The patient visited the athletic training room over six times in a period of two weeks.

During these visits, the patient complained of five different areas of injury. While this was not exactly new behavior from the patient, it was an increase in the amount of times he visited. This also corresponded with the end of the football season. I believe that this athlete was showing signs of deeper emotional issues with a combination of burnout and depression. He had a history of trouble at home, and at times seemed to be withdrawn from his peers. Additionally, it was not uncommon for him to visit the ATR frequently with complaints of pain, usually without a direct mechanism and with evaluation, minimal injury. As part of the management strategy I continued to evaluate his injuries, attempted to foster an air of trust and confidence between us, and referred him to the sports psychologist who works at BHSN. The patient was cleared to participate in activity as tolerated by his pain levels for the majority of this time period. However, the last three days of the season, the patient was removed from activity completely. This was a decision made because of his continued insistence on new injury, which seemed to indicate his reluctance to participate. This decision was reached after discussion with the athlete, and was agreed upon by said athlete. *Note: Each injury presented was thoroughly evaluated, and serious injury ruled out before any decision was made about them relating to a psychosocial disorder. Burnout/ Overtraining is a state of chronic stress that leads to: physical and emotional exhaustion cynicism and detachment feelings of ineffectiveness and lack of accomplishment

Signs/ Symptoms: Movement coordination symptoms: o Increased incidence of disturbances in movement (the re-appearance of faults that seemed to have been overcome, cramp, inhibitions, insecurity) o Disturbances in rhythm and flow of movement o Lack of ability to concentrate o Reduced power of differentiation and correction Condition symptoms: o Diminished powers of endurance, strength, speed. Increase in recovery time, loss of 'sparkle' (competitive qualities) o Reduced readiness for action, fear of competition, giving-up in face of difficult situations, especially at the finish

o Confusion in competition, departure from usual tactics o Susceptibility to demoralizing influences before and during competition o Increasing tendency to abandon the struggle Psychological symptoms: o Increased irritability, obstinacy, tendency to hysteria, grumbling, defiance, increased quarrelsomeness, avoidance of contact with coach and colleagues o Over sensitivity to criticism, or increasing indolence, poor incentive, dullness, hallucination, anxiety, depression, melancholy, insecurity

Depression: a mood disorder that causes a persistent feeling of sadness and loss of interest. Signs/ Symptoms: Difficulty concentrating, remembering details, and making decisions Fatigue and decreased energy Feelings of guilt, worthlessness, and/or helplessness Feelings of hopelessness and/or pessimism Insomnia, early-morning wakefulness, or excessive sleeping Irritability, restlessness Loss of interest in activities or hobbies once pleasurable, including sex Overeating or appetite loss Persistent aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment Persistent sad, anxious, or "empty" feelings Thoughts of suicide, suicide attempts