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Recovering From Injury

It’s gonna get you. Maybe it already has, but don’t fool yourself and say it will never happen to you. If you participate in triathlons for any significant length of time, you will likely experience an injury. It may only be a mild injury that can be treated without interrupting training, such as a tight or strained muscle; but odds are that sooner or later you will move up to the moderate injury category where it interferes with on-going training and limits participation. Perhaps it will be a major injury that requires surgery or hospitalization. A few unfortunate colleagues will be faced with injuries so severe that they will never return to previous levels of competition; and some may even face permanent functional disability.

For me, the major injury occurred on May 28, 1999, two weeks before I was scheduled for my first race of the 1999 season. It started out as a slight muscle tightness in the back—uncomfortable, but not enough to interfere with my ten mile run. The back was tighter and more tender the next day as I started my interval workout; but still not enough to postpone the scheduled task. Upon getting out of bed the following day I graduated to full-blown back injury that immediately threw me to my knees, brought involuntary tears to my eyes, and the sensation of puke in my throat as the pain seared to my core.

Getting the biological pieces back in order can be relatively simple with todays medical technology. The mental and emotional aspects often pose a greater challenge. Even if your physician is an athlete and has specialized in working with athletes, the mental aspects of dealing with injury are often neglected.

Mental Aspects of Injury

Emotional Impact. Most athletes experience some level of “mood disturbance” following an injury. Even the most optimistic individual is likely to wrestle with irritability and depression. Some reports estimate that as many as 19% percent of injured athletes develop clinical depression following injuries that require moderate down time, hospitalization or surgery.

Coping with physical pain and discomfort. It drains you and wears you down; often it interferes with your sleep. A person can choose between being alert, but distracted by pain and sleep deprivation; or being pain-tolerant and in a medicated, drug-hazed state. Concentration and focus suffers. This can have serious implications on on the ability to work, manage children or run a household.

Challenge to self-identity. It’s often said that being a triathlete is a life-style rather than a reflection of having raced in a triathlon. It is a cornerstone of a person’s identity and self-esteem. Boom! Get injured and instead of trying to break 3 hour 30 minutes for a marathon, the current goal is being able to walk to the end of the block and back. The unspeakable fear is, “What happens if full recovery never comes?” Serious injury can rattle the very foundation of one’s identity.

Abrupt shift in lifestyle. Most triathletes go to great lengths to develop a routine that allows for training an average of 11-12 hours per week. A major injury radically shifts one’s day to day routine. These changes often impact our partners as well. Your wife, husband or partner may actually have enjoyed that alone time while you were off doing your 100 mile bike rides. Many athletes struggle if placed in the role of having to rely upon others for help.

There are new stresses in juggling schedules to attend medical appointments, usually requiring time off from work. Let’s not forget the financial stress of paying for medical treatment and subsequent rehabilitation.

[In case you’re wondered, it is insurance companies in this world are an incredibly sinister plot designed to take your money and then refuse payment when you need it the most. They ruthlessly train hordes of drones to answer your phone calls, and then place you on hold while listening to Muzak with subliminal messages that seep your will power and advocate acceptance of your helplessness and hopelessness.]

Serious, But Not Hopeless

A major injury is a serious situation, but not hopeless. The majority of athletes experiencing major injury are able to recover, and many actually come back stronger than before the impairment. Dr. Richard Steadman, of the Steadman- Hawkins Clinic in Vail, Colorado, has gained reputation world-wide for treating athletes with serious injury and successfully returning them to competition. He attributes his success, in part, to incorporating a four-point psychological program into every treatment plan.

Athlete education. The first step is to fully educate the athlete about the nature of the injury, the treatment options, and the anticipated phases of treatment. Not only is time taken to explain each of these aspects in detail, information is presented visually with models and examples. If the athlete has a spouse or significant other, he or she is included in this educational process.

Establishment of attainable goals at each stage in rehabilitation. Athletes tend to be goal oriented. In injury recovery, goals need to be simple and yet demanding. This allows for an immediate focus without looking too far ahead. It may be as simple as moving each toe for five seconds twice a day, or walking 20 yards. By achieving clear, simple, yet challenging goals, a person knows that progress is being made. As long as progress is being made, there is hope.

