Doctor Sussamn's Blog
Wednesday, October 10, 2018
Five years ago, running was my life. It was the perfect package of fitness, friendship and competition, all wrapped up in a shiny coat of endorphins. It was my therapy after the breakup of a four-year relationship and my secret to staying slender, despite a daily ice cream habit. So in 2008, when a string of injuries intruded on my running career, I felt stripped of my identity.
It’s no wonder. Whether they end a professional athletic career or simply disrupt an established exercise routine, injuries like mine have been shown to lower self-esteem, trigger depression and increase risk of further injury.
“Depending on how strongly and exclusively you identify yourself as an athlete, the psychological impact of being injured can be significant,” says Judy Van Raalte, PhD, a sports-psychology professor and co-editor of Exploring Sport and Exercise Psychology (APA, 2002). “Exercise itself has a therapeutic effect as strong as some antidepressants. Being unable to participate in physical activity means these benefits are taken away.”
What I learned from my own experience, though, and what should give hope to anyone struggling with sports-related pain, is that there can also be a bright side to injuries. Namely, that if you make the most of your recovery process, you may very well come out stronger — both emotionally and physically — on the other side.
Injured athletes may have an opportunity to pursue and develop other interests, and to put more attention on their relationships, says Doug Jowdy, PhD, a sports psychologist who works with athletes at all levels in Boulder, Colo. “It can help break the cycle of addiction to physical activity and achievement. Instead of being a slave to your heart-rate monitor, you can be freed from overidentification with sports and exercise.”
Dealing with a physical vulnerability can also serve as a reality check, helping you become a more effective athlete in the long run, says Van Raalte. “Being injured is sometimes the body’s way of saying, ‘Whoa! Whatever you’re doing is too much or not right for this body.’” she says.
So rather than seeing an injury as a setback, you can use it as an incentive to train differently.
The athletes profiled in this story have all ridden injury’s roller coaster. They’ve known the endless doses of ibuprofen, the mounting medical bills and the agony of relapse. But at the end of the ride, they’ve come out with renewed clarity and confidence — about themselves, their fitness passions and their deepest athletic motivations.
Kelly Alice Robinson had just done sprints during a CrossFit class in April 2011 when she felt pain in her left heel. Robinson suspected plantar fasciitis, but she figured it would clear up on its own. “One of the challenges of being an athlete is that you’re used to pushing through pain and having tweaks in your body. You never know when something is going to turn into a full-blown injury,” says the 36-year-old Boston resident.
As Robinson’s heel pain became more frequent and severe, she stopped running and tried acupuncture, but her symptoms continued to worsen. Still, she clung to the rest of her workout routine, attending classes three to four times a week.
It’s not that Robinson was ignoring the injury — at this point, she was seeing a physical therapist and had also gone to a podiatrist for a cortisone shot. But she was struggling with a compulsion to exercise, fueled by fears of gaining weight and losing her fitness. Robinson also didn’t want to lose her relationship with her fitness friends and community, even though continuing the workouts ultimately made her frustrated and anxious.
“I would worry about what the workout was and how I’d have to edit it. And every time I walked in, I’d have to explain what was going on,” she says. “I remember one day being almost in tears, I was just so tired of being injured and so tired of talking about it.”
Seven months after her initial injury, Robinson’s plantar fasciitis had not improved and she started having panic attacks, sometimes waking her at night or hitting her while she was out in public. Besides being concerned about her weight, she worried about how treating her injury would hurt her financially and the indefinite amount of time it might take to heal.
Intense emotions — from worry and irritability to extreme frustration — are not unusual after an athletic injury, according to Jowdy. “Athletes who are driven by self-will have developed the belief that once their mind is set on achieving a goal, their body will follow through,” he notes. “And when there is an injury, they can experience a sense of betrayal. A main component of healing is having the humility to accept that your body cannot perform the way your mind wants it to — and that’s OK.”
