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 Pre-competitive anxiety in sports physiotherapy refers
to the psychological stress or apprehension
experienced by athletes or sports participants before
a competition or sporting event, specifically in the
context of their physiotherapy treatment or
preparation.
 This type of anxiety can affect athletes at various
levels, from amateur to professional, and may arise
due to factors such as the pressure to perform well,
fear of injury, concerns about physical readiness, or
the importance of the event.
 Sports physiotherapists play a crucial role in
addressing pre-competitive anxiety among athletes
by implementing strategies to help manage stress
and enhance performance.
 Some approaches that sports physiotherapists may
use include:
 Education and Communication: Providing athletes
with information about the physiological and
psychological aspects of pre-competition anxiety can
help them better understand and manage their
emotions.
 Relaxation Techniques: Teaching athletes
relaxation techniques such as deep breathing,
progressive muscle relaxation, or visualization can
help alleviate tension and promote a calm state of
mind before competition.
 Goal Setting: Collaborating with athletes to set
realistic and achievable goals for their performance
and rehabilitation can help reduce anxiety by
providing a sense of direction and purpose.
 Cognitive-Behavioral Techniques: Implementing
cognitive-behavioral strategies such as cognitive
restructuring or thought reframing can help athletes
identify and challenge negative thoughts or beliefs
that contribute to anxiety.
 Biofeedback and Mindfulness: Utilizing biofeedback
tools or mindfulness techniques can help athletes
develop greater awareness of their physiological
responses to stress and learn to regulate their
reactions effectively.
 Social Support: Encouraging athletes to seek
support from coaches, teammates, friends, and family
members can provide them with emotional
reassurance and a sense of camaraderie, which can
buffer against pre-competitive anxiety.
 Progressive Exposure: Gradually exposing athletes
to competitive situations through simulated practice
sessions or exposure therapy can help desensitize
them to anxiety-provoking stimuli and build confidence
over time.
 Multidisciplinary Collaboration: Working
collaboratively with sports psychologists, coaches, and
other members of the athlete's support team can
ensure a comprehensive approach to addressing pre-
competitive anxiety and optimizing performance
outcomes.
EDUCATION AND
COMMUNICATION
Education and communication are essential components
in addressing pre-competitive anxiety in sports
physiotherapy. Here's how they can be effectively
utilized:
• Psychoeducation:
i. Provide athletes with information about the
physiological and psychological aspects of pre-
competitive anxiety. Explain the normalcy of
experiencing anxiety before competitions and help
athletes understand the physical and cognitive
responses associated with anxiety.
ii. Educating athletes about the mind-body connection
can empower them to recognize and manage their
anxiety more effectively.
• Anxiety Management Strategies:
i. Educate athletes about evidence-based anxiety
management techniques, such as relaxation
exercises, mindfulness, cognitive restructuring, and
goal setting.
ii. Teach athletes how to apply these strategies in
practice and competition settings to cope with pre-
competitive anxiety and optimize performance.
• Understanding Individual Triggers:
i. Work with athletes to identify their individual triggers
for pre-competitive anxiety.
ii. By understanding what specific situations, thoughts,
or behaviors exacerbate their anxiety, athletes can
develop personalized coping strategies tailored to
their unique needs.
• Normalization of Anxiety:
i. Normalize the experience of pre-competitive anxiety
by emphasizing that it is a common and natural
response to competitive situations.
ii. Help athletes recognize that experiencing anxiety
does not signify weakness or failure but rather
reflects their investment in their sport and desire to
perform well.
• Communication Channels:
i. Establish open lines of communication between
athletes, coaches, sports physiotherapists, and other
members of the athlete's support team.
ii. Encourage athletes to communicate openly about
their feelings, concerns, and needs related to pre-
competitive anxiety, fostering a supportive and
collaborative environment.
• Goal Setting and Expectations:
i. Educate athletes about the importance of setting
realistic and achievable goals for performance and
rehabilitation.
ii. Help athletes understand the relationship between
goal setting, motivation, and anxiety management,
and guide them in setting goals that are specific,
measurable, attainable, relevant, and time-bound
(SMART).
• Stress Management Skills:
i. Teach athletes stress management skills to help
them regulate their physiological and psychological
responses to anxiety.
ii. This may include techniques such as diaphragmatic
breathing, progressive muscle relaxation,
visualization, and biofeedback training.
• Role of Sports Physiotherapy:
i. Sports physiotherapist supports athletes' mental
health and performance.
ii. Sports physiotherapists can collaborate with athletes
to address physical challenges, enhance
performance readiness, and promote overall well-
being in the context of pre-competitive anxiety.
• Continued Support and Follow-Up:
i. Provide ongoing education and support to athletes
as they implement anxiety management strategies
and work towards their performance goals.
ii. Follow up regularly to assess progress, address any
concerns or obstacles, and reinforce positive coping
behaviors.
 By incorporating education and communication
strategies into sports physiotherapy, athletes can
develop a deeper understanding of pre-competitive
anxiety and acquire the skills and knowledge needed
to manage anxiety effectively and optimize their
performance outcomes.
RELAXATION
TECHNIQUES
 Relaxation techniques play a vital role in managing
pre-competitive anxiety in sports physiotherapy.
 Here are some relaxation techniques that can be
particularly effective:
• Deep Breathing:
i. Deep breathing exercises involve taking slow, deep
breaths to activate the body's relaxation response.
ii. Athletes can practice diaphragmatic breathing,
where they inhale deeply through their nose, filling
their lungs with air, and exhale slowly through their
mouth, focusing on releasing tension with each
breath.
• Progressive Muscle Relaxation (PMR):
i. PMR involves systematically tensing and then
relaxing different muscle groups in the body.
ii. Athletes can start by tensing specific muscle groups,
such as their fists or shoulders, for a few seconds
and then releasing the tension while focusing on the
sensation of relaxation.
iii. Moving through the body progressively, they can
release tension from head to toe.
• Visualization or Guided Imagery:
i. Athletes can use visualization techniques to mentally
rehearse successful performance scenarios or
imagine themselves in a calm and confident state
before competition.
ii. Guided imagery scripts or recordings can help
athletes create vivid mental images of positive
outcomes and relaxation.
• Mindfulness Meditation:
i. Mindfulness meditation involves focusing on the
present moment without judgment.
ii. Athletes can practice mindfulness by paying
attention to their breath, bodily sensations, or
surroundings, grounding themselves in the here and
now and letting go of worries about the future.
