coping with injury

A Sports Psychologist On... Injuries

5 actionable tips to help any athlete recover mentally and physically

Welcome to A Sports Psychologist On... For this new series, running during the month of March, we'll bring you insight from top sports psychologists each week on various psychological issues athletes face. First up, how to deal mentally when you get sidelined. 

By: Chris Carr, Ph.D., sport and performance psychologist at St. Vincent Sports Performance in Indianapolis as told to Rachael Schultz

When you have an injury where you're going to miss competition, miss training, and potentially be limited in everyday ways, you're going to have some very normal emotional responses that don't feel normal. There is a huge emotional component to rehabilitation. I often hear athletes say their competitiveness is dormant or on hold when they get injured, but in reality you can—and should—use that drive to optimize rehabilitation and set the stage for a great return to play. Becoming aware of what is typical and having the tools to manage those feelings can help you engage that very self-directed part of you that makes you a great athlete.

The Emotional Stages of an Injury

At the time of injury, the emotional response is similar to the grieving response: shock, denial, and unrealistic expectations. You might tell yourself it’s "not that bad” but the important thing is you go see a medical professional and are prepared for good news—or bad.

If a specialist takes x-rays and says you’re sidelined, there’s one common response—most people just shut down. When we’re sad, we’re tearful; happy, we’re joyful; but when we don’t know what to feel or when our feelings don’t fit our thoughts, psychologists call this “emotional disorganization.” It’s common for people to just laugh at being told they’re having surgery, for example. It’s when you have time between the information and the treatment that your emotions will start to organize. A lot of the time, this includes anxiety on top of the grief because now there are more unknowns.

The grieving evolves and often deepens. Even normally happy, energetic people may suddenly not feel like themselves. Whether you were a competitive athlete in your younger years or you’ve adopted sports later in life, you have that strong identity as an athlete. When you lose the ability to compete and train, you lose that identity. Similar to getting fired from a job or going through a divorce, your personal dynamics get interrupted and there’s an emotional scramble to get everything resolved.

As you get into late rehabilitation or late post-ops, where your range of motion increases and you feel better, the anxiety becomes more anticipatory—you feel better, but wonder if you’re going to be okay, if you’re going to be the same.The final emotional stage of an injury comes when your physical therapist or orthopedic surgeon says you are good to return to your sport. This part is tricky; a lot of athletes think they can’t wait for this moment, but then are often overcome by fear. It’s both the fear of performance (”Am I going to be as good as I was?”) and fear of re-injury (”They told me I’m healed and strong, but am I?”).

How to Cope

Taking as much care to recover emotionally as physically can help. As a sports psychologist, I work in collaboration with sports medicine physicians, athletic trainers, and physical therapists so we can better address the emotional side of rehab. I recommend seeking professional emotional help, but at the very least, you should create an intentional plan—don’t just think about the mental recovery process, but outline actual steps and goals. In over 30 years of treating elite athletes, I’ve come to find a few techniques that are pretty reliable: 

Journal

I prescribe journaling to any client that works with me individually, but it's particularly important for those who are injured as an outlet for frustrations. While it can be cathartic, it can also function as a tool for goal setting. When active, athletes get validation and encouragement from doing this. During rehabilitation, you can derive that same sense of accomplishment from setting recovery-specific goals, like getting to the next phase of physical therapy. 

Practice Mindfulness

Four to five times a week before you go to bed, be intentional about relaxation exercises. It’s not only helpful in managing the stress and anxiety, but it also allows for your muscles to relax, which can aid the physical therapy you’re undergoing. It also gives you an opportunity to be mindful and attentive of your body, and to be accepting of where you're at physically. I have a 13-minute autogenic relaxation exercise I prescribe to my athletes, but you can download any number of apps that involve 10 to 13 minutes of progressive muscle relaxation or relaxation training.

Practice Visualization

When I worked with the Kansas City Royals and we’d have a pitcher coming off an arm surgery, we’d talk about cues he associated with his best pitches. Then I’d have him visualize executing those pitches from the mound.  Subconsciously, you know the biomechanics and movements that make a good pitch, a good stride, or good technique in whatever sport. By visualizing this, there will be fine muscle movement that'll fire and engage even while you're laying still. Visualization is so effective because you’re engaging that quasi-sensory movement repeatedly, building a reservoir of confidence for what that perfect pitch, stride, swing looks like, and, when you return to play, you’ve been mentally practicing the movements, which is the next best thing to physically practicing them.

Create a Pre-Rehab Plan

Use positive cue words (i.e., strength, healing), listen to music that makes you relaxed and happy, change your phone background to a race you want to do five months from now. By generating motivation for the task at hand and the goal you have for today, you can maximize rehabilitation and reach that greater goal of healing faster. Plus, this kind of routine has great transferal, since once you’re cleared to go back, you have a mental routine set that you can adapt to your fully active plan.

Accept That You’re a Different Athlete Now

Once you have an injury, your body is now different than before but that does not mean it’s “worse” than before. Sports medicine has evolved greatly. There are stories upon stories of athletes who have one or two serious injuries yet are able to resume their activity at a high level. Take Molly Beckwith-Ludlow, for example. Back when I was consulting with the Indiana University athletics department, she came in as a soccer player, but after she had her second or third ACL tear, she switched sports and is now one the top 800-meter athletes in the U.S. This is a young woman who had a resilient response to her injury as it ended one career but she just launched into another.You have to accept that you can get hurt at any moment in any sport, and then do everything you can to prevent it while still performing optimally.