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An adolescent perspective on injury recovery and the return to sport

Leslie Podlog a,*, Ross Wadey b, Andrea Stark a, Marc Lochbaum c, James Hannon a, Maria Newton a

aUniversity of Utah, USAbUniversity of Roehampton, UKc Texas Tech University, USA

a r t i c l e i n f o

Article history:Received 2 June 2012Received in revised form12 December 2012Accepted 16 December 2012Available online 12 January 2013

Keywords:Self-determination theoryRehabilitationSocial supportCoping

a b s t r a c t

Objectives: The purpose of this investigation was to examine adolescent athletes’ injury recovery andreturn-to-sport experiences. Given previous research highlighting competence, autonomy, and related-ness concerns among returning athletes (Podlog & Eklund, 2006), we sought to examine the extent towhich basic psychological needs theory (BPNT: Ryan & Deci, 2007) could be used as framework forinterpreting the research findings.Design: A qualitative design was employed in the present investigation.Method: Eleven Australian athletes (M age ¼ 15.3) who had incurred a range of severe injuries (e.g.,anterior cruciate ligament tears, shoulder dislocations) were interviewed on 2e3 occasions (n ¼ 27 in-terviews) spanning an 11-month period.Results: Analysis of the data revealed the following four key themes: (a) injury stress, (b) coping strat-egies, (c) experiences with social support, and (d) recovery outcomes. Injury stress provides insights intoa range of stressors and strain responses reported by the adolescents across the recovery phases, whilethe theme on coping highlights the specific strategies used to maintain motivation, reduce uncertaintiesassociated with the injury experience, and to keep focused on future athletic attainment. The thirdtheme, experiences with social support, considers the transactions the adolescents held with members oftheir social network throughout their recovery. The final theme, recovery outcomes, describes partic-ipant perceptions of a successful/unsuccessful recovery and stress-related growth.Conclusions: Results suggest that competence and relatedness issues highlighted in BPNT may be relevantin exploring adolescent athletes’ injury experience. Somewhat less evidence for the autonomy dimensionof BPNT was apparent in adolescent comments.

Published by Elsevier Ltd.

Introduction

Injury rehabilitation and a return to sport following injury isoften an arduous challenge for competitive athletes (Podlog,Lochbaum, & Stevens, 2010). In addition to the physical trauma,injury may induce a host of deleterious consequences such asdiminished self-esteem, negative mood states, and a lost sense ofsocial identity (Tracey, 2003). Among other injury hurdles com-monly reported are the tedium of repetitious (and often painful)rehabilitation exercises, feelings of isolation and alienation fromsport peers, and a perceived lack of social support from relevantothers (Charlesworth & Young, 2004; Rees, Smith, & Sparkes,2003). Performance related concerns such as re-injury anxiety,

uncertainties about performing at pre-injury levels, physicalfitness concerns, and pressures to return to sport are also welldocumented, particularly as the return to sport approaches(Bianco, 2001). While these injury challenges have been high-lighted among adult and elite athletes, few investigations havefocused on adolescent injury rehabilitation and return to sportexperiences (Brewer et al., 2003; Udry, Shelbourne, & Gray, 2003).

In reviewing the literature on elite athlete injury challenges,Podlog, Dimmock, and Miller (2011) argued that competence, au-tonomy, and relatedness issues underlined many of the concernsrevealed by athletes, coaches, and sport medicine professionals. Forinstance, uncertainties regarding the ability to perform to pre-injury levels, apprehension regarding the impact of injury on theexecution of sport specific skills, and physical fitness concernssuggest that competence issues are prominent (e.g., Charlesworth& Young, 2004; Walker, Thatcher, & Lavallee, 2010). External pres-sures to meet particular return deadlines and internal contin-gencies of guilt associated with letting down teammates for not

* Corresponding author. Department of Exercise and Sport Science, University ofUtah, College of Health, 250 S. 1850 E., HPER North, SLC, UT 84112, USA. Tel.: þ1 801581 7630.

E-mail address: les.podlog@utah.edu (L. Podlog).

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returning, highlight the salience of autonomy issues (e.g., Bianco,2001). Finally, a loss of social identity, feelings of isolation fromteammates and coaches, and a lack of social support, suggest thatrelatedness concerns are prevalent (e.g., Podlog & Eklund, 2006;Rees et al., 2003).

One theory explicitly examining issues of competence, auton-omy, and relatedness is the basic psychological needs mini-theory(BPNT) of Ryan and Deci (2007) self-determination theory (SDT).In the mini-theory, competence is characterized by a sense ofeffectiveness or accomplishment in one’s pursuits (Ryan & Deci,2007). The signature feature of autonomy is an internal locus ofcausality and the belief that one’s actions are self-endorsed (Ryan &Deci, 2007). Finally, relatedness refers to a perception of inter-connectedness with others and the belief that one has a securerelational base. According to BPNT, satisfaction of the needs forcompetence, autonomy, and relatedness should positively impactthe well-being, personal development, and self-determinedbehavior of an individual in a variety of settings (Ryan & Deci,2000).

Research across numerous contexts including education, healthcare, and occupational settings supports need satisfaction conten-tions (Ryan & Deci, 2000). Recent quantitative findings in a sportinjury setting also reinforce BPNTassumptions. In particular, Podloget al. (2010) found that competence and autonomy need sat-isfaction was associated with a renewed perspective on sport andthat this relationship was partially mediated by positive affect.Specifically, perceptions that rehabilitation specialists and coachessatisfied adult athletes’ need to be competent (e.g., feelings ofproficiency in performing rehabilitation exercises) and autono-mous (e.g., the provision of choice and options during injuryrehabilitation sessions) was linked with a renewed sport per-spective e that is, a positive return-to-sport outcome includinga greater appreciation of sport, heightened motivation for sportsuccess, and enhanced mental toughness. Moreover, positive affectappeared to account for some, but not all of the relationship be-tween competence/autonomy need satisfaction and a renewedsport perspective. In addition, negative affect, self-esteem, and vi-tality fully mediated the negative relationship between relatednessneed satisfaction and return concerns. These findings suggest thatsatisfaction of athletes’ injury rehabilitation needs may fosterpositive rehabilitation outcomes (and offset negative outcomes),a finding that remains to be replicated in the case of adolescentathletes.