• Autogenic Training:
i. Autogenic training is a self-relaxation technique that
involves repeating a series of phrases or affirmations
to induce a state of deep relaxation.
ii. Athletes can use phrases such as "my arms are
heavy and warm" or "my breathing is calm and
steady" to evoke a sense of relaxation and
tranquility.
• Biofeedback:
i. Biofeedback techniques involve using electronic
monitoring devices to provide real-time feedback on
physiological responses such as heart rate, muscle
tension, or skin conductance.
ii. Athletes can learn to regulate their physiological
responses by observing changes on the biofeedback
monitor and adjusting their relaxation techniques
accordingly.
• Yoga or Tai Chi:
i. Yoga and Tai Chi incorporate gentle movements,
stretching, and breathwork to promote relaxation,
flexibility, and balance.
ii. Athletes can benefit from participating in yoga or Tai
Chi classes to enhance physical and mental well-
being, reduce stress, and improve focus and
concentration.
• Progressive Relaxation:
i. Progressive relaxation involves systematically
tensing and relaxing specific muscle groups in a
progressive sequence, starting from the toes and
moving upward through the body.
ii. Athletes can practice progressive relaxation
techniques to release physical tension and promote
overall relaxation.
 By incorporating these relaxation techniques into their
pre-competition routine, athletes can effectively
manage pre-competitive anxiety, improve their mental
resilience, and optimize their performance in sports
physiotherapy.
GOAL SETTING
 Goal setting is an essential component of managing
pre-competitive anxiety in sports physiotherapy.
 By setting clear, specific, and achievable goals,
athletes can direct their focus, enhance motivation,
and reduce anxiety.
 Here's how goal setting can be implemented
effectively:
• SMART Goals:
i. Encourage athletes to set SMART goals – Specific,
Measurable, Achievable, Relevant, and Time-bound.
ii. Specific goals provide clarity, measurable goals
allow progress tracking, achievable goals maintain
motivation, relevant goals are meaningful to the
athlete, and time-bound goals create a sense of
urgency.
• Performance Goals vs. Outcome Goals:
i. Help athletes differentiate between performance
goals (related to their own performance) and
outcome goals (related to winning or specific
results).
ii. While outcome goals are important, focusing solely
on them can increase anxiety due to factors beyond
the athlete's control.
iii. Emphasizing performance goals allows athletes to
focus on aspects within their control, such as
improving technique or fitness level.
• Short-term and Long-term Goals:
i. Encourage athletes to set both short-term and long-
term goals.
ii. Short-term goals provide immediate targets that
contribute to long-term success, helping athletes
stay focused and motivated.
iii. Long-term goals provide a sense of direction and
purpose, guiding athletes through their overall
development and achievements.
• Process Goals:
i. Emphasize process goals, which focus on the
actions and behaviors necessary to achieve desired
outcomes.
ii. Process goals help athletes concentrate on specific
tasks or strategies within their control, fostering a
sense of competence and confidence.
iii. For example, a process goal for a runner might be to
maintain proper form throughout a race.
• Positive Goal Framing:
i. Encourage athletes to frame their goals positively
rather than negatively.
ii. Positive goal framing emphasizes what athletes aim
to achieve rather than what they want to avoid,
promoting a constructive mindset and reducing
anxiety.
iii. For example, instead of setting a goal to "avoid
mistakes," encourage setting a goal to "execute skills
with precision."
• Flexible Goal Adjustment:
i. Teach athletes the importance of flexibility in goal
setting.
ii. Circumstances may change, and adjustments to
goals may be necessary.
iii. Emphasize the value of adapting goals based on
feedback, performance assessments, and changing
circumstances to maintain motivation and
momentum.
• Self-monitoring and Feedback:
i. Encourage athletes to monitor their progress
regularly and provide feedback on their performance
relative to their goals.
ii. Self-monitoring promotes self-awareness and
accountability, while feedback provides valuable
information for goal adjustment and improvement.
• Celebrating Achievements:
i. Celebrate the achievement of goals, whether big or
small.
ii. Recognizing and celebrating progress boosts
morale, reinforces positive behaviors, and motivates
athletes to continue striving for excellence.
 By implementing goal setting techniques in sports
physiotherapy, athletes can effectively manage pre-
competitive anxiety, enhance performance, and
achieve their full potential on and off the field.
COGNITIVE-
BEHAVIORAL
TECHNIQUES
 Cognitive-behavioral techniques (CBT) are highly
effective in managing pre-competitive anxiety in
sports physiotherapy.
 CBT focuses on identifying and modifying
maladaptive thoughts, beliefs, and behaviors that
contribute to anxiety.
 Here are some CBT techniques that can be applied:
• Cognitive Restructuring:
i. This technique involves identifying and challenging
irrational or negative thoughts related to performance
and competition.
ii. Athletes learn to recognize cognitive distortions such
as catastrophizing (expecting the worst outcome),
black-and-white thinking (seeing situations as all
good or all bad), and overgeneralization (drawing
broad conclusions from isolated incidents).
iii. They then work to reframe these thoughts in a more
balanced and realistic way.
• Thought Stopping:
i. Athletes are taught to recognize and interrupt
negative thought patterns by using techniques such
as mental imagery (visualizing a stop sign) or a
verbal cue (saying "stop" or "cancel") whenever they
notice themselves engaging in anxious or self-
defeating thoughts.
ii. Thought stopping helps break the cycle of rumination
and redirect focus to more productive thoughts or
actions.
• Attentional Control Training:
i. This technique involves training athletes to focus
their attention selectively on task-relevant cues while
filtering out distractions and irrelevant information.
ii. By improving attentional control, athletes can
maintain concentration during competition, reduce
performance anxiety, and enhance performance
efficiency.
• Imagery and Mental Rehearsal:
i. Athletes use visualization techniques to mentally
rehearse successful performance scenarios and
create positive mental imagery of themselves
performing well under pressure.
ii. By repeatedly visualizing themselves executing skills
with confidence and precision, athletes build self-
efficacy and develop a sense of mastery over their
performance.
• Self-Talk Modification:
i. Athletes learn to replace negative self-talk (e.g., "I
can't do this," "I'm going to fail") with positive,
affirming statements (e.g., "I am prepared and
capable," "I will give my best effort").
ii. By consciously choosing empowering self-talk,
athletes boost self-confidence, manage anxiety, and
maintain a resilient mindset during competition.
