For many athletes, whether an elite professional or a recreational athlete, dealing with the possibility of missing a really important event or even having to retire from sport can create significant psychological challenges.
The process of dealing with feelings associated with sport injury is in some ways similar to the phases of grief a person may go through with life-threatening issues. In medical school one of our required readings was "On Death and Dying" by Swiss psychiatrist Dr. Elisabeth Kübler-Ross.
She outlined five stages: denial, anger, bargaining, depression and acceptance. These stages don’t always happen in this order, nor does everyone go through each.
Sport injuries are a long way from dealing with a terminal illness, but her model is still a useful framework and is used by many sports psychologists.
One sport psychologist I’ve heard lecture and really like is Dr. Jim Taylor. Here’s how I recall he applied the basic framework of Dr. Kübler-Ross’s model to sport injury recovery:
• This is where you just can’t believe you’re actually injured. Many athletes with ongoing nagging injuries in this stage try to power through and continue. If this goes on for months it’ll affect performance and often leads to a minor injury becoming major. Dr. Taylor writes that getting stuck here is dangerous. Action step: If you’re having ongoing issues affecting performance get proper evaluation and a plan for recovery.
• Why did this happen to me? Injustice, unfairness, or outright anger. This is incredibly common especially if you’re about to miss a once in four years or once in a lifetime event. It’s fine to be angry for a while, but then move on. Action step: If you really can’t move on you should seek professional help.
• In the sports injury world this often involves what we refer to as “doctor shopping.” This is the process of seeking multiple opinions in hopes of finding one who says “it’s no big deal, go ahead and play.” A second opinion is a good idea but a fourth or fifth opinion is usually draining and counterproductive. My advice, shared by every sports medicine colleague I know: get a couple of opinions, go with what you’re most comfortable with, and move on.
• Sometimes recovery can take many many months, and in some instances even a short recovery time can push someone into depression. As an orthopedic surgeon, this is out of my area of expertise so if we see cues from our patient, or if family members voice concerns we’ll quickly refer for proper psychological evaluation and treatment. Depression is usually treatable and nothing to be ashamed of. Get help quickly.
• For an athlete, reaching acceptance can be turned into an asset. Once you get to this point the best athletes will use the injury as an opportunity to correct issues that may have led to the injury in the first place and actually come back from injury better. Getting to this mindset is incredibly important, and once you get there you’ll usually find that physical recovery comes faster. Action steps: Make small and measurable gains with assistance of your physical therapists and athletic trainer. Small successes build on each other and will motivate you to get to your peak potential.
• Dealing with the psychology of sports injury can be difficult for many athletes, and there are several ways to deal with these issues effectively.
• With the right mindset and demonstration of small gains in recovery, you can turn the injury into an asset and in many instances come back better than you were.
(Dr. Dev K. Mishra, a Clinical Assistant Professor of orthopedic surgery at Stanford University, is the creator of the SidelineSportsDoc.com online injury-management course, now a requirement for US Club Soccer coaches and staff members. Mishra writes about injury recognition and management at SidelineSportsDoc.com Blog, where this article first appeared.