On June 1, I was attempting a bouldering problem that I could barely make one move on a month earlier. But that day, on my first attempt, I got to the halfway point with relative ease. I was climbing strong, finally feeling like I was getting ‘good’ since I had started climbing 4 months prior. The indoor bouldering gym was pretty empty for a Sunday afternoon, so I had the problem all to myself. After falling from the midpoint on 3 more attempts, I decided to try it one more time before heading into my cooldown. As I got to my trouble spot on the problem, I started to feel myself slipping again, but I went for the next move anyways. I missed the hold and fell as predicted and as I did 4 times already. But this time, I landed wrong. There was a loud crack as my ankle rolled, and I crumpled to the mat in pain. My boyfriend, who had been watching and has experience with ankle injuries (having torn 3 ligaments in a bouldering fall 3 years prior), quickly checked to see if there was any severe ligament damage, then wrapped my ankle and drove me to the pharmacy for NSAIDs and a brace. Anxiety started rolling in, but my boyfriend kept me calm, telling me it didn’t look nearly as bad as his ankle had.
For a week, I made my way around on crutches and struggled to beat off feelings of depression from not being able to get a good sweat in. Finally, I found a friend of a friend who had an old walking boot I could borrow. The walking boot gave me a little mood boost as I was able to be more mobile and include more variety in my workouts. But when swelling around my ankle started to go down, bruising appeared. The bruising concerned my physical therapist enough to say he wouldn’t treat me until I got an X-ray to rule out a fractured bone (because he's legit). So, reluctantly, I scheduled an X-ray.
I went into the appointment with confidence. I was certain it was just minor ligament damage, and I would be able to start physical therapy that week. But the doctor looked at the fuzzy X-ray with concern. He consulted the foot and ankle specialist who immediately ordered a CT scan that same day. My hopes were being choked out. After the CT scan, I went home and immediately started crying. If my ankle was broken, I wouldn’t be allowed to put any weight on it, which would kill my workout routine and my hopes of a quick return to full activity. And if I needed surgery, there would be no way I could pay for it. Stress made my sleep restless that night and thinking about the cost of surgery made me feel nauseous all the next morning. That afternoon, I went back for the results of the CT scan, and this time, instead of walking into the office with confidence, I crutched in despondent.
I had come with a list of questions for the specialist, but when she rushed in the room mid-sentence, I immediately felt unprepared and alone. I barely responded to one question before she started asking the next. But finally, she remembered me and that she had been the specialist who ordered the emergency CT scan the day before. She took a deep breath and slowed down a bit, making me wonder if yesterday’s doctor had written “fragile” in my chart. She confirmed that my ankle was fractured, and I would not be able to weight it for 4 more weeks. BUT then she delivered the good news that I would not need surgery and I could swim. So, I could move! I wasn’t great at swimming and I didn’t yet belong to a pool. But I could move!
It was 10 days since the incident, and I was already starting to feel atrophied and soft. I couldn’t stand another sedentary day. I needed to get into a pool ASAP! I had clung so tightly to that little shiny piece of hope that when it became clear finding a pool in Philly to safely swim laps in was not likely to happen, I started to break. My thoughts became darker, my anger became hotter, and my anxiety skyrocketed. I felt completely out of control, stuck, and alone. I couldn’t drive, walk, grocery shop, take on new clients, teach new classes, sweep my floors, or even carry a glass of water to the couch. I was feeling sorry for myself and that made me even more mad. Frustration became my constant.
I hid it all behind smiles and jokes. But in reality, whenever someone asked how it happened or how I was, I wanted to throw a crutch at them. I didn’t want to go to work, go out to eat, visit family, or even bathe. I just wanted to swim, move my body the only way I was allowed. But I couldn’t, because I couldn’t get myself to a pool and it seemed no one else could either. I was feeling alone and unseen. My depressive thoughts were out of control. I started to get lost in 'this is it,' thinking I should just quit my job and move home because who wants a trainer on crutches and my boyfriend would surely get sick of helping me. They were completely irrational thoughts, and yet I couldn't shake them. It had now been only 3 weeks since my injury, yet I was ready for someone to just put me down. But then I got in a pool.
I swam just 20 minutes the first day and then 30 minutes the following day. But it helped my thoughts to become a little brighter. I started to see and appreciate the social support around me, like my dad driving over an hour to pick me up from the city to take me to a pool in the Philly ‘burbs, and like my boyfriend patiently waiting on me and taking me to top rope with one foot. I also started to feel a little motivation come back to do the nonactive things I love, like writing, reading, and eating. And with this renewed outward awareness and inner motivation, I started to wonder ‘why.’