As indicated, much of the psychology of injury research focuseson adult and elite level athletes, with relatively little examination ofinjured adolescent athletes (Weiss, 2003). Preliminary evidencesuggests that there are important reasons for examining injury ex-periences across the life-span. In particular, a number of age-relateddifferences have been found with respect to injury responses andrehabilitation (Brewer et al., 2003). For example, adolescents haveindicated greater preoperative mood disturbances than adults (Udryet al., 2003), as well as heightened pain, catastrophizing, and anxietyin the 24 h post-surgery (Tripp, Stanish, Reardon, Coady, & Sullivan,2003). Moreover, a strong athletic identity has been associated withearly depressive symptoms following injury among adolescents,while increased social support was associated with lower initialdepressive symptoms (Manuel et al., 2002). Collectively, thesestudies indicate that the sport injury experience may vary asa function of age. The studies also highlight the fact that adolescents,in particular, may struggle with the onslaught of injury related de-mands inherent in the rehabilitation process. As adolescencemay bea tumultuous time period characterized by heightened emotionality,identity concerns, and self-regulation issues, injury related diffi-culties are not entirely surprising (Weiss, 2003). Finally, the abovestudies suggest the potential relevance of BPNT in examining

adolescents’ injury recovery and return to sport experiences. Forexample, the depressive symptoms associated with a strong athleticidentity suggest that competence concernsmay be prevalent amonginjured adolescents no longer able to engage in self-defining activ-ities. Similarly, heightened adolescent catastrophizing and anxietyindicates that the uncertainties associated with the post-operativeaftermath, may leave adolescents with a perceived lack of controlover their athletic future, a characteristic of low autonomy percep-tions. Finally, the enabling influence of social support highlights therelevance of relatedness issues articulated in BPNT.

In order to better understand the source and nature of adoles-cent injury related difficulties and experiences, a deeper appreci-ation of adolescent perspectives is needed. Acquiring suchperspectives would enable a greater theoretical understanding ofthe factors influencing adolescents’ injury rehabilitation and returnto sport, and in the development of age appropriate interventions.From a BPNT standpoint, the extent to which adolescents experi-ence satisfaction of their basic psychological needs may have directimplications for their rehabilitation motivation, their psychologicalhealth and well-being, and the quality and nature of their return-to-sport experiences. Given preliminary evidence for the benefitsof need satisfaction among injured adult athletes (Podlog et al.,2010), examining the extent to which injured adolescents experi-ence concerns over (and satisfaction of) competence, autonomyand relatedness needs is essential for optimizing rehabilitationenvironments, and promoting enhanced adolescent well-being.This knowledge would be useful for parents, coaches, and reha-bilitation specialists attempting to better understand and facilitatethe rehabilitation of injured adolescents. Unfortunately, with theexception of the aforementioned studies, researchers have yet toheed the call for further developmental inquiry on the psycholog-ical aspects of sport injury (Brewer, 2002; Weiss, 2003).

The purpose of this study therefore was to explore adolescentathlete perspectives of their rehabilitation and return to sport ex-periences. Given previous research highlighting competence, au-tonomy, and relatedness concerns among returning athletes(Podlog & Eklund, 2006), we sought to examine the extent to whichbasic psychological needs theory could be used as framework forinterpreting the research findings. In order to meet the study ob-jectives, a qualitative approach was utilized. Qualitative method-ologists such as Denzin and Lincoln (2011) and Patton (2002) havesuggested the value of qualitative approaches in examining therelevance of theoretical issues in particular contexts, in under-standing and expanding a priori theoretical knowledge, and intheory testing. Adolescent athletes were interviewed on two orthree separate occasions during their rehabilitation and return tosport. Repeated interviews enabled a greater repetition of themesto emerge across interviews. Multiple interviews facilitated par-ticipant reflection of their injury recovery and return to sport ex-periences close to the actual occurrence of such events.

Methods

Participants

A purposive sample of elite level adolescent athletes wasselected based on several eligibility criteria including: 1) sportinvolvement as determined by membership on a regional sportacademy squad, or a state/national team), 2) a current muscu-loskeletal injury requiring a minimum 1-month absence from sportparticipation, 3) undergoing physiotherapy treatment for the injuryat the time of study involvement, and 4) the intent to return toa similar level of pre-injury participation or higher. Participantrecruitment took place until it was apparent that saturation of keythemes, within the aims of this study, had been reached. This

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process resulted in the recruitment of eleven participants (8 fe-males, 3 males) aged 12e17 (M¼ 15.3, SD¼ 1.55). Participants werefrom regional towns in the CentralWest region of New SouthWales(NSW), Australia who gave consent for participation in one-on-oneinterviews lasting one to two hours. The sports in which the ado-lescents competed were: basketball (n ¼ 1), netball (n ¼ 5), soccer(n ¼ 3), rowing (n ¼ 1), and track and field (n ¼ 1). Adolescents’injury types included: torn anterior cruciate ligament (ACL, n ¼ 1),shoulder dislocation (n ¼ 2), dislocated knee (n ¼ 2), broken bone(n ¼ 1 fibula, n ¼ 1 arm), lumbar spine fracture (n ¼ 1), Sherman’sDisease (n ¼ 1 back), injured Achilles (n ¼ 1), and a bulging disc(n ¼ 1). All participants competed at the top state level (i.e., statesport academies and NSW regional institute teams) and hadexperienced a range of severe injuries requiring a minimum 1-month absence from sport participation. The average absencefrom sport participation was 5.41 months (range 1e13 months,SD ¼ 3.58). Table 1 provides demographic details on each partic-ipant. To ensure adolescents’ anonymity, pseudonyms wereutilized.

Interview guide

An interview guide was developed by the first author based onthe psychology of sport injury research, previous experiencedeveloping injury interview guides, and personal experience inrecovering from numerous severe sport injuries. The interviewguide was designed to address rehabilitation phase (e.g., “Describeany stressors you have experienced during your injury rehabil-itation”), pre-return to competition (e.g., “Discuss any forms ofsupport/assistance that you have received as you prepare to returnto competition?”), and return to competition phase issues (e.g., “Towhat extent do you feel you have been successful in your comebackto date? Explain why or why not?”). When necessary, probequestions such as what do you mean by.? or “Why was thatstressful when.?” were used for clarification and to explore spe-cific issues in greater detail (see Table 2 for further follow upquestions). For the purposes of this investigation, the rehabilitationphase was defined as the time from injury occurrence until athleteswere given medical clearance to resume sport specific training. Thepre-return to competition phase reflected the time period follow-ing medical clearance when athletes had resumed sport specifictraining, but had yet to return to competition. The return-to-competition period referred to the time period following athletes’return to sport and included the first 3 months following theirreturn to competition. The first 3 months was selected for exami-nation given previous research highlighting the initial months to be

challenging for athletes (Bianco, 2001; Podlog & Eklund, 2006). Theactual amount of time a participant spent in each phase dependedupon factors such as injury severity and rehabilitation progress. It isimportant to note that while three distinct phases were examinedin this research, such phases are in reality, more continuous thandiscrete in nature. A full list of interview questions spanning thedifferent phases is included in Table 2.

