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I decided to write this article after one of our club athletes hurt her wrist recently in training. Although this athlete approached the injury with her usual positive attitude, and was determined not to let it stop her doing anything, I have known a lot of people who have struggled with the mental aspect of coping with injury.
I wanted to provide some tools from sports psychology that help athletes develop the right mindset to deal with this challenge just as they would focus their efforts to beat their rivals to a gold medal.
Is it important to state now that injuries should be pretty rare if you are just training for general health and keeping sound technique. From my experience over the years with gym clients, minor aches and pains have been usually been caused by a lack of focus when doing something completely insignificant, like bending over and twisting whilst picking up a flower pot in the garden, or worse, due to being sat down molded into one position for far too long (desk jobs are dangerous!).
Injuries often occur when there is an imbalance between stress and adaptability of the body. Athletes who push their bodies towards what they are genetically capable of are going to be more at risk.
It can be tempting to take unnecessary risks during training when you are really hungry for progress. I have done this before by deliberately ignoring how my body is feeling and thrown weight on the bar just because it was on the program, even though I actually felt knackered and should have just eased off a bit.
Be aware of all the factors that can potentially tip the body over the edge, such as not warming up properly, not planning enough recovery periods (including decent sleep!), not ensuring overload is done gradually over time, continuously lifting near maximal loads, neglecting general conditioning, training one muscle group / movement too frequently, poor training nutrition, prolonged periods of psychological stress etc. Also keep an eye on those common overuse hotspots i.e. the back, shoulders, knees and wrists.
So when something does go wrong and you have hurt yourself, you need to quickly accept the situation in order to then take control. Playing the victim in this situation or becoming defeatist is probably the worst thing you can do, so try and do your best to avoid this.
There are two hard truths that you must accept fast and remember throughout your recovery
1) You are solely responsible for taking ownership of the situation and sticking to the recovery process.
2) Just because you can’t do what you usually do in training does not mean that you cannot train at all! Try to see the injury as an opportunity to focus on something else that will be useful to your sport or goal.
The rest of this article is split into two parts. The first is a quick guide to the coping strategies that have been shown to be effective for getting athletes through recovery. In the second part, for those who are interested, I have gone into a little more detail about why these strategies actually work.
Strategies for coping with injuries
Education
Become as informed as possible about the injury and recovery process. It is very easy to get out of touch with the reality of the situation, become anxious, depressed and lose motivation if you are unaware of the stages involved during recovery and don’t see an end point. If in doubt get it checked out by someone who is educated enough to know what they are talking about (a specialist sports physio or a doctor). It is also important to become aware of possible future emotions along the path to recovery, such as frustration and anger, this will enable you to be better prepared to deal with them when / if they occur.
Goal setting
Take control of your recovery by creating realistic short-term and long-term goals. Goal setting and monitoring your progress will help to keep motivation high and improve confidence along the way as each goal is completed and ticked off. I would advise sitting down with your coach to discuss how to adapt your training and to agree on achievable goals. Whilst I was recovering from Achilles surgery, I found it useful to record things like how much I felt pain the next day after introducing running. It was really motivating to watch my squat strength and ankle flexibility improving gradually each month.
Imagery
Imagery involves creating or recreating an experience in the mind that mimics a real life event. During performance imagery, the movements required in the sport are visualised to reproduce the proprioceptive pathways that are active during the physical experience (proprioception just means how we sense our body’s movement and position in space). For example, picturing how you would perform a snatch on the competition platform. These mental images will help maintain skills that the body is not able to perform physically. It has also been suggested that the nervous system and muscles involved in a movement can be stimulated by visualisation, resulting in an increase in blood circulation to the injured area. Isn’t that weird.
Self talk
This strategy involves the use of cognitive restructuring, positive thinking and self-monitoring in order to recognise and change negative thought patterns. A brief summary is outlined below;
1) Express yourself! - You’re obviously going to be a bit pissed off at first - find someone who is willing to listen to you vent for a bit!
2) Identifying negative thoughts – Write down any thoughts which could have a negative impact on your recovery.
3) Try to find positive aspects of the injury. Example: any progress that has occured during recovery or even the increase in social support that you have received from friends or family.
4) Identify three positive thoughts and write them down. Example “I am getting stronger each week”.
5) Read the three positive statements out loud. Aim to carry out steps 1-5 with another person - hopefully the same person from step 1 if they still want to talk to you...
6) Keep the paper and read it at least once a day.
By identifying the negative thoughts and replacing them with optimistic thoughts we learn to learn to take more control over our actions. Helplessness can by learned and therefore so can optimism!
