The Mental Struggle of Physical Injury

 Photography:  Lua Valentia  Words:  Nicole Priddle  

Photography: Lua Valentia
Words: Nicole Priddle 

Being active can mean something different for everyone. Whether you play with grandchildren, walk the dog, hit the gym to workout, or play sports at any level, everyone can experience some of the various benefits of exercise[1], including: 

  • Weight control
  • Stronger bones and muscles
  • Better sleep
  • A longer life 
  • Reduced risk of:
    • Cardiovascular disease
    • Diabetes
    • Breast and colon cancer
    • Depression
    • Falls

Many of those who engage in sports, including high school athletes, define themselves by the activities they participate, forming their sense of identity[3]. As we all know, one's personal identity is very important because it affects an individual's perception of themselves as well as how they will behave in difficult situations. Moreover, physical activity coupled with medication, has even be shown to aid in treatment or management of depression[2].

When it comes to wellness and mobility, predictability is something that most of us appreciate. But accidents happen when we least expect it to – you may take an accidental tumble down a creek while hiking, sprain your ankle while walking, get injured during sport, or even sustain workplace injury that limits your activity outside of work. What happens to all of these benefits of activity if suddenly that activity stops and one is no longer able to be active? 
 

Connections between physical injury and mental struggles

An injury challenges the identity formed by your chosen activity and can lead to not only the obvious physical struggle but a mental struggle as well[3]. Although even elite athletes show comparable risk levels of mental disorders, such as anxiety and depression, as the general public, this risk is much higher for those who have become injured[4, 5] and can ultimately have an impact on an athlete’s well-being[6, 7, 8].

Once one begins to suffer from these psychological stressors, this also has a direct negative impact on the healing process[9]. By also fighting a mental health challenge you may not physically heal as quickly either, adding even more stress to the situation. The final issue comes from a fear of re-injury once one returns to activity, especially if it is the same activity that resulted in the injury[3].

With an education background in kinesiology, and significant time working in the healthcare field and with sports teams, athletes, and active groups of all ages, each day patients are seen in clinic seeking options to aid in the healing of either acute or chronic injury. In many cases, this pain from injury is limiting their activity in daily life and they are looking for help.

Although we directly work to treat the physical factors leading to a delayed recovery, a large part of treatment is also talking about how this affects the person mentally. If you or someone you know has recently suffered an injury that is limiting desired activities, take some comfort in the fact that you are not alone.

The following are a few cases of people from all walks of life who have experienced an injury and the story of the mental struggle behind it.

Case 1: A runner came in after injury while training for a marathon the coming summer, unable to run everyday errands without wincing in pain. She had consulted with numerous professionals to treat her physical injury, and although slowly getting better, still could not run. As she spoke of her story her eyes filled with tears. She was doing everything possible to treat her physical pain but had not addressed her mental pain. Running had always been the way she dealt with the stresses of life, her time to escape, her way to relax. Without this outlet, her stresses were building up and she was breaking down.
Case 2: An elderly lady came in after falling on the ice and injuring her ankle devastated that she was no longer able to comfortably walk down the hallway to get the mail. Due to her deteriorating health, walking to get her mail was the highlight of her day. Not being able to do this was causing much turmoil and she was looking for answers. Again, it was evident that her physical injury was having a large impact on her ability to do the activity she wanted to, and thus her mental well-being.
Case 3: A university rugby player suffered an ankle injury last year and spent most of last season on the sidelines while attending frequent physiotherapy sessions. This season, her last season, she was ready to get back into it, working harder than ever to get back to the physical level she was at before her injury. As the season began, she excelled through tryouts and the first few practices. The time came for the team’s first exhibition game and she was beyond excited to play once again. Less than halfway through the game there was an intense cry, she had torn her ACL, putting her out for the season and back in physiotherapy pre and post-surgery. After spending countless sessions with her through her rehabilitation, it was clear that there was more than the physical injury. She missed the game, she missed the team. Each practice and each game she sat sideline cheering them on, but her university rugby career was ended before it began and this was taking a toll on her mental health.

Signs/Symptoms of Anxiety[10, 11] – What to look out for: 

  • Dizziness
  • Chest pain
  • Headaches
  • Neck tension
  • Upset stomach
  • Pulsing in ear
  • Burning skin
  • Shortness of breath
  • Increased heart rate
  • Weakness in legs
  • Sleep disturbance

Signs/Symptoms of Depression[12] – What to look out for: 

  • Feeling sad, empty
  • Angry outbursts
  • Loss of interest in normal activities
  • Increased reluctance to leave home 
  • Sleep disturbance
  • Tiredness
  • Physical problems (unrelated to injury)
  • Loss of appetite

What can you do to help? 

