Goal Setting: A Key to Injury Rehabilitation Valerie K. Wayda, EdD Physical Education Ball State University , *-- Francine Armenth-Brothers, MS, ATC Health Education Heartland Community College *- - B. Ann Boyce, PhD Health & Physical Education University of Virginia If' ommitment and motivation are very important to an injured athlete's adherence to rehabilitation. Athletic therapists can enhance the athlete's commitment and motivation by making sure the athlete plays an active role in the design and implementation of the rehabilitation program. If an athlete perceives himself or herself as an integral part of the process, he or she is much more likely to be committed to the program. One way to make sure an athlete feels he or she is part of the process is to have him or her help set the rehabilitation goals. Setting goals is not new to athletes. Most are continually driven to become better at their sport and thus are naturally goaldirected (Heil, 1993). Their focus on goal achievement can be transferred to include the establishment of rehabilitation goals. Effective goal setting requires a systematic approach (Boyce & King, 1993), which few have employed despite the abundance of articles in support of this strategy. A systematic approach can enhance the athlete's commitment and motivation in several ways: - clarifies each person's role gives thc;athlete Ic both y~~sycholoj . . 111s o yslcally In i iitation. ~ Jt stand the importance oi Ion exer~ -s optir 1 . 1 . gives the athlete a feeling eing back in control. It holds the athlete accon given standard ce. . .L .. L l,.&,.*.. r I ,.A Goal SeBing as a Psychological Strategy Goal setting helps the injured athlete by (a) facilitating a faster return (DePalma & DePalma, 1989); (b) motivating one's effort and persistence (Weiss & Troxel, 1986); (c) providing a sense of accomplishment (Fisher, Mullins, & Frye, 1993);and (d) increasing adherence (Fisher, Mullins, & Frye, 1993). Goal Seeing Model This paper presents a three-phase (planning, implementation, evaluation) process that can be broken down into seven steps adapted from the work of Boyce and King (1993), Martens (198'7),and Botterill (1983). The three phases are outlined in Figure 1. In Phase 1 the therapist and injured athlete collaborate to design a goal-setting plan (Steps 15). In Phase 2, implementation, they develop a monitoring system for goal attainment (Step 6). In the final phase, evaluation, the therapist provides information on goal attainment (Step '7). The sidebar on p. 23 lists several guidelines that enhance the effectiveness of the goal-setting strategy. The planning phase begins immediately after the injury occurs. In this phase the athletic therapist and the injured athlete must follow five steps: .,. .. . . , . Step 1: Itlentif+the exercises, treatmc:nt, a n d ~.csponsil)ilities (c'.g., tin~c.cotnnlit~nt:nr, ;irrit~~d(>, off01.t). Step 2: Dcterrnine hoiv the go;11can 1 ) ~ meawrctl. Stel) 3: Set t l ~ cgoal. Step 4: (:larif\>t11c goal. Step 5: I>cvclop;I strategy f i ) ~ ;~chie\ingtlic goal. In addition, potential barriers such as boredom, time constraints, severity of the injury, and plateaus in recovery must be identified and addressed. O 1998 Human Kinetics January 1998 A & l e ~ cnw~k.&T@d&t~ 21 PLANNING PHASE 9 (Steps 1-5) ? ? ++++ 3 + IMPLEMENTATION PHASE + + + + + + EVALUATION P (Step 6) ? C C C C C C C C C C C C C C C C c c c c c c c c c c c c c c c c c c c c c c c c c c c c c c Step 1 Identify Exercise, Action, Responsibility :meaningful controllable focus on individual Step 6 Monitoring System record goals supervise goal process accountability reinforcement/support Step 7 Feedback reset new modify Step 2 Measurement objective specific criterion for success Step 3 Set the Goal difficult but attainable stated in a positive manner progressive short-term goals leading to a long-term goal Step 4 Goal Clarification set target dates prioritize multiple goals Step 5 StrategyIPlan achievement strategies Figure 1 Implementing a goal-setting strategy. (Reproduced w t h permission from the Journal of PhyszcalEducatzon, Remeatton &Dance, J a Early in Phase 1 the therapist and the injured athlete discuss the severity of the injury, the duration of the disability, the expected recovery level, and the athlete's role in the rehabilitation process. The time spent in planning can enhance adherence by clarifying each person's role in the process. The following five steps will explain how the athletic therapist and the athlete can collaborate to establish a positive experience. Step 1: Identification of Exercise, Action, Responsibilities. One way to ensure the athlete's active participation in this process is to jointly iden* the exercise (task),action, or responsibility (the goal) to be undertaken. Although the severity of injury may dictate the type of goal, an effort should be made to ensure that the athlete under- stands why achieving the goal is critical for successful rehabilitation. The athlete must also perceive the goal as meaningful, otherwise he or she may not accept it and this could hinder his/ her commitment (Heil, 1993). Just as one must individualize the rehabilitation prescription according to the severity of the injury, the goal must also be individualized. Characteristics such as intrinsic motivation should be noted when identifying the rehabilitation goal. Athletes with low internal motivation may