What finally helped Robinson accept her limitations was shifting her focus to the things she could do. This realization empowered her to let go of her old routine and put her energy into something new. “CrossFit was not only my exercise regimen, but the people there were my friends and my adopted family. It was very hard to decide to let go of all that, but I knew my personal goals were more important,” she says.
In December 2011, Robinson started setting goals in kettlebell lifting and heavy barbell lifting. Within two weeks, she felt great. “Those new goals gave me direction, purpose and, I suppose, relief,” she says. “I thought, ‘Oh, this is good! Maybe I don’t need to do long conditioning workouts.’” Robinson’s plantar fasciitis has vastly improved, and though her foot still bothers her from time to time, she knows when to back off for a bit.
In April 2012, Robinson became certified as a kettlebell instructor, and, in June 2012, discovered New England Women of Strength (N.E.W.S.), a community of female strongman athletes. Last September, she competed in her first contest and won third place. “It took soul searching and some time being depressed,” Robinson says, “but I am so happy about where everything led me.”
For Emily Edelson of New Hope, Pa., fitness wasn’t just a pastime, it was a daily ritual and the core of her social life. For years, the stay-at-home mom would drive her two kids to school and meet her friends at a boot-camp class or on the tennis court, where she played in a number of highly competitive leagues.
In February 2012, the 43-year-old tweaked her shoulder during boot camp and began feeling pain radiating down her arm and back. Diagnosed with three bulging discs and numerous bone spurs in her neck, as well as pinched nerves, Edelson conceded to seeing an orthopedic surgeon and a physical therapist, and took a few weeks off to rest, but changed little about her fitness routine.
Ultimately, a tennis drill did her in. “I threw my back out and couldn’t get out of bed for weeks,” she says. Edelson learned that she now had three bulging discs in her lumbar spine, too. Multiple specialists told her she couldn’t expect to compete at the same level with her injuries. “I was lonely. I was depressed. I was in pain. I didn’t want to leave the house,” she says.
Initially, Edelson could not imagine her life without her well-established fitness routine. But a health coach helped her see injury as a gateway to alternative pursuits. “She got me to think about other things I could do with my time and energy,” says Edelson. “What I realized is that as much as I had enjoyed life the way it was, I was sort of craving something different, something more mentally stimulating.”
For Edelson, this “something” was a career as a sommelier (trained wine professional). She had long been interested in wine, but had never found the time to do more than take an occasional class. In the fall of 2012, Edelson committed to a sommelier program and began going to New York two or three times a week for classes. She also started her own wine consulting business, Vine Ideas.
Today, she is once again doing boot-camp classes — albeit with a modified program — and her goal is to find a job in the wine industry where she can balance her love of wine with family and fitness.
Though Edelson misses parts of her old routine, she says her new pursuits are rewarding and have helped her be more patient with recovery.
“If we view injury as a chance to learn more about ourselves, it gives us a better prognosis for emotional recovery, as well as physical,” says Megan Pietrucha, PsyD, LPC, who works with student athletes at Elmhurst College in Elmhurst, Ill.
On a deeper level, an injury can help you find answers to questions like What do I value? and What do I believe in? Jowdy stresses that this kind of reflection can enrich not just your fitness regimen, but your entire self-perception, your relationships — and by extension, your life.
When Kristen Pertner of Dayton, Ohio, suffered a knee injury in 2007, tearing her posterior cruciate ligament (PCL), she was forced to discontinue a 12-year rugby career, as well as give up many of the other athletic activities she enjoyed.
“To get stripped of something like that is so hard,” says Pertner, who at the time was playing on a senior women’s team. “It was scary, too, wondering if I was going to lose my friends. You just get so close to the other players.”
After having PCL reconstruction surgery in 2009, Pertner initially avoided even being around rugby. Watching her teammates lace up their boots was just too difficult. But as she returned to the sidelines, she began to reconnect with other former players. Pertner says some of these rekindled friendships grew to be stronger and more meaningful than they had been on the playing field. “It helped me realize there’s life outside of rugby,” she says.
