Athletes Need to Recover Mentally From Injuries, Too
Madison, Wisconsin - Recovering from a sports injury involves more than healing an athlete's physical pain, says UW Health sport psychologist Shilagh Mirgain.
To once again thrive, the athlete's psyche needs as much attention as her torn ACL, concussion or broken ankle.
"It's important that an athlete is psychologically healed after rehab before returning to play," Dr. Mirgain says. "Injury is a kind of trauma for athletes, and if we're not addressing it from a multidimensional view, it's a disservice to our athletes and can lead to further injury."
Dr. Mirgain invokes "Mike," a high school football star who experienced a right hip labral tear in the middle of his senior season. During their sessions, Dr. Mirgain learned Mike was having trouble dealing with the aftermath of an injury that ended his high school sports career prematurely. He was depressed and wasn't sleeping well, and devolved from an engaged student into a despondent one.
"He wasn't coping well," Dr. Mirgain says. "His mother said, 'This isn't like him.'"
In a way, it wasn't him. Mike was no longer the Mike who spent so many hours honing his skills on the field. He could no longer play football, and that sport was the dominant factor in how he defined himself as a person.
"Athletes are vulnerable to a disruption in their identities when they are injured," Dr. Mirgain says. "They have been in sports their whole lives. They've spent their time and passion developing their skill sets, and in an instant it's all taken from them."
Mike was also subjecting himself to a tremendous amount of emotional pressure, which manifested itself as anxiety. He had already accepted a college football scholarship but worried his injury would prevent him from returning to top form. And his team, a state championship contender with him in the lineup, was eliminated from the playoffs while he watched from the sidelines.
"He felt like he let his team and coach down," Dr. Mirgain says.
Such thoughts are common to injured athletes, and can get in the way of proper physical rehabiitation as well as put the athlete at risk for further injury.
"Frustration, tension, confusion, anger, transient fatigue," Dr. Mirgain says, listing the common symptoms for athletic anxiety. "Athletes who are injured can also be at risk for clinical depression, and that can cause more complications. When they're depressed, they're not as motivated for treatment and have a negative outlook about their recovery."
Mike's anxiety didn't rise to the level of clinical depression, and he hadn't numbed his pain with alcohol and drugs or binge-eating, as some athletes do. But he was trapped in a vortex of negative thoughts about his injury - rumination, in Dr. Mirgain's parlance. If Mike's injury was a story, it was dark and brooding, as though lifted from the canon of Edgar Allan Poe. He needed a different story, so Dr. Mirgain worked with him to shift the narrative of his hip injury.
"It's about helping the athlete tell a different story," she says. "If they focus on a story of loss or threat, they don't do well."
But a "hero narrative," wherein the protagonist (athlete) perseveres through difficulty to ultimately triumph, can instill in the athlete a more positive mindset, which can benefit both his physical rehabilitation and his mental state.
"When Mike started to change his narrative, he got excited about his collegiate career," Dr. Mirgain says. "He used the time to develop other strategies. He normalized injury and realized he was just one of many athletes who get hurt, and can still move forward."
And he didn't stop with mental narratives. At Dr. Mirgain's urging, Mike took up pen and paper and wrote about his injury. It's an exercise first popularized by social psychologist James Pennebaker, who asked his patients to compose stream-of-conscious texts for 20 minutes, three or four times a week, about a difficult and emotional experience. He encouraged people to write down whatever came to mind, and made no deductions for faulty logic or erratic grammar.
"It allows you to more fully process something that's upsetting," Dr. Mirgain says.
Mike believed his journaling sessions led to an acceptance of his injury that surfaced during a conversation with his parents and other relatives.
"Mike said, 'I was talking about the injury, and for the first time I didn't get upset. I remembered the details but there was no emotion,'" Dr. Mirgain recalls.
The unifying recovery thread, for Mike and many injured athletes, is confidence, which leads to the positive attitude needed to fully engage in rehab and return to sport.
"I'm always encouraging athletes to work on a confident mindset," Dr. Mirgain says. "Each moment we're either building it or taking it away, and it's determined by what an athlete is saying to himself or herself."
How can athletes achieve that confident mindset? Dr. Mirgain endorses breath regulation and mind-body exercises such as mindfulness of the moment as methods for encouraging mental health through physiological regulation. Dr. Mirgain has the athletes with whom she works think about their own "highlight reel" in combination with a "4-6" breathing pattern (count to four while drawing breath into the abdomen and six while releasing the breath) intended to calm their bodies and minds.
"I have them recall the top moments in their sport on the in breath, and on the out breath they focus on releasing tension and fear," she says. "It helps an athlete get back in the moment and feel ready for the next play."
And from that moment - centered, calm, present - the physical and mental healing can begin.
Date Published: 05/19/2015