need more help in identifying and setting their goals, and more s u p port as they work to attain those goals. In addition, the athletic therapist should ensure that the rehabilitation goal is controllable or performance oriented as opposed to an outcome oriented goal. Performance oriented goals are specific behaviors that are directly under an athlete's control; they focus on the rehabilitation process. An example is when an athlete sets a performance goal of lifting 210 lbs on the leg press for 10 reps. Outcome goals are not directly under the athlete's control and may not be attainable. An injured athlete could set a goal of regaining his or her starting position on the team, but there is no guarantee this will happen since this decision is up to the coach. Step 2: Measurement. Once the task, action, or responsibility has been identified, one must make sure it is objective and specific. An objective goal can be measured by January 1998 an established instrument and leaves no question as to whether the goal has been attained. A common mistake is establishing subjective goals, which can be difficult to determine (e.g., "I want to throw like I used to"). A specific goal has a criterion of success and provides clear expectations so the athlete knows exactly what must be achieved (e.g., "I need to have 90% strength as measured by isokinetic testing on the affected side before full participation"). Most injured athletes are unaware of what goals need to be accomplished, therefore the athletic therapist must guide them to the appropriate goals. Step 3: Setting the Goal. Working together, the athletic therapist can guide the athlete in setting goals that provide an optimal challenge yet remain physically safe. Some athletes may set goals that are either too difficult or too easy. This may be due to unrealistic personal expectations, trying to impress someone, underestimation of ability, being pressured for a quick recovery, or lack of knowledge. A challenging goal can increase one's level of motivation, but an unattainable goal can pose a threat to self-confidence and physical well-being. Once a difficult but challenging goal has been determined, it is important to state it in positive terms. Have the athlete focus on what is to be accomplished (success) rather than what to avoid (failure). For example, instead of setting a goal of "not being on crutches for more than 5 days," set GUIDELINES FOR GOAL SE'ITING 1. Goals should be meaningful to both therapist and athlete. 2. Goals must be performance-not outcome-oriented. 3. Goals should be individualized for each athlete. 4. Goals must be objective and measurable. 5. Goals must be specific. 6. Goals must include a criterion for success. '7. Goals must be realistic but challenging. 8. Goals should be stated in positive terms. 9. Progressive short-term goals should lead to a long-term goal. 10. Goals should have a target date for completion. 11. Goals should be few and prioritized. 12. Goals should be accompanied by strategies for achievement. 13. Goals must be recorded and monitored. 14. Goals must hold athletes accountable: 15. Goals must be reinforced or supported. January 1998 AchJe~c~ W ~ T Todagt PY ip d the goal as "to walk with a normal gait within 5 days." In severe injuries, progressive short-term goals should lead to a long-term goal. Short-term goals are important because they tend to be more flexible than one overall long-term goal. They also provide more frequent feedback, which can enhance an athlete's level of confidence and allow opportunities for constant reinforcement. Step 4: Goal Clarification. When determining the goal, it is important to set a target date for goal attainment. This will keep the athlete focused on accomplishing the goal and provides a medium in which the therapist can evaluate the progress of rehabilitation. Depending on the nature or type of injury, it might be appropriate to set several goals. But make sure not to set more than three or four goals and prioritize them (Boyce & King, 1993). For example, in most injuries it is important to decrease the pain and swelling before attempting to strengthen the injured area. Thus there is a specific sequence that could encompass short-term goals leading to one long-term goal. Since most athletes have no medical background, it is imperative the athletic therapist help the injured athlete sequence these goals and monitor target dates to ensure that they are realistic. Step 5: ~ e u e l e ' an ~ Plan or Strategy. Once the rehabilitation goal has been clarified, it is time to identify strategies that will help the athlete reach the goal. It is also important to plan for potential barriers such as plateaus, boredom, distractions, or alienation. The following strategies can be used to prevent these barriers: I avariety of exer 2 , Arrange renanil~rauon 1 1 . appoinltments around tl athlete' s practic:e scliedi , It is important r-or tne athlete to remaiin in cor with thts e a m st~ h e o r s does not reel* ,~ s c, , 3. Allow tlle athlet e to express anger, f rustratic)n,anxie43'7 --- - * L and 0thL-.C1 ~ I I L U ions. Reassur.e the at1llete tha pro,gress will not always apparel~t and tl lat moqt lapses a re temporary. 0 . 