Coping with injuries

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Vulnerability is hard to accept.

Most of us who have been involved in exercise or sports have experienced injuries at some point in our lives. Some injuries are so minor that they have remained unnoticed, some so severe that they have put a complete end to participation in exercise or sports. Working in the field of rehabilitation has brought to my attention many different cases and some of them have really been startling to me. There are people who go on with their lives with injuries that affect their normal daily living and place some serious restrictions on their lives. Some people come to me seeking help only when they can’t even walk 200m. Living with some kind of pain seems to be surprisingly common and I’m not talking about occasional back or neck pain. When we first get signals from our body that something is going wrong that alert us to possible problems we tend to change our behavior in some way, for example, by stopping our daily run, easing up on our gym program etc. Then, as time goes on and the minor pain remains, we start to forget it or ignore the pain and try to get back to exercising. The idea of lost training hours gets to us and we might exercise twice as hard to ‘win back’ the lost time. This is the point when things start to go really wrong and get really bad!

The human body is a very intelligent structure. When we put stress on it, it becomes stronger and can handle additional stressors much better. A very simple thing to remember is to allow the body sufficient recovery and to allow its strength levels to increase. This very simple thing is something that we just don’t seem to understand even though it is a very simple and logical concept. Minor pain becomes a part of everyday training, which means that, for example, minor injuries, micro-tears and cellular fluid imbalances slowly progress to become major injuries that are far more complicated to deal with.

The stage model in sport psychology deals with the injury process in five stages. These stages are called denial, anger, bargaining, depression and acceptance. The model suggests that person goes through these stages before healing can begin. Of course this model does not occur in every situation, but at least some of these stages can be identified in most cases. What do these stages mean then?  Many injured people don’t really want to believe that ‘this has happened to me’. Denial is quite common, especially in the case of overuse injuries, which start with minor pain and do not stop individuals from exercising. ‘It’s nothing, just a little knifestab in the calf everytime during a run.’ I have tried to convince myself with amazing arguments. Just yesterday my old friend ‘runners knee’ decided to pay me a visit, but I managed to reason myself into thinking that it wasn’t actually anything to worry about. Anyway, if and when an injury is real, denial won’t help you at all. After denial comes anger. For Finnish people especially, this is the time for blame by finding out who or what is responsible for our problem. ‘Somebody sold me wrong kind of shoes’, ‘the road surface was crappy’, “My personal trainer doesn’t know what he is doing’ etc etc. We are actually quite skilled in finding fault in everybody else but ourselves.

Plantar fascitisPain = potential tissue damage. That’s the time when you should think about if continuing exercise is smart thing or not. After the anger stage, bargaining comes into the picture. ‘Ok, I can’t run 10km, but I will do 5… but twice as often and twice as fast.’ A good idea? No!

 

When bargaining does not work, we move to depression. ‘I will never run again’, or some other smart idea. The sad thing is that some people do not get over the depression stage at all and they stop exercising completely. The final stage of the model, acceptance, is surprisingly uncommon. I have seen the presentation of all of these, but acceptance seems to be missing in most cases. Even when people are already in rehabilitation and doing specially planned exercises, they are still in denial, angry abd bargaining all they can. Oh yeh, and depressed too! I would say that most people just go through the three stages: denial-anger-bargaining and then it starts all over again.

DenialEven though the stage model or any other model can’t totally explain human behaviour, it does give us clues about the ways we handle difficult situations. The most important thing is to accept the fact that sometimes you train too hard or just get unlucky, and to get back into normal shape, rest and special planning is required. So maybe, today, I will finally start paying attention to my own mobility and pelvic control, to minimize all my minor injuries that keep me from coming back when I try to train harder. Acceptance is the key, whether the advice is coming from yourself or from somebody else, like a physiotherapist or specialist sports coach, who just knows better. However, the decision to do something about your problems can only come from one place and that is you, and how well you can motivate yourself to take the necessary steps to heal. I will leave you with a wise Chinese saying – ‘The Teacher can only open the door, but you yourself will need to step inside’.

Aki-Matti Alanen

Physiotherapist & FAF instructor

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