlete that they know what is wrong, and know exactly how to treat it. This

allows the athletes to feel confident that they will get better, and not have to just rely on someone

looking at pictures to help them. This shows that physical therapy is special because of the

scientific and medical background of the therapists, and that they are able to treat the root cause

of an injury. This is important to athletes because it gives them confidence in their treatment, and

because this treatment is geared towards preventative practices.

Finally, one of the most overlooked, but most important, aspects of Physical Therapy is

teaching athletes about what happens when they are injured, and how they can better prevent and

treat the injury should it occur again. First of all, athletes should be taught about symptoms of

common injuries, and how to monitor and recognize these symptoms. In Sports Injuries, author

Robin Roberts states: “As an athlete, you must know your body. You must learn to judge which

aches and pains need medical attention, and which may indicate serious injury. There are,

however, certain general signs and symptoms that your injury isn’t minor. Any sharp or burning

pain that does not subside in a short time.. Any pain or tightness… that restricts movement or

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ability to put pressure on that part.” It is common for athletes to feel a bit sore or tight after

activity, but they should be taught to recognize symptoms that are not just a result of

participating in activity. Education is a huge aspect of physical therapy, and as stated previously

by Roberts, knowing the symptoms of injury can be so beneficial for an athlete. Beyond that,

playing through injury is the worst thing an athlete can do for their overall health: “Continuing to

play if you have an injury can make that injury worse. A small stress fracture that might have

healed quickly can grow into a more serious, more painful fracture that will take longer to heal.

Returning to play too soon after a concussion increases your risk of serious brain injury”(“What

Happens If…”). This is why athletes need to take advantage of the treatment that is available,

and not just try to “walk it off” when it comes to injuries that require significant treatment.

Additionally, re-injury is a very common occurrence, and going through previous treatment

allows the athlete to recognize this injury, and know exactly what to do. This shows that

education is vital to athletes, and physical therapists are one of the groups that can communicate

this most effectively to an athlete.

Finally, both Walters and Lawrence stress the importance of education, and how

education leads into prevention. First, Lawrence explains: “You definitely want to talk to them

about where it came from, and that leads into how to prevent it. I do give advice that is like ‘if

this starts popping up again, first start with this, then go do this.’” Here, it is shown that should

the injury occur again, an athlete can reflect on their time in physical therapy, and be able to

manage the injury better than they might have been uneducated. In addition, “ I’ll show them the

anatomy. So that they can start to picture it, and once they can start to picture ‘oh, this is the way

my shoulder should be moving’. When I show them that, a light bulb goes off, and then they buy

into what I’m going to ask them to do” (Walters). Another aspect of the education part comes

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from the athlete following their treatment. If they don't know what's going on, they will be

confused and not be trustworthy of their treatment. On the other hand, if the athlete can see why

the injury happened, their treatment will make more sense, and they can take note of how to treat

the injury. The bottomline, according to Walters is, “It [education] is essential. You cannot leave

your patient uneducated; it just doesn’t work.” Walters stresses the importance of education for

all of his clients, and the significance of going through the details of their injury.

Physical therapy has a wide array of benefits to athletes. From something as simple as

just rebuilding strength, to something as complex as treating depression, physical therapy truly is

like no other form of rehabilitation. Even teaching an athlete about their injury is something that

many other professions do not do. Physical therapy is unique, and is the best way for athletes to

recover and receive treatment for injuries and pain. As for the tangible, physical benefits of

physical therapy, building strength and balance is crucial for athletes returning to play. Retraining

muscles and their triggers from the brain is also another very important physiological benefit. As

for the mental side, restoring confidence is one of the hardest things to achieve rehabilitation,

and physical therapists specialize in this area. This goes hand in hand with having a true

relationship with your therapist, and just having someone that will give you a positive outlook on

your treatment, and do away with fear and anxiety about the injury. On the other hand, physical

therapists find it vital to teach their clients about what is going on when they are hurt, and how to

recognize symptoms of re-injury. They create personalized recovery plans, and walk the athlete

though everything they should if re-injury should occur. Physical therapy is something

commonly viewed as just when someone is hurt, they should go to physical therapy to get better.

However, there are so many other aspects of the industry that are hidden behind the doors of the

office. When athletes are injured, their mental health goes out the window, and become lost in

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their next steps. Therapists are the people that want to help, and connect with them emotionally.

They don’t skip small details, and find the true cause of the injury unlike other professions that

just treat symptoms. Physical therapy puts them back on track, strengthens their muscles and

mind simultaneously, and teaches them strategies to treat the injury.

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Works Cited

Carroll, Michelle. “How to Fight Muscle Atrophy after Injury: A Personal Trainer's Guide (the

Science).” The physical therapyDC, 20 Jan. 2022, https://www.thephysical

therapydc.com/articles/muscle-atrophy-after-injury.

CORA Development Team. “Mental Health Benefits of Physical Therapy.” CORA Physical

Therapy, 23 Dec. 2022,

https://www.coraphysicaltherapy.com/mental-health-benefits-of-physical-therapy/

Heil, John, and Leslie Podlog. “The Psychology of Sports Injuries.” NCAA.org,

https://www.ncaa.org/sports/2015/2/10/the-psychology-of-sports-injuries.aspx.

“How Physical Therapy/Exercise Improves Mental Health.” Raintree Systems, 15 Aug. 2022,

https://www.raintreeinc.com/blog/physical-therapy-and-mental-health/.

Lawrence, Kathy. Personal Interview. 12 March 2023

Lindberg, Sara. “What Are the Benefits of Physical Therapy?” Healthline, Healthline Media, 14

Oct. 2022, https://www.healthline.com/health/benefits-of-physical-therapy#benefits.

Putukian, Margot. “Mind, Body and Sport: How Being Injured Affects Mental Health.”

NCAA.org,

https://www.ncaa.org/sports/2014/11/5/mind-body-and-sport-how-being-injured-affects-

mental-health.aspx.

Robbins, Jamie. “Understanding The Psychology Of Injured Athletes And Returning To Play.”

Hmpgloballearningnetwork.com, June 2012,

https://www.hmpgloballearningnetwork.com/site/podiatry/understanding-psychology-inju

red-athletes-and-returning-play.

Roberts, Robin. Sports Injuries. Millbrook Press, 2001.

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Spencer, Katherine. “Physical Therapy's Role in Wellness and Injury Prevention.” The Charlotte

News, 5 Mar. 2021,

https://www.charlottenewsvt.org/2019/02/20/physical-therapys-role-in-wellness-and-injur

y-prevention/?fbclid=IwAR29XnepAqlBE-EWDblB-qWNS4KM9jVxdhCVcnb3t-27gO

VGy4ZBQ1DJYAY.

Walters, Robert. Personal Interview. 26 February 2023

“What Happens If You Keep Playing Sports When You're Injured? (for Teens) - Nemours

Kidshealth.” Edited by Sarah R. Gibson, KidsHealth, The Nemours Foundation, Oct.

2020,

https://kidshealth.org/en/teens/play-injury.html#:~:text=Continuing%20to%20play%20if

%20you,risk%20of%20serious%20brain%20injury.

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