• Relaxation Training:
i. Incorporating relaxation techniques such as deep
breathing, progressive muscle relaxation, or
mindfulness meditation can help athletes reduce
physiological arousal and counteract the physical
symptoms of anxiety.
ii. By practicing relaxation regularly, athletes develop a
repertoire of coping skills to manage stress and
maintain optimal performance readiness.
• Performance Desensitization:
i. Athletes gradually expose themselves to anxiety-
provoking situations in a controlled and systematic
manner, allowing them to habituate to the stressors
over time.
ii. By progressively confronting fears and challenges,
athletes build resilience and confidence in their ability
to cope with pre-competitive anxiety.
• Goal Setting and Performance Monitoring:
i. Setting specific, achievable goals and monitoring
progress toward those goals helps athletes maintain
focus, motivation, and accountability.
ii. By breaking down larger objectives into smaller,
manageable tasks, athletes can track their
performance improvements and celebrate their
successes along the way, reinforcing positive
behaviors and beliefs.
 By integrating cognitive-behavioral techniques into
sports physiotherapy, athletes can develop effective
coping strategies, enhance mental resilience, and
perform at their peak potential despite pre-competitive
anxiety.
BIOFEEDBACK AND
MINDFULNESS
 Biofeedback and mindfulness are two valuable
techniques in managing pre-competitive anxiety in
sports physiotherapy. Here's how they can be
effectively utilized:
BIOFEEDBACK:
i. Biofeedback involves using electronic monitoring
devices to provide real-time feedback on
physiological responses such as heart rate, muscle
tension, or skin conductance.
ii. In the context of pre-competitive anxiety in sports
physiotherapy, biofeedback can help athletes
become more aware of their physiological arousal
levels and learn to regulate them effectively.
iii. Here's how biofeedback can be applied:
• Stress Monitoring:
i. Athletes can use biofeedback devices to monitor
their stress levels during training sessions and
competitions.
ii. By observing changes in physiological parameters
such as heart rate variability or skin conductance,
athletes gain insight into their stress responses and
learn to identify triggers for anxiety.
• Relaxation Training:
i. Biofeedback can be used in conjunction with
relaxation techniques such as deep breathing or
progressive muscle relaxation.
ii. Athletes receive visual or auditory feedback based on
their physiological responses, helping them gauge
the effectiveness of relaxation techniques and adjust
their strategies accordingly.
• Self-Regulation:
i. Through biofeedback training, athletes develop self-
regulation skills to modulate their physiological
arousal levels in real time.
ii. By learning to control their heart rate, muscle tension,
or breathing patterns, athletes can counteract the
physical symptoms of anxiety and promote a state of
calmness and focus.
MINDFULNESS:
i. Mindfulness involves paying attention to the present
moment with openness, curiosity, and acceptance,
without judgment.
ii. In the context of pre-competitive anxiety, mindfulness
techniques can help athletes cultivate mental clarity,
emotional stability, and resilience.
iii. Here's how mindfulness can be incorporated:
• Focused Attention:
i. Athletes practice mindfulness by directing their
attention to their breath, bodily sensations, or
surroundings, anchoring themselves in the present
moment.
ii. By developing greater awareness of their thoughts
and emotions, athletes can prevent rumination and
anxiety about past or future events.
• Acceptance and Nonjudgment:
i. Mindfulness encourages athletes to adopt an attitude
of acceptance and nonjudgment toward their internal
experiences, including thoughts, emotions, and
physical sensations.
ii. By letting go of resistance and self-criticism, athletes
can reduce the intensity of pre-competitive anxiety
and approach challenges with greater equanimity.
• Stress Reduction:
i. Regular mindfulness practice has been shown to
reduce stress levels and promote relaxation.
ii. Athletes can incorporate mindfulness meditation into
their pre-competition routine to calm their nerves,
quiet their minds, and enter a state of optimal
performance readiness.
 By integrating biofeedback and mindfulness
techniques into sports physiotherapy, athletes can
develop greater self-awareness, emotional regulation,
and resilience in managing pre-competitive anxiety,
ultimately enhancing their overall performance and
well-being.
SOCIAL SUPPORT
 Social support plays a crucial role in managing pre-
competitive anxiety in sports physiotherapy.
 Athletes who feel supported by their coaches,
teammates, friends, and family members are better
equipped to cope with stress and perform at their
best.
 Here's how social support can be beneficial:
• Emotional Support:
i. Athletes benefit from knowing that they have a
supportive network of individuals who care about
their well-being.
ii. Emotional support involves expressing empathy,
encouragement, and reassurance, which can help
athletes feel understood, valued, and less alone in
dealing with pre-competitive anxiety.
• Informational Support:
i. Providing athletes with relevant information and
resources about managing pre-competitive anxiety
can empower them to take proactive steps toward
stress management.
ii. Sports physiotherapists can educate athletes about
relaxation techniques, goal-setting strategies, and
other evidence-based interventions to enhance
mental resilience and performance.
• Practical Support:
i. Practical assistance from coaches, teammates, or
sports physiotherapists can alleviate stressors and
facilitate preparation for competition.
ii. This may include assistance with equipment,
transportation, scheduling, or logistical
arrangements, allowing athletes to focus their energy
and attention on their performance.
• Modeling and Social Comparison:
i. Observing peers or role models who effectively
manage pre-competitive anxiety can inspire athletes
and provide valuable insights into coping strategies.
ii. By witnessing others successfully navigate similar
challenges, athletes may feel more confident and
capable of managing their own anxiety.
• Team Cohesion and Camaraderie:
i. A strong sense of team cohesion and camaraderie
fosters a supportive and inclusive team environment
where athletes feel accepted, respected, and valued.
ii. Positive relationships with teammates promote
camaraderie, cooperation, and mutual
encouragement, buffering against feelings of
isolation and anxiety.
• Feedback and Encouragement:
i. Constructive feedback and words of encouragement
from coaches, teammates, and sports
physiotherapists can boost athletes' confidence and
self-belief.
ii. Acknowledging athletes' efforts and progress,
regardless of outcomes, reinforces their sense of
competence and resilience in the face of pre-
competitive anxiety.
• Social Belongingness:
i. Feeling a sense of belongingness and connection
within the sports community provides athletes with a
supportive context in which to navigate the
challenges of competition.
ii. Belongingness promotes a sense of identity and
purpose, fostering resilience and psychological well-
being in the face of pre-competitive anxiety.