Procedures

After receiving institutional research approval, adolescents werecontacted through administrators at the Western Region Academyof Sport. An information sheet was given to each participantexplaining the purpose of the study and questions of interest per-taining to the study were addressed. During the initial meeting,informed consent and assent procedures were conducted with theathlete and his/her parent. All the participants who were contactedagreed to participate and were interviewed in a quiet room at thefirst author’s University or via telephone when necessary. Eightathletes were interviewed in person while four were interviewedby phone. Different data collection procedures may have hada number of consequences with regard to interviewer/participantrapport and the type or depth of information participants feltcomfortable in revealing. The consequences of different data col-lection procedures may have influenced the results presentedbelow, in ways the researchers can only speculate upon. A total 27semi-structured interviews were conducted over an 11-monthperiod spanning athletes’ initial injury rehabilitation to 3 monthsfollowing the return from injury. Interviews were completed one-on-one in person or when pragmatic concerns such as adoles-cent/parent availability or researcher travel necessitated, via thetelephone.

Data analysis

All interviews were recorded and transcribed verbatim. The firststage of analysis involved intratextual (i.e., within-text) and inter-textual (i.e., cross case) analysis of the data using the constantcomparative method of analysis (Maykut & Morehouse, 1994).Intratextual analysis entailed writing analytic memos in the mar-gins regarding salient adolescent injury experiences and groupingmeaningful text segments (i.e., quotes) into raw data themes. Thus,an adolescent’s comments that explicitly or implicitly related tophysical pain were grouped into the raw data theme “physicalpain”. For example, the comments of one adolescent who stated “SoI went to the Nationals, and I came fourth there [in long jump], but I

Table 1Participant demographic.

Athlete Age Sport Level ofcompetition

Injury Injury type Time awayfrom training

First seriousinjury

Femaleathletes

Candice 16 Netball Regional Partial shoulder dislocation Acute 1 month YesLinda 14 Basketball Regional Injured achilles Acute 1 month YesAllegra 12 Netball Regional Dislocated knee Chronic 12 months NoAmy 16 Netball State Dislocated shoulder Chronic 6 weeks NoValerie 17 Netball National Bulging disk Chronic 13 months NoHeather 14 Rowing State Sherman’s disease (back) Chronic 6 months YesWanda 16 Soccer National Broken fibula Acute 9 months YesGabrielle 17 Netball Regional Torn ACL Acute 9 months YesMale

athletesPatrick 16 Track and field National Lumbar spine fracture Acute 3 months YesBrad 14 Soccer State Broken arm Acute 2 months YesRichard 16 Soccer State Dislocated knee Chronic 2 months No

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knew I could have done better if my painwasn’t there” and “I think Iwent to the physio after and they saw that my pelvis was out, andthey fixed that up so I thought it was all good. But I still had painafter it.” were grouped into the raw data theme reflecting physicalpain. During intertextual analysis, raw data themes that werecommon across interviews were identified to form higher orderthemes. For example, statements made by different athletes such as“Yeah, she [my coach]made sure that I was doingwell. When I wentback to training she asked me if I was okay and she helped me strapmy shoulder” and “My coach, when the injury initially happened,he sort of rang up, you know; ‘What’s happened? How long tillyou’ll be playing again?’ I told him, and he said ‘Oh, sorry about thatmate’ and ‘Make sure you’re rehabilitated properly and get back toplay whenever you feel you’re ready’” highlighted the concept of“experiences with social support” and were therefore grouped intoa higher-order theme reflecting this underlining similarity acrossthe interviews. Once no new themes surfaced, it was assumed thatsaturation, within the aims of this study, had been achieved. Fourhigher order themes emerged from the data analysis, which arereported in the Results section below.

The second stage of analysis involved an examination of theextent to which emergent themes had an underlying conceptualoverlap with competence, autonomy, and relatedness needs artic-ulated within self-determination theory. Given our a priori purpose

of using BPNT as a framework for interpreting adolescent percep-tions of their injury experiences, we did not adopt a pure groundedtheory approach (Glaser & Strauss, 1967). Rather, a hybrid approach(Patton, 2002; Podlog & Dionigi, 2010) was employed in order toenable (a) the emergence of key themes from the data and (b) theuse of BPNT to interpret our findings. Given previous researchhighlighting competence, autonomy, and relatedness issues amonginjured athletes we were aware that these issues might also berelevant to adolescents. While the theory helped shape our inter-pretation of the themes, we used a combination of inductive anddeductive procedures to derive themes based on participantstatements and to subsequently interpret those themes based onthe BPNT (Ryan & Deci, 2007) informing the research. This com-bination of inductive and deductive procedures is consistent withanalytic procedures commonly described by qualitative method-ologists (e.g., Creswell, 2007; Denzin & Lincoln, 2011; Patton, 2002).Multiple interviews, empathetic stance, investigator triangulationand the use of “devil’s advocate” were used to address the “good-ness criteria” (Sparkes, 1998). Conducting multiple interviews withadolescents provided the opportunity to ensure repetition ofthemes. Having the first and third authors read through the tran-scripts on multiple occasions enabled the development of anempathetic stance by gaining a thorough understanding of partic-ipants’ perspectives and point of view. Empathetic understanding

Table 2Athlete interview guide.

Rehabilitation phase questions1) When did you first start playing your sport and why did you get involved?2) How did your injury occur?3) Can you describe how your rehabilitation has progressed to this point?4) What are some (if any) stressors you have experienced during your injury rehabilitation?5) Describe any specific strategies you have used to cope or deal with the stresses of your injury recovery?6) Can you describe any rehabilitation goals or goals for your return to sport participation?7) Tell me about whether your injury has been painful physically or psychologically? How so?8) Have you received pressure from any one to make a speedy recovery? If so, describe what was said or done?9) Discuss any forms of support/assistance that you have received from your: a) coach, b) parents, c) teammates or d) physiotherapist in assisting youwith your recovery.