Prompt initiation of an aerobic program. Steadman recognizes that athletes are used to a daily “fix” of endorphins from exercise. Every effort is made to have the athlete exercise at an aerobic level within 24 hours of surgery. A hand-crank cycle machine may challenge a person with an ACL operation; a person with back surgery can walk on an inclined treadmill. This process counters the psychological changes due to the abrupt transition from intense daily activity to no activity at all. It also helps avoid the depression that is commonly associated with the immediate post-injury period.

Counseling to help deal with a person? altered status as an athlete, especially during periods of extended activity. As noted earlier, an injury can challenge the very essence of a person? identity. This is especially true for many of Steadman? clients who are professional athletes. Putting the injury into perspective, appreciating non-athletic aspects of one? life, and possibly exploring new dreams and goals for the future— these challenges may easier with the assistance of a counselor sensitive to an athlete? needs.

Once you have been through treatment and rehab, Sport Psychologist Eileen Udry recommends a gradual return to competition to insure success and avoid re-injury. First, all medical parties need to confirm that the bio-mechanical aspects of recovery are complete. The athlete should then address regaining the physical and technical abilities required of his or her sport. This is a gradual process, building to the physical and technical pre-injury level. Only after this has this has been achieved does the athlete move to high intensity training. If high intensity training goes well, then the athlete is ready to test the recovered injury in actual competition. This is a gradual process in which the athlete is required to successfully complete each stage prior to moving to the next. Doing so minimizes the risk of re-injury and mentally prepares the athlete to trust his or her body when eventually returning to competition.

As for my back? After six months of unsuccessful “non-invasive” treatment efforts, surgery in December brought immediate relief from what was diagnosed as a herniated disk. Unfortunately, the disk re-ruptured a month later while stretching (see Item #5 in the sidebar). I am now back at the beginning of a gradual rehabilitation program. All you middle-of-the-packers have a reprieve until the fall of 2000. I may have only walked around the block today, but watch out; I plan to be back in full form by November 2000.

Helpful Hints

Not everyone has the resources to receive treatment from the Steadman-Hawkins Clinic. Your chances of rapid physical and psychological recovery from injury will be improved if you follow these simple tips.

Choose you doctor wisely. Ideally find a physician who is both an athlete and has expertise in treating athletes. If none are available in your community, choose one close in age to yourself. Don? necessarily go to the first doctor available, and feel free to get a second opinion.

Be an educated consumer. Find out everything that you can about the nature of your injury and the treatment options. Ask the doctor about his or her experience with your particular type of injury, the success rate, and the risks. Unless used to dealing with athletes, most physicians will propose a conservative treatment plan. Ask about the risks and liabilities for various treatment options. Athletes tend to know their bodies better than the average population, and may be better suited for certain risks than sedentary individuals.

Don’t be afraid to be a squeaky wheel. The medical industry is a vast machine that often plods along in rote fashion. I?e had physician friends confide that it is easy to slip into the course of action that requires least hassle. Be respectful and polite, but don? be afraid to speak your needs. Ideally develop a collaborative relationship with your physician where you jointly decide the best options for your unique needs.

Make plenty of charts and lists. If there is anything you want to remember, write it down. Short-term memory is vulnerable to stress, depression and medications. Write the questions you want to cover with the physician, as well as any and all instructions following treatment. Set rehabilitation goals and chart your progress. It helps with motivation and keeping your focus on the immediate step before you.

Follow your treatment plan and go slow. Most triathletes have no problem with completing an exercise program; their problem is staying within the limits of the program and allowing sufficient rest and recovery. Better to go slow and take a little longer in the initial rehab than to re-injure yourself and have to start all over.

Use your support system. Don’t feel as though you have to “tough it out on your own.” Dealing with a major injury can be incredibly difficult by oneself. Talk to someone who has been through a similar experience. Allow yourself to lean on your friends and you will soon be in a position to return the favor. Seek professional counseling if you find yourself struggling and losing hope.

## Copyright 2000, Dr. Charlie Brown.  All rights reserved.