Results
This section identifies the themes that emerged from the analysis of the transcripts and field notes. My advisor and I trust that participants’ voices are heard in the examples used to illustrate themes and to portray each student-athlete’s experience with COVID-19 and its impact on their sport injury rehabilitation. We identified emerging themes from this study into three topics: (1) emotional stress, (2) impact on interpersonal relationships, and (3) delay in recovery. Subthemes further expanded the concepts illustrated within the main themes. We explored the meaning of each theme through quotations from the participant interviews and field notes.
Emotional Stress
All 11 participants expressed emotional distress stemming from their injury, COVID-19, or a combination of the two. The most common feelings were uncertainty, fear of retraumatization, and identity loss.
“The Unknowns”. The most common emotional response the participants expressed was uncertainty. Olivia expressed her uncertainty originating from “the unknowns of time – times of when I’m supposed to be hitting, times of when I’m supposed to run, jump, all that – it’s all up in the air.” Due to COVID-19, Olivia has not had access to doctors or her athletic trainer, causing her to feel unsettled. Noah also expressed uncertainty over his athletic ability, stating, “You don’t know where you stand versus where you were, and it can get really tough.” Obstructions in athletic ability is a scare for many student-athletes, especially when their timeframe to play is short. Mason said, “It’s not professional where you’re on a team and you know you’re going to come back. College is just four years.”
Inconsistencies in the rehabilitation process can also cause uncertainty, leaving the student-athlete unaware of the outlook for their future athletic career. Ava stated, “A lot of rehab is subjective. So, my trainer will do things that my doctor in Indianapolis doesn’t approve of and… there was just this constant contradicting.” Without reassurance from medical personnel and a coherent rehabilitation plan, anxiety may begin to form within the student-athlete. Sophia was never given a confident answer concerning her injury due to inconclusive MRI scans, leaving her in a state of worry concerning what the injury may even be. Sophia shared, “Last year, my friend passed away from cancer on her spine. It was super sudden, just came out of nowhere. Things like that would pop into my mind.”
Retraumatization. Three student-athletes specifically highlighted stress over the injury reoccurring. Emma explained the mental battle of preparing for return-to-play and “if [the injury] is going to happen again.” Ava described the hardest challenge of being injured is imitating the movement that caused the injury the first time. She stated, “I think the hardest part is moving to the right or moving to the left… Just being fearful that I’m going to do it again.” Ava later added, “All it took was obviously one time for me to be really fearful of that.” Another participant’s anxiety over retraumatization has been so significant that it has caused anxiety dreams. Noah explained, “I’ll have dreams that I re-hurt it because that’s how much it worries me.”
Identity Loss. Being a student-athlete formed a significant part of the participants’ identity. Lily questioned, “What does that do to you as a person if you worked really hard, but you just can’t come back to where you were?” Lily particularly stated that sustaining an injury can cause a student-athlete to question who they are as a person. Noah also mentioned experiencing some loss and separation due to his injury, stating, “Athletes can feel forgotten when they lose a role on the team and have been reduced to all of a sudden this athlete on injured reserve.” Olivia explained, “I had a starting position last year, and I’m like, ‘Damn, did I just lose it due to this injury’?”
Feelings of separation also were identified in the student-athletes. Grace stated, “It can be hard when you’re used to just doing something every day, and then it has to stop all of a sudden.” Lucas added on to Grace’s comment, saying, “Watching everyone else kind of do what you want to be able to do is definitely super hard.” Abby’s injury kept her physically separated from her teammates, and she said, “I spent a whole year present, around the team, but not actively engaged with people… being there but not actually being out there.” Abby later added that the most difficult part of rehabilitation is “joining back to a team that you felt you weren’t a part of.”
Impact on Interpersonal Relationships
All 11 student-athletes reported a negative impact on their interpersonal relationships due to both their injury and COVID-19. The student-athletes described communication deficits and conflict among their teammates.
Lack of Communication. All 11 participants expressed frustration with communication issues concerning their injury and rehabilitation. Lucas had a difficult time receiving a clear answer on his injury, leaving himself and others in a state of uncertainty. Lucas explained, “It’s been really hard, because there’s been so much back and forth to what’s even going on with my injury, and you’re not able to convey that with your teammates.” Abby had difficulty communicating with her teammates as well, but on a more personal level. Abby shared, “I remember reaching out to people when they were away on tournaments to try and check in, and nobody wanted to talk to me about softball.”
Isabella was upset over the lack of communication, sharing, “None of my coaches said anything or reached out… I’ve had to text my trainer multiple times to get them to respond.” Isabella later added, “When they don’t respond or people don’t reach out, it feels like they really just don't care about you as a person.” Olivia also felt isolated, stating, “I was going through a lot of hard stuff mentally, trying to get through my recovery process… It was difficult not hearing from [my teammates] or having that extra support.”
Teammate Conflict. Ava was concerned about the reaction she would receive from her teammates when she was injured, sharing, “I was terrified that my teammates were going to think I was faking it.” Ava later added:
“When I found out I tore my ACL, as sad and as heartbreaking that it was… I kind of have validation now… This is a true injury… [my teammates] don’t have permission to talk behind my back.”
Ava’s fear of her teammates’ reaction is rooted in some experiences other participants shared. Emma stated:
“I had some [teammates] saying I was faking it and doing it for attention, and they were kind of mad at me because I wasn’t coming to practice on time, and I was in the training room rehabbing.”