Follow up: do you feel you have received adequate support from these individuals? Why or why not?10) What does it mean for you to be successful in returning to sport after injury? Follow up: how will you determine or know whether you’re successful in coming back?11) Is there anything about your injury recovery you’d like to discuss that we have not touched on?Pre-return to competition questions1. Describe your feelings regarding your upcoming return to competition?2. Do you have any fears or concerns about returning to sport following your time off from injury? Follow up: if so, can you describe what these are?3. Describe any specific strategies you have used to cope or deal with the stresses of your injury recovery?4. Tell me about some of the goals you have in regards to your first season back? i.e. what do you hope to achieve/accomplish once you return to sport from injury?5. Have you received pressure from any one to return to competition? If so, describe what was said or done?6. Last time I asked about support or assistance received from others. Perhaps you can tell me again about any forms of support/assistance that you have received from

your: a) coach, b) parents, c) teammates or d) physiotherapist in assisting you with your recovery. Follow up: do you feel you have received adequate support fromthese individuals? Why or why not?

7. What are some of the things that you have missed about your sport?8. Do you think that having suffered a serious injury will be of benefit or of help to you once you return to competition?9. How do you think you will perform once you begin competing?10. Last time I asked youwhat it means for you to be successful in returning to sport after injury? Perhaps you can answer the same question now. Follow up: howwill you

determine or know whether you’re successful in coming back?11. Is there anything about your upcoming return to competition that you’d like to discuss that we have not touched upon?Return to competition interview questions1. Describe for me what returning to competition has been like mentally and physically?2. How do you feel you have performed since returning from injury. Follow up: what do you attribute this to? Do you feel you are performing better or worse than you

were before your injury, and if so why?3. Have you had any fears or concerns since returning to competition following your lay-off from injury? Follow up: if they say no provide list of things that they haven’t

had: e.g. anxiety before first few comps, etc). If so, can you tell me about them and why you’ve experienced these concerns?4. Can you describe any setbacks, physical or mental, that you may have had since returning to competition?5. To what extent have you accomplished what you hoped to achieve/accomplish prior to your return from injury?6. Do you feel that you have learned anything, either technically, physically or mentally since returning to sport from your injury? Follow up: have there been any

benefits to having had an injury?7. Describe for me the most/least enjoyable aspect(s) of your return, i.e. what has been the best part and what has been the worst?8. Do you feel that you’ve been successful in your comeback to date? Why or why not?9. Have you received pressure from anyone to compete? Follow up: if so, describe what was said or done?10. Describe for me the kind of feedback or any assistance you’ve had from coaches, teammates and friends and family in regards to your performances? Follow up: have

you received adequate feedback, assistance or support from coaches, teammates, parent, or physiotherapists since returning to competition?11. Is there anything about your return to competition that you’d like to discuss that we have not touched upon?

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was further cultivated through ongoing discussions between two ofthe investigators regarding salient points emerging from interviewtranscripts. Investigator triangulation was addressed by the inde-pendent analyses of the data using the constant comparativemethod described above by the third author and two sport psy-chology graduate students. Independent categorization of thethemes was followed up with multiple discussions of the themeclassifications to ensure trustworthiness of the theme classifica-tions. These discussions took place on multiple occasions duringthe intra and intertextual data analyses to arrive at a general con-sensus on emergent themes. Finally, the first author and twograduate students served as devil’s advocate by questioning, chal-lenging and discussing the appropriateness of the independenttheme classifications. Any disagreements resulted in a review of thetranscripts followed by further discussion, until points of con-tention were resolved and the key themes agreed upon.

Results

The findings are divided into four higher order themes. The firsttheme, Injury Stress, provides insights into a range of stressors andstrain responses reported by the adolescents across the recoveryphases (i.e., rehabilitation, pre-return to competition, and return tocompetition). The second theme, Coping Strategies, highlights thespecific skills and strategies used by the adolescents over time tomaintain motivation, to reduce uncertainties associated with theinjury experience, and to keep focused on future athletic attain-ment. The third theme, Experiences with Social Support, considersthe transactions the adolescents held with members of their socialnetwork throughout their recovery. The final theme, RecoveryOutcomes, describes participant perceptions of a successful/lessthan successful recovery and stress-related growth (i.e., positivechanges they experienced as a result of injury).

Injury stress

Interviews with adolescents revealed a range of injury relatedstressors and strain responses varying in nature and intensitydepending upon the phase of rehabilitation and the proximity ofthe return to sport. One of the most commonly cited responses inthe immediate injury aftermath was the physical pain associatedwith injury occurrence. Typical of others, Linda suggested thathaving to contend with the physical pain of injury occurrence wasarduous, although in her case the pain appeared to subside fairlyrapidly. She commented, “[The pain] was there for about three daysand then it wasn’t as intense for the next few days and then iteventually wore away.” For adolescents with severe injuries and/orprolonged rehabilitation regimens, the pain associated with reha-bilitation also proved onerous. Gabrielle stated, “The swelling las-ted about amonth or a bit more and it was pretty challenging tryingto regain all the muscle back in the leg. I’ve only got it equal to theother leg now, after about 9 months.”

For others, it was not so much the physical pain of rehabilitationbut the prospect of missing substantial periods of competition andimprovement that was psychologically taxing. As Wandacommented:

It has been painful just because it’s constant; I’d say more psy-chological. Because I knew what I’d done, I was really upset, butnot because it was hurting. I knew I was going to miss out onNationals and because I knew that I was missing that six monthperiod of improvement.

As adolescents settled into their rehabilitation program, a rangeof other stressful experiences were described. These included beingscared by “twinges” of pain or discomfort felt when performing

rehabilitation exercises, concerns that the injury would not healproperly, and confusion about whether to follow conflicting infor-mation from doctors and physiotherapists. Frustration among thoseliving in remote communities who had long commute times toreceive medical treatment, and the negative impact of injury onone’s life outside of sport (e.g., social life, or school) were alsohighlighted.

During the early stages of rehabilitation another prominentconcern was the impact of injury on one’s physical capabilities.Gabrielle indicated that “the recovery was a bit frustrating at timeswhen I couldn’t do things that I knew I used to be able to do”.Frustration over prolonged rehabilitation regimens also createda sense of agitation as adolescents were unable to experience themeaning and fulfillment that sport provided, and from engaging ineveryday physical activities or hobbies such as skate boarding ornon-competitive sport.

During the middle and later stages of rehabilitation the primaryconcerns appeared to revolve around falling behind teammates andcompetitors in terms of competitive ability and physical fitnesslosses. For example, Patrick commented, “If I go to a competitionand they’re [competitors are] so far in front of me, I’ll probablythink negative again, getting back into that way of like thinkingwhat’s the point?” Concerns of a social nature also emerged duringthe middle and later stages of rehabilitation. Some indicated feel-ings of separation from their teammates and that they “no longer fitin”, being relegated to the role of team supporter or side-lineviewer. Wanda shared that she still “didn’t feel like I was part ofthe team” even when the coaches and managers asked her to helpcheer up her teammates after a loss. She indicated that felt “help-less” watching her team play as there was “no possible chance ofyou affecting the game.”

