Recovering from injury. The mental approach…

armThis will be the slowest blog post I’ve ever typed – as I’m doing it with one arm. Last Sunday in a triathlon I was smugly congratulating myself for almost finishing the bike section without a puncture or crash (the weather was dreadful, the road surface was rough – very rough) and suddenly, without grace or intent, I’m flying through the air and bounced on my back, my head and then my right arm. My bike is fine. She got a lovely soft landing, right on top of me.

The first cyclist past went to tell a marshall. The next stayed with me and did everything in her power to distract me from the pain (I am very grateful). The race organisers and paramedics were wonderful and eventually reassured it was just a broken wrist and nothing more serious (my helmet was rather dented) and let my husband drive me to A&E. After x-rays it was actually found to be a broken elbow; a fracture to the Radial Head.

The only information I got from A&E was that they won’t give information – you have to get it from the fracture clinic. Great if the clinic is the next day, not so great if they give you a date over two weeks away. So I needed to do my own research for physical recovery and this made me think about the mental recovery too.

I’m definitely no expert on the physical side (though if anyone else does fracture their radial head I liked this leaflet from Oxford University Hospitals (https://www.ouh.nhs.uk/patient-guide/leaflets/files/14214Pradialhead.pdf ) but I regularly work with injured athletes on the mental side. When I run workshops and ask athletes who has been injured in their sport at some point probably 90% of hands go up. So recovering well, both mentally and physically, is important for us to learn.

As psychologists, everything we do with athletes is completely confidential so it is hard to share or give examples of processes that we go through. So I thought being the injured athlete myself could be a great way to show how we would ideally use psychology strategies to recover from an injury. As an additional positive if we manage our mental recovery well we can sometimes benefit from stress related growth and certainly manage to see our sport in a little more context than before.

We can follow five steps when dealing with an injury.

Anger

Being upset is perfectly ok. We have to grieve the effort we have put in that won’t now come to fruition, the missed competitions, the lost opportunities and the fact we won’t get to do what we love for a while. Spending a few days sulking is ok. But then we need to get proactive. Often some of the anger isn’t about the actual injury but the uncertainty around it. How long will it take, what caused it, what can I do? This can be really disconcerting and certainly where my frustration has come from. So, the next step is to get the information we need to put some concrete plans in place.

Information gathering

The more information we have the better decisions we can make. Finding out more about our injury and recovery is called ‘instrumental coping’ and has been found to improve how well our rehabilitation goes.  Someone suggested I look at how bones heal so I could visualise and understand what was going on in my am. I loved this idea and found this videos of what my body is doing as it repairs itself: https://www.youtube.com/watch?v=USbjj0wWvYA

As well as this, if we are able to reflect on what caused it we can not only rehab from the specific injury but practice things to strengthen any weak areas to reduce the risk of the injury happening again. Unfortunately for me I have no idea what caused the crash as could see nothing in the road (though I was a little high on gas and air by that point) but I can certainly practice riding on pothole-y and gravel-y roads in future. 

Finding experts to help

The next step is to identify and approach experts. Ideally we need someone who is an expert in their field and is clear and concise with what is required (both in time spent on rehabilitation exercises and how to do them properly) – studies have found this makes us more likely to do our rehab exercises and help us feel more confident in our long term recovery. I have a fantastic physio and as soon as I get the fracture clinic all clear I’ll be booking in with him to ensure I get full range of movement back.

Goal set recovery

The athletes who recover best are those who take their recovery as seriously as they do their training. Just as we create specific goals and training plans for our sport we should do the same to recover. Those who do this have been found to have a higher return to sport rate, returned to their sport quicker and had the highest chance of returning to pre-injury participation levels. Goal setting for recovery helps us feel we are doing something productive and when we feel gloomy we can clearly see the right elements are in place to get ourselves back to full health and fitness.

So for me I’ve picked a race to get ready for. I didn’t want to leave it over the winter and have the fear of racing my bike hanging over me. And from that outcome goal (finishing the race) I’ve considered what I will need to achieve to do it, and then what processes and actions I’ll have to put in place and complete in order to hit those achievements. Here is my plan:

Elbow goals

Fill the injury gap

Finally, our mental health can become fragile when we are injured. Many of us use our sport as a coping mechanism for stress as it provides a physical release of any pent-up frustration, some head space to calm down and some thinking space to put everything into perspective. When injured we lose all of that – and have extra time to fill – so having a plan in place to hold up your mental health is important; friends to chat to, other physical activities you can do, another hobby you haven’t had time for lately. 

  • Friends: Social interaction is really important when injured as it can act as a bit of a buffer for the emotional trauma of injury. Studies have shown the more social support an athlete has, the lower the initial depressive symptoms. I have been so grateful for the support and sympathy from my friends over the last week and for so many comments, shared stories and pieces of advice on social media. They all help.
  • Learning new skills: If physically possible then spending time on cross training or learning new skills or techniques (such as swimming, a Yoga or Pilates course or some strength and conditioning sessions) which will help your sports performance in the long term will be good. I’m going to focus on stretching and core work (which I regularly neglect)
  • Mental skills: Using this time to learn mental skills can help us be a better athlete when we get back to it. Skills such as imagery, breathing techniques and self-talk can all help build our confidence so we have an advantage when we get back to competition and some (such as attentional control, imagery, team building and developing better ways to communicate) have been found to help reduce fear of re-injury. I’m going to use imagery to help me feel more confident back on the bike.

So – that is my plan – I have two months till the race I’ve picked to see how well I manage to stick to it!

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