How to mentally handle an injury
Updated: Jun 9, 2022
Can you do physical therapy on your brain?
In my last blog, about injury pre-hab, we discussed the importance of strengthening your body in multiple ways. Chronic injuries usually occur by one of two ways. One is that stressed tissue moves well but isn't given time to recover. Think Rafael Nadal's shoulder during a tennis serve. It moves exquisitely with perfect technique, but that gorgeous shoulder might not get a break for months. Even a perfectly-moving joint can wear down when you hit it with the power of Greyskull.
The other type of chronic injury comes when stressed tissue moves poorly. Think of a weekend warrior's shoulder during a tennis serve. He doesn't play nearly as often as Nadal, or with nearly as much power. But the shoulder moves poorly when he does play, leading to bad serves and bad shoulders.
Chronic injuries are like wearing a shoe that chafes. At first it's annoying and you can focus on other things, but the longer it chafes, the more pissed off it gets and the more it hurts. Then it gets a blister and you can't walk right and you complain to everyone at the party about how your Jimmy Choos are filling with blood.
Bad movement is a painful shoe. That chafing inside the shoulder ultimately "blisters" it in some way (labrum tear, bone spur, tendinopathy, etc). This chronic pain is your shoulder bitching to everyone at the party. Improving movement in the joint with physical therapy is the equivalent of taking off your painful shoes and throwing them across the room with relief.
But what about your brain? Dealing with ongoing injuries can blister your brain too, in the form of anxiety, depression, self-doubt, and withdrawl. What do you do with a brain blister? Can you do physical therapy for your brain? Can you throw your mental Louboutins across the room with relief and dive into a pair of Havaianas?
Hell yeah you can. Lazer's got your neural flip flops right here.
In a perfect world, we would all train with perfect technique, have perfect joint movement, and understand perfect recovery. But as Margaret Atwood said, "If I waited for perfection, I'd never write a single word." Imperfect movement is a given, so we need to prepare for imperfection.
I don't believe that being active means you're destined to get hurt. But I do believe that you need to be prepared for the possibility of getting hurt. Having an injury can be devastating to one's self-worth. Being hurt for a long time can cause, exacerbate, or even reveal existing mental health struggles like depression, anxiety, societal withdrawal, and disordered eating. In other words, if someone were (consciously or not) using athletics to keep mental health struggles in check, then the removal of the protective shield could cause the glass to crack.
One of the keys is to get your mental recovery and your physical recovery on a similar timeframe. They have to progress together, like sonic frequencies. When frequencies are the same wavelength, they merge together seamlessly. When they aren't, it shows.
If your brain and bodily recoveries are slightly out of phase, you'll feel a little bit off. Kinda like Justin Timberlake circa 2002.
But if your brain and body are entirely out of phase, they can actively combat each other. This leads to glitches where one sound gets negated completely, not unlike the other four members of N'Sync ever since 2002.
Did I do this entire thing just to set up an Out Of 'Sync joke? You bet I did.
What does wave frequency look like when it's not squealing microphones and it's not JC Chasez's faux tweed?
It looks like this.
Think of how you would take a physical injury from point of disaster to 100% again:
✔️ 1) Do everything to understand the source of the pain.
✔️ 2) Back off from activities that exacerbate the current level of trauma.
✔️ 3) Make liberal use of whatever accessory modalities make you immediately feel better, no matter how temporarily. (Ice, heat, ibuprofen, massage, etc.)
✔️ 4) Start movement as pain allows.
✔️ 5) Gradually add more advanced exercise back into your training plan.
✔️ 6) Full return to sport.
This is pretty standard treatment protocol. I've been through this process a thousand times for everything from a shattered arm to herniated discs and ankle surgery. But at no point in rehabilitation did any medical provider say anything about how to handle the mental return. I just kind of worked through it, mostly by crying a lot.
It wasn't until I dove full time into fitness that I started understanding the massive disconnect here. People would get hurt and then getting worse before getting better. If there was a slight derailment from the treatment protocol, it was an emotional obstacle. And if the treatment protocol straight blew up like Mel Gibson's career after "sugartits," my clients would be emotionally trainwrecked.
You have to actively keep your brain in check when it comes to injuries. You ever walk down the street with a three year old? Not only can you not walk normally, but you've gotta stop every four seconds. Gotta look at the dandelion, gotta cry about the velcro on the shoes being crooked, gotta kick a rock and watch where it goes and see whether a car will run it over and if it does, to watch where it goes after that.
It doesn't matter how fast you'd like to walk, or how soon you have to be somewhere, because dammit there are burrito wrappers that need to be studied. Your injury is the toddler and your brain is the parental control. You have no choice but to walk at your injury's pace. And what happens when you try to rush the process? You pick up the toddler and try to carry them to your destination? Forget scorned women. Hell hath no fury like a toddler who does not want to be carried. Nor like an injury that isn't ready to be run on.
You have to actively keep your brain in check.
A few blogs ago, I wrote that psychological problems are physiological problems. As Dumbledore said when Harry asked him if his visions were happening in real life or just in his head, "Of course it's happening in your head. But what on earth makes you think that isn't real?"
What's happening in your brain is every bit as valid as what's happening in the rest of your body. So why doesn't the brain get some injury rehab too?
It will now.
But how does this even work? Can brains do clamshells and quarter squats and theraband slides?
Metaphorically speaking, yes.
