RECOVERING FROM INJURY: IT'S ALL IN THE MIND
Recall a time when you got injured and could no longer participate in your sport for a period of time. How did you feel?
What was your reaction when you were told the news that you would have to miss the rest of the season?
How did you feel seeing your teammates training and winning games without you?
Did you feel sad, frustrated or angry for not being able to play or exercise?
If you haven’t experienced an injury yet, how do you think you would react?
I certainty felt frustrated and angry when I got injured and was told I would have to stop participating in sports for at least 6 months. I honestly hated everything about being injured (despite the smile on my face in the picture). Looking back, I realize that I learnt a lot from my injury, although it certainly did not feel like a positive experience at the time.
I often questioned myself whether I was overreacting, being too grumpy or frustrated during my recovery. Knowing what I know now, I don’t blame myself for having had these types of feelings and reactions, it was completely normal given the mental implications sustaining an injury entails. However, I do wish I had had some strategies which could have helped me better manage and cope with my injury at the time.
Me after my second surgery after sustaining a torn patellar tendon from a bad football tackle
This article aims to help those of you who:
1. Haven’t experienced an injury yet, to prepare yourself and become more aware of what you could potentially expect psychologically, if and when injury does happen
2. Are currently experiencing an injury, by explaining different types of strategies you could use to better cope with and manage your recovery from injury
3. May know someone who is struggling with their injury and you want to help them cope and provide useful support
No matter which of these three scenarios you find yourself in, whether you are a recreational exerciser who enjoys a Sunday morning run, a competitive amateur football player, or an athlete competing at the highest level in your sport, this blog will help in some way, shape or form.
Right, enough waffle and let’s get to the interesting part.
SPORTS INJURIES? TELL ME MORE
Simply put, a sports injury refers to damage to bones, ligaments, tendons and nerves caused by sport participation (i.e. musculoskeletal damage). Unfortunately, injuries are inevitable and tend to occur quite frequently in sports, no matter a person’s experience or level, as demonstrated by the bubbles below (1,2,3).
I included these numbers not for the purpose of comparing amateur vs professional athletes’ incidence of injuries but rather to show how relevant injuries are to ALL athletes.
HOW DO ATHLETES PSYCHOLOGICALLY RESPOND TO THEIR INJURY?
Injured athletes face problems not only from the actual painful and unpleasant physical repercussions of sustaining an injury, but also other hurdles such as enduring tedious, repetitious and sometimes painful rehabilitation exercises (3).
Whilst the physical repercussions are usually easily apparent, those of a psychological nature are less obvious. Injured individuals tend to experience many different negative psychological responses (4).
I) Emotional = ‘‘how you feel about the injury’’
II) Behavioural = ‘’how did you act and react to the injury situation’’
III) Cognitive = ‘’how you viewed the situation of being injured’’
Some examples:
Depression: It’s not surprising that when an athlete’s primary source of enjoyment is no longer accessible to them due to injury, their mood is affected. This type of reaction is particularly evident when an athlete truly identifies with their sport and it plays a big part in their life (e.g. their career/full-time job or a way to escape from daily stressors (5)).
Fear & Anxiety: Injured athletes can feel fearful and/or anxious for different reasons; because they don’t know how fast they will recover from their injury, or because they wonder if they will re-injure themselves during their rehabilitation or upon their return to sport (5,6).
Some Examples:
Seeking Social Support: Injured athletes tend to seek social support from their social support circle (family, friends, teammates, coaches, physiotherapists etc.). Social support provides athletes with crucial reassurance, comfort and encouragement for them to successfully manage their emotions, thoughts and feelings during their recovery. They may initially resist help but will certainly be grateful for it when they seek it (7).
Non-Adherence to Rehab Program: Rehabilitation programs can be long, monotonous and repetitive, with only little or slow progress evident and it can therefore be hard for injured athletes to adhere to it. The temptation to return and compete in their sport prematurely can be overwhelming, despite the risk of re-injury or causing new injuries (5,7).
Some Examples:
Alienation & Social Isolation: Injured athletes can feel isolated and lonely, particularly if they train and compete in a team sport from which they may now feel disconnected. They may also feel envious of those who are able to continue participating in their sport or activity (8).