Adolescents also suggested that missing out on important as-pects of their sport participation was stressful. In particular, theinability to experience a sense of “fun” and enjoyment, to bond andsocialize with teammates, and to improve sport skills and achieveathletic goals was psychologically testing for participants. Thecomments of Richard nicely encapsulated the void experienced byadolescents as a consequence of injury. He suggested that hemissed “.the enjoyment of playing. That’s why I play, because it’senjoyable, fun to play. You get a good feeling when you do some-thing in the game, kick a goal or whatever. Just enjoyment ofplaying and enjoyment of the team aspect.”

As the return to competition grew imminent, adolescentsreported a range of positive and negative responses. Epitomizingthe ambivalent feelings regarding the upcoming return was thecomment of Wanda: “I’m nervous, because, it’s just like my first biggame for a while, I’m a bit, on edge, don’t know how I’m going totake it, kind of thing, and I’m also just excited because I’m playingagain.”

As the quote above suggested, a number of positive responsessuch as the anticipation of re-initiating one’s sport involvement,demonstrating sport skills, and attaining personal goals wereexpressed. A range of negative strain responses however, were alsoelucidated. In particular, re-injury worries, doubts over performingat pre-injury levels, physical fitness concerns, letting down one’steammates or oneself, and the impact of injury on one’s sport skillswere all mentioned. As Brad suggested he was

a little worried because I hadn’t played in so long. Like, I didn’twant to let the team down or nothing like that. Normally I neverworry about that. But yeah, I just worried then [prior toreturning] because I hadn’t played for so long.

Typically, adolescents were concerned about re-injury becausethey wanted to avoid being “out for the rest of the season” ormissing further opportunities to compete and attain higher

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performance levels. In some instances however, in particular thosewith multiple injury occurrences, the long-term health conse-quences of further injury damage was of primary importance. AsValerie commented, “I just now feel like thinking about is it worthit? Now is the third time that it’s happened. Like, should I reallypush myself further if it’s just going to affect my back which couldaffect my future.”

Upon resumption of competitive play, some athletes indicatedfeelings of disappointment in their performances, shared regretsabout not working harder in rehabilitation, or reported playingwith less tenacity (e.g., being hesitant in “going for the ball” or not“playing aggressively”) as a result of re-injury concerns. The ma-jority of adolescents however, reported feeling confident in theirrehabilitation, that they were happy and excited to be competingand “contributing to the team”, and that worries over re-injuryquickly dissipated after testing the formerly injured limb. More-over, Patrick and Brad reported that they were not as “fit” as theywanted to be, but were optimistic that competitive fitness levelswould return with time.

Coping strategies

Despite the plethora of stressors and strain responses experi-enced by adolescents, relatively few deliberate coping strategieswere described. Of the few strategies reported however, they couldbe divided into three categories: (a) problem-focused coping, (b)emotion-focused coping, and (c) avoidance coping. Consistent withprevious research (Crocker & Graham, 1995, p. 326), problem-focused coping was defined as “.cognitive and behavioral effortsused to change the problem causing distress” while emotion-focused coping involved strategies used to regulate emotionalarousal and distress (e.g., denial, wishful thinking, venting ofemotions). Avoidance coping was characterized as “the effort toescape from having to deal with a stressor (Carver, 2007, p.124).” Interms of avoidance coping, one strategy employed by the adoles-cents was to “try not to think about it [injury]” by keeping one’sattention on other enjoyable pursuits. In particular, adolescentssuggested that they simply focused “on having fun”, “hanging outwith friends”, or playing computer games. Adolescents alsodevoted greater time and energy into their academic pursuits ornon-sport relationships, a strategy that diverted attention awayfrom negative injury stressors and strain responses. In contrast,emotion-focused coping involved engaging in physical exercise tolower the strain responses they were experiencing. The main typesof physical activity mentioned were cycling, swimming and Pilates,exercises which were deemed acceptable within the confines ofone’s injury. Finally, the majority of the participants used problem-focused coping to expedite the rate of their recovery, which typi-cally involved transferring their energy into their rehabilitation orto adapted forms of physical exercise and activity that wereacceptable within the confines of their injury. One adolescentreported, “All I did was just try to improve it [injury] by doing morephysio exercises and stuff like that.”

The other problem-focused coping strategy reported by theadolescents was goal-setting; they suggested that goals which theyset in conjunction with coaches and physiotherapists helpedexpedite their recovery from injury by maintaining motivation,reducing uncertainties associated with the injury experience, andpreserving a focus on future athletic attainment. Adolescentshighlighted rehabilitation goals, those for the immediate return tocompetition, and more long-term goals. Although the aim of “get-ting over the injury” and resuming competitive play as soon aspossible was at the forefront of adolescents’ minds, the need toachieve intermediary rehabilitation goals and progressions wasalso commented upon. Amy for instance, shared, “Netball’s one of

the big ones [goals]. It takes a little while to get there, but normallyit’s just to, you know, be able to get this exercise done and be able todo it properly by the time you go see the physiotherapist again.”

In regard to the return to competition, the aim of simplyre-initiating competitive activity and doing so without pain or re-injury was highlighted by virtually all adolescents. Commentssuch as “my goal is to play netball again” or “my goal is to not re-injure myself again” typified this sentiment. The occurrence ofmultiple injuries however, meant that in some instances, a returnto competition without further injury was an end goal in and ofitself. Richard stated, “My goal is to play, I suppose, for the rest ofthe year without re-injuring and at the grand final whenwe start toplay again. [The goal] at the moment is just to play as well as I canfor the team I’mplaying for now. And if that goes well thenmay be Ican set new goals.”

Adolescents also discussed a number of general and specificlong-term goals. Such goals included continuing to improve one’sskills and to regain pre-injury fitness levels, to make certain teams(e.g., state or national teams), to win a medal at a national cham-pionships, or to eventually represent one’s country at internationalcompetitions. The various rehabilitation and sport-specific goalsarticulated by adolescents appeared important in helping themremain focused on attaining functional outcomes, cope with theuncertainties of the injury experience, and stay committed to thepursuit of higher levels of future athletic proficiency.

