Toolbox: Recovering from Injury
When you’re hurting from an injury, the effects may not be entirely physical. Especially if you’ve been in a crash, you may be mentally depleted, fragile, or even traumatized. Cyclists who have made mental fitness a priority know how to manage, and at times accelerate, their recovery from injury.
By Marvin Zauderer
Last month, to begin our series on Responding to Adversity, I discussed how you can increase your tolerance for suffering on the bike. This month, I explore Recovering from Injury, the second advanced skill of the mentally fit cyclist.
Injury is among the most challenging experiences you can face as a cyclist. When you’re injured, you almost certainly can’t ride in the way to which you’ve become accustomed, and you’re often not able to ride at all. If you were injured in a crash, your mental fitness may have taken a hit; perhaps a big one. While you’re not riding, your physical fitness may be decreasing, and you may be starting to lose confidence in yourself as a rider as well. And if all that isn’t enough, nobody can reliably foretell the path and likelihood of your recovery.
What happens next? (Please don’t answer, “I reach for [insert vice here].”)
Do you become depressed, demotivated, and down on cycling? Do you rush frantically to get back on the bike and your previous level of performance? The cyclist with sufficient mental training can navigate between these two extremes, avoid unhealthy vices, and manage the recovery process effectively. How? As with so much in life, living skillfully with injury begins with self-awareness, and most importantly, knowing the forces that can push you toward the extremes.
Step 1: Understand the Effects of Your Injury
To begin to uncover how the injury is affecting you, some specific questions you can ask yourself are:
• What thoughts are you having about the injury, about cycling, about yourself?
• What emotions are coming up? To what extent are you keeping them to
yourself, leaking them onto other people, or intentionally sharing them with
• How about sensations – pain, weakness, numbness, tensing, spasms?
• Which of your behaviors seem to be influenced by the injury? How are those behaviors affecting your view of yourself and your relationships with other people?
Particularly if you’re sad, angry, or scared at times, it may be helpful to ask yourself this question: What have I lost, even if the loss seems temporary?
You may have lost power, function, and skill. You may have lost a significant source of fun, exercise, and challenge. Go a bit deeper: you may have lost a significant source of social contact, stress/anxiety reduction, and life balance. Go deeper still: you may have lost hope for your recovery, or you may have lost a significant source of meaning and purpose in your life. And finally, you may have lost a big part of your identity.
Psychiatrist Elizabeth Kubler-Ross theorized in the late 1960’s that, when confronted with our impending death, we have a characteristic response: the Five Stages of Grief. The stages, which can be traveled in any order and sometimes repeat, are Denial, Anger, Bargaining (eg. “Just let me live until….”), Depression, and Acceptance. Not surprisingly (at least to me), Homer Simpson illustrates all the stages quite well – after eating a fugu fish and being given one day to live – in Episode 211 of The Simpsons. At any rate, it was later observed that we often go through these same stages when we experience a loved one’s death, and it was then further observed that Kubler-Ross’ model seems to encapsulate the experience of many other kinds of loss.
I’m not suggesting that losing your cycling, even permanently, is likely to have the same effects on you as life-threatening illness or the death of a loved one. However, given that your injury has resulted in a sense of loss – and perhaps, as noted above, a sense of loss that cuts quite deeply – truly accepting what’s happened may accelerate your recovery. In other words, if you’re stuck in one of the other stages, your recovery from injury could be stuck. What might this look like?
• Denial: “It’s not that bad.” “I’m fine.” “I’m still racing tomorrow.” “It’s just a flesh wound.”
• Anger: Repeatedly becoming angry with unusual intensity, frequency, or provocation. Could be anger directed toward self, others, pets, lawn furniture…
• Bargaining: “Coach, just let me do this one race.” “If I do this one double century, I’ll rest for the next seven days afterwards.” “Doc, couldn’t you just give me some pain pills?”
• Depression: Sadness, hopelessness, helplessness, irritability, loss of appetite, sleep disturbance, loss of libido, loss of enjoyment, over- or under-sleeping, anxiety, inability to concentrate, lowered self-esteem.
Acknowledging and accepting what you’ve lost doesn’t preclude working to get it back. (Darn, I wish that worked with loved ones.) But the more clear-eyed and clear-headed you are about what you’ve lost, the less likely you’ll be to fill that space with something unhealthy.
Four More Steps Toward Recovery
Once you’re clearer about what’s going on within you, there are several things you can do to optimize your recovery:
1. Determine your needs and build a team to meet those needs. Perhaps you’re the kind of person who just needs a great doctor. On the other hand, you might benefit from support and guidance from such people as a physical therapist, alternative healthcare practitioners, a coach, a trainer, family and friends, a counselor or therapist, or clergy.