1 ~mg!ementafs'~n Phase The implementation phase emphasizes a monitoring system. It consists of both the athlete and athletic therapist developing a regulating system to collect information on progress toward goal attainment. Step 6: Monitoring System. A key component of the monitoring phase is supervising goal attainment. For example, it could be helpful to compile a folder for each athlete that contains the written goal, documentation of progress, and other pertinent information. But make sure the athlete is involved in this recording procedure since it signifies his or her responsibility and commitment (Tutko, 1990). The folder serves many functions, among them, providing a record of progress for comparing objective measurements; providing a medium fo'r recording thoughts and reminders that can be discussed later; and helping the athlete feel a sense of ownership by giving him or her a special, confidential plan. An athlete's motivation and commitment can also be facilitated through the supervision of goal attainment. It is important for the athletic therapist to point out progress, including small gains, to the injured athlete since he or she may not realize that progress is being made. Athletic therapists also need to remind athletes that small setbacks are normal and to focus instead on the overall gains made. Since most athletes do not understand the healing process, they need to be educated about normal progression. If it can be demonstrated to the athlete how progress is being made, for example ;mall gains in range of motion, then the athlete's motivation will likely be higher. Second, supervisingan athlete's progress t@ ward a goal holds the athlete ac- Evaluation Phase The third and final phase is evaluation. During this phase the athletic therapist provides the athlete with evaluative feedback in order for the athlete to assess the goal. Step 7: Feedback. Once a goal has been accomplished, there are two options. The goal could be reset with a different criterion (e.g., return to planning phase, Step 3) or another goal could be identified (return to planning phase, Step I). It is important to remind the athlete that goal setting is an ongoing, dynamic process, and as one goal is attained, this is a signal that healing is occurring. If the goal was not achieved, review the goal and any problems encountered (return to the planning or implementation phase) since the goal may need to be modified (e.g., tarachievement strat- setting minimum and maximum standards and then holding the athlete accountable for attaining those standards (Fisher, Scriber, Matheny, et a]., 1993). In this way the athlete is more likely to be committed to the entire rehabilitation process. Of equal importance to monitoring and recording goals are the reinforcement and support of the therapist and others such as the coaching staff. Words Stress to the athlete that progress has been made but that perhaps the goal was not achieved because of a plateau in the rehabilitation (Fisher, Scriber, Matheny, et al., 1993). Discuss what a rehabilitation plateau is and modify the target date. Typically athletes will be less frustrated if they understand that the lack of progress is simply a temporary plateau (DePalma & DePalma, 1989). I program. While we recognize that many individuals do set goals during rehabilitation, the use of a systematic strategy has largely been neglected. A systematic approach could enhance the athlete's commitment and motivation since it ensures that he or she becomes an active participant at every step of this strategy. References Botterill, C. (1983). Goal setting for athletes with examples from hockey. In G.L. Martin & D. Hrycaiko (Eds.), Behavioral modzjication and coaching Principles, procedures, and research (pp. 67-85). Springfield, IL: C.C Thomas. Boyce, B.A., & King, - V. (1993). Goal-setting strategies for coaches.Journal ofPhysica1 January 1998 Education, Recreation andDance, 63(I), 6568. DePalma, M.T., & DePalma, B. (1989). The use of instruction and the behavioral approach to facilitate injury rehabilitation. Athletic Training, 24,217-219. Fisher, A.C., & Hoisington, L. (1993). Injured athletes' attitudes andjudgments toward l rehabilitation adherence~ o u r n aofAthletic Training, 28,4854. Fisher, A.C., Mullins, S.A., & Frye, P.k (1993). Athletic trainers' attitudes and judgments of injured athletes' rehabilitation adherence.Journal ofAthletic Training, 28, 4347. Fisher, A.C., Scriber, K., Matheny, M., Alderman, M., & Bitting, L. (1993). Enhancing athletic injury rehabilitation adherl Training, 28,312ence.~ o u r n aof~thletic 318. Heil, J. (1993). Psychology of sport injury. Champaign, IL: Human Kinetics. Martens, R. (1987). Coaches guide to sport psycholom. Champaign, IL: Human Kinetics. - A - Athl&.c 'P7EmaB Today Tutko, T. (1990, Spring). Character and goals. The Sports Psychology Newslettm, 5(3), 1-4. Weiss, M., & Troxel, R. (1986). Psychology of the injured athlete. Athletic Training, 21, 104109,154. Valerie K. Wayda is an assistant professor of sport psychology at Ball State. For the past 3 years her masters level students have collaborated with senior athletic training students on a psychology-of-injuryrehab practicum experience. Francine Armenth-Brothers teaches health education at Heartland Community College in Bloomington, IL. She holds a masters from Ball State University. B. Ann Boyce is associate professor of pedagogy/teacher education at the University of Virginia. She has conducted research on goal setting for 10 years and has published research articles and scholarly papers on this topic. 25