• Peer Support Networks:
i. Encouraging athletes to connect with peers who
share similar experiences and challenges can
provide a valuable source of peer support and
understanding.
ii. Peer support networks offer opportunities for athletes
to exchange advice, share coping strategies, and
offer mutual encouragement, enhancing their ability
to manage pre-competitive anxiety effectively.
 By fostering a supportive social environment within
sports physiotherapy settings, athletes can draw upon
the strength of their social support networks to cope
with pre-competitive anxiety, enhance their mental
resilience, and optimize their performance outcomes.
PROGRESSIVE
EXPOSURE
 Progressive exposure is a therapeutic technique
commonly used in the treatment of anxiety disorders,
including pre-competitive anxiety in sports
physiotherapy.
 The goal of progressive exposure is to gradually
expose individuals to anxiety-provoking stimuli or
situations in a controlled and systematic manner,
allowing them to habituate to their fears and reduce
anxiety over time.
 Here's how progressive exposure can be applied in
the context of pre-competitive anxiety:
• Identify Anxiety Triggers:
i. Work with the athlete to identify specific situations,
thoughts, or experiences that trigger anxiety related
to competition or performance.
ii. Common triggers may include fear of failure, fear of
injury, fear of judgment from others, or uncertainty
about performance outcomes.
• Create a Hierarchy of Anxiety-Provoking
Situations:
i. Collaboratively develop a hierarchy of anxiety-
provoking situations or challenges related to
competition, ranging from least to most anxiety-
inducing.
ii. For example, this hierarchy might include scenarios
such as visualizing a competition, practicing skills in
front of teammates, participating in a low-stakes
scrimmage, and eventually competing in a full-scale
event.
• Start with Low-Intensity Exposures:
i. Begin with exposures that are relatively low in
intensity and anxiety-provoking, allowing the athlete
to gradually acclimate to the experience.
ii. This might involve activities such as visualization
exercises, relaxation techniques, or brief simulations
of competition in a low-pressure environment.
• Gradually Increase Exposure Intensity:
i. Progressively expose the athlete to more challenging
and anxiety-provoking situations as they become
more comfortable and confident.
ii. Increase the intensity of exposures incrementally,
moving up the hierarchy at a pace that is
manageable for the athlete.
• Practice Coping Skills:
i. Encourage the athlete to practice coping skills such
as relaxation techniques, positive self-talk, and
mindfulness during exposure exercises.
ii. These skills help the athlete manage anxiety
symptoms and maintain focus and composure in
challenging situations.
• Provide Support and Encouragement:
i. Offer support, encouragement, and feedback
throughout the exposure process.
ii. Validate the athlete's efforts and progress, and
provide reassurance that experiencing anxiety is
normal and manageable with practice.
• Monitor Progress and Adjust Accordingly:
i. Continuously monitor the athlete's response to
exposure exercises and adjust the intensity or pacing
of exposures as needed.
ii. Pay attention to signs of progress, such as
decreased anxiety symptoms or increased
confidence, and tailor the exposure plan accordingly.
• Generalize Skills to Real-World Settings:
i. Encourage the athlete to apply the coping skills and
strategies learned through progressive exposure to
real-world competition and performance settings.
ii. Help the athlete develop a toolbox of techniques to
manage pre-competitive anxiety effectively in various
situations.
 By systematically exposing athletes to anxiety-
provoking situations in a controlled and supportive
environment, progressive exposure can help them
build resilience, reduce anxiety, and enhance
performance readiness in sports physiotherapy.
MULTIDISCIPLINARY
COLLABORATION
 Multidisciplinary collaboration is essential for
effectively addressing pre-competitive anxiety in
sports physiotherapy.
 By bringing together professionals from various
disciplines, such as sports physiotherapy, sports
psychology, coaching, and sports medicine, athletes
can receive comprehensive support tailored to their
individual needs.
 Here's how multidisciplinary collaboration can be
beneficial:
• Comprehensive Assessment:
i. A multidisciplinary team can conduct a thorough
assessment of the athlete's physical, psychological,
and performance-related factors contributing to pre-
competitive anxiety.
ii. Physiotherapists can evaluate the athlete's physical
condition and injury history, while sports
psychologists can assess psychological factors such
as anxiety levels, coping skills, and performance
mindset.
• Integrated Treatment Planning:
i. Collaborating professionals can develop an
integrated treatment plan that addresses both the
physical and psychological aspects of pre-
competitive anxiety.
ii. Physiotherapy interventions may focus on injury
prevention, rehabilitation, and performance
enhancement, while psychological interventions may
include cognitive-behavioral techniques, relaxation
training, and goal setting.
• Holistic Support:
i. Multidisciplinary collaboration ensures that athletes
receive holistic support that considers the
interconnectedness of physical, mental, and
emotional well-being.
ii. Professionals from different disciplines can work
together to address underlying issues contributing to
anxiety, such as chronic pain, stress-related muscle
tension, or negative performance beliefs.
• Tailored Interventions:
i. By pooling their expertise, professionals can tailor
interventions to meet the unique needs and
preferences of each athlete.
ii. Physiotherapists may incorporate specific exercises
or manual therapies to address physical symptoms of
anxiety, while sports psychologists may provide
individualized coaching on cognitive restructuring or
imagery techniques.
• Communication and Coordination:
i. Multidisciplinary teams facilitate communication and
coordination among professionals involved in the
athlete's care.
ii. Regular meetings, case conferences, and shared
documentation ensure that all team members are
informed about the athlete's progress, goals, and
treatment plan, fostering continuity of care and
collaboration.
• Maximized Resources:
i. By leveraging the resources and expertise of multiple
disciplines, athletes have access to a broader range
of interventions and support services.
ii. This may include access to specialized equipment,
facilities, or referral networks that can enhance the
effectiveness of treatment and optimize outcomes.
• Team Approach to Rehabilitation:
i. In cases where injury contributes to pre-competitive
anxiety, a multidisciplinary team can take a
collaborative approach to rehabilitation.
ii. Physiotherapists, sports psychologists, and coaches
can work together to develop a comprehensive
rehabilitation plan that addresses physical recovery,
psychological resilience, and return-to-sport
readiness.
• Long-Term Performance Enhancement:
i. Multidisciplinary collaboration extends beyond
immediate symptom management to focus on long-
term performance enhancement and athlete
development.
ii. By addressing pre-competitive anxiety
comprehensively, athletes can build resilience,
confidence, and mental skills that contribute to
sustained success in their sport.
