Monday, September 27, 2010

"The Pink Ladies"

Breast cancer has touched so many lives in one way or another.  Many people have lost loved ones to cancer, but there are more and more people who survive this terrible illness.  For those survivors it is important to focus on their health and overall quality of life.  As treatments improve, a greater number of patients with breast cancer will survive their cancer.  They have fought so hard and beat cancer, but this can have a huge effect on their mental state and well-being.  In 1975, the survival rate for breast cancer in women was 75 percent; in 2007, it was 89 percent.  Although survival rates continue to increase, breast cancer survivors are at increased risk for osteoporosis and decreased quality of life compared to healthy women (Van Poznak & Sauter, 2005).  My job is to develop an exercise program for women at a cancer center that will have a number of different benefits including an increased quality of life.  The program is called “The Pink Ladies” for a couple of reasons.  First, I believe there is some pride that comes with being a breast cancer survivor.  They have gone through so much physically and emotionally, for them to have won the battle is empowering.  Secondly, the color pink is the theme color for breast cancer so obviously there is some meaning there.  And finally, I think it is a name that will make people smile and be happy to be a part of this program, and that is the starting point to getting healthy and improving quality of life. 
There has been extensive research with cancer patients and survivors demonstrating the benefits of physical activity (Gill & Williams, 2008).  In developing an exercise program, I want to take into consideration the wants and interests of the women in the program.  I believe this will help me develop something that will not only benefit their body, but also their mind.  A big focus of this exercise program has to be improving their quality of life.  “Quality of life is an individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (Gill & Williams, p.176).  Allowing them to participate in an activity they enjoy will help enhance their experience and allow them multiple benefits both physically and emotionally. 
One activity I believe will benefit all of the exercisers is yoga.  Yoga is a full body exercise that has many of the positive benefits we are looking for in our exercise program.  Speed-Andrews (2010) found that after yoga 94 percent of breast cancer survivors said they had improvements in their quality of life; 88 percent felt better physically; 87 percent reported being happier and 80 percent were less tired. Other improvements were reported in body image and in decreased levels of stress, anxiety and depression. This is significant, considering breast cancer treatments often leave women in pain, immobilized, tired and depressed.  I believe incorporating yoga into the program at least two days a week will result in greater overall strength both inside and out.
Another important aspect we need to incorporate into the exercise program is strength and resistance training.  Some may be concerned about the risks of strength training after being treated for breast cancer, but there have been a number of studies done and their findings provide clear evidence that weight training is safe and even beneficial after breast cancer surgery (Kaunitz, 2009).  My focus would be a lot of free weights and resistance bands for strength training and toning.  We would do these exercises two to three times per week in order to see benefits.  According to the American College of Sports Medicine (2006), to achieve the health benefits of resistance training, participation should include a minimum of two days per week.  Strength training can improve the quality of life for breast cancer survivors; however research on this topic is very new.
Cancer is one of the most feared words in the English language.  The women in this program all have something in common; they are all survivors.  This commonality allows them to have immediate trust in each other and therefore will benefit each other through motivation and encouragement.  Taking part in group activities will increase enjoyment because of interactions and feedback from peers (Gill & Williams, 2008).  Therefore, taking part in this exercise program and sharing this experience with women who have walked in their shoes will allow them maximum benefits.  As with any workout program, there will be struggles, but knowing they are surrounded by people who have been where they have been, and have similar goals as they do, will allow them to get the benefits both physically and emotionally.


American College of Sports Medicine. (2006). ACSM's resource manual for guidelines for exercise testing and prescription (7th ed.). Baltimore, MD: Human Kinetics.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Kaunitz, A. (2009). Strength training: Safe in breast cancer survivors with lymphedema. Journal Watch Women's Health, NA.

Speed-Andrews, A. (2010). Special yoga classes aimed at breast cancer survivors improves recovery. Women's Health Weekly, 142.

Van Poznak, C., & Sauter, N.P. (2005). Clinical management of osteoporosis in women with a history of breast carcinoma. Cancer, 104(3), 443-456.