Experiences with social support

In attempting to attain their goals and to alleviate the stressfulaspects of the injury experience, adolescents expressed theimportance of social support from parents, teammates, coaches,sport medicine specialists, and role models. Although adolescents’did not elaborate in detail about the types of social supportreceived, it appeared that emotional support (i.e., comfort andencouragement from parents and coaches to work though reha-bilitation challenges), tangible support (i.e., rides to physiotherapysessions from parents or performing rehabilitation exercisesalongside adolescents) or informational support from physiother-apists (i.e., providing knowledge about the injury, demonstratingrehabilitation exercises) were the main forms of support received.It was suggested that social support served a variety of functionsincluding the maintenance of a positive outlook, enhancing moti-vation to comply with rehabilitation protocols, and facilitatingphysical and emotional healing. For instance, Heather reported“trying harder [in rehabilitation] because encouragement from hercoach was motivating” while Candice indicated that having thesupport of her coach allowed her to have a “positive outlook” andhelped her heal both mentally and physically. Additionally, athleteshighlighted the receipt of support from sport medicine practi-tioners and from peers. Amy indicated “the assistance was from thephysio. He helped me a lot. He showed my mum how to strap myshoulder. I don’t exactly know what it’s called, but he just workedon it with different types of technology, sort of thing. That helpeda lot.” With regard to peer support, mixed statements were maderegarding the amount of support received. In responding towhether she received support from school peers, Candice indicated“Yeah, not so much because I’m playing at a higher level than mostof them. They don’t really know that much about it.” Conversely,the comment by Richard captured the sentiment echoed by mostadolescents regarding peer support: “A few of my teammatesobviously ring me up, to see how I’m going, you know..They justencourage me to get back playing, you know. ‘You’ll be right, you’llbe playing soon’.”

Although the extent of support varied from one athlete to thenext, the majority of adolescents felt as though they had received

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sufficient support and positive feedback. Amy for instance, sharedthat she knew she had enough support “because I never thought atany moment that I was doing it on my own.” Adolescents alsodiscussed the benefits of support received from injury role models.Role models who had experienced similar injuries were describedas instrumental in providing a sense of comfort and reassuranceregarding injury related difficulties, inspiration and motivation tokeep pursuing one’s goals, and confidence that one could alsoovercome injury related hurdles and attain personal goals. Typicalof this sentiment was the remark of Amy, who commented that shewas “inspired” by role models who had overcome similar injuriesbecause it made her feel like “I can do that too.”

Interestingly, several adolescents reported feeling a degree ofpressure from their friends and parents to make an expedited re-turn to sport. Patrick’s friends for instance were “always asking himto hurry up and get better” and Wanda interpreted her parents’comment that she “play through the pain” as pressure to return tosport. Somewhat surprisingly, none of the athletes indicated feelingpressure to return from their coaches. Wanda described her coachas having “expectations” but not feeling like she was being pres-sured. Other athletes, including Patrick, Amy, and Linda, stated thattheir coach was the person encouraging them to take time torecover. Patrick’s coach “[gave] me as much time as possible”whileLinda’s required medical clearance from the doctor and/or physi-otherapist before returning.

Recovery outcomes

Perceptions of a successful/less than successful return to sportAs the ultimate goal for adolescents appeared to be a successful

return to sport, they were asked to discuss what the concept meantto them. Prior to the return to sport, perceptions of success includedbeing able to “play at my full potential.injury free, one hundredper cent” or simply “just being there” and being “able to play likeeverybody else does.” It was also commonly indicated that the re-turn to sport would be a success if adolescents were able to returnto pre-injury performance levels, to fulfill their role on the team,and to avoid re-injury. Valerie, an athlete dealing with a particularlydifficult back injury, shared her insights on success: “For me at thisstage it wouldn’t really be about winning or losing, it would just beto feel no pain when I play; to, I guess, be more happy when I playand smile.”

Following the return to competition, athletes were asked if theybelieved their return had been a success. Most adolescents indi-cated unequivocal feelings of success in their return, describinga range of success metrics including: the attainment of particulargoals or higher levels of athletic accomplishment (e.g. makingparticular teams, achieving personal bests), the ability to avoid re-injury, and the receipt of positive feedback from coaches and sig-nificant others. Also of significance, was the feeling that one waspersonally satisfied with his or her post-injury performances andhad played to the best of their ability. As Amy commented, “Youknow in yourself that you did the best you could and that’s whatmatters.”

While the majority of adolescents reported feelings of sat-isfaction and a sense of success in their return, some expresseduncertainty over the issue. For several athletes “not playing as well”as before the injury, lacking assertiveness on the field of play, dif-ficulties with match fitness, and having a negative mindset fol-lowing the first performance contributed to a sense of ambivalenceregarding the perceived success of one’s return. Brad for instancestated “Um [long pause] not real sure actually [if the return hasbeen a success]. A little bit, but probably not because I haven’t beenplaying as well as I was before the injury. I’ve just not been able tolike, I could keep up with the game, but not as much as what I could

before.” Similarly, Allegra, commented that she felt successful ingetting back to compete but did not feel her return was a successgiven that she experienced another knee dislocation within lessthan an hour of her initial netball game.

Stress-related growthAs highlighted previously, injury entailed numerous challenges

and stressors. Importantly, however, the injury experience was notentirely a negative one or one without benefit. In general, adoles-cents were able to take a philosophical approach to their injury andto convey a number of positive changes occurring as a result of theinjury including enhanced mental “strength”, increased motivationto attain athletic goals, superior sport performances, and the abilityto “push” through challenging life circumstances. In discussing hergoal of winning a medal at the rowing State Championships andattending the national competition, Heather indicated that herinjurymade her “.want it a bit more. Because I’ve had the time off,I just want to keep trying harder to get it.” The comments of Can-dice personified some of the other growth-aspects of injury:

I’ve just learned how to be a better player. My performance haslifted I know a lot and I’ve been told by people I’m playing a lotbetter because I’ve been selected in this squad. It’ll [injury will]probably help me mentally, like, it’ll make me stronger, with megetting back into it again.

Adolescents also suggested that injury provided a number oflearning opportunities. These included the importance of beingpatient in giving injury sufficient time to heal, when it wasnecessary to cease sports participation and report injury, injuryprevention measures (e.g., proper taping or strapping techniques),and the fact that even long-term injuries would heal. The occur-rence of multiple knee dislocations helped Richard cultivate “.abit more patience. So instead of being ‘Oh, I’ve got to play this nextgame’, you get like ‘Oh, it’s only another game, I’ve already misseda heap’. If I got another injury, you could think ‘No, it’s worth sittingout just so I don’t re-injure it again’.

