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Recovering Psychologically from Illness/Injury

article by Molly Breslin MS, CRNA

Unfortunately, most of us have experienced an illness or an injury that has sidelined us from our athletic pursuits. It’s challenging enough to deal with these events from a physical standpoint. Managing the psychological aspects of the recovery process is just as important as managing the physical ones and can make-or-break your return to optimum athletic performance.

We all talk about the rational mind – but the mind can be terribly irrational when dealing with events that have emotional components to them. Triathlon isn’t just swim, bike and run with a bunch of gear, training plans, race dates and entry fees. It’s something we’ve committed to, that gives us purpose, makes us happy, diminishes our stress, and provides a social network. Whether you are a beginner or an Olympic contender, hopes and dreams are inextricably intertwined with the physical labors of training and racing.

In part one of this two-part series I will discuss dealing with the initial stages of psychologically recovering from illness/injury. This sets the platform for the psychology of actual physical recovery that comes later. Part two will focus on actual techniques to recover psychologically so that physical recovery will be successful.

Swiss psychiatrist Elisabeth Kubler-Ross famously defined the Five Stages of Grief. We tend to think of these stages as only being applicable to very large, devastating life events but they also apply to smaller disappointments and set-backs as well. Understanding and thoughtfully managing these stages is really the first step in recovering from illness/injury. Let’s examine the five stages as they apply to use as injured or ill triathletes.

Stage 1 – Denial:
“This can’t be happening to me. I’ve put all this time and effort into training for X Event.” “There is NO way I’ve ruptured my Achilles tendon. The doctor must be wrong!” Sound familiar? In this stage the athlete is incredulous that the scenerio is actually happening to him or her and constructs an alternative paradigm in which the injury is not real or is minimal and can be overcome easily. Recognizing this part of the process is important – denial can lead to attempting to train or race with an injury/illness and that can be damaging physcially.

Stage 2 – Anger:
This stage begins when the denial process can no longer be maintained – for instance, the athlete cannot walk due to the Achilles tendon rupture, yet alone complete their next speed workout. “This is so @*%#$ unfair! I don’t deserve this!” “It must be those new shoes I bought last week.” “There is no way this should be happening to me – I’ve been working so hard at my training.” This stage can be ugly and unpleasant – but it’s normal and necessary. Go ahead and let it all bubble to the surface – just be careful not to harm any innocent bystanders in the process.

Stage 3 – Bargaining:
In this stage the athlete makes attempts to compromise in some manner that she or he anticipates will minimize the situation/damage/disappointment. “I’ll just cut back on my workouts this week so that I can hit it hard next week when I’m feeling better.” “I promised my doctor that I’ll get more sleep at night so that I can keep up my training program.” “Giving up that one beer I have on Friday night will be a good way to get better faster.” Some level of denial is still working behind the scenes here. Once again, it’s important not to do any more harm and prolong the recovery phase or, worse yet, cause irrevocable damage.

Stage 4 – Depression:
“I’m so bummed out that I’m not going to be racing. What’s the point of all this training I’ve been doing?” “I gave up so much to do my training and spent so much money on a coach – and now it’s all for what?” “Things will never be the same.” Once again, this is not a pretty state-of-mind to be in, but necessary for the recovery process. Go ahead and let these feelings arise. They don’t make you weak or more ill or more injured. Your loss is significant and recognizing and honoring that is important. Allow yourself to be sad – but also be aware when sadness becomes problematic and effects normal functioning in life. Out of this stage will come the gratitude that will help bolster your recovery.

Stage 5: Acceptance:
“Ok, I’ve ruptured my Achilles tendon. My racing season is over. I guess I’d better listen to my doctor and my coach and let this heal or next season will be a wash too.” Acceptance does not equal defeat. Here is where the athlete starts digging himself/herself out of the hole of illness/injury and takes the initial big steps toward a full recovery. There is a lot of power in this stage – the seeds of optimism take hold and begin to germinate into the foundation for a solid and successful recovery. The positive energy generated here will translate into the fuel that feeds the action steps of the recovery process that we will explore in part two.

Knowledge is power!
An athlete’s brain is the most important organ in their body. Knowing the facts about your injury or illness and how it will affect you and your athletic pursuits is of utmost importance. Educate yourself intelligently. The Internet is our primary source for information these days but it is rife with what I call “voodoo”. It’s tempting to latch onto the information that will lead to the fastest recovery but it is generally not in your best interest and can be exceptionally harmful. Make sure you are getting information from reputable sources. Some of my favorite sites are: Mayo Clinic (www.mayoclinic.org), Centers for Disease Control (www.cdc.gov), National Institutes of Health (www.nih.gov), Up To Date (www.uptodate.com), American Academy of Orthopaedic Surgeons (www.orthoportal.aaos.org), and Pub Med (www.ncbi.nlm.nih.gov/pubmed). Choose your health care provider wisely and consider them to be your number one training partner. Make sure they are willing to spend adequate time with you and understand your athletic lifestyle and goals.