Grace and her other injured teammates also experienced conflict on their team, adding, “I had a few teammates that were kind of going behind our backs and saying that we weren’t working as hard, and we weren’t putting in as much.”
Hoping to avoid the backlash, Isabella felt she had to push through her injury. She said, “It put a lot of tension on me trying to prove that I was a better athlete than I was showing.” Lucas shared his relationships with certain teammates have been affected due to interpersonal conflict:
“It’s easy to see from an outside perspective of they just think you're basically slacking off and just making stuff up and you're not really trying your hardest, and that's definitely impacted a couple of the ways that I interact with some of my teammates.”
Delay in Recovery
All 11 participants expressed they experienced some sort of delay in their recovery and felt less prepared than they believed they would have if COVID-19 did not affect their rehabilitation. Lily shared, “It’s been almost 6 months that I’ve been having to deal with it now when it was supposed to be 2-3 [months].” Emma agreed with the delay in her recovery, adding, “I’m still kind of stuck in the same place I was 9 months ago.” Olivia’s delay has caused her to feel “behind on where [she] should be as an athlete.” The most common reasons for delayed recovery identified were due to COVID-19 restrictions, virtual barriers, and lack of access.
COVID-19 Restrictions. COVID-19 sent many states into a lockdown period, including stay-at-home orders, curfews, and business closures. However, nationwide lockdowns and stricter policies placed strain on injured student-athletes seeking rehabilitation. Noah said, “When it came to March, he closed down, he wasn’t seeing anybody… That really set me back because all of a sudden I had to do everything on my own.” COVID-19 also implemented quarantine procedures, typically requiring a 14-day isolation period (CDC, 2021b). Abby experienced stress with this policy:
“[The doctors] said if you’re coming in from out of town, you have to self-quarantine for 2 weeks, and I cannot drive to (Major City) and self-quarantine for 2 weeks just to get in for one appointment.”
Olivia also faced a tough situation. Her surgery was delayed for weeks, and when there was finally an opportunity, she had to take extra steps:
“I had a 2-week notice [of my surgery options], so I had to get a COVID test… had to quarantine 14 days before I could go get surgery… that was very stressful on what places were offering COVID testing because it was still new.”
Virtual Barrier. Many student-athletes struggled with the social distancing implemented by different state and local health departments. With the cancellation of NCAA sport seasons and closures of universities across the nation, many student-athletes were forced home without hands-on rehabilitation from their athletic trainers. Without being able to see their trainers in person, many student-athletes reported they received a text message or email containing their rehabilitation exercises. Noah said, “Getting a sheet or text of things you’re supposed to do is not the same.” Lily agreed with Noah’s frustration, adding, “It’s different when you’re messaging with someone versus them actually seeing you in person.” Olivia’s virtual issues concerned being released to play again. Olivia’s doctor moved all appointments virtually, blocking the opportunity for her doctor to examine her recovery and release her back to play. Olivia said, “Everything was online for how the doctors [saw me], so he was like, ‘I’m not going to fully know until I see you’.” Without full medical clearance, Olivia’s rehabilitation was delayed further.
Lily, along with five other student-athletes, identified accountability as a problem stemming from virtual rehabilitation. Lily shared that her exercises were sent to her on a word document. Other student-athletes shared the same experience, whether it be a word document, text message, email, etc. Lily said, “I didn’t really have anyone holding me accountable.” Mason also shared, “I didn’t have my trainer saying, ‘Come at this time.’ You have to do it on your own.” Without having scheduled appointments and a trainer supervising the rehabilitation, many student-athletes found it difficult to complete their exercises on time, consistently, and correctly.
Lack of Access. All 11 student-athletes experienced a lack of access to some sort of resource. Due to the restraints of COVID-19, many student-athletes lost access to trainers, doctors, equipment, and support. Noah said, “I don’t know that I ever recovered the way that I would have if I was on my normal [rehabilitation] schedule.” Lily also felt deprived of her trainer, stating, “At the time where I needed to be at the trainer the most, I couldn’t.” Lily lacked the support she needed to feel confident in her rehabilitation. She added on, “It was hard not being able to really see anyone for so long and not hearing, ‘Oh, you’re making progress, you’re looking good, doing better’.”
Beyond athletic trainers, many student-athletes were barred from seeing professional doctors regarding their injuries. Lucas claimed, “It was about two and a half months before I really had any kind of contact with any kind of medical personnel.” Abby also experienced a struggle with this, adding, “The hip institute was shut down for a while when we were trying to get in earlier this year, and now they’re seeing surgery-needed-only patients.” Emma also wanted to meet with her school’s sports psychologist, but never received any response to her emails. She said, “It’s really hard to contact her now since everything is virtually.”
The lack of access to resources created many feelings of confusion and defeat for the student-athletes. Emma reported being unmotivated to complete her rehabilitation, explaining, “[I was] coming home to just bands and I had to use a backpack filled with books to do the weight.” Olivia was unsure how to proceed with her rehabilitation due to the lack of supervision from her trainer. She said, “I would feel pain, but I didn’t know if I could push the envelope, to keep going… because I didn’t have somebody watching me.” Lily added on to the lack of supervision, adding the lack of therapy caused feelings of failure. She said, “I’ll come home feeling defeated, and how am I ever supposed to play in a game if I can’t get into therapy, and I can’t get better?”