Building the team behind the athlete: practical steps toward holistic sports injury care

The role of mental health and social support in recovery

Returning to sport is only one part of the athlete's journey after injury. Athletes can grapple with loss of identity, changes in daily routine, and the psychological impact of being sidelined. Mental health and social support are central to successful outcomes. Addressing these factors, from fear of re-injury to managing family and team expectations, makes the difference between functional recovery and a genuine return to performance. Long-term well-being hinges on supporting the whole athlete, not just the injury.

The core team: who's involved and why

Effective rehabilitation depends on a coordinated support network. The core team typically includes physicians, orthopaedic surgeons, physical therapists, nutritionists, psychologists, and athletic trainers. Each contributes a distinct perspective:

• Physicians and surgeons guide diagnosis, treatment, and medical decision-making.
• Physical therapists develop and progress rehabilitation plans, focusing on strength, mobility, and return to function.
• Nutritionists optimize healing, energy availability, and long-term health.
• Psychologists support mental resilience, help manage anxiety, and facilitate identity rebuilding.
• Athletic trainers oversee safe progression and sport-specific skills.

Family is often the unsung hero in recovery, providing emotional support and helping manage daily logistics. Clear communication between all parties keeps expectations realistic and prevents misunderstandings.

In practice, particularly outside of academic centres, the full team may not be readily available. Even a minimal configuration, consisting of surgeon, sports physiotherapist, and engaged family, can function effectively when communication is structured and each member understands the broader clinical picture.

Case example: when an ACL tear reveals a bigger picture

During the Fireside Chat, we discussed a case that stayed with us, not because the surgery was complex, but because the injury turned out to be the visible tip of a much larger problem.

A 15-year-old female soccer player at regional U16 level sustained a non-contact ACL rupture during a change-of-direction drill. MRI confirmed the ACL tear along with a medial meniscus ramp lesion. But the clinical picture extended well beyond the knee.

The warning signs had been there. Over the preceding months, recurrent hamstring tightness had never fully resolved. Performance had plateaued despite increasing training volume. School grades were declining. A dynamic valgus pattern on landing was already known from screening—bilaterally. Nobody had connected the dots.

The workup revealed more. Her BMI was 16. Menstrual cycles had been irregular for over a year. She reported eating "clean" to stay light and fast. This is a recognizable constellation: Relative Energy Deficiency in Sport (RED-S)—low energy availability driving menstrual dysfunction, impaired tissue healing, recurrent soft-tissue injuries, and declining cognitive performance. The hamstring problems, the performance plateau, the dropping grades: not separate issues, but manifestations of the same underlying deficit. The ACL rupture was the moment the system failed visibly.

This changed the treatment plan fundamentally. Within two weeks, the team was expanded to include a sports gynecologist, a nutritionist specializing in sport, and a sport psychologist, not as optional extras, but as clinical necessities. The parents became active partners, monitoring nutrition at home and supporting psychological care. The club was informed directly by the treating physician: this athlete requires 9–12 months minimum, return-to-sport will be criteria-based, and the club shares a responsibility toward a minor athlete that extends beyond the pitch.

The surgical plan: ACL reconstruction with quadriceps tendon autograft, lateral extra-articular tenodesis, and ramp lesion refixation reflected the full clinical context. The quadriceps tendon was chosen deliberately to preserve the hamstrings, which this athlete needed as dynamic stabilizers against her known valgus pattern. The LET addressed the high re-rupture risk in young female pivoting athletes. Every decision was informed by the whole patient, not the ligament in isolation.

Rehabilitation was criterion-based, with progression tied to functional milestones, not calendar weeks. Neuromuscular valgus control was addressed bilaterally from Phase 2 onward. Nutritional status and menstrual function were tracked as biological markers of recovery alongside the standard orthopaedic milestones. Psychological readiness was assessed using validated tools, including the ACL-RSI questionnaire. Return-to-sport clearance required a composite of objective criteria: LSI ≥90% on hop tests and isokinetic strength, satisfactory movement quality on video analysis, and adequate psychological readiness scores.

Safeguarding in sport: our responsibility as clinicians

This case forced an honest conversation: as sports medicine clinicians, are we trained to recognize when an injury is a symptom of something larger?

Safeguarding in sport means more than preventing abuse or misconduct. It encompasses a broader duty of care toward young athletes, recognizing when health, development, or welfare is being compromised by training load, nutritional practices, psychological pressure, or a combination. As orthopaedic surgeons and sports physicians, we are often the first clinician to see these athletes after injury. The injury is our entry point. What we do with that entry point matters.

We do not need to be the experts who treat RED-S or manage menstrual dysfunction or provide psychological therapy. But we need to be the clinicians who recognize these patterns, ask the uncomfortable questions, and ensure the right team is assembled around the patient. This is not about what we know or what we can do. It is about what the patient needs.

Practical tips for clinicians

Based on our discussion and the lessons from cases like the one above, we identified several strategies that can make a tangible difference:

1. Look beyond the injury. A non-contact ligament rupture in an adolescent female athlete warrants screening for RED-S—at minimum, ask about menstrual history, nutritional habits, and recent changes in performance or mood.
2. Assemble the team early. Even with limited resources, a surgeon–physiotherapist–family triad with clear communication can function effectively. Know your referral network for nutrition, psychology, and sports gynecology before you need it.
3. Communicate directly with the sporting environment. A single phone call to a coach or sporting director, early in the process, sets expectations and establishes boundaries. Use the language of shared responsibility and safeguarding.
4. Use criterion-based return-to-sport protocols. Communicate from day one that return will be based on functional milestones (LSI ≥90% on hop tests, isokinetic strength symmetry, psychological readiness via ACL-RSI), not calendar dates.
5. Address the whole athlete in rehabilitation. Neuromuscular deficits, nutritional recovery, and psychological readiness are not add-ons to the surgical follow-up—they run in parallel and must be monitored with the same rigor.
6. Document and share the broader picture. Written rehabilitation plans that include nutritional and psychological goals, not just range-of-motion targets, help align the entire team and keep the patient at the center.

The lasting impact of collaborative athlete support

The best outcomes in sports injury care come from building a team behind the athlete. Holistic, multidisciplinary care addresses physical, psychological, and social needs, not just return to sport, but lifelong health and well-being. Not every case will be as complex as the one discussed above. But every injured young athlete deserves a clinician who looks beyond the MRI, who asks the difficult questions, and who has the awareness to connect the dots before the next injury does it for them.