Why was I, who prided herself on her resilience, so fragile in the face of injury? Why was I, who worked so hard to achieve self-actualization and -growth, losing myself in apathy? And it turns out, I’m not special. Many studies have been done that researched the negative mental effects injuries cause athletes and the psychological interventions used to alleviate the negative emotional responses to injury. And this validation of my emotional down spiral started to bring it back on the up. This is that research:
Athletes—professional, elite, or recreational—often use activity as a coping mechanism for stress and/or see their sport as part of their identity. When an injury sidelines them, they not only lose use of the injured limb, but they also lose their ability to cope and/or lose part of their perceived identity. Even if the loss is temporary, it can create a grief response. Emotional responses to injury can include isolation, denial, frustration, anger, irritability, disengagement, sleep and appetite disturbances, lack of motivation, and depression. And depression even heightens the affect of all other negative emotions.
Which emotional responses an athlete has is unique to them, and those responses and the severity of them varies over time and by circumstance. Therefore, emotional response to injury is not predictable. So not only does an injured athlete feel out of control when it comes to their athletic performance, but they’re also feeling out of control when it comes to their emotions and moods. They can start to feel their athletic progress slip away and their future progress starts to appear impossibly far, raising levels of anxiety and helplessness. They might even start to think, ‘what’s the point,’ when it comes to rehabilitation, adversely affecting their recovery. But psychological interventions have proven effective in treating mental health disturbances in post-injury athletes. These psychological interventions include guided imagery, deep breathing, acceptance and commitment therapy, talk therapy, written expression, and goal setting.
Guided imagery is often imagining a scenario in the injury rehabilitation process, such as progress through the different phases of rehabilitation, the emotions that may occur during each phase, and even the successful completion of rehabilitation with a full return to activity. Imagining successful completion of a task is something most athletes do often, in training and in competition, so it is easier for them to implement. This refocus on what they can do in rehabilitation will help them to stop dwelling on what they cannot do.
Guided imagery can also be used to reconnect the athlete with their body by having them imagine the injured area and the healing process occurring within their body, picturing the repair cells building proteins that will be used to create new bone, muscle, and/or connective tissue. This reconnection to self can help the athlete alter their view of their body from a submissive servant to a vessel of self, thinking not what their body can do for them but what they can do for their body, which will lead to even more positive impacts on recovery.
Deep diaphragmatic breathing is utilized in the practice of yoga to slow the heartbeat, calm the senses, and bring focus to the present moment. This deep breathing can also help injured athletes reduce anxiety and distress, moving focus away from their limitations and toward the here-and-now. When the athlete’s breathing and heart rate become erratic as depressive emotions start to build, they can take deep diaphragmatic breaths to lower their blood pressure and relieve the compounded negative psychological reactions.
ACCEPTANCE AND COMMITMENT THERAPY
Acceptance and Commitment Therapy (ACT) aims to increase psychological flexibility by having the injured athlete actively participate in acknowledging emotional responses and altering how they interact with those responses. Simply avoiding difficult emotions will only intensify them, which is why ACT is a good option for injured athletes experiencing denial. You cannot remedy what you refuse to acknowledge.
Talk therapy provides injured athletes with emotional and listening support, providing them the space for reflection. Talking with a licensed professional allows injured athletes to safely talk through their emotions and come to realizations on their own about how they are responding to their injury and rehabilitation. The injured athlete can then start to process those identified reactions and regain a sense of control over their emotions.
Written expression, like talk therapy and often coupled with talk therapy, provides injured athletes with the space to reflect. They write down their emotional responses to their injury and the surrounding circumstances, giving them the ability to self-regulate. This self-regulating of emotions helps them to reestablish a feeling of control over their emotions.
Goal setting, like picturing success, is not foreign to athletes and so is more natural to implement. When injured, it is common to feel a lack of motivation. Setting goals within the rehabilitation process provides the athlete with direction and enhances persistence. In addition, most athletes find comfort in training programs and group accountability. Working with their rehabilitation team to set and meet realistic goals throughout the process will help the athlete regain a sense of social support and community.
If you are, or an athlete you know, is injured, check in. Feeling lost, angry, insecure, depressed, or all of the above is normal, and there are interventions to help process all those debilitating emotions. Unfortunately, there is a stigma around therapy and asking for psychological help, as though seeking mental strength gains is a sign of weakness. But even professional sports organizations have realized that injured professional athletes also require mental health rehabilitation for a successful recovery. So, get after those mental gains too.