Discussion

The purpose of this investigation was to examine adolescentathlete perspectives of their rehabilitation and return to sport ex-periences. A further objective was to examine the extent to whichself-determination theory could be used as framework for inter-preting the research findings. Analysis of the interview datarevealed several key themes including injury stress, coping strat-egies, experiences with social support, and recovery outcomes.Interpretation of these themes revealed that issues of competence(i.e., proficiency) and relatedness (i.e., connectedness or belonging)were salient in adolescent comments regarding their injury expe-riences. Some support, albeit to a lesser extent, was also evidentwith regard to autonomy issues and adolescent injury experiences.Given the focus on these three needs in BPNT, it may be a partic-ularly germane theory in interpreting and understanding adoles-cent injury rehabilitation and return to sport experiences.

As highlighted below, links between findings from this inves-tigation and the theoretical constructs of BPNT are apparent. Thatsaid, BNPT is by no means the only framework in which to examineor interpret the themes from this investigation. There are otherpossibilities. For example, themes regarding stress and copinghighlight health-related quality of life issues (ValovichMcLeod, Bay,Parsons, Sauers, & Snyder, 2009). Moreover, participant statementssuggesting the simultaneous inclination to approach and avoidcertain aspects of their return to competition (e.g., wanting tocompete again while hoping to avoid re-injury), indicates therelevance of Elliot’s (Elliot & McGregor, 2001) 2 � 2 achievement

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goal framework in examining motivational aspects of the return tocompetition. While a number of different theories may help toexplain various aspects of the rehabilitation and return to sporttransition, BPNT seems to provide a comprehensive perspective inexamining the experiences of adolescent athletes’ in this study.

With regard to injury stress, many of the concerns reported byadolescents in the present investigation parallel those reportedpreviously among adult and/or elite level athletes (Podlog &Dionigi, 2010; Tracey, 2003; Walker et al., 2010). For instance, dif-ficulty in dealing with the physical pain of injury, concerns thatone’s injury would not fully heal, and frustrations over missingimportant competitions were all highlighted. As these concernswere not explicitly related to BPNT needs, it is apparent that there isa need to explore other theories (or for theoretical integration) inexamining adolescent injury experiences. Other concerns however,had a more apparent link with BPNT. In particular, worries aboutthe impact of injury on one’s physical fitness and capabilities, aninability to improve sport skills and achieve athletic goals, and“falling behind” competitors were also reported, findings con-sistent with past research (Bianco, 2001; Walker et al., 2010).Additionally, stresses of a social nature were articulated includingfeelings of separation from teammates, the perception that one “nolonger fit in” with their team, and missed bonding and socializingopportunities. Such results highlight the fact that competence andrelatedness issues were of primary concern among adolescents.Given adolescent preoccupations with demonstrating competenceto others (Weiss, 2003), findings from this investigation suggestthat competence based strategies should be at the forefront ofintervention efforts aimed at mitigating adolescent injury stresses.Consistent with BPNT theorizing (Ryan & Deci, 2007), implement-ing functional progressions during rehabilitation, exposing injuredadolescents to optimal rehabilitation challenges, setting self-referenced goals, and providing positive feedback following prog-ress, may all serve to build adolescent perceptions of competenceduring the rehabilitation and return to sport phases. Moreover,ensuring athletes remain involved in their sport, setting up one-on-onemeetings with coaches, and providing injured adolescents withteam roles and responsibilities may enhance feelings of relatedness(Podlog et al., 2011). Further research examining the efficacy ofcompetence and relatedness based interventions, particularlyduring the return to sport phase, warrants additional attention.

A range of apprehensions highlighted during the initial andmiddle phases of injury rehabilitation re-emerged as salient duringthe return to competition. In support of previous research (Podlog& Eklund, 2006) adolescents reported mixed thoughts and emo-tions regarding the return to competition. Feelings of excitementand anticipation about re-initiating one’s sport involvement,demonstrating sport skills, attaining personal goals, and bondingand socializing with teammates were tempered by heightened re-injury anxieties, doubts over performing at pre-injury levels,physical fitness concerns, and letting down one’s teammates oroneself. While these findings highlight competence and related-ness based concerns articulated in BPNT, implicit in adolescents’statements was the desire to simultaneously approach and avoida return to sport. Such approach/avoidance tendencies suggest thevalue of Elliot’s (Elliot & McGregor, 2001) 2 � 2 achievement goalframework in examining motivational issues surrounding adoles-cents’ return to training and competition. Further research is nee-ded to explore the extent to which the return to competition ischaracterized by approach versus avoidance tendencies andwhether task versus performance goals predominate during thereturn to competition phase.

A number of previously unreported stresses also emerged andwarrant consideration in future research. Specifically, confusionabout whether to follow conflicting information from doctors and

physiotherapists, frustration among rural based athletes who hadlong commutes to receive medical treatment, and the impactof injury on adolescents’ future health and non-sport commitmentsmay all be relevant issues confronting injured athletes. Onceagain, these stresses are not explicitly related to basic psychologicalneeds; this suggests that although the theory may providea framework for examining many adolescent injury stresses, it doesnot capture the breadth of such stresses. With regard to conflictinginformation from various medical providers, past research hashighlighted the need for a team approach to injury recovery and forcommunication among treatment team members and athletes(Podlog & Dionigi, 2010). Findings from this investigation furtherreinforce the need for open lines of communication among varioussport medicine practitioners in order to ensure consistent infor-mation is conveyed to athletes; doing so, will likely reduce poten-tial frustrations among recovering athletes. Such communicationmay be all the more relevant among practitioners and athletesliving in rural communities where frequency of contact may besporadic or non-existent. Further research examining the mosteffective means to ensure the provision of consistent rehabilitationinformation to injured adolescents is needed. Communicationbased theories may be relevant in exploring this issue.

Consistent with previous research (e.g., Carson & Polman, 2010)a number of injury coping strategies were reported by adolescents.Several avoidant coping strategies, previously highlighted aseffective in an injury context were also described in the currentstudy. In particular, the use of physical activity (within injury lim-itations), socializing with others, and avoiding thoughts of injury bydevoting one’s attention to academic or non-athletic pursuits wereemployed. Athletes appeared to use physical activity as a way tomaintain a certain level of physical competencewhereas socializingwith others clearly served a relational need. Thus, fulfilling basicneeds described in BPNT appeared to serve an important copingfunction. Although further research examining the effectiveness ofvarious adolescent coping strategies is needed, it is interesting tonote that relatively few deliberate coping strategies wereemployed. This may be a reflection of the developmental level ofadolescents, many of whommay have limited experience in dealingwith difficult life events. The relatively minimal range of copingstrategies employed suggests the value of sport psychology servicesfor injured adolescents. As adolescents are a group notoriouslyunderserved by sport psychology practitioners, the implementa-tion of coping strategies may be well advised.