Monday, September 20, 2010

Mind over Matter

       Participating in intercollegiate athletics takes a great amount of athletic skill, but it also takes a very strong mind.  As in the case study, many female athletes battle the consequences of an ACL injury.  And as an athletic trainer, my job would be to work with her and prepare her to get back to competition.  A number of studies point to the importance of using a well-defined, guided rehabilitation protocol for a successful outcome after ACL surgery (Thomee, Wahrborg, & Borjesson, 2010).  But there is more to rehabilitation than just taking the athlete through their exercise program.  Working with the athletes mind plays a huge role in their work ethic and therefore, the overall outcome of their rehabilitation.  The main cognitive skills I believe to be effective in a rehabilitation program are imagery, goal setting, and self-talk.  With the use of these cognitive skills, I would be able to work closely with the athlete and get her back on the court with a healthy body as well as a healthy mind.
       “Imagery, attention skills, and cognitive-control skills are increasingly used in training and rehabilitation” (Gill, 2008). Ievleva and Olick (1991) found that imagery helped athletes cope with pain, as well as stay motivated and positively involved in their sport and in the rehabilitation process.  Being able to know what the athlete is thinking while they are rehabbing is important to me as an athletic trainer.  In incorporating imagery in the rehab program, I am able to have some control and guidance as to how or what the athlete is thinking.   I would make sure we practice imagery regularly so it is developed over the course of the rehabilitation program.  I would also use triggers and cues to help with the athletes’ concentration when performing her exercise routine.  Shaffer and Wiese-Bornstal (1999) suggest that imagery has several roles for injured athletes: “Imagery helps in reading the body and reactions to the injury, skill imagery helps in the practice of skills, and rehabilitation imagery helps in the healing process by promoting a positive mindset, keeping the athlete engaged in the rehabilitation process, and even influencing physiological function.” 
       Goal setting is another huge thing I can incorporate in the rehabilitation program.  Having a strong background in volleyball, I can also personally relate to this particular athlete, which can help me establish specific challenging, but also realistic goals.  One of the most consistent research findings is that specific goals enhance performance more than vague or no goals (Gill, 2008).  Gill also suggests goals should be challenging but attainable.  In a rehabilitation program, it is important to not only look at the big picture, or the main goal which is getting back into competition.  But it is also important to recognize the little accomplishments and goals that are set throughout the program.  Having both short and long term goals will help the athlete stay on track with her rehabilitation.  The volleyball season is a minimum of 10 weeks long, so she still has the opportunity to compete in the current season.  I believe this would be the ultimate goal for her at this time.
       Self-talk is the final skill I would incorporate into this rehabilitation program.  “Self-talk occurs whenever a person thinks—whether the self-talk is spoken aloud or silently—and makes perceptions and beliefs conscious” (Gill, 2008).  This is a skill that most individuals already use, but it is also a skill that can be taught and practiced so it is used effectively in the rehabilitation setting.  With this particular athlete I would make sure we focus on changing negative thoughts into positive ones.  The way athletes react emotionally to an ACL injury appears to be closely connected to their rehabilitation behavior and clinical outcome, as well as their subjective well-being” (Thomee et al., 2010).  When rehabbing an injury such as the ACL, there are going to be times of discouragement and negative thoughts because the athlete can not currently do what they used to be able to do.  The focus would be to switch the negative thought to a positive, constructive one.  Another similar focus would be to practice thought stopping: when the athlete has a negative or unwanted thought, they need to stop that thought and counter it with a positive one.  An athletes’ use of self-talk has received considerable attention in that it has been reported to be used for motivational and cognitive benefits by athletes (Hardy, Gammage, & Hall, 2001).
       In conclusion, I need to take many angles when working with a female volleyball athlete in the rehabilitation setting.  It is more than just taking her through the physical exercises.  As an athletic trainer, I need to use these cognitive strategies along with her exercise program in order to gain an optimal outcome in her rehabilitation program.


Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Hardy, J., Gammage, K., & Hall, C (2001). A descriptive study of athlete self-talk.  The sport Psychologist, 15, 306-318.

Ievleva, L., & Orlick, T. (1991). Mental links to enhanced healing: An exploratory study. The sport Psychologist, 5, 25-40.

Shaffer, S.M., & Wiese-Bjornstal, D.M. (1999). Psychological interventions in sports medicine.  In R. Ray & D.M. Wiese-Bjornstal (Eds.), Counseling in sports medicine (pp. 41-54). Champaign, IL: Human Kinetics.

Thomee, P. , Wahrborg, P. , Borjesson, M. , Thomee, R. , Eriksson, B. , et al. (2010). A randomized, controlled study of a rehabilitation model to improve knee-function self-efficacy with ACL injury. Journal of Sport Rehabilitation, 19(2), 200-213.

