3 Reasons Why Pitch Side Care Must Include the Mind

When an athlete goes down on the pitch, the first responder's training kicks in immediately. They assess the mechanism, stabilise the injury, manage pain, and facilitate safe removal from the field of play. But in that same moment, something else is happening that rarely features in any emergency action plan.

The athlete's psychological world is fracturing alongside their body. Their identity, their season, and potentially their career are all suddenly in question. The person best placed to address that crisis in its earliest seconds is the very person kneeling beside them, focused entirely on the physical aspects.

An athlete's mindset can be significantly disrupted the moment an injury occurs. Concerns about their identity, the current season, and their future in the sport may suddenly weigh heavily on them. The individual best equipped to provide reassurance during these initial moments is the first responder at their side, who is simultaneously managing their physical care.

This is the first responder blind spot. It is a critical gap in pitch side care, and it is time we addressed it. Addressing this gap aligns directly with the mission of the SPRINT Project, which emphasises that effective injury management requires seamless collaboration between physical and psychological practitioners.

1. The psychological crisis begins at the whistle

There is a persistent assumption in sport that mental health is a downstream concern. It is often viewed as something to be addressed once the swelling subsides and the rehabilitation programme begins. However, the evidence tells a different story.

The American College of Sports Medicine (ACSM) Consensus Statement identifies injury as a significant life event that triggers immediate responses. These include cognitive, emotional, and behavioural reactions such as anger, denial, fear, grief, and isolation. For athletes whose sport participation is a primary coping mechanism and a core part of their identity, these reactions can be intense and destabilising from the very first moment.

A landmark 2024 consensus statement summarising 50 years of sport injury psychology research reinforces this point. Stress responses are the strongest psychological risk factor for acute injuries. Furthermore, the rehabilitation process itself shapes cognitive, emotional, and behavioural outcomes from the outset.

In other words, the psychological trajectory of recovery does not begin in the physiotherapy room; it begins on the field. A 2026 systematic review and meta-analysis of over 221,000 adolescent athletes confirmed a bidirectional relationship between sports injuries and mental health. Injury worsens mental health, and poor mental health increases injury risk.

This is not a linear problem with a linear solution. It is a cycle, and the earlier it is interrupted, the better the outcomes.

2. First responders recognise the gap

If the evidence is clear, why does the gap persist?

In part, because the people on the front line have not been equipped to close it. A cross-sectional study of 226 certified athletic trainers found that the majority felt dissatisfied or only slightly satisfied with their education related to mental health recognition and referral.

A 2025 scoping review reached a similar conclusion regarding the preparedness of sports medicine professionals. Athletic trainers have reported receiving insufficient training to support athletes facing psychological distress. This is the case despite many having been in positions where counselling was clearly necessary.

This is not a criticism of individual practitioners. It is a systemic failure in how we educate and prepare those who are first on the scene. Physiotherapists, athletic trainers, and team doctors are trained extensively in musculoskeletal assessment, taping, bracing, and return to play protocols. Yet, the psychological dimension of the injury they are managing receives minimal attention.

3. The danger of delaying support

The conventional model treats psychological support as something that follows physical rehabilitation. But a prospective study tracking competitive athletes weekly from acute care through return to sport revealed a striking pattern. Self-efficacy and satisfaction were lowest not at the moment of injury, but during the adapted training phase.

This phase marks the transition from controlled rehabilitation to sport specific activity. If psychological support has not been initiated early, athletes arrive at this vulnerable period without the coping tools they need. The ACSM consensus statement is explicit on this point: interventions to address problematic emotional responses are more successful early in treatment. Delaying psychological care does not simply postpone it. It actively diminishes its effectiveness.

A Framework for Psychological First Response

This does not mean first responders need to become clinical psychologists. It simply means they need a framework, just as they have frameworks for spinal injury or cardiac arrest. The ACSM Return to Sport consensus statements outline core competencies that can be adapted for the acute pitch side setting:

• Build trust and rapport in the immediate interaction: The tone, language, and demeanour of the first responder in those opening minutes set the emotional trajectory.

• Educate the athlete about the injury honestly and clearly: This involves providing realistic, measured information about what happens next.

• Identify and correct misinformation early: Do this before the athlete fills the information vacuum with worst case scenarios from teammates or the internet.

• Activate the social support network: This includes preparing coaches, parents, and teammates for their role in the recovery process.

• Know the referral pathway: Every emergency action plan should include a mental health component, with clear steps for when and how to connect the athlete with a licensed professional.

The IOC has developed the Sport Mental Health Assessment Tool (SMHAT-1) for screening athletes at risk of mental health symptoms and disorders. Additionally, the 2025 IOC consensus driven guidelines for mental health support the call for pre-event planning that includes promotion, prevention, treatment, and recovery. These tools and frameworks exist; the challenge is translating them from the clinic to the touchline.

Conclusion

If you are a physiotherapist, athletic trainer, or team doctor who runs onto the field when an athlete goes down, you are already the athlete's first psychological contact point. The question is not whether you are influencing their mental health response, but whether you are doing so intentionally and with the right framework.

We need to advocate for psychological first-response training to be embedded in professional education programmes for all pitch side practitioners. We need mental health emergency action plans that sit alongside cardiac and spinal protocols. Furthermore, we need research that examines what effective psychological first aid looks like in the acute sporting context.

Key Takeaways:

• The psychological response to injury begins at the moment of injury, not weeks later in rehabilitation.

• First responders in sport are the athlete's first psychological contact point, yet most report feeling underprepared for this role.

• Delaying psychological support reduces its effectiveness, early intervention produces better outcomes.

• A psychological first response protocol does not require clinical psychology expertise, but it does require intentional training, clear frameworks, and established referral pathways.

• Mental health emergency action plans should be standard components of every sporting organisation's emergency procedure.

Call to Action

How does your organisation handle psychological care on the pitch? Do you feel prepared as a first responder? We invite you to share your feedback on this blog and let us know your thoughts! Explore more of our resources, tools, and previous discussions on the SPRINT Project Website.

Written and infographic by Alex Wakim

References:

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