Emotional Hurdles

By Dr. Cathlin Fitzgerald, PT, DPT, CSCS

Runners who have experienced injury know that there can be many mental and emotional hurdles to overcome throughout the recovery process. It can challenge your identity as a runner or athlete, you can feel isolated from your community, you can experience the sadness of not being able to do what brings you joy… and those are just off the top of my head!

Those on the outside, especially your friends and family that don’t run, often have trouble understanding what you’re going through. The level of mental and emotional distress that you are experiencing might be baffling to these people. I came across a recently published article about the mental health of injured athletes, and I think it can help to shed some light on what some runners might experience while injured.

The article looks at the prevalence, manifestations, and impact of trauma-related disorders in athletes. The authors specified that they looked at elite athletes (defined as professional, Olympic, or collegiate level), but I think this could be informative for any runners that place a high value on the running aspect of their lives.

It is known that events that create life-disrupting circumstances for people may lead to trauma-related disorders, and there is evidence that physical injury alone may induce a trauma-related response in athletes. In fact, many athletes experience clinically significant increased levels of PTSD (post-traumatic stress disorder) symptoms following a musculoskeletal injury. And, chronically-injured athletes actually develop post traumatic symptoms and coping strategies similar to people traumatized by natural disasters! Younger athletes (high school and college-aged), female athletes, and those with a strong athletic identity (something I see with many recreationally competitive runners) are at a higher risk of developing these symptoms.

The next logical question is: what do these symptoms look like? Symptoms specific to athletes included inconsistencies in performance, increased physical complaints, and avoidance behaviors; often behaviors that the athlete has associated with the injury.

The three key parts of trauma-related disorders are compartmentalization, dissociation, and perfectionism. The issue is that these behaviors, when used correctly, are also used for successful athletic performances. This makes it difficult to figure out when the behavior has become maladaptive and unhealthy. For example, dissociation is a great tool for any endurance athlete. It allows the athlete to detach from their environment and focus on the task at hand. However, this same strategy can also be used to manage unresolved past experiences (i.e. injury), leading to a numbing of positive feelings of joy and accomplishment.

There are a few takeaways here. First, the mental and emotional aspects of injury are normal. However, if they are not addressed it can lead to maladaptive behavior, trauma-related stress disorders, and of course a drop in performance. Don’t neglect your mental and emotional recovery when you’re addressing your physical recovery!

Aron CM Harvey s Hainline B Hitchcock ME Reardon CL. “Post-traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite athletes: a narrative review”. Br J Sports Med. 2019; 0: 1-7.