 Overall, multidisciplinary collaboration is essential for
effectively addressing pre-competitive anxiety in
sports physiotherapy, ensuring that athletes receive
comprehensive, coordinated care that maximizes
their potential for success and well-being.
THANK YOU!

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Pre-Competition Anxiety I Sports Psychology

  • 1.
  • 2.  Pre-competitive anxiety in sports physiotherapy refers to the psychological stress or apprehension experienced by athletes or sports participants before a competition or sporting event, specifically in the context of their physiotherapy treatment or preparation.  This type of anxiety can affect athletes at various levels, from amateur to professional, and may arise due to factors such as the pressure to perform well, fear of injury, concerns about physical readiness, or the importance of the event.
  • 3.  Sports physiotherapists play a crucial role in addressing pre-competitive anxiety among athletes by implementing strategies to help manage stress and enhance performance.  Some approaches that sports physiotherapists may use include:
  • 4.  Education and Communication: Providing athletes with information about the physiological and psychological aspects of pre-competition anxiety can help them better understand and manage their emotions.  Relaxation Techniques: Teaching athletes relaxation techniques such as deep breathing, progressive muscle relaxation, or visualization can help alleviate tension and promote a calm state of mind before competition.
  • 5.  Goal Setting: Collaborating with athletes to set realistic and achievable goals for their performance and rehabilitation can help reduce anxiety by providing a sense of direction and purpose.  Cognitive-Behavioral Techniques: Implementing cognitive-behavioral strategies such as cognitive restructuring or thought reframing can help athletes identify and challenge negative thoughts or beliefs that contribute to anxiety.
  • 6.  Biofeedback and Mindfulness: Utilizing biofeedback tools or mindfulness techniques can help athletes develop greater awareness of their physiological responses to stress and learn to regulate their reactions effectively.  Social Support: Encouraging athletes to seek support from coaches, teammates, friends, and family members can provide them with emotional reassurance and a sense of camaraderie, which can buffer against pre-competitive anxiety.
  • 7.  Progressive Exposure: Gradually exposing athletes to competitive situations through simulated practice sessions or exposure therapy can help desensitize them to anxiety-provoking stimuli and build confidence over time.  Multidisciplinary Collaboration: Working collaboratively with sports psychologists, coaches, and other members of the athlete's support team can ensure a comprehensive approach to addressing pre- competitive anxiety and optimizing performance outcomes.
  • 9. Education and communication are essential components in addressing pre-competitive anxiety in sports physiotherapy. Here's how they can be effectively utilized:
  • 10. • Psychoeducation: i. Provide athletes with information about the physiological and psychological aspects of pre- competitive anxiety. Explain the normalcy of experiencing anxiety before competitions and help athletes understand the physical and cognitive responses associated with anxiety. ii. Educating athletes about the mind-body connection can empower them to recognize and manage their anxiety more effectively.
  • 11. • Anxiety Management Strategies: i. Educate athletes about evidence-based anxiety management techniques, such as relaxation exercises, mindfulness, cognitive restructuring, and goal setting. ii. Teach athletes how to apply these strategies in practice and competition settings to cope with pre- competitive anxiety and optimize performance.
  • 12. • Understanding Individual Triggers: i. Work with athletes to identify their individual triggers for pre-competitive anxiety. ii. By understanding what specific situations, thoughts, or behaviors exacerbate their anxiety, athletes can develop personalized coping strategies tailored to their unique needs.
  • 13. • Normalization of Anxiety: i. Normalize the experience of pre-competitive anxiety by emphasizing that it is a common and natural response to competitive situations. ii. Help athletes recognize that experiencing anxiety does not signify weakness or failure but rather reflects their investment in their sport and desire to perform well.
  • 14. • Communication Channels: i. Establish open lines of communication between athletes, coaches, sports physiotherapists, and other members of the athlete's support team. ii. Encourage athletes to communicate openly about their feelings, concerns, and needs related to pre- competitive anxiety, fostering a supportive and collaborative environment.
  • 15. • Goal Setting and Expectations: i. Educate athletes about the importance of setting realistic and achievable goals for performance and rehabilitation. ii. Help athletes understand the relationship between goal setting, motivation, and anxiety management, and guide them in setting goals that are specific, measurable, attainable, relevant, and time-bound (SMART).
  • 16. • Stress Management Skills: i. Teach athletes stress management skills to help them regulate their physiological and psychological responses to anxiety. ii. This may include techniques such as diaphragmatic breathing, progressive muscle relaxation, visualization, and biofeedback training.
  • 17. • Role of Sports Physiotherapy: i. Sports physiotherapist supports athletes' mental health and performance. ii. Sports physiotherapists can collaborate with athletes to address physical challenges, enhance performance readiness, and promote overall well- being in the context of pre-competitive anxiety.
  • 18. • Continued Support and Follow-Up: i. Provide ongoing education and support to athletes as they implement anxiety management strategies and work towards their performance goals. ii. Follow up regularly to assess progress, address any concerns or obstacles, and reinforce positive coping behaviors.
  • 19.  By incorporating education and communication strategies into sports physiotherapy, athletes can develop a deeper understanding of pre-competitive anxiety and acquire the skills and knowledge needed to manage anxiety effectively and optimize their performance outcomes.
  • 21.  Relaxation techniques play a vital role in managing pre-competitive anxiety in sports physiotherapy.  Here are some relaxation techniques that can be particularly effective:
  • 22. • Deep Breathing: i. Deep breathing exercises involve taking slow, deep breaths to activate the body's relaxation response. ii. Athletes can practice diaphragmatic breathing, where they inhale deeply through their nose, filling their lungs with air, and exhale slowly through their mouth, focusing on releasing tension with each breath.
  • 23. • Progressive Muscle Relaxation (PMR): i. PMR involves systematically tensing and then relaxing different muscle groups in the body. ii. Athletes can start by tensing specific muscle groups, such as their fists or shoulders, for a few seconds and then releasing the tension while focusing on the sensation of relaxation. iii. Moving through the body progressively, they can release tension from head to toe.
  • 24. • Visualization or Guided Imagery: i. Athletes can use visualization techniques to mentally rehearse successful performance scenarios or imagine themselves in a calm and confident state before competition. ii. Guided imagery scripts or recordings can help athletes create vivid mental images of positive outcomes and relaxation.
