The Anxiety of Athletic Injury

Humans have a deep aversion toward uncertainty. Our brains are primed to be highly sensitive to threat, at the expense of opportunity.

Athletic Injury

Athletic injury brings with it both ‘threat’ and ‘uncertainty’ provoking an evolutionary emotional frenzy. It first enters consciousness when the niggle appears or gets worse. At this point the brain is getting ready for war, assessing the level of threat amid uncertainty.

Denial

Acknowledging the potential enormity of a situation all at once could be damaging to the individual, which is why denial is often the brains first defence mechanism. It also provides greater time to assess the extent of the threat. If the niggle is just that, it settles down and our brain relaxes. If it is the beginning of an injury, denial allows us to continue with some certainty while we decide how to cope with the threat. Unfortunately, it also allows us to make the injury worse and delay our journey toward acceptance and recovery.

Bargaining

Our brain begins to consider damage limitation. If this is a ship wreck, what can be salvaged?

‘I’m very fit, the race is only 4-weeks away. I’ll get that far and then I’ll rest’.

At this point we’re starting to acknowledge this won’t go away but we’re still in denial about the loss of our goals.

Hope

It’s the hope that kills us. A day or two off and things feel a little better. A treatment that your friend had for a similar injury that worked instantaneously. Being a week closer to the event.

Hope is a mixture of denial and bargaining that gets you ready to plunge into despair.

Anger

Anger usually manifests itself at a sub-conscious level. Being short with colleagues or family members. Blaming yourself and others. There is still an element of shock, “I can’t believe that this is actually happening to me again. I did everything right”.

Despair

This is the big one. Without denial and bargaining, in essence hope, threat and uncertainty are stood there in the cold light of day. The threat to our goals and our identity and the uncertainty about when or if they will return is all too vivid. We are forced to confront all of the internal narratives about ourselves and our ambitions.

• I’m so embarrassed that I’m injured again, what will other runners think.
• I trained so hard for so long and made all those sacrifices.
• I’ll lose all my fitness now and it’ll be nearly impossible to get it back.
• This is stupid, I’m not doing this anymore. I’m just going to go out with my friends and enjoy myself.

This phase can be the longest and has the greatest potential to harm the rehabilitation process. Limiting the length of this phase is key. If the athlete has been injured frequently, a sense of helplessness can develop in this phase.

Acceptance

Some form of denial and bargaining is inevitable. However, the sooner the athlete moves through the phases of anger and despair toward acceptance, the sooner they will be back running. In my own running career, I have had to learn the skills to drastically shorten the time spent in each phase.  For many years, it would take months to be fully engaged in what was required for recovery. Now, it takes little more than a week to progress from hope to acceptance. This week provided the perfect scenario to give you a worked example:

Hello Darkness My Old Friend, I’ve Come to Talk with You Again

The trouble with consistency is that you have to put up with it. You find yourself learning to cope with the diligence and boredom it demands. After 110-weeks, injury was no longer toward the forefront of my mind. Nailing next week’s session or doing another disciplined phase of training was my main pre-occupation. The persistent pain on the inside of my right heel (insertional achilles tendinopathy), that I’ve had for the last 5-years, became a companion along the journey. Every morning and after every session it was there but in a non-threatening way – it became normal.

Failing to Respond

It’s a bit like a disease that has flare ups before going into remission. Over the last two years, I became adept at taming it. Heavy isometric lifts. Plyometrics. Load management. Limiting fear avoiding behaviour. I became an achilles tendon whisperer. However, like many diseases, it stops responding quite as well to treatment over time. Last September, it was bad. I thought this might be a season too many. But I tamed it once more and got to Christmas in good shape (even if the target 10km was cancelled due to snow). I ran 16:20 for a training 5km back home, bang on track towards a sub 33-minute 10km.

I took 4 consecutive days off over Christmas, which in part contributed to a massive flare up after Christmas. It wasn’t helped by the fact that I also started marathon training. Regular 18 – 20 mile runs in January and February were no problem physiologically or for the rest of my body – but my achilles began to scream and no amount of reassurance could tame it.

Denial

As I entered February, I could feel it in sessions and my gut told me it wasn’t going away. But I had too much riding on it to accept that. I had just trained for 106 weeks. I was going for a sub-33 attempt at Trafford on March 4^th and the Manchester Marathon on April 8^th. Those events were going to be my swan song. I would walk away into the sunset after that with my goals achieved, my identity preserved and my painful achilles intact.

