The psychological consequences of injury

By Dr. Alan Goldberg

(Note: This is the third in a series on Injuries to Athletes:)

So what happens to all of these psychological goodies when you’re suddenly sidelined by an injury? To put it simply, you become overwhelmed by a variety of internal and external losses. As the athlete struggles with the impact of these losses, all hell breaks loose! If the injury is significant enough to keep you out of commission for a good chunk of time, the first thing that you lose is your identity as an athlete and team member. You lose your place and role on the team. “Identity confusion” sets in. Translated into understandable English, this means that you start to question who you are if you’re not constantly in the pool, out on the field, course or court practicing and competing in your sport. An Olympic gymnast permanently sidelined from her sport because of a career-ending injury put it quite clearly. “I’ve been doing gymnastics since I was 6 years old. It’s all I know. It’s who I am and what I do. If I’m not a gymnast then who am I really”?

Without your sport, with its’ frequent practices and competitions, you suddenly have a potentially significant vacuum in your sense of self that you have to try to fill. This is only less extreme if you have been able to expand your involvement into other activities in other areas of your life. Unfortunately, most serious athletes commit so much of their free time to excelling in their sport that other, non-athletic activities are virtually impossible.

This individual identity confusion is compounded by the fact that your injury has suddenly changed your identity and place on the team! You are no longer the leader, workhorse or clutch performer. Now your position is on the deck, bench, or sidelines with the coach and your role on the team is suddenly unclear and questionable!

Hand in hand with this sense of identity confusion comes 2 other significant losses: First, you lose you physical health and sense of invincibility. Many athletes are used to being independent and relying upon their bodies to respond as trained and directed. With the injury, you have to face the cold hard fact that your body has somehow failed you. This can be a tough pill to swallow. Furthermore, injuries frequently make you dependent upon others, i.e. doctors, trainers, physical therapists, etc.; Most athletes have a strong independent streak and hate having to depend on anyone other than themselves.

Second, you lose a major source of your self-esteem. If you get your goodies from being faster than everyone else, hitting the ball harder, throwing touchdowns or shutting an opposing player down, then you’ll get precious few good feelings from standing on the sidelines helplessly watching the action. Suddenly, you’re plagued with self-doubts and have to struggle with questions of your own self-worth. If you’re not pushing others in practice, working hard on your game, and helping your team in competitions, then what real value do you have on the team? For many athletes this is probably the hardest part of their injury. It’s a huge blow to your ego. Suddenly, slower or weaker athletes are taking your place and doing what you should be doing, but can no longer do.

The other significant feeling that accompanies these losses is a sense of alienation and isolation. Robbed of the limelight, unable to fulfill your old role on the team, and unable to even practice with the rest of the team, it’s common to struggle with feelings that now you are suddenly very different, that you no longer fit in.

In H.G. Bissinger’s “Friday Night Lights”, the story of the Permian Panthers High School football team from Odessa, Texas, the author tells about the experience of Booby Miles, the team’s star running back. A young man with tremendous promise and pro potential, Booby is suddenly sidelined by a career-ending injury. Instead of capturing the limelight, he now captures splinters on the bench. He becomes a forgotten man on the sidelines. With his injury, his stock on the team and in the community suddenly plummets to zero as the media, coaches and fellow teammates contribute to his sense of isolation and alienation by completely ignoring him.

The final loss that accompanies a physical injury lies in the athlete’s inability to constructively cope with stress. If your sport has been a vehicle for you to tame chronic low self-esteem or manage psychic stress, an injury suddenly robs you of this familiar and comfortable coping mechanism. As a consequence you are now in an even more vulnerable position and further susceptible to the negative affects of stress and depression.

For example, a distance runner was sidelined for 4 months for the very first time in his life because of broken ribs. After he was finally given the doctor’s go-ahead to resume training he was distressed to find that he was continually plagued by an inexplicable shortness of breath and feelings of intense anxiety, both of which were so bad that they actually prevented him from running the way he had before his injury. Despite the fact that the doctors had ruled out any medical reasons for his breathing problems, he continued to suffer from these symptoms.

After meeting with him I learned that he had grown up in a very abusive home and from the time that he could remember, he had dealt with his problems by literally running away from them. When his best and only way of psychologically coping, running, had been temporarily taken away by the rib injury, a lot of the problems he’d been avoiding for all those years finally caught up to him. In fact, those problems were so upsetting and anxiety provoking that they literally “took his breath away” and forced him to finally face them head on.

So what does all this loss mean to you as an athlete or to your coach? If you want to speed up the rehab process as much as possible, then you need to EXPECT certain feelings and behaviors to emerge as a result of your injury. You need to understand that these feelings and behaviors are absolutely NORMAL and a natural part of successfully coping. As with any kinds of loss, the athlete may go through a number of stages directly related to mourning. Some sport psychologists feel that these stages parallel Kubler-Ross’s five stages in her discussion of death and dying: Denial; Anger; Bargaining; Depression; Acceptance.

Many athletes first meet their injury with outright denial. They may downplay or ignore the seriousness of the injury, falsely believing that everything’s O.K. As a consequence they may continue to train through the injury, only making matters worse. Frequently the injury is often accompanied by feelings of intense anger. The athlete may adopt a “why me, why now” attitude and act hostile and resentful to coaches, teammates, parents and friends. Some athletes then get into an internal bargaining with themselves, i.e. “if I do this and that, then maybe I’ll be able to get back out there”. At some point in this whole process, depression finally sets in as the athlete comes to directly realize the nature and seriousness of his/her injury and loss. The depression may entail a loss of interest in or withdrawal from once favored activities, sleep and eating disturbances (sleeping too much/insomnia, overeating/loss of appetite), low energy and possibly even suicidal thoughts and feelings. At the end of this depression stage, the athlete comes to accept his/her situation and make the best of it.

So what is the best way to handle injury so that the psychological pain is minimized? Next: ATHLETE STRATEGIES FOR COPING WITH INJURIES

Dr. Alan Goldberg is a nationally-known expert in the field of applied sport psychology, Dr. Goldberg works with athletes and teams across all sports at every level, from professional and Olympic caliber right down to junior competitors. He is the author of 25 mental toughness training programs and Director of Competitive Advantage. His website is www.competitivedge.com.

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