Low Self-Esteem & Perception: Self-esteem can suffer in injured athletes, leading them to feel worthless which is highly correlated with an individual’s athletic identity. The more the athlete is committed and devoted to his/her sport or if it’s their job, for example, the higher his/her athletic identity will be (5).
SUSTAINING AN INJURY ISN'T ALWAYS BAD
A common misconception that athletes frequently have when sustaining an injury is that it is ONLY negative. However, once recovered, athletes, (including myself), may be able to perceive the experience in a totally different manner. I certainty experienced negative feelings, but going through my injury experience was definitely insightful and I grew as a person. This way of responding is also known as post-traumatic growth (9).
After experiencing an adversity such as an injury, the positive outcomes can include:
1. Enhanced Relationships: Post injury, athletes may value friends and family highly and feel more compassion towards others, demonstrating their appreciation for all the support they received from their support circles.
2. Changed Self-Perception: Recovered athletes can develop wisdom, personal strength and gratitude and may have a greater acceptance of their vulnerabilities and limitations. Any athlete, no matter the level or their current form can easily get injured. No one is invincible.
3. Changed Life Philosophy: Spending time away from sport enables athletes to reflect upon their life in general and current circumstances, to put things (e.g. minor life issues) into perspective and to appreciate things they didn’t before. I know this may sound a bit cliché, but you would be surprised how much this is actually the case, especially when you are deprived of something you thoroughly enjoy.
4. Other Responses: Being injured can also lead to the development of new skills such as time-management and goal setting, which can be applied outside of sport. Additionally, overcoming such a difficult experience undoubtedly strengthens an individuals’ character, self-confidence and resilience (5,10,11).
If I didn’t perceive my injury experience as being a positive and insightful experience, I probably wouldn’t have written this blog. Don’t forget, there’s always light at the end of the tunnel.
Tiger Woods’ comeback win in 2018 after Spinal Fusion Surgery
SO, WHY DO ATHLETES RESPOND IN THESE WAYS?
Well, the best way I can explain this to you is by sharing with you a model which was developed by sport injury researchers.
It has a long name (The Integrated Model of Psychological Response to the Sport Injury and Rehabilitation Process) but the important thing to understand is how different factors interact with each other to determine how an athlete can potentially react to their injury.
The Integrated Model of Psychological Response to the Sport Injury and Rehabilitation Process (adapted) (12).
The model suggests that both personal and situational factors influence the way an athlete perceives his/her injury (i.e. cognitively respond). This influences the way he/she will emotionally respond which will in turn affect the way he/she will behaviourally respond.
These factors combined with the different responses, will determine if an athlete will have a positive or negative injury experience and recovery.
For example:
If Cristiano Ronaldo sustained an ACL injury, which is a severe injury, and given the fact that he has a competitive, ambitious and determined personality (personal factors) combined with the fact he is at the highest level, he trains every day, plays competitive matches every week (situational factors) he is highly likely to have negative thoughts concerning the injury. As a consequence, his cognitive responses (e.g. social isolation and low self-esteem), will influence his emotional responses (e.g. fear, anxiety and depression) and his behavioural responses (e.g. seek social support and difficulty to adhere to his rehabilitation program). These factors combined (either being positive or negative) will determined his recovery outcomes.
What does this mean?
The key takeaway from this model is that the way an athlete responds to his injury is entirely individualistic, as there can be many contributing factors. There isn’t a ‘’right way’’ to feel, think or behave when it comes to enduring and coping with injury (12). It is NORMAL and OK to feel the way you are feeling; no one should decide for you.
HOW CAN I BETTER COPE WITH MY INJURY?
Now, this is the part you are probably most curious about.
There are various psychosocial strategies you can learn, practice and apply to yourself to better manage and cope with your injury. Don’t be put off by the word ‘’psychosocial’’, it’s just the name of the type of intervention sport psychologists use.
These specific ones are designed to promote positive factors such as self-efficacy, confidence and athletic identity and reduce negative factors such as anxiety and depression which majorly influence the recovery process and an athletes’ successf