  • 25. • Mindfulness Meditation: i. Mindfulness meditation involves focusing on the present moment without judgment. ii. Athletes can practice mindfulness by paying attention to their breath, bodily sensations, or surroundings, grounding themselves in the here and now and letting go of worries about the future.
  • 26. • Autogenic Training: i. Autogenic training is a self-relaxation technique that involves repeating a series of phrases or affirmations to induce a state of deep relaxation. ii. Athletes can use phrases such as "my arms are heavy and warm" or "my breathing is calm and steady" to evoke a sense of relaxation and tranquility.
  • 27. • Biofeedback: i. Biofeedback techniques involve using electronic monitoring devices to provide real-time feedback on physiological responses such as heart rate, muscle tension, or skin conductance. ii. Athletes can learn to regulate their physiological responses by observing changes on the biofeedback monitor and adjusting their relaxation techniques accordingly.
  • 28. • Yoga or Tai Chi: i. Yoga and Tai Chi incorporate gentle movements, stretching, and breathwork to promote relaxation, flexibility, and balance. ii. Athletes can benefit from participating in yoga or Tai Chi classes to enhance physical and mental well- being, reduce stress, and improve focus and concentration.
  • 29. • Progressive Relaxation: i. Progressive relaxation involves systematically tensing and relaxing specific muscle groups in a progressive sequence, starting from the toes and moving upward through the body. ii. Athletes can practice progressive relaxation techniques to release physical tension and promote overall relaxation.
  • 30.  By incorporating these relaxation techniques into their pre-competition routine, athletes can effectively manage pre-competitive anxiety, improve their mental resilience, and optimize their performance in sports physiotherapy.
  • 32.  Goal setting is an essential component of managing pre-competitive anxiety in sports physiotherapy.  By setting clear, specific, and achievable goals, athletes can direct their focus, enhance motivation, and reduce anxiety.  Here's how goal setting can be implemented effectively:
  • 33. • SMART Goals: i. Encourage athletes to set SMART goals – Specific, Measurable, Achievable, Relevant, and Time-bound. ii. Specific goals provide clarity, measurable goals allow progress tracking, achievable goals maintain motivation, relevant goals are meaningful to the athlete, and time-bound goals create a sense of urgency.
  • 34. • Performance Goals vs. Outcome Goals: i. Help athletes differentiate between performance goals (related to their own performance) and outcome goals (related to winning or specific results). ii. While outcome goals are important, focusing solely on them can increase anxiety due to factors beyond the athlete's control. iii. Emphasizing performance goals allows athletes to focus on aspects within their control, such as improving technique or fitness level.
  • 35. • Short-term and Long-term Goals: i. Encourage athletes to set both short-term and long- term goals. ii. Short-term goals provide immediate targets that contribute to long-term success, helping athletes stay focused and motivated. iii. Long-term goals provide a sense of direction and purpose, guiding athletes through their overall development and achievements.
  • 36. • Process Goals: i. Emphasize process goals, which focus on the actions and behaviors necessary to achieve desired outcomes. ii. Process goals help athletes concentrate on specific tasks or strategies within their control, fostering a sense of competence and confidence. iii. For example, a process goal for a runner might be to maintain proper form throughout a race.
  • 37. • Positive Goal Framing: i. Encourage athletes to frame their goals positively rather than negatively. ii. Positive goal framing emphasizes what athletes aim to achieve rather than what they want to avoid, promoting a constructive mindset and reducing anxiety. iii. For example, instead of setting a goal to "avoid mistakes," encourage setting a goal to "execute skills with precision."
  • 38. • Flexible Goal Adjustment: i. Teach athletes the importance of flexibility in goal setting. ii. Circumstances may change, and adjustments to goals may be necessary. iii. Emphasize the value of adapting goals based on feedback, performance assessments, and changing circumstances to maintain motivation and momentum.
  • 39. • Self-monitoring and Feedback: i. Encourage athletes to monitor their progress regularly and provide feedback on their performance relative to their goals. ii. Self-monitoring promotes self-awareness and accountability, while feedback provides valuable information for goal adjustment and improvement.
  • 40. • Celebrating Achievements: i. Celebrate the achievement of goals, whether big or small. ii. Recognizing and celebrating progress boosts morale, reinforces positive behaviors, and motivates athletes to continue striving for excellence.
  • 41.  By implementing goal setting techniques in sports physiotherapy, athletes can effectively manage pre- competitive anxiety, enhance performance, and achieve their full potential on and off the field.
  • 43.  Cognitive-behavioral techniques (CBT) are highly effective in managing pre-competitive anxiety in sports physiotherapy.  CBT focuses on identifying and modifying maladaptive thoughts, beliefs, and behaviors that contribute to anxiety.  Here are some CBT techniques that can be applied:
  • 44. • Cognitive Restructuring: i. This technique involves identifying and challenging irrational or negative thoughts related to performance and competition. ii. Athletes learn to recognize cognitive distortions such as catastrophizing (expecting the worst outcome), black-and-white thinking (seeing situations as all good or all bad), and overgeneralization (drawing broad conclusions from isolated incidents). iii. They then work to reframe these thoughts in a more balanced and realistic way.
  • 45. • Thought Stopping: i. Athletes are taught to recognize and interrupt negative thought patterns by using techniques such as mental imagery (visualizing a stop sign) or a verbal cue (saying "stop" or "cancel") whenever they notice themselves engaging in anxious or self- defeating thoughts. ii. Thought stopping helps break the cycle of rumination and redirect focus to more productive thoughts or actions.
  • 46. • Attentional Control Training: i. This technique involves training athletes to focus their attention selectively on task-relevant cues while filtering out distractions and irrelevant information. ii. By improving attentional control, athletes can maintain concentration during competition, reduce performance anxiety, and enhance performance efficiency.
  • 47. • Imagery and Mental Rehearsal: i. Athletes use visualization techniques to mentally rehearse successful performance scenarios and create positive mental imagery of themselves performing well under pressure. ii. By repeatedly visualizing themselves executing skills with confidence and precision, athletes build self- efficacy and develop a sense of mastery over their performance.
  • 48. • Self-Talk Modification: i. Athletes learn to replace negative self-talk (e.g., "I can't do this," "I'm going to fail") with positive, affirming statements (e.g., "I am prepared and capable," "I will give my best effort"). ii. By consciously choosing empowering self-talk, athletes boost self-confidence, manage anxiety, and maintain a resilient mindset during competition.