Downtime can be productive and invigorating.
You are most likely going to have to take some time off from your usual training schedule and intensity. Most of us are over-trained. Reframe this break in your mind as the opportunity for the body (and the mind) to rebuild on all levels. Here is your chance to read that great Joel Friel book you’ve been meaning to get to and catch up on those fabulous USA Triathlon webinars. Review your training plans, data in Training Peaks, and race results; identify what went well and where there is room for improvement. Begin developing some good training and racing habits: take your resting heart rate every morning, weigh yourself at regular intervals, keep a food journal, develop a regular stretching routine. These are all things we often mean to do but they are often deemed less important than our track workout that day. Anticipate your next season: look at race calendars, set goals, and keep up your relationship with your coach if you are using one.

Volunteer!
This is an incredible opportunity to give back to the sport while staying involved and engaged. Race directors always need help and will accommodate your limitations. Race packets need to be assembled, registrations completed, bibs handed out, feed stations manned…..the list is endless. Even if you are on crutches there is a job you can do. Volunteering gives you the chance to see the side of the sport that you might be taking for granted. There are a lot of people out there working for little or no money to make sure that your race day is a success. It’s an incredible way to meet the people behind the scenes and develop gratitude. Watching a race can be extremely instructive. Pay attention to running and cycling form and examine transition set-ups and techniques. You are bound to learn an incredible amount. And cheer on the competitors with all your heart – what a way to boost your spirits.

Baby Steps.
At some point you will be allowed to do something physical in terms of athletic recovery. Make sure you follow your health care provider’s orders and are in contact with your coach. The limits they set might be frustrating but they are in your best interest. Beware of getting stuck in “compare and despair” mode. Accustomed to running a 19 minute 5K and now you can barely make it a mile without having to stop and walk? I know how demoralizing it can be; I’ve been there. Rather than getting depressed over your current lack of prowess, think back to the time when you were just getting started in athletics. Everything seemed difficult and you might have felt as though you would never be fast. It’s easy to forget all that time and effort you invested to get to your peak – you did it once, you can do it again. Take this opportunity to work on your form, utilize your heart rate monitor and power meter to their full potentials, tweak your gear so that it’s functioning and fitting optimally, and practice positive self-talk and imagery.

Explore.
Usual 10K training route bumming you out because it makes you feel so slow? Here’s the opportunity to explore other routes and ways of doing things. One of my favorite quotes is “The difference between a rut and a grave is the depth.”. By choosing a different direction for your bike or your run you won’t be reminded by the usual mileposts/landmarks that you are not up to your usual pace. Take the opportunity to look around at your environment; make a point to notice the wildlife, the people, and the terrain. Chances are you’ve been missing a lot and you might have been missing better training on different terrain. A great way to boost your spirits is to wave and smile as your encounter people, especially kids. Go to group workouts that are at a slower pace: Join the C group with the weekly cycling training ride. Run at the back of the pack with your trail running club. Jump in the slow lane at the morning master’s swim workout. You’ll meet incredible people, make new friends, learn a lot, and perhaps even find someone to mentor or be mentored by.

As cliché as it sounds, be grateful for your injury/illness and what it has to teach you. Turn your injury/illness into an opportunity instead of an obstacle. You’ll be stronger for the experience.

Jackson Hole, Wyoming is where I work and play. My life has been spent working in a variety of professions and locations, from framing houses in Alaska to volunteering in medical clinics in the Himalaya and Africa. Besides coaching, I am a practicing nurse anesthetist who has worked in over 45 hospitals across the country, from New Jersey to Hawaii. I studied economics and business administration at Ursinus College and biology at Temple University. After working in sales management and marketing in the greater New York/Philadelphia area, I returned to nursing school at Pennsylvania State University and spent the next eight years working in critical care neonatology and pediatrics at The Children’s Hospital of Philadelphia. During this time I did my biomedical graduate work at University of Pennsylvania and then completed a Masters of Science in Anesthesiology at Saint Joseph’s University and clinical anesthesia training with the University of Pennsylvania Health System.

I’ve earned a professional certification in Sports Nutrition and Nutrition for Optimal Health and Wellness from San Diego State University. I am a Level I USA Triathlon Coach and a certified Health and Wellness Coach for Wellcoaches (an affiliate of the American College of Sports Medicine and Harvard University School of Medicine). Besides coaching individual athletes, I have coached a women’s developmental running group through Runner’s World in Emmaus/Allentown, Pennsylvania. I also maintain certifications in TRX Suspension Training and Schwinn Indoor Cycling.

Adult-onset asthma introduced me to exercise as a way to control my breathing difficulties. Very quickly I found myself hooked on triathlon and progressed from a wheezing, almost dead-last finish at my very first race to frequenting the steps of the podium and earning the Wyoming State Triathlon Champion title as well as a national recognition as one of the Top 50 Amateur Triathletes in the Best of the US Triathlon competition. Realization that I could not have accomplished these goals without good coaching, as well as my love of teaching and mentoring led me into a career of coaching. I continue to practice in the medical profession part-time and continue to race, affording me the experience and the wisdom to successfully coach busy professionals as well as coach athletes with medical challenges.

It is my belief that coaching should be tailored to the individual and be part of a balanced life. 22Tri provides highly specialized individual training plans and coaching for each athlete. I also provide group clinics on all aspects of triathlon as well as running and swimming and co-manage a women’s cycling group. I have extensive knowledge and experience with high altitude training and racing environments and welcome the opportunity to work with athletes with health challenges.

http://www.22tri.com

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