The 33-year-old also found emotional support from her parents, husband and church. Ultimately, though, what helped Pertner most was connecting with others who knew exactly what she was going through. She discovered a blog and online forum where people with PCL injuries could exchange information and share their experiences. “It was almost like a support group. Those were the only people who really understood,” she says. “Imagine that — finding comfort in perfect strangers.”
Ultimately, communicating with people who understand your injury may not only spare you from feeling alienated, it can also net you valuable insights and information. “It gave me a better sense of what to expect during recovery,” says Pertner, “and it clarified what kinds of goals I could set.”
Pertner’s experience is consistent with established data, notes Pietrucha. “Whether you are temporarily sidelined or have experienced a more severe, long-term injury, research has shown that social support is an important part of the rehabilitation process.”
Burke Jenkins was 15 miles into the 2010 Chicago Marathon when his right knee began to ache. He managed to drag himself across the finish line, but knew something was seriously wrong. Shortly after the race, a physical therapist diagnosed him with iliotibial band syndrome (ITBS) and temporarily prohibited him from running.
“A bit of panic set in as I was worried about gaining weight,” Jenkins says. “I was a heavy kid all through high school and running had helped me lose about 50 pounds.”
For the first couple of months after his injury, the Detroit native was lost. “I just kept watching the scale creep up because I couldn’t run,” he says. Then he heard about a coworker who had lost 30 pounds working with a personal trainer. He decided to give it a try, and between strength training and being careful about his diet, Jenkins soon dropped more than 10 pounds.
In March 2011, the 37-year-old resumed running while continuing his strength training. He has since set personal records in a 5K, 10K and half-marathon. “In my mind, that knee injury ended up making me more fit and a better runner than I ever would have been without that setback,” Jenkins says.
Robert Forster, PT, a physical therapist and performance specialist in Santa Monica, Calif., says an injury can offer an opportunity to work on aspects of fitness that your sport might not emphasize.
“When I meet with an athlete, I frame it: ‘Yes, you need to take time off from your sport, but that doesn’t mean you’re going to lose fitness,’” says Forster. “In fact, we are going to use the time to sharpen areas that were holding you back before.”
Barry Breffle, a triathlete in Cedar Rapids, Iowa, was two days into a triathlon-training camp in June 2012 when he broke his collarbone in a bike accident. He had planned to compete in a Half Ironman in August and knew his injury might prevent him from doing the race, but he also knew that he still had a chance.
Following surgery, Breffle relied heavily on his physician and physical therapist for advice. “I was fortunate to have both a surgeon and physical therapist who were athletes and who understood my situation. While they were cautious and conservative, they were also willing to let me push the envelope a little,” Breffle says.
Although any injured fitness buff can benefit from sound medical advice, it may be especially important for driven athletes like Breffle, and for those with type A personalities, says Jowdy. Seeking out sports-medicine specialists who understand their sport and athletic mentality gives them the best chance of optimizing their recovery and maintaining their fitness without risk of additional injury.
Throughout his rehabilitation, Breffle worked with his PT to assess how much his body could handle. In addition to doing his assigned exercises, he stayed active, riding his bike on a trainer, running in a pool, and later using an elliptical machine. “I played an active role in my own recovery and I think that really helped my mindset,” Breffle says.
Two weeks before the race, he was feeling confident but wanted to make sure his collarbone had healed before deciding whether to compete. His doctor agreed to take an x-ray ahead of his scheduled appointment date and cleared him for competition. Breffle went on to have a “surprisingly good race.”
Breffle’s example is the ideal, of course, but even if your road to recovery is longer or more complicated, a positive physical-therapy experience can improve your outlook.
“Following a rehabilitation program builds confidence, especially if you are surrounded by professionals who understand your physical and emotional recovery,” says Pietrucha.
She recommends setting concrete, attainable goals, such as doing 20 minutes of physical therapy every day or practicing pool running twice a week, rather than having outcome-oriented expectations. “Finding ways to make empowered, healthy decisions while you adhere to your goals is what it’s all about,” she says.
Here are 10 things you can do right now.
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