It is a common scenario sadly, both in professional and amateur sports. One injury, then another and another, each demoralising further. It is noteworthy that the science of pain would say that expectations and other thoughts about the pain and injury will affect the pain itself, potentially increasing the overall threat value — recall from previous writings that pain is a response to threat, and not to just that of the actual injury itself. We must consider any threat to the whole person, and this includes thoughts about oneself and one’s career.

When the body is sensitised by an initial injury, despite healing this sensitivity can persist subtly. In other words, at a certain level of activity there is no problem, no defence. But reaching a new level of training may then reach the current threshold that is not yet back to normal. The threshold is the physiological point where messages are scrutinised by the neuroimmune system that is already vigilant to potential threat. There does not need to be an actual threat, just a perceived one by these vigilant body systems, which then triggers a biological defence: pain, altered planning of movement, altered thinking etc.

The continuous journey back to full fitness requires a complete integration of physical and mental preparedness. As well as tissue strength, endurance and mobility, the controlling mechanisms must switch back to normal settings rather than protect — i.e. the upstream: muscles do what they are told by the motor system that originates in the motor areas of the brain, and the motor system plans and executes movement. The planning of movement not only occurs when the ball is about to be kicked or a run begun, but also when thinking about the acts or watching another. As well as these influencing what is happening, these are also great rehabilitation tools to fully prepare the system for the rigours of the game as well as ensuring completeness of recovery: the player resumes the right thinking, decision-making, motor control as well as fitness.