Discussion

Thematic Analysis Review

         This study highlights themes that represent the experiences of injured student-athletes impacted by COVID-19. These experiences overlapped with previous research concerning sport injury rehabilitation, and also found new themes specific to COVID-19. First, all 11 student-athletes experienced emotional distress. Participants felt uncertain of their rehabilitation process due to the injury itself, COVID-19, or a combination of the two. Participants also disclosed fears of retraumatization. The fear of reinjury is at its highest immediately following the injury, and generally lessens throughout the rehabilitation process (Hsu et al., 2017). However, without addressing the psychological barrier of reinjury, the rehabilitation process and return to sport can be delayed (Wiese-Bjornstal, 2010). Finally, participants suffered feelings of identity loss and separation from their sport and/or teammates. Sustaining an injury can threaten a student-athlete’s identity (Heird & Steinfedt, 2013), resulting in negative emotional and psychological repercussions (Brewer et al., 2010; Green & Weinberg, 2001). Due to this fear of losing a part of who they are, student-athletes experience great psychological stress tying to their athletic identity and role after an injury (Weinberg, Vernau, & Horn, 2013). Feelings of separation from a student-athlete’s sport and teammates may also precede or happen simultaneously with feelings of identity loss (Smith & Hardin, 2018).  The sudden disruption in routine can lead to feelings of loss, and athletes have even reported delusions due to the intense focus on athletics in response to no longer being able to participate (Lally, 2007; Lotysz & Short, 2004; Wylleman et al., 2004).

         Second, participants experienced interpersonal-relationship struggles. All 11 student-athletes reported communication issues with their teammates, coaches, and/or athletic trainers regarding their injury. The lack of communication stemmed from both the injury itself and the addition of COVID-19. Due to COVID-19, student-athletes all over the country were forced to return home and be away from their teammates, coaches, and athletic trainers. Student-athletes with injuries now had to rehabilitate on their own, without the consistent, in-person support they would typically receive if they were able to still recover at their school. This left many of the participants feeling alone, separated, and forgotten about. Participants also reported teammate conflict from their injury. When a student-athlete sustains an injury, the possibility of a “negative reaction from their teammates” (Mallard, 2017, p. 8) can deter them from reporting the severity of it. Student-athletes explained fears of their teammates believing their injury was fake and/or talking negatively about their injury and rehabilitation process. These fears led some student-athletes to avoid reporting their injury to their athletic trainer, and some student-athletes reported team incohesion due to the conflict (Leo et al., 2015).

         Finally, all 11 participants reported a delay in their recovery due to COVID-19 causing them to feel less prepared. Atalan (2020) found lockdowns significantly reduced the spread of COVID-19. However, COVID-19 implemented many state and national restrictions that affected the availability of rehabilitation. Due to these restrictions, surgeries were delayed, physical therapy was postponed, and patients had to take extra precautions such as COVID testing and self-quarantines. COVID-19 also moved many medical appointments and sessions to a virtual platform. Full medical clearance is required for return to play (Kraemer et al., 2009), and many doctors and physicians limited their appointments based on the severity and imminency of the injury. The absence of medical clearance lengthened many student-athletes return-to-play timeline. The deficit of hands-on therapy and in-person instruction also left many student-athletes feeling confused, defeated, and unmotivated. The virtual rehabilitation caused accountability issues for many student-athletes and delayed their recovery and release to play. Lastly, all 11 participants reported a lack of access to some sort of resource they felt was vital to their rehabilitation. Without access to their athletic trainer, proper equipment, and medical personnel, student-athletes felt even more confused and uncertain of their rehabilitation process.

         At the conclusion of each interview, participants were asked for recommendations regarding supporting an injured student-athlete. The responses included validating the student-athlete, adding more mental-health resources, and eliminating the stigma surrounding mental health. Many student-athletes reported feeling forgotten or as if their physical health was the only important aspect in their recovery. The participants discussed the importance of having unconditional support from their teammates, coaches, and athletic trainers and wanting more awareness among others of the physical and mental stress that comes with a sports injury.

Limitations and Future Research

The first limitation of this study is the findings rely on self-reports from the student-athletes. Sleijpen et al. (2016) found self-reported data does not always reflect real transformation. Another limitation was the length of the focus group interviews. It is possible saturation was not reached (Hennink et al., 2019). This design also utilized focus groups rather than individual interviews. Focus groups allow for quicker gathering of information, but it may not be representative of those that do not participate or share as much as the rest of the group (Queirós et al., 2017). The fourth limitation is the lack of member checking, where participants review the results to check for accuracy (Birt et al., 2016). Finally, the last limitation is the possibility of research bias. My advisor and I have extensive experience with athletics which may have affected the data analysis (Anderson, 2010).

As the COVID-19 pandemic continues to affect daily life, future research should explore how attitudes toward COVID-19 and rehabilitation progress. Restrictions are beginning to lift with the assistance of the COVID vaccines becoming more and more available, but social distancing guidelines and required mask-wearing is still in place in many areas. Future research should also explore feelings of relief from injured student-athletes due to COVID-19. Four student-athletes reported optimism from COVID-19. Because of the restrictions put in place, all student-athletes, injured or not, were forced to temporarily stop their training. The four student-athletes felt a burden taken off their shoulders knowing they had extra time to recover and that their teammates also experienced lack of access to different resources needed to continue preparing for their upcoming seasons. These findings can help better train mental health professionals and athletic trainers working with injured student-athletes. This study highlighted key experiences injured student-athletes experience (i.e., identity loss, lack of communication, etc.) and new challenges from COVID-19 (i.e., lack of access, virtual barrier, etc.). Understanding injured student-athletes’ perspectives and struggles can lead to more effective intervention strategies and prepare professionals for future pandemics or global challenges.