How to Take Control of Your Injury Recovery
Expert advice on understanding the emotions of injury and taking tactical steps toward recovery.
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Unless you’ve been extraordinarily fortunate, you know what it’s like to suffer through an injury layoff. Not only can you no longer race, but you can’t train. Sometimes, you can’t even get out for an easy jog…and, if you can, you can still feel your hard-won fitness slipping away.
A case in point is Corinna Jackson. Last May, despite COVID quarantine, she ran two successive 5K PRs in time trials. She was on top of the world. Two months later, having switched out of competitive training into distance and relatively light speed work, she found herself with a sore knee.
At first it seemed minor — a few days off, and she’d be fine. But it just wouldn’t abate. Ultimately, she also had to give up cross-training, because bicycling was aggravating it, and pools were shut down due to COVID. She even had to drop non-essential walking and limit the use of the stairs in her own home. And still it wouldn’t heal, even as weeks mounted to months.
“When it happened, it took a while to process,” she says.
The worst part was the uncertainty. “I didn’t know what the injury trajectory was going to look like,” she says. “That was the hardest part in the beginning, just realizing that the knee wasn’t going to get better overnight.”
Mitch Smith, Director of Sport Psychology Services at Florida Atlantic University, Boca Raton, Florida, compares experiences like Jackson’s to grieving. “It’s a little like the stages of dealing with death: denial, anger, etcetera,” he says. Not that it’s the same as the death of a loved one, but the emotions are similar — you’re coping with a loss.
Jackson found help by reading about others who’d gone through the same process. Particularly useful, she says, was Cindy Kuzma and Carrie Jackson Cheadle’s book Rebound: Train Your Mind to Bounce Back Stronger from Sports Injuries, which taught her that it’s OK to let yourself experience the emotions. “It was OK to feel some grief,” she says.
Also useful, she says, was to have a friend with whom she could just vent her frustrations—something she was able to do with her training partner, even though they weren’t able to run together. “It was important for me to communicate,” she says.
Smith agrees. And, he says, don’t let that person just feed you “false platitudes.” However well-meaning these are, he says, they originate from your friend’s need to feel helpful, which may not be the same thing as actually being helpful. What you want is someone who will listen, without feeling the need to respond (other than not letting you wallow in self-pity).
The next step is to assemble a support team — for Jackson, it was a trusted physical therapist, her coach, her training partner, and her family — and figure out what she could and couldn’t do to facilitate her recovery.
That type of assessment is important, even if you don’t have a team as strong as Jackson’s. “It’s very easy to get into this cycle of ‘it’s all out of my control, and there’s nothing I can do,’” says Lauren Loberg, a sports psychology consultant and licensed clinical mental health counselor at Pyramid Performance Consulting, Park City, Utah.
In fact, there are numerous things you can control, she says, including important ones unrelated to the injury itself, like sleep and nutrition. Not to mention actually doing your physical therapy, stretching, or foam rolling. Before she finally started to recover, Jackson was doing so much physical therapy each day that there was no reason to pop the bucks for an MRI that might have told her exactly what tissue in her knee was injured, because she had all the bases covered in her daily exercise routine.
Grateful for Good
Also important is to realize that the injury has not changed who, at heart, you are. “You’re still the same person,” Loberg says.
“Sometimes,” Smith adds, “[an] athlete’s identity is so caught up in their athletic ability that when it’s sidelined, they feel like the rug has been pulled out from under them. They feel totally lost.”
The key to fighting off this type of despair, Jackson found, was to examine her life for good things unrelated to running, then to fill her time with as many as she could. She listened to more music. She got the Harry Potter books on tape, and listened to them, reliving the pleasures of reading those books as a child.
“I might not have been able to run without pain today,” she says, “but I can spend time making dinner, listening to a podcast, and eating dinner with my husband. So, there is this other thing I can look forward to doing today.”
And then, eventually, the injury starts to turn around. Because that, unless you did something truly catastrophic to yourself, is how it almost always goes.
Week Over Week
Now, the challenge is accepting that you are not going to come back instantly. “You have to set realistic goals,” Smith says.
Also useful is to avoid comparing today’s performance with what once was, before the injury. Instead, compare today’s performance with last week’s to see if you are going in the right direction.
Looked at this way, injury comebacks can be surprisingly fun. One day, maybe you can only go 50 meters without pain. A day or two later, it’s 100 meters. How often do you get a two-fold improvement that quickly? Then all of a sudden, you are off and going. “I had this mindset during the recovery of focusing on what I can really do, and appreciating it,” Jackson says. “I could see the progress, and developed trust that it would continue.”
Not that every day is guaranteed to be better than the one before. Smith suggests looking at it in weeklong blocks, writing them down, each week. That way, you can not only reflect on your most recent progress, but create a record to chart your overall progress.
Mind Your Recovery
Also useful is visualization.
Most of us think of this as a way to mentally rehearse technical skills, such as shooting hoops or perfecting form for events like the high jump or pole vault. But it can also help you with your physical therapy. “Picture performing the rehab exercises properly and effectively,” says Smith.
It can also assist healing, via the well-known mind-body connection, under which your mental state affects your body’s ability to rebuild. A lot is involved in this, but one of the simplest is the effect of a positive mental state and positive inner dialog on stress hormones. “We know that stress leads to injury,” Loberg says. “[It’s also] going to impact your recovery time if you’re always down on yourself.”
Don’t believe it? Look at all the athletes who’ve had setbacks and come back stronger than ever. Including Jackson. After a 7-week total layoff, and an excruciatingly slow 14-week recovery, she finally felt ready to put herself to the test in a 10K time trial.
She shocked herself by cutting her PR from 38:54 to 37:50, even though she didn’t yet feel fully recovered. Why the big improvement? Partly it was because she knew her 10K PR was soft, compared to her pre-injury 5K, which made it a good target. But there was more to it than that. The injury and slow, frustrating recovery had given her something she could harness. They’d taught her that she could survive. They’d made her come back not just recovered, but tough, and determined. “I had newfound confidence,” she says.
Your Mileage May Vary
That said, there are some caveats. To begin with, not all injuries rebound at the same rate. Use the success of others as incentive, but realize that comparing yourself to them can be counterproductive.
More importantly, realize that injury layoffs can produce major effects on your mental health, far beyond simple frustration. “Seek help if you find your mood or anxiety worsening, or if you feel trapped, isolated, or have worsening thoughts of being a failure or having let others down, and definitely if you have thoughts of self-harm or suicide, or disordered eating, body checking, mirror gazing, etc.,” says Tiffany McClean, a psychiatric nurse practitioner and marathoner in Portland, Oregon.