Social support
Keep your usual social life as undisrupted as possible! So try to go those training sessions you love or any of the social events that you do just for fun and avoid isolating yourself. Surround yourself with positive, well-informed people who can provide you with decent emotional support. This network could include friends, family, coaches, teammates (if you can stay positive around them!) or someone you might know who has had experience with a similar injury. There are also people who you will want to avoid at costs. This is any individual who says things like “I guess you will have to quit this sport now……”, “if I were you I would just take time off and stay at home...”, “Ooooh god, I heard that kind of injury never heals properly...”. Smile, ignore it and refocus (sensible option) or even channel that rage into proving them wrong. Hopefully there isn’t anyone like this in your immediate social circle anyway but if there is, then go celebrate the occasion by deleting them! I think getting this strategy right is incredibly important and will significantly help to boost wellbeing during the recovery period.
The Psychological Model Behind These Strategies
To get an idea into why these strategies are successful we need to explore the psychology of motivation in a bit more detail.
Fundamentally we are going to need to stay motivated to get through the recovery period of an injury. One motivational model that is relevant to this situation that we will discuss is self-determination theory, which explains motivation underlying athletes’ behaviors. Behaviour and actions are best powered by intrinsic motivation (motivation that comes from within you solely because you are interested in it and want to do it).
The state of amotivation (absence of motivation) is when self-determination is at its lowest and the state of intrinsic motivation is when our self determination is on fire. Demotivation is displaying non-regulatory behaviours that show the lack of intention to act. These individuals lack a sense of control and are not able to regulate themselves in terms of their behavior.
There is said to be a continuum that ranges from demotivation to the amazing intrinsic motivation which can be seen in the table below. We want to reach that beautiful star as quickly as we can.
Table 1.Self-determination theory (adapted from Pietrantoni & Prati, 2012)
Behaviours seen through the continuum of motivation.
Non-regulatory: “I don’t understand why I should do training”
External regulatory: “I should return, because the coach threatens to drop me from the team”
Introjected regulatory: “I should return, because I don't want to disappoint my Coach”
Identified regulation: “I want to return, because I want to maintain fitness”
Integrated regulation: “I want to return, because sport / fitness is part of my life-style”
Internal regulation: “I enjoy taking part in sport / training”
So now we can see what the most ideal type of motivation is we need to take actions that will help us achieve it.
Self determination theory supports the idea that the intrinsic motivation (personal enjoyment and satisfaction) is driven by the individual’s need for competence, autonomy and relatedness. Research has also shown that it is important that those you seek support from make sure that the advice they give is in line with self-determination and avoids extrinsic styles of motivation - for example it is not helpful for your club to want you in to train because they are worried about losing the impact of your results at the next comp. Instead they should want you to come in because you enjoy it. External factors such as financial rewards, punishments, team influences or the possibility to win a trophy are known as controlled motivations and are seen as less effective because of the low level of self-determination and control.
Competence Athletes may desire to recover their prior level of ability (that they enjoy being at) in that sport, and this may in itself promote high intrinsic motivation during rehabilitation.
Autonomy is characterized by the desire to keep control of events: if athletes think that recovery outcomes are the result of their behavior they will be more determined to follow their program.
Relatedness is the degree of integration with the social environment: Injured athletes may often feel a sense of isolation from their friends, teammates and fellow competitors - solved by still attending training and social events.
As you can see these needs relate back to the strategies discussed before: Improving education, using imagery,setting goals & monitoring progress, self-talk, and social support.
Ryan Fearn, Coach at Canterbury Strength
References and further reading
Bakker, F. C., Boschker, M. S. J., & Chung, T. (1996). Changes in muscular activity while imagining weightlifting using stimulus or response propositions. Journal of Sport & Exercise Psychology, 18, 313–324.
Camilla J. Knight, Chris G. Harwood, Daniel Gould (2018) Sport Psychology For Young Athletes. Routledge. London.
Hardy, Lew, J. Graham Jones, and Daniel Gould (1996) Understanding Psychological Preparation for Sport: Theory and Practice of Elite Performers. Chichester: J. Wiley.
John Perry (2016) Sport Psychology: A complete introduction. John Murray Press. London
Owen Walker (2016) Warm ups. Available at <https://www.scienceforsport.com/warm-ups/> Date accessed: 29 aug. 2019.
Santi Giampaolo; Pietrantoni Luca “2013) Psychology of sport injury rehabilitation: A review of models and interventions. Journal of Human Sport and Exercise.
USA Weightlifting (2015) Advanced Weightlifting & Sports Performance Manual. Available at <http://www.teamusa.org/~/media/usa_weightlifting/documents/coaching%20courses%20and%20advancement/manual%20r16b.pdf> Date accessed: 29 aug. 2019
Yuri Verkhoshansky, Mel Cunningham Siff, Michael Yessis (Translator) (2009). Supertraining. 6th edn. Verkhoshansky.com