Mental therapy, like physical therapy, needs to start at the moment of injury. Being in pain is mentally exhausting. Feeling restricted is mentally exhausting. The thought of only hearing fucking yoga music for your next three months of workouts is mentally exhausting. I need my Lizzo, and it's ok if you do too. You can do yoga to Lizzo. Tell me this isn't a meditative experience.
This pattern of being in pain and mentally suffering is the default train-of-thought track we get on when we get hurt. We're getting held up by a switching problem. We don't know how to pilot anywhere else, so we just mentally ride along, with the guy next to us who watches emotionless donkey porn and the woman who uses her phlegm as hand moisturizer. (Don't worry, Charlie Baker, I still love the T.)
Depression and pain are psychological neighbors. They share many biological pathways, trigger many of the same neurotransmitters, and release inflammatory molecules into the body. Depression and chronic pain co-exist so strongly that tons of research right now is being done to try and untangle the chicken-and-eggness of it all. Pain and depression can make inflammation worse. High levels of inflammation can make both pain and depression worse. All of this takes a hit on your mental state. Being in a bad mental state is the very best way to continue getting hurt at the gym.
What kind of crap is that, Mia? If everything makes everything worse, how can the cycles ever be broken? Can we just stream Keeping Up with the Kardashians forever and be done with it?
If you'd chosen The Bachelor, I'd say yes, but you didn't. So I'm gonna say no. Never the Kardashians.
These are giant topics in pain research, so this is only working on one piece. Still, it's a good piece. First move is to acknowledge your unhappiness. You don't have to talk to anyone else (because who wants to talk about feelings), but at least talk to yourself. Pretending that you aren't having a problem is an excellent way to add months or years to your injury recovery time. Just like many other ongoing problems, acknowledging an injury and the unhappiness it's causing you is the first step towards recovery. This seems obvious, but people can mentally ignore injuries for years, to their body's massive detriment.
You have no choice but to walk at your injury's pace.
Start practicing the long game of positivity, optimism, and confidence. Focus on what you can do today. This is how physical therapy works too. If you broke your leg, and all you can do today is clamshells, then that's today's goal. It doesn't matter how badly your leg would like to be running a marathon today, because it can't run a marathon today. It's broken.
Same with mental therapy. If all you could do for physical therapy today is fifteen clamshells, then that's also your mental therapy for today. Saying, "I did fifteen clamshells today and they didn't hurt my hip," can be an invaluable mental lesson. It stops the thought pattern on a positive note. It keeps your wave frequencies the same.
It's easier to be patient when you accept that you've got a ways to go, and this reframe promotes optimism for future improvement. You ARE going to get better, and it doesn't HAVE to be today. We think of optimists as those rare assholes who are persistently happy. They're like midwesterners—how can ANYONE be that happy all the time? It's incredibly annoying.
But being happy all the time isn't how science defines optimism, and the scientific definition is more reasonable. We are motivated by things of high value to us. The more important something is to us, the higher value we place on it. In scientific literature, optimism is used to describe whether people feel that they can accomplish their most valued goals. It doesn't have to be fast. It just means that when it matters the most, you believe that you'll be able to get the result you want. In injury recovery, this is the gold standard mindset. (And, frankly, this is also the life gold standard mindset.)
Research shows that optimistic people have better physical and mental health, better social relationships, and better levels of subjective well-being. Even one effort at a more optimistic mindset can have lasting impact. One unusual study tested out a single session of optimistic thinking with traumatized earthquake survivors. It was a small sample size, but their sample demonstrated a net positive effect for years.
Other studies have found that people feeling optimistic about heart surgery were half as likely to need re-hospitalization afterwards, and that pessimists were more likely to suffer a heart attack or extra surgeries in the next six months. One study of two hundred people found that when infected with a cold, the most optimistic people were the least likely to get sick. WTF is this real-life shield charm? Who knows? But it's been repeated repeatedly in research. (I just wrote that sentence and I'm so horrified by it that I'm leaving it in an ode to the department of redundancy department.)
OK, Mia, so, this is all well and good to type out in your bathrobe with your cat in your lap and your hot chocolate. Like, just feel happy already, amirite? Stop being so anxious! Everything is fine, just fine.
No, I'm not that dickhead who just tells people to try being happy. I know that working with depression and anxiety isn't always easy. I've been deep in the black holes of injuries before. But they remind me that every relationship with sport and athletics is, like everything, ever-changing. Everyone can think of a time when their body was doing something that it's not doing now. It's not automatically a bad thing. By a number of standards, I'm a much better gymnast now than I was as a kid training thirty hours a week.
Of course, you'd like to get your body back the way you like it, and there's every reason to think that you can. I firmly believe that if you keep doing what you're doing, even if it's slow, you'll be onto the Sexy Silvers In Slinky Velvet Leotards adult gymnastics team when you're 90 years old. Seriously, watch that video. Johanna is 91. She must be optimistic AF.
To be like Johanna, you'll have to be more proactive than just wishing things were different. If there's no other reason to try my mental therapy method, consider the alternatives:
✔️ Do nothing, be miserable, and assume nothing will ever change, or
✔️ Do nothing, be miserable, and assume something might change eventually.
I like optimism, but these are more like straight crazy. How about:
✔️ Do something, assess misery levels, then consider the next possible steps?
Fast forwarding to the mental end game without regard to the physical current game is disaster. "I'm no closer to running than I was two months ago," is the mental equivalent of setting out for a run on a broken leg. The only possible result is continued pain.
So what does practiced optimism look like in real life?
Stay tuned for the second part of this blog. We'll put mental therapy into practice.