Social support also appeared important in helping athletes copewith injury related demands, in maintaining motivation to adhereto rehabilitation protocols, and in facilitating emotional adjust-ment. An abundance of previous research has highlighted thebenefits of social support among injured athletes (e.g., Bianco,2001; Rees et al., 2003). In line with previous qualitative reports(e.g., Bianco, 2001), most adolescents were satisfied with the sup-port they received, support which came from a variety of sourcesincluding coaches, parents, teammates and sport medicine pro-viders. Social support was also received from injury role-models.The benefits of role models including the provision of emotionalcomfort, inspiration and motivation to overcome injury rehabil-itation obstacles and setbacks, and confidence that one could stillachieve athletic goals, have been echoed previously (Flint, 2007).Collectively, the above findings provide further support for thebenefit of social support among injured athletes, support that maybe especially relevant among injured adolescents. The findings alsosuggest that ensuring athletes feel connected to and cared for byothers is of prime importance in facilitating adolescent recoveryfrom injury. From a BPNT standpoint, ensuring relatedness needsatisfactionmay be crucial in optimizing the likelihood of beneficialhealth and well-being outcomes (Ryan & Deci, 2007). Researchers

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have suggested that the provision of various forms of social support(e.g., listening support, informational support, emotional comfort,emotional challenge) will help ensure relatedness perceptions anda greater likelihood of subsequent compliance with rehabilitationprotocols (Podlog et al., 2011). Further research testing the efficacyof relatedness interventions among injured adolescents is needed.

Although most adolescents indicated the receipt of sufficientsocial support, this was not always the case. Adolescents sug-gested that parents did not always provide the support required,particularly in instances where parental pressures were exerted toplay through pain and injury. Hellstedt (1990) also found thatparental pressures to compete in sport or to play through pain andinjury represented a source of adolescent stress. Conversely, noneof the adolescents indicated pressures from coaches to return tosport, a finding contrary to previous research (Charlesworth &Young, 2004). Adolescents suggested that coaches attempted tominimize return to sport pressures and to ensure that they did notrush the return. These findings suggest that adolescents experi-enced varying degrees of external pressure during their injuryrehabilitation and return to sport. From a BPNT standpoint,external pressures may suppress perceptions of autonomy needsatisfaction because such pressures conduce toward an externallocus of causality (Ryan & Deci, 2007). Findings from this studyadd to the growing body of sport injury research suggesting thebenefit of athlete autonomy and diminished perceptions of pres-sure in making a return to competition following injury (Podlog &Eklund, 2006, 2009, 2010; Podlog & Dionigi, 2010). Given thecentrality of autonomy need satisfaction within BPNT, furtherinvestigation examining the effectiveness of autonomy enhancingstrategies at various phases of the injury recovery process (e.g.,injury onset, rehabilitation, decisions to return to competition)seems warranted.

Two final themes to emerge from the present study pertainedto adolescent recovery outcomes following injury. In particular,descriptions of the meaning of a successful return to sport andperceptions of stress-related growth emerged during participantinterviews. Similar to elite athletes, adolescents suggesteda number of success indicators including a return to pre-injurylevels and attaining particular goals, remaining uninjured, anda feeling of self-satisfaction with one’s performance (Podlog &Eklund, 2009). Receiving positive feedback from coaches and sig-nificant others regarding one’s performance was also an importantdeterminant of a successful return to sport. Conversely, “notplaying as well” as before the injury, lacking assertiveness on thefield of play, difficulties with match fitness, and having a negativemindset following the first performance contributed to a per-ceived lack of effectiveness or success in one’s return to com-petition. These findings highlight the fact that perceptions ofsuccess and/or a lack of success were largely based on one’s per-ceived competence or indications from others that one was ach-ieving desired proficiency levels. As adolescent self-worth andesteem may be highly contingent on positive evaluations fromothers (Weiss, 2003), ensuring positive feedback and graduatedopportunities for successful task accomplishment may be essentialin fostering perceptions of competence and subsequent evalua-tions of success in the return to sport.

Finally, perceptions of injury related growth were articulated.These included enhanced mental “strength”, heightened intrinsicmotivation to attain athletic goals, superior sport performances,and the ability to “push” through challenging life circumstances.Other forms of growth including learning about the importance ofinjury prevention measures were also articulated. These findingsare consistent with previous reports of perceived benefits followingthe injury experience (Podlog & Eklund, 2006; Wadey, Evans,Evans, & Mitchell, 2011). Interpreted in BPNT terms, adolescents’

experienced growth following injury as they gained perceivedcompetence from the experience (e.g., enhanced “mental strength”,superior sport performances), they cultivated an increased sense ofautonomy (i.e., enhanced intrinsic motivation to pursue theirsport), and they experienced satisfaction of their relatedness needs(i.e., socializing with non-sport peers). That adolescents’ experi-enced greater “mental strength” following injury, also suggests thatthey may have gained a sense of autonomy to follow their ownrehabilitation path or direction and to make decisions they feltwere appropriate at various stages of their recovery. As indicated,BPNT research demonstrates that need satisfying experiences arepredictive of beneficial health and well-being outcomes (Ryan &Deci, 2007). Further research is needed to examine the extent towhich injury related growth occurs as a result of need satisfyingexperiences during injury rehabilitation.

Conclusions

To our knowledge, this was the first investigation examiningadolescent perspectives of their injury recovery and return to sportexperiences. Important information regarding the nature of ado-lescent stresses, coping methods, social support interactions, andrecovery outcomes was obtained. Findings suggest that adoles-cents’ experienced a range of competence (e.g., concerns aboutperforming at pre-injury levels), relatedness (e.g., missed bondingopportunities, feelings of isolation), and to a somewhat lesserextent, autonomy based stresses (e.g., pressure to return). A num-ber of coping strategies e several of which were avoidant in naturee were described as beneficial in dealing with injury or divertingattention away from injury related challenges. That said, the factthat few deliberate coping strategies were employed suggests theneed for sport psychology services among injured adolescents.Consistent with previous research (e.g., Bianco, 2001; Rees et al.,2003), the benefit of social support was also highlighted suggest-ing the relevance of relatedness need satisfaction. Finally, it wasapparent that notions of competence, autonomy, and relatednesssurfaced with regard to athlete experiences of success (or a per-ceived lack of success) and perceptions of injury related growth.Given the relevance of competence, and relatedness needs amonginjured adolescents, further research examining the benefits ofbasic psychological need satisfaction among injured adolescents iswarranted. As autonomy issues were not overly prevalent in ado-lescent interviews, further research examining the relevance ofautonomy based challenges would be prudent.

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