Since it’s critically important to see health care professionals with whom you feel highly comfortable and trusting, you may need to get clearer beforehand on what affects your feelings of comfort and trust. Is it the person’s approach to treatment and recovery? Their bedside manner? The cost? Whether they’re on your insurance plan? Whether they’ve been referred to you by someone you trust?
And don’t forget: you’re on the team, too. How you relate to yourself during your recovery – your self-talk, how you manage your emotions, your expectations – may make the biggest difference of all. Speaking of which…
2. Set and reset your expectations for the recovery process/time as accurately as possible. Having healthcare professionals who you trust will certainly help with this. It may also help you to get educated about your injury via other sources. Arnie Baker’s Bicycling Medicine, Andy Pruitt’s Complete Medical Guide for Cyclists, and Brian Halpern’s Knee Crisis Handbook are examples of books that I’ve found helpful.
3. Minimize any decline in your physical fitness. You may be off the bike, but you may not be completely prevented from doing any sort of physical exercise. Physiologically, exercise will tend to help combat any mood or anxiety problems that you experience as a result of the injury. Plus, if you can see and feel that certain non-injured areas of your body are staying strong, or perhaps even getting stronger, your outlook will tend to improve. For example, I do “superslow” strength training, an approach that not only works for me, but also seems to minimize the chances of (re)injury.
4. Take inventory of your core mental skills and use them. You’re still in training; recovering from injury is just a different kind of training program from the one you’re used to. All of your five core mental skills, some of which may need rehabilitation themselves, can make a big difference as you heal.
• Goal-setting: Reset (or suspend) your cycling goals. If they’re out of synch with the reality of your recovery process, you’re likely to create stress, frustration, or even hopelessness. Apply your goal-setting and goal-management skills to your recovery program. And, extending point #2 above, be careful of goal-creep!
• Self-talk: What kind of coach would you like to have supporting you every step of the way through your recovery? Shamelessly paraphrasing Gandhi, who said, “be the change you wish to see in the world,” I urge you to strive to be your ideal coach. Encourage and support yourself; don’t decide that’s the domain of other people on your recovery team. As you heal, use self-talk to reinforce your growing confidence and trust in the injured area of your body. If you’re getting down on yourself, telling yourself you can come back sooner than you should, or freaking out because you’re distorting what’s happening (or what you think will happen) in your recovery process, it’s time for an intervention. And you’re the one to intervene. Stop those thoughts, replace them if necessary, and use your anxiety-reduction techniques to decrease the negative self-talk’s fuel. Speaking of which…
• Managing Emotions: Injury tends to be a big catalyst for anxiety. You may be afraid that you’ll miss a ride or race, miss the season, or never ride again. As you begin riding during your recovery, you may fear reinjury, a(nother) crash, or not reaching your goals. Your anxiety may be a drain, and your energy, motivation, and confidence may suffer. Remember, anxiety (an “out of control” feeling) and control often go together; turning the screws on your healing process isn’t the only way to exert control. So, if you notice yourself driving too hard to heal more quickly, it may be your unwitting response to stress. You may need to aim your control in a different direction – one that still reduces your anxiety.
Bad crashes can occasionally create a more complex challenge than anxiety: true, clinical trauma. Judith Herman, in her landmark book Trauma and Recovery, notes that “recovery [from trauma] can take place only in the context of relationships; it cannot occur in isolation.” If you feel it might be useful to be assessed for clinical trauma, your friends, your doctor, or (in the U.S.) the free Psychology Today service are examples of potential sources for a qualified mental health professional.
• Concentration: It’s critically important that you stay focused on your recovery plan. And yet there may be more distractors than ever: pain, thoughts fueled by your anxiety, pain, frustration, pain, and that list of honey-do’s that’s so much harder to avoid now that you’re off the bike. Notice when you’ve lost focus (or listen to someone on your team when they tell you), identify the triggering factors (eg. a situation that stresses your injury or evokes your crash), and have ways to refocus that are matched to the triggers.
• Communication: This one’s more important than ever. You’ll need to be communicating well with your recovery team, managing the flow of information (and possibly, pressure) with riding partners or teammates, and sharing what’s happening with significant others. Decide who would benefit from hearing about the injury’s effects on you and, as we say in California, share that. Be respectful yet assertive with health care professionals. And be aware that your communication may be affected at times by any stress you experience.
Here’s to your health!
Marvin Zauderer leads the Mental Training program at Whole Athlete, a performance center in Marin County, California that provides a comprehensive set of coaching, testing, fitting, and consulting services to amateur and professional athletes. He is a licensed psychotherapist , USA Cycling Level 2 coach, and Masters road racer for Synergy Racing. You can email comments and questions to him at [email protected].