Getting Back from Injury/Illness (or making sure WID beats DID every time!)
Brian Miller, Chairman of the UK Athletics Sports Science Panel
"In the early part of my career I suffered several injury setbacks and I don't think I handled them very well. I also had injuries and illness in the latter part of my career, but I'm sure that I did a much better job at that time. I only wish I'd been taught those techniques five years earlier!" Roger Black, former World Champion (4x400m) European Champion, Commonwealth Champion and Olympic Silver medallist (400m).
Competitive sport is a breeding ground for injury. Almost all serious athletes experience an injury at some time during their careers - it is part of the sport. If we take it for granted that most athletes will get injured, then it is obviously very important that athletes and coaches learn how to cope with these injuries when they do occur. This brief paper looks at some practical ways of dealing with such events.
Different athletes react differently to injury and illness. There is also likely to be a different reaction to a major season threatening event, as opposed to some minor strain. But we know for a fact that significant injuries will have a psychological impact as well as the more obvious physical consequences.
Being aware of this is important for at least two reasons:
i) the rate of recovery from the physical illness will be slower if the mental side of the event is not dealt with, and
ii) even if the damaged muscle (as an example) does make a full recovery from the injury, that does not guarantee that the athlete's mind will be completely ready to re-enter the competitive arena at exactly the same time.
Most researchers in sport psychology agree that there is a predictable pattern to the emotional reaction of athletes who receive a significant injury. The first stage or phase can be characterised by a sudden shock like state. Common emotions during this phase are anger, denial of the injury and various bargaining behaviours. Unfortunately, denial and bargaining behaviours are likely to hinder recovery from injury.
The second phase can involve an intense preoccupation with the injury. During this time athletes can experience insomnia, fatigue, troubling dreams and even bouts of crying. Depression is a common emotional reaction for athletes during this phase.
The third and final phase is based on reorganisation. This is where the athlete begins to display renewed or more realistic interest in the return to competition. Acceptance of the situation is the key to this stage of injury related grief.
If the health professionals involved can work together with the coach and athlete, it should be possible to speed up the transition from denial to acceptance. My experience in this area has consistently shown that athletes who use WID techniques are far more likely to make timely progress than those using DID. So what are WID and DID?
WID versus DID
WID stands for "Winning Inner Dialogue" and refers to a way of thinking that is more likely to see the positive side of events.
DID stands for "Defeating Inner Dialogue" and refers to a way of thinking that emphasises the more negative side of life. WID versus DID is a bit like the glass which has been half filled with water. Someone using WID as an outlook says that the glass is half full, while someone using DID sees it as being half empty.
It is possible to talk ourselves into or out of things. Let's look at a relevant sporting example. The physiotherapist does not turn up at the injury clinic when the athlete has booked in for an appointment. An athlete who is using DID will probably get frustrated by this and might adopt an attitude that says: "That's all I need. I can't even get treatment for my injury. Right, well I'm off then - I'm not going to hang around to waste my time. What's the point." As a result the athlete will probably miss a treatment session, will become tense and agitated, and simply make matters worse.
A WID athlete might react differently to the same situation. The WID athlete is more likely to wait around longer to see if the physiotherapist does turn up. He is more likely to quickly book in for another time or date, and he is also more inclined to go off and do some complementary rehabilitation exercises (e.g. specific stretches for a hamstring injury).
So while the DID athlete has probably gone away muttering and eating a bar of chocolate, the WID athlete is getting on with the process of rehabilitation. The non-arrival of the physiotherapist is a trivial example but it is an illustration of something I have witnessed on several occasions. The truly successful athlete will be using WID to get on with whatever is possible. They would look to control all of the controllable factors. Others will simply use DID to make life harder for themselves.
An important element of the rehabilitation has to be that athletes understand that they are likely to move from stage one to stage three as they recover. It is a totally normally process and they are not "weak" or "wimps" for experiencing some of the 'moodiness' associated with moving through the different stages. It is predictable, understandable and even necessary if the athlete is to make a full recovery. It could even be argued that when the athlete reaches stage two, complete with tears and depression, this is a welcome sign because they are clearly moving along the continuum which finally leads to the healthier stage three. But the trick has to be about making sure the injured athlete works hard at whatever is available to them during the recuperation process. This has been described as moving from being a Victim to being a Survivor. Typically athletes using WID consider at least three areas: physical exercises, mental work and nutritional control.
Physical Exercise
Obviously, it very much depends on the injury involved, but there is usually some area of the body that can be usefully employed during rehabilitation. For example, a javelin thrower I worked with had a groin strain and was out for about two months. He took the opportunity to do additional upper body strength and mobility work, and made some significant progress while still protecting his injury. Other examples include the use of flotation jackets for "running" in water, or taking up yoga or even learning to juggle! Athletes, coaches and medical personnel need to be creative when looking for alternative forms of exercise.
Mental Work
Sport psychologists would argue that during a period of physical rehabilitation, athletes should and could spend time acquiring or refining their mental skills. UK Athletics Performance is establishing a network of qualified sport psychologists to service the psychological needs of athletes on the World Class Performance Plan as well as servicing World Class Potential athletes at specific Regional Squads, and they will certainly show athletes how to acquire such skills as Goal Setting Visualisation and Thought stopping.
Nutritional Control
UK Athletics Performance is also establishing a network of qualified nutritionists who will be able to offer assistance to World Class Performance athletes similar to that indicated by the Sports Psychology support in this area. But the general conclusion has to be that athletes don't use as much energy as they do when fit to train, so they should not consume as much energy. This is a simple enough concept but sadly too many athletes come back from an injury weighing a few kilograms above their normal weight. This makes the return to competitive form even more difficult and it also increases the chances of re-injury.
In summary, we know from painful experience that an important skill in sport is the ability to get back to competition after an injury. There are psychological and attitudinal aspects of the recovery, as well as the obvious physical elements. Athletes should adopt a positive approach to rehabilitation, and work hard at any component of their preparation that is still available to them when they are injured. And remember, WID is much better than DID!
