Injuries suck, plain and simple. Whether it’s for a big or small issue, being sidelined can be a struggle to deal with.
For me, it was a torn ACL—a pickup game of soccer that derailed my running goals for a year and a half as I underwent and recovered from surgery. Luckily, the surgery itself and the subsequent recovery was the simple part. I had a map of milestones to aim for, and plenty of guidance from my surgeon, physical therapist (PT), and post-PT specialist. I knew if I worked hard and stuck to the plan, I’d get my body where it needed to go.
But the mental side was a whole other story. Yes, it was a huge boost to reach milestones that had been set by my care team. But as my recovery continued, those milestones became fewer and further between—yet I still didn’t feel like I was back to my normal self.
As the coronavirus pandemic made us all acutely aware, America’s healthcare system as a whole doesn’t dedicate nearly enough attention or resources to mental health. A recent State of Mental Health in America report found that, while the number of people looking for support has skyrocketed, more than 23 percent of adults with a mental illness have an unmet need for treatment.
“One part of [the problem] is really structural,” Lindsey Blom, Ed.D., C.M.P.C., executive board member for the Association for Applied Sport Psychology, tells Runner’s World. “Insurance covers the physical components [of an injury], but unless there’s a diagnosis of psychological challenge, then insurance typically isn’t going to cover [mental health treatment].”
Which means people who may already be worried about covering their health bills for a major surgery likely can’t afford to take care of their mental health on top of it.
But the reality is, mental health has a major impact on your physical performance. A review of various studies of elite athletes found anxiety in particular had negative associations with athletic performance, with one study noting slower race times in distance runners.
In other words: Without a strong mental game, your physical performance is bound to suffer.
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It’s Time to Talk About Mental Health Around Injuries, Early and Often
When you prepare for a major procedure like ACL reconstruction, you often get a packet from your surgeon’s office. In mine were papers and pamphlets covering everything I needed to know about what I was about to go through: what medicines I could and couldn’t take, what tools I could utilize to speed up recovery, how payment would be handled in conjunction with my health insurance.
But there wasn’t a single sheet to prepare me for the mental impact coming up. And that, Blom says, is the first area of opportunity to make a change.
“We have to do a better job of getting resources into the hands of athletic trainers and sports medicine clinics to make sure that ... when someone comes in, there’s [information available],” she says. “We’re [also] trying to train a lot of sports doctors and physical therapists to understand the psychological side [of an injury], and how important it is to talk about it early to try to help people get resources.”
Of course, Blom says there’s still progress to be made around de-stigmatizing open discussion around mental health. “There’s a norm for us to not talk about things that are psychological ... especially across sports,” she explains. “There’s this idea that we play through pain, play through injury, and we’re not supposed to show it—[it’s this sentiment] that the tougher you are, the better you are.”
Society as a whole—and professional athletes in particular—are starting to change that line of thought thanks to moments like gymnast Simone Biles pulling out of the Olympic team finals and tennis star Naomi Osaka withdrawing from the French Open, both of whom cited mental health concerns as their reason for backing out of their respective competitions. It’s times like this that put mental health recovery in the spotlight, allowing people from all walks of life—everyone from the average 5K runner to Olympic team coaches—to focus on prioritizing mental health in a way that allows them to be prepared if and when a physical injury does strike.
How to Get into Strong Mental Shape
When recovering from a physical injury, here are some of the top tactics mental health experts recommend you put into practice to make sure your brain is just as game as your body.
Do the Prep Work
The unfortunate reality is that, for many, prioritizing mental health is one of those things that falls by the wayside when things are good; some have a tendency to only focus on it when something bad happens.
But Blom says it’s important to regularly support your mental health. Not only does it make finding help easier—taking that first step is often a real barrier in getting professional help—but it allows time to figure out what works best for you, given mental health is not a one-size fits-all situation.
“The more solid of a psychological foundation you have, the easier it is to deal with the challenge when it comes your way,” she says. “It might not interfere with performance in the same way it might if you’re not already grounded and psychologically feeling well.”
Focus on Your Own Process
“Athletes can fall into the trap of comparing their injury experience and return-to-sport to those around them,” Kelsey Griffith, M.S., performance enhancement and rehab specialist at The Micheli Center for Sports Injury Prevention and creator of The Mental Side Series for The ACL Club, told Runner’s World. It’s not uncommon to hear someone say, “they got back to running faster than me.”
But these comparisons shift the athlete’s focus away from process and onto results, and that can hinder your ability to appreciate all the milestones that are reached throughout injury recovery, Griffith says.
That’s why she suggests using a training journal and setting short-, medium-, and long-term goals. These can help you break down what could be a long recovery into phases that make managing your expectations easier. Asking questions like, “what am I learning from this?” or “what can I change or do differently?” also offers an opportunity to reflect internally on how you’re feeling.
Celebrate the Wins
From a mental perspective, a big part of being ready to return to sport is evaluating confidence in your physical abilities. “When an athlete has been sidelined for quite some time, they may have lost that sense of physical readiness—they may worry they can’t keep up with others, have re-injury concerns, or experience difficulty rebounding from mistakes,” Griffith says. “These challenges can present themselves as hesitancy ... or lack of effort in performance.”
One way to battle this: look back. “One of the greatest predictors of present and future success is past success,” Griffith says. “When athletes take time to think about moments of achievement—sport-specific or otherwise—it can help generate feelings of competence and self-efficacy.”
So first, think about a moment of success. Maybe it’s when you failed and came back stronger—such as the time you started one race too fast, only to lace up again and pace yourself perfectly—or when you listened to advice that actually worked, such as that day you finally did a long run at a sexy pace. Then, think about why that moment of success matters to you, and say it out loud.
“Using these past scenarios to develop statements of affirmation gives them greater weight when said aloud,” Griffith says. And that can give you the extra oomph of confidence needed when getting back on the run.
Manage Your Stress
The average American is dealing with more stress than maybe ever before. Throw an injury into the mix and things get really complicated, as too-high stress levels can overtax your body’s coping resources and make overcoming adversity feel crippling, Griffith says.
To help keep your stress in check, she suggests looking for mindfulness activities and tools that work for you. Utilizing apps like Headspace and Calm—particularly their meditations around sports performance and injury recovery—can help you stay present in the moment, calming swirling thoughts of anxiety and fear.
Journaling may also be useful with this, as Griffith says it provides athletes with a place to “brain dump” and more readily move through stress. “When the thoughts start swirling and are becoming too much to handle, put them on paper,” she says.
Write about all the things that are bothering you, and allow yourself to express every feeling of hesitation, concern, fear, and anxiety. After, crumple up the paper. “The idea is to have a place to ‘leave’ those thoughts and clear your mind,” Griffith says, giving your body—and brain—more space to breathe.