  • 49. • Relaxation Training: i. Incorporating relaxation techniques such as deep breathing, progressive muscle relaxation, or mindfulness meditation can help athletes reduce physiological arousal and counteract the physical symptoms of anxiety. ii. By practicing relaxation regularly, athletes develop a repertoire of coping skills to manage stress and maintain optimal performance readiness.
  • 50. • Performance Desensitization: i. Athletes gradually expose themselves to anxiety- provoking situations in a controlled and systematic manner, allowing them to habituate to the stressors over time. ii. By progressively confronting fears and challenges, athletes build resilience and confidence in their ability to cope with pre-competitive anxiety.
  • 51. • Goal Setting and Performance Monitoring: i. Setting specific, achievable goals and monitoring progress toward those goals helps athletes maintain focus, motivation, and accountability. ii. By breaking down larger objectives into smaller, manageable tasks, athletes can track their performance improvements and celebrate their successes along the way, reinforcing positive behaviors and beliefs.
  • 52.  By integrating cognitive-behavioral techniques into sports physiotherapy, athletes can develop effective coping strategies, enhance mental resilience, and perform at their peak potential despite pre-competitive anxiety.
  • 54.  Biofeedback and mindfulness are two valuable techniques in managing pre-competitive anxiety in sports physiotherapy. Here's how they can be effectively utilized:
  • 55. BIOFEEDBACK: i. Biofeedback involves using electronic monitoring devices to provide real-time feedback on physiological responses such as heart rate, muscle tension, or skin conductance. ii. In the context of pre-competitive anxiety in sports physiotherapy, biofeedback can help athletes become more aware of their physiological arousal levels and learn to regulate them effectively. iii. Here's how biofeedback can be applied:
  • 56. • Stress Monitoring: i. Athletes can use biofeedback devices to monitor their stress levels during training sessions and competitions. ii. By observing changes in physiological parameters such as heart rate variability or skin conductance, athletes gain insight into their stress responses and learn to identify triggers for anxiety.
  • 57. • Relaxation Training: i. Biofeedback can be used in conjunction with relaxation techniques such as deep breathing or progressive muscle relaxation. ii. Athletes receive visual or auditory feedback based on their physiological responses, helping them gauge the effectiveness of relaxation techniques and adjust their strategies accordingly.
  • 58. • Self-Regulation: i. Through biofeedback training, athletes develop self- regulation skills to modulate their physiological arousal levels in real time. ii. By learning to control their heart rate, muscle tension, or breathing patterns, athletes can counteract the physical symptoms of anxiety and promote a state of calmness and focus.
  • 59. MINDFULNESS: i. Mindfulness involves paying attention to the present moment with openness, curiosity, and acceptance, without judgment. ii. In the context of pre-competitive anxiety, mindfulness techniques can help athletes cultivate mental clarity, emotional stability, and resilience. iii. Here's how mindfulness can be incorporated:
  • 60. • Focused Attention: i. Athletes practice mindfulness by directing their attention to their breath, bodily sensations, or surroundings, anchoring themselves in the present moment. ii. By developing greater awareness of their thoughts and emotions, athletes can prevent rumination and anxiety about past or future events.
  • 61. • Acceptance and Nonjudgment: i. Mindfulness encourages athletes to adopt an attitude of acceptance and nonjudgment toward their internal experiences, including thoughts, emotions, and physical sensations. ii. By letting go of resistance and self-criticism, athletes can reduce the intensity of pre-competitive anxiety and approach challenges with greater equanimity.
  • 62. • Stress Reduction: i. Regular mindfulness practice has been shown to reduce stress levels and promote relaxation. ii. Athletes can incorporate mindfulness meditation into their pre-competition routine to calm their nerves, quiet their minds, and enter a state of optimal performance readiness.
  • 63.  By integrating biofeedback and mindfulness techniques into sports physiotherapy, athletes can develop greater self-awareness, emotional regulation, and resilience in managing pre-competitive anxiety, ultimately enhancing their overall performance and well-being.
  • 65.  Social support plays a crucial role in managing pre- competitive anxiety in sports physiotherapy.  Athletes who feel supported by their coaches, teammates, friends, and family members are better equipped to cope with stress and perform at their best.  Here's how social support can be beneficial:
  • 66. • Emotional Support: i. Athletes benefit from knowing that they have a supportive network of individuals who care about their well-being. ii. Emotional support involves expressing empathy, encouragement, and reassurance, which can help athletes feel understood, valued, and less alone in dealing with pre-competitive anxiety.
  • 67. • Informational Support: i. Providing athletes with relevant information and resources about managing pre-competitive anxiety can empower them to take proactive steps toward stress management. ii. Sports physiotherapists can educate athletes about relaxation techniques, goal-setting strategies, and other evidence-based interventions to enhance mental resilience and performance.
  • 68. • Practical Support: i. Practical assistance from coaches, teammates, or sports physiotherapists can alleviate stressors and facilitate preparation for competition. ii. This may include assistance with equipment, transportation, scheduling, or logistical arrangements, allowing athletes to focus their energy and attention on their performance.
  • 69. • Modeling and Social Comparison: i. Observing peers or role models who effectively manage pre-competitive anxiety can inspire athletes and provide valuable insights into coping strategies. ii. By witnessing others successfully navigate similar challenges, athletes may feel more confident and capable of managing their own anxiety.
  • 70. • Team Cohesion and Camaraderie: i. A strong sense of team cohesion and camaraderie fosters a supportive and inclusive team environment where athletes feel accepted, respected, and valued. ii. Positive relationships with teammates promote camaraderie, cooperation, and mutual encouragement, buffering against feelings of isolation and anxiety.
  • 71. • Feedback and Encouragement: i. Constructive feedback and words of encouragement from coaches, teammates, and sports physiotherapists can boost athletes' confidence and self-belief. ii. Acknowledging athletes' efforts and progress, regardless of outcomes, reinforces their sense of competence and resilience in the face of pre- competitive anxiety.
  • 72. • Social Belongingness: i. Feeling a sense of belongingness and connection within the sports community provides athletes with a supportive context in which to navigate the challenges of competition. ii. Belongingness promotes a sense of identity and purpose, fostering resilience and psychological well- being in the face of pre-competitive anxiety.
