We can do a better job of recognizing that injuries are rooted in physical issues, but often come with huge mental consequences.
Most of us are familiar with the Kübler-Ross’ five stages of grief: denial, anger, bargaining, depression, and acceptance. They were originally developed to understand the emotions that come with terminal illness, but have you ever thought about how they can be used to cope with injuries that bring a halt to our fitness goals? So often we treat sports injuries as purely physical ailments, leaving the mental wounds untreated.
I’ve had a lot of time to think about this since I was diagnosed with a femoral neck stress fracture in late 2018. Stuck on crutches for 10 weeks with absolutely no training permitted—not even swimming—I struggled mentally and emotionally. (Seriously, when do they ever prohibit swimming? This was a bad one.)
I spoke with other athletes who have endured tough recoveries and they all identified with the stages, but also expressed feeling shame for having such emotional responses to physical injury. We shouldn’t be embarrassed; we should see the mental challenges as a natural part of healing.
Denial
What it looks/sounds like: I can run/race on this!
Why it happens to runners: Confidence coach and host of “Find Your Awesome” podcast, Kelsey Abbott, says our training can be our downfall. “As endurance athletes we train to be comfortable with being uncomfortable so when we feel pain all of our training teaches us that it’s ok.”
How to cope: Learn to listen to your body! We improve at conquering denial as we improve as athletes. We will all have injuries and most of us learn the hard way not to ignore them. Eventually athletes learn to differentiate between good and bad pain.
Don’t obsess over green Training Peaks boxes or each day’s mileage. Kelsey notes how hung up we get on individual workouts, to our detriment. “If we could take one step backwards and look at the whole picture then skipping one run wouldn’t feel tragic.” It’s better to rest or see the doctor early than wait or push and end up injured or sidelined longer.
Anger
What it looks/sounds like: Why me? I hate my body!
Why it happens to runners: We’re very demanding of our bodies. Maddie Kirch, a Team USA member who was diagnosed with osteoporosis at the age of 30, says that anger has dominated her experience. “I was doing all the right things, and being angry with the situation and with myself.”
How to cope: Live in the rage for a little while. Don’t try to bury it. Let it out.
But don’t stew forever. If your injury allows you some activity, get moving however you can to get endorphins flowing. If you’re fully sidelined, use the down time to discover or rediscover other passions. For those of us who let our identities get too intertwined with the sport, Abbott says some forced time away can be healthy. “If we do fall into the trap of it being our whole identity, injuries can be helpful to pull us out of that.” After a decade away from music, I used this time to sign up for voice classes, which has given me a sense of accomplishment to displace some of my anger.
Bargaining
What it looks/sounds like: If I just stick to an easy pace I’ll be fine. If it hurts I’ll stop! (Will you really?) “Doc, can’t I at least swim, or bike with no resistance?”
Why it happens to runners: As Abbott said, running is part of our identity.
How to cope: Change your thinking: if you can’t run, can you make some swim gains? (Most of us need the swim-provement!) If, like me, you can’t do any training, can you still attend team practices or volunteer at a race? If you can stay engaged in the sport you might not feel the need to haggle your way around your recovery.
Be an active participant in your care. Per another athlete’s suggestion I kept a pain diary, which helped me stay focused through my recovery and provided my orthopedist and PT enough information to feel comfortable transitioning me off crutches.
Trust your care team, but also be your own advocate. After “transactional” encounters with an orthopedist to treat a stress fracture, Kirch knew something bigger was wrong. She got the osteoporosis diagnosis when she proactively sought answers with other providers. It wasn’t the answer she wanted, but now at least she knows.
If you’re not getting what you need from a doctor it’s fair to reevaluate that relationship. A unanimous complaint I heard was the lack of bedside manner. Virginia endurance athlete Clarice Lorenzini underwent ankle surgery in February of 2018 and was told by one doctor afterward that she “probably wouldn’t get dorsiflexion back” like it was no big deal. Fortunately, teammates were able to connect her with practitioners who better understood athletes. Ask around; there are providers out there who will take more care to get you racing again.
Depression
What it looks/sounds like: I’ll never BQ/insert goal here.
Why it happens to runners: We do this sport because we love it, so we suffer real loss when we’re injured.
How to cope: Abbott suggests a mental exercise humoring the mental spiral all the way down. Eventually you’ll reach the bottom—”I can’t train or race” somehow leads inevitably to “I’ll die alone in a van down by the river”—and you’ll see the mental hysterics are ridiculous.
Lorenzini’s surgery was elective so she says she felt depressed more than angry. She cried constantly and at one point even asked her husband to throw all her medals away. What helped pull her up was her community, in particular a teammate who had been through a similar injury and really understood. When you can’t see athletese in real life you can even tap into the online endurance-world for backup.
Connect with people outside the #fitfam too. Many of us eschew social gatherings to train morning and night. Take this time to be “normal” and hit up a happy hour. Go on a proper date night. (Time with fur-friends also helps!)
Acceptance
What it looks/sounds like: I just have to give my amazing body time to heal. I’ll be better in the long run.
Why it happens to runners: Like all things, practice makes perfect.
How to cope: If you’re someone who uses racing mantras, develop some to cope with recovery. Telling myself “one day down” every night of my 10 weeks on crutches sustained me. Once PT started, I stole a mantra from Abbott: “One percent better every day” to remind myself that while progress may seem slow, it’s happening.
Recovery is a journey, not a destination. A year since her surgery, with a successful 2018 under her racebelt, Lorenzini still struggles with acceptance. She’s still “overthinking the little twinges” and gets nervous during certain workouts.
But she also has a novel take on “acceptance,” and that is not to accept things. Several doctors and “friends” told her that she would never fully return to normal after surgery, but she didn’t “accept” that. Instead she used negativity as motivation to return to the sport she loves. Despite the continued challenges, she revels in her victories however big or small.
If and when you find yourself benched with an injury embrace the mental and emotional journey. Be prepared to experience any of the above and in no particular order. Remember you are not alone in these feelings and challenges.
From Triathlete