The first step is recognising the signs above, whether in yourself or someone close to you (e.g. family member, friend, teammate). Having a social support system is also important for reducing the stress response and adhering to the rehabilitation process, as well as increasing the success of treatment[13, 14].

Speaking with a counsellor, therapist, or psychiatrist who specialises in exercise or athletic injuries can also be extremely helpful in learning specific coping techniques. The key point is not to suffer alone – there are people out there who are more than happy to extend their care to you; all you need to do is reach out and ask. 

References: 

  1. “Physical Activity and Health,” Centers for Disease Control and Prevention, https://www.cdc.gov/physicalactivity/basics/pa-health/index.htm
  2. Sun, M., Lanctot, K., Herrmann, N., & Gallagher, D. Exercise for cognitive symptoms in depression: a systematic review of interventional studies. Canadian Journal of Psychiatry. 63, 2 (2018):115-128. doi: 10.1177/0706743717738493
  3. Neal, T. L., Diamind, A. B., Goldman, S., Liedtka, K. D., Mathis, K., Morse, E. D., Putukian, M., Quandt, E., Ritter, S. J., Sullivan, J. P., & Welzant, V. Interassociation recommendations for developing a plan to recognize and refer student-athletes with psychosocial concerns at the secondary school level: a consensus statement. Journal of Athletic Training. 50, 3 (2015):231-249. doi: 10.4085/1062-6050-50.3.03
  4. Gulliver, A., Griffiths, K. M., Mackinnon, A., Batterham, P. J., & Stanimirovic, R. The mental health of Australian elite athletes. Journal of Science and Medicine in Sport. 18, 3 (2015):255-261. doi: 10.1016/j.jsams.2014.04.006
  5. Rice, S., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. The mental health of elite athletes: a narrative systematic review. Sports Medicine. 46, 9 (2016):1333-1353. doi 10.1007/s40279-016-0492-2
  6. Drawer, S. & Fuller, C. W. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. British Journal of Sports Medicine. 35, 6 (2001): 402-408.
  7. Hagger, M. S., Chatzisarantis, N. L. D., Griffin, M., & Thatcher, J. Injury representations, coping, emotions, and functional outcomes in athletes with sports-related injuries: a test of self-regulation theory. Journal of Applied Sport Psychology. 35, 11 (2005):2345-2374
  8. Lohmander, L. S., Anglund, P. M., Dahl, L. L., & Roos, E. M. The long-term consequences of anterior cruciate ligament and meniscus injuries: osteoarthritis. American Journal of Sports Medicine. 35, 10 (2007):1756-1769.
  9. Ivarsson, A., Tranaeus, U., Johnson, U., & Stenling, A. Negative psychological responses of injury and rehabilitation adherence effects on return to play in competitive athletes: a systematic review and meta-analysis. Journal of Sports Medicine. 8 (2017):27-32. doi: 10.2147/OAJSM.S112688
  10. “Anxiety Symptoms,” Anxiety Centre, http://www.anxietycentre.com/anxiety-symptoms.shtml?gclid=Cj0KCQiA2Y_UBRCGARIsALglqQ0st1oSrWcgHCCd5Q4hQS1HfIbUBP7ywuAES9GO6bAMhclIyxEXLNIaAvUxEALw_wcB
  11. “Anxiety,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/anxiety/symptoms-causes/syc-20350961
  12. “Depression,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/depression/symptoms-causes/syc-20356007
  13. Chan, D. K., Lonsdale, C., Ho, P. Y., Yung, P. S., & Chan, K. M. Patient motivation and adherence to post-surgery rehabilitation exercise recommendations: the influence of physiotherapists’ autonomy-supportive behaviours. Archives for Medicine and Rehabilitation. 90, 12 (2009):1977-1982.
  14. Johnson, U., Ivarsson, A., Karlsson, J., Hagglund, M., Walden, M., Boirjesson, M. Rehabilitation after first-time anterior cruciate ligament injury and reconstruction in female football players: a study of resilience factors. BMC Sports Science Medical Rehabilitation. 8 (2016):20

Based in Canada, Nicole Priddle is a Certified Pedorthist. She earned her Bachelor of Science degree in Kinesiology from Western University, followed by the completion of a diploma program in Pedorthics. Nicole has spent significant time within physiotherapy clinics as both a volunteer and patient. She has also had the chance to be an athletic trainer with a university women's rugby team. She now works with patients from all walks of life, of all ages and physical abilities, often working alongside other healthcare professionals to ensure the best treatment plans for recovery. An ideal pause for Nicole involves quality time with her puppies, going hiking and just enjoying nature with them.