  • 73. • Peer Support Networks: i. Encouraging athletes to connect with peers who share similar experiences and challenges can provide a valuable source of peer support and understanding. ii. Peer support networks offer opportunities for athletes to exchange advice, share coping strategies, and offer mutual encouragement, enhancing their ability to manage pre-competitive anxiety effectively.
  • 74.  By fostering a supportive social environment within sports physiotherapy settings, athletes can draw upon the strength of their social support networks to cope with pre-competitive anxiety, enhance their mental resilience, and optimize their performance outcomes.
  • 76.  Progressive exposure is a therapeutic technique commonly used in the treatment of anxiety disorders, including pre-competitive anxiety in sports physiotherapy.  The goal of progressive exposure is to gradually expose individuals to anxiety-provoking stimuli or situations in a controlled and systematic manner, allowing them to habituate to their fears and reduce anxiety over time.  Here's how progressive exposure can be applied in the context of pre-competitive anxiety:
  • 77. • Identify Anxiety Triggers: i. Work with the athlete to identify specific situations, thoughts, or experiences that trigger anxiety related to competition or performance. ii. Common triggers may include fear of failure, fear of injury, fear of judgment from others, or uncertainty about performance outcomes.
  • 78. • Create a Hierarchy of Anxiety-Provoking Situations: i. Collaboratively develop a hierarchy of anxiety- provoking situations or challenges related to competition, ranging from least to most anxiety- inducing. ii. For example, this hierarchy might include scenarios such as visualizing a competition, practicing skills in front of teammates, participating in a low-stakes scrimmage, and eventually competing in a full-scale event.
  • 79. • Start with Low-Intensity Exposures: i. Begin with exposures that are relatively low in intensity and anxiety-provoking, allowing the athlete to gradually acclimate to the experience. ii. This might involve activities such as visualization exercises, relaxation techniques, or brief simulations of competition in a low-pressure environment.
  • 80. • Gradually Increase Exposure Intensity: i. Progressively expose the athlete to more challenging and anxiety-provoking situations as they become more comfortable and confident. ii. Increase the intensity of exposures incrementally, moving up the hierarchy at a pace that is manageable for the athlete.
  • 81. • Practice Coping Skills: i. Encourage the athlete to practice coping skills such as relaxation techniques, positive self-talk, and mindfulness during exposure exercises. ii. These skills help the athlete manage anxiety symptoms and maintain focus and composure in challenging situations.
  • 82. • Provide Support and Encouragement: i. Offer support, encouragement, and feedback throughout the exposure process. ii. Validate the athlete's efforts and progress, and provide reassurance that experiencing anxiety is normal and manageable with practice.
  • 83. • Monitor Progress and Adjust Accordingly: i. Continuously monitor the athlete's response to exposure exercises and adjust the intensity or pacing of exposures as needed. ii. Pay attention to signs of progress, such as decreased anxiety symptoms or increased confidence, and tailor the exposure plan accordingly.
  • 84. • Generalize Skills to Real-World Settings: i. Encourage the athlete to apply the coping skills and strategies learned through progressive exposure to real-world competition and performance settings. ii. Help the athlete develop a toolbox of techniques to manage pre-competitive anxiety effectively in various situations.
  • 85.  By systematically exposing athletes to anxiety- provoking situations in a controlled and supportive environment, progressive exposure can help them build resilience, reduce anxiety, and enhance performance readiness in sports physiotherapy.
  • 87.  Multidisciplinary collaboration is essential for effectively addressing pre-competitive anxiety in sports physiotherapy.  By bringing together professionals from various disciplines, such as sports physiotherapy, sports psychology, coaching, and sports medicine, athletes can receive comprehensive support tailored to their individual needs.  Here's how multidisciplinary collaboration can be beneficial:
  • 88. • Comprehensive Assessment: i. A multidisciplinary team can conduct a thorough assessment of the athlete's physical, psychological, and performance-related factors contributing to pre- competitive anxiety. ii. Physiotherapists can evaluate the athlete's physical condition and injury history, while sports psychologists can assess psychological factors such as anxiety levels, coping skills, and performance mindset.
  • 89. • Integrated Treatment Planning: i. Collaborating professionals can develop an integrated treatment plan that addresses both the physical and psychological aspects of pre- competitive anxiety. ii. Physiotherapy interventions may focus on injury prevention, rehabilitation, and performance enhancement, while psychological interventions may include cognitive-behavioral techniques, relaxation training, and goal setting.
  • 90. • Holistic Support: i. Multidisciplinary collaboration ensures that athletes receive holistic support that considers the interconnectedness of physical, mental, and emotional well-being. ii. Professionals from different disciplines can work together to address underlying issues contributing to anxiety, such as chronic pain, stress-related muscle tension, or negative performance beliefs.
  • 91. • Tailored Interventions: i. By pooling their expertise, professionals can tailor interventions to meet the unique needs and preferences of each athlete. ii. Physiotherapists may incorporate specific exercises or manual therapies to address physical symptoms of anxiety, while sports psychologists may provide individualized coaching on cognitive restructuring or imagery techniques.
  • 92. • Communication and Coordination: i. Multidisciplinary teams facilitate communication and coordination among professionals involved in the athlete's care. ii. Regular meetings, case conferences, and shared documentation ensure that all team members are informed about the athlete's progress, goals, and treatment plan, fostering continuity of care and collaboration.
  • 93. • Maximized Resources: i. By leveraging the resources and expertise of multiple disciplines, athletes have access to a broader range of interventions and support services. ii. This may include access to specialized equipment, facilities, or referral networks that can enhance the effectiveness of treatment and optimize outcomes.
  • 94. • Team Approach to Rehabilitation: i. In cases where injury contributes to pre-competitive anxiety, a multidisciplinary team can take a collaborative approach to rehabilitation. ii. Physiotherapists, sports psychologists, and coaches can work together to develop a comprehensive rehabilitation plan that addresses physical recovery, psychological resilience, and return-to-sport readiness.
  • 95. • Long-Term Performance Enhancement: i. Multidisciplinary collaboration extends beyond immediate symptom management to focus on long- term performance enhancement and athlete development. ii. By addressing pre-competitive anxiety comprehensively, athletes can build resilience, confidence, and mental skills that contribute to sustained success in their sport.
  • 96.  Overall, multidisciplinary collaboration is essential for effectively addressing pre-competitive anxiety in sports physiotherapy, ensuring that athletes receive comprehensive, coordinated care that maximizes their potential for success and well-being.