Monday, September 13, 2010

Bounce Back

     There are a countless number of athletes who have the misfortune of suffering a serious injury during competition and having to deal with the physical and emotional demands of rehabilitation. Rob is a high quality athlete competing at a nationally ranked institution where he most likely has high expectations of himself. But all that can change with an injury as serious as his. Now Rob has to adjust to not competing and continuing with his rehabilitation. Both of these will affect his self esteem, self efficacy, and overall athletic identity and physical self-worth. This review will discuss options to help Rob get past these challenges and move forward in his rehabilitation efforts and reach his goal of returning to the court.

     As a coach, I have encountered many athletes in the same boat as Rob. Each athlete dealt with their injury a little different than the other. Some of that is because of the seriousness of the injury, and therefore the duration they would not be able to compete. But a lot of it is based on their emotional state and how the athlete deals with their injury. The main issue Rob needs to deal with is his physical self-worth. Gill (2008) describes physical self-worth as general feelings of happiness, satisfaction, pride, respect, and confidence in the physical self. In Rob’s case, he was happy and confident before the injury and he probably started his rehabilitation program with high expectations. But over time he began to question his self-worth and therefore his self-efficacy decreased. In rehabilitation settings, self-efficacy is a determinant of physical activity behavior (Gill, 2008). He can’t do the things he used to be able to do, and it is frustrating over time.

     When an athlete hits a point in their rehabilitation when they begin to question their self worth, coaches and physical trainers need to step in and take action. Motivation is a big part of this, and is key to the success of the physical and mental recovery of the athlete. Fox (1997) talks about five main motivational elements; direction, persistence, continued motivation, intensity, and performance. Rob first needs to find a direction, and make a choice about his rehabilitation. He is only a freshman and with successful rehabilitation he could still have a very strong collegiate athletic career. As a coach, I think setting mini-goals during Rob’s rehab will help motivate him continue in his direction. If Rob can see himself succeeding with these mini-goals, he will be able to progress more quickly.

     Persistence is Rob’s second motivation factor. This refers to his “degree of sustained concentration or involvement in one task” (Maehr & Braskamp, 1986). This is a choice that Rob will need to make daily. In order to help develop his physical strength and necessary muscle development he will need to be consistent with his rehabilitation. This will also be a part of redeveloping his athletic identity.  The third motivation element Fox (1997) refers to is continued motivation. Rob lost some of his sense of athletic identity when he was injured and could not compete. A key part of his overall direction needs to be regaining what he believes he lost. “Athletic identity is the degree to which a person identifies with the athletic role and looks to others for acknowledgement of that role” (Gill, 2008). As a coach I need to reassure him of his place on the team and the importance of why he is training so hard. Remember, he is only a freshman and I still see him as an asset to our team now and in future years.  Intensity is another indicator of motivation. We have to remember that Rob is a college level athlete and is used to being challenged and trained hard. He will gain a sense of accomplishment when he is pushed in his rehabilitation exercises.  A combination of direction, continued motivation, persistence, and intensity bring us to our final indicator of motivation; performance (Maehr & Braskamp, 1986). This is the ultimate goal for Rob. He is working so hard each day in his rehabilitation so he can reach his previous level of performance. Ultimately in doing this, Rob will also regain his self-esteem, physical self-worth, and athletic identity.

     In conclusion, the overall goal is to help Rob regain his sense of physical self-worth and athletic identity. So many athletes today deal with these issues even if it is not directly related to an injury. The pressures of sport today lead athletes to additional stressors, and when things get in the way of their success they can battle with decreased levels of self-efficacy, athletic identity, and overall self-worth. For Rob, tennis has been a big part of his life for so many years, and to suddenly not have the identity of being “the tennis athlete” is terrifying. In developing a continuous plan and working with Rob emotionally as well as physically, we are able to help him reach his goal of getting back out onto the court.


Fox, K.R. (1997). The physical self: From motivation to well-being. Champaign, IL:
Human Kinetics.

Gill, D.L., & Williams, L. (2008). Psychological dynamics of sport and exercise (3rd Ed.). Champaign, IL: Human Kinetics.

Maehr, M.L., and Braskamp, L.A. (1986). The motivation factor: A theory of personal
investment. Lexington, MA: Lexington Books.