Bargaining

I worked it out. There was only 4 weeks to Trafford, 7 weeks to Salford and 9 weeks to the marathon. Surely after so long, I could manage 9 more weeks. It seemed miniscule in relation to what I had just done. I could use anti-inflammatories on the bad days and to get me through sessions. It was so close, I could almost touch it.

 Hope

The week of Trafford (last week) was when I knew I was injured. In Wednesdays pre-race session, I covered a mile and then stopped. For the first time in 110-weeks I was transported back to the days of limping off a pitch, a track or a road. I had planned for after April to have a high-volume stripping injection to help with the pain in my achilles. When Trafford was cancelled due to snow, I brought it forward to last Friday. ENTER HOPE.

Anger

Monday and Tuesday this week, the pain wasn’t subsiding, in fact it might have been worse. I was walking with a limp and beginning to realise I hadn’t responded to the injection. I was short in my communications with friends and colleagues. A conscious effort not to lose it in trivial situations. I wasn’t fully ready to let go though, so I slipped back into hope for a while. I cross-trained for the week thinking I might get one more run out of myself in the Cheshire 10km this Saturday. Surely, I could get one run in to show that the last 6-months of hard training had been worth it. I bargain with myself that I’ll show up and just jog around as a symbolic gesture before declaring officially injured.

Despair

Tuesday and Wednesday, I stick to the cross-training plan but I’m starting to realise that travelling to Cheshire is pointless. I declare injured there and then. It’s tough. After 110-weeks, it’s over. The dream of retiring on my own terms – gone. No sub-33 10km. No sub-3 marathon. My consistent athletic identity a thing of the past.

Acceptance

Thursday things start to happen. Counter to previous responses to injury, within a week – I’m coming around.  I start trawling the evidence on insertional achilles tendinopathy, almost the only injury I have yet to get the better of. I sign myself off running for a month and write a cross-training plan to match. Shockwave therapy seems to have proven effective in my condition. I find a clinic that does it and book myself in for a course. I bid for a bike on eBay. I order a weighted vest to make progression of my eccentric loading easier. I’m inspired by the opportunity to make this my best comeback yet. Another opportunity to learn and later, to educate. This is another step on the journey. I’ll get there, just not on the timeline I had intended – stay tuned!

This is Me. What Should I Do?

Very simply. Two things.

• Talk: when you reach despair open up to a coach, a friend or a fellow athlete. Preferably someone with experience of what you’re going through. You might feel a bit embarrassed talking about your injury given there are much worse things happening in the world. Let that go. You have worked incredibly hard toward your goals and demonstrated a level of application that most adults never will, you deserve a moment to be upset about it.

• Change the Narrative

Negative Emotion	Positive Response
This is a disaster.	This is an opportunity to learn.
I’m gutted.	I’m inspired about the possibility of overcoming this hurdle on the way to my goals.
I’m embarrassed that I’m injured again.	I just haven’t learned all I need to know yet.
What will others think.	I am not only defined by my athletic identity and associated strength. People appreciate me and my vulnerability. Lots of runners have been here.
I’ve trained for so long and made so many sacrifices.	Therefore, I am in great shape. This is a superb platform from which to build toward my goals.
I’ll lose all my fitness.	I’ll only lose it if I choose to do so. I can become a better athlete during this period. I can work on aspects of my fitness / conditioning that I have been neglecting.
I’ll lose my identity.	I can train every day. Therefore, I am still an athlete in training toward my goals.
This is stupid, I’m not investing in running anymore. I’m just going to party instead.	Partying will be fun for a week or two. Then I’ll lament the purpose and direction my athletic pursuits give me. I need to get cross-training straight away.
I’m going to match my running with cross-training pound for pound.	This is unrealistic. I need a cross-training programme that helps to maintain my fitness in a consistent manner. I am not in training for the tour de France.
I’ll be just as focused as before.	I’ll be focused but because of the lower demands psychologically from not having an intense run programme, I might use this time to progress a bit more in work or other areas of life.
I won’t get distracted by socialising.	I’ll do a little more socialising than normal because I can. This will help me get through the period of not running.

Take pride in the suffering #runningfrominjury