The Road to Recovery: Endorphins and the Injured Athlete
“The spirit, the will to win, and the will to excel are the things that endure. These qualities are so much more important than the events that occur.”
I was four when I joined my first co-ed basketball team at the local YMCA. Since then, I have identified myself as an athlete above all other things. This self-identity is stronger now than it has ever been. I have chosen to be a professional water sports coach as my career and my hobbies include only
athletic pursuits (kiteboarding, paddleboarding, running, cycling, weight lifting, yoga and climbing). With a flexible schedule, my days are typically filled with at least a few different activities. Recently, I suffered a Talus dislocation during a climbing accident. If you are not familiar, the Talus is in the ankle. I was quite lucky in that it was a closed injury with no fractures-very rare with this type of high impact injury. Even so, I now face 10 weeks in a cast (at least 4 of those non-weight bearing) and 4-6 months before a full recovery. Now, I have had a serious injury
before-a series of head and neck injuries that left me in physical therapy for over a year, forced a medical retirement from the Army, and continue to cause me chronic pain an discomfort. When dealing with that injury, I was surprisingly uninformed about the psychological effects. As I approach this injury, I am aiming to be better informed and I hope this information helps other injured athletes out there.
We have all heard of the “runners high”, but what is that really? Endorphins. These amazing chemicals produced by the pituitary gland block sensations of pain and produce overall feelings of euphoria (in addition to modulating the appetite, releasing sex hormones and enhancing the immune response). The release of the chemical is brought on by strenuous exercise. Endorphins were accidentally discovered in the 1970’s by scientists doing research into drug addiction. They wanted to know why our brains have receptors for chemicals from the poppy plant. The answer was, of course, that our brains already produced chemicals (endorphins) with the same neural receptors as morphine, opium and heroin-thus the natural high for athletes. This helps to explain why athletes seem to become addicted to their sports.
High on endorphins, it is not uncommon for athletes to try to perform through illness or injury. The more fit the athlete is, the more receptive they are to endorphins. Additionally, the longer and harder that fit athlete trains, the more endorphins are released. So, when an athlete suffers an injury that restricts or prevents their training, the consequences are psychological as well as physical. An injured athlete is susceptible to depression, anxiety,
moodiness, irritability, weight gain, insomnia and low self esteem. The outlet that the person once had to release stress and regulate the body is gone. Often, the athlete suffers from a loss of identity. What once defined the person is now temporarily or permanently gone. Coinciding with this is the real or perceived feeling that they have lost their “group”. It is easy to withdraw partially or completely from a group. Even by attending practices, games and training, the athlete is unlikely to experience the same social and psychological feedback from the group as they did when they were “fully functioning”. Finally, the fear of what comes next can be overwhelming. A knee injury, a broken bone, or (in my case) a dislocation can leave a lot of doubt about the recovery. Will I be as strong as before?, What happens if it doesn’t heal right and I can’t be 100% again?, What if I can never play again? are just some of the questions that can plague an injured player. As important as physical rehabilitation is, psychological care and rehabilitation is just as important for a complete recovery.
An athlete who has effectively been sidelined goes through the same stages as a grieving person-essentially, the athlete is also grieving a loss. The first stage is denial. It is hard to deny the reality of a broken born or torn muscle. When I hurt my ankle, all I could think for the next few hours was that this could not possibly be happening to me… After denial, anger is experienced. Anger can be directed at the other player or exercise they were performing, a coach,
themselves..the world. It is an irrational, but normal response to a situation that the athlete was not prepared to face. An athlete will then experience the bargaining phase as they come closer to accepting what has happened. This will often take shape during rehab. They may take the healing process to the extreme, trying to push the physical therapy (for example) too hard, thinking that if they display the same vigor in PT as they did on the field, the injury will heal faster. While it is important to adhere to doctor’s instructions, overdoing the rehab can do more harm than good. When he/she realizes bargaining their way to health doesn’t work, depression sets in. The loss of full health, identity and group all contribute to this stage. This is the stage where it is important that the athlete is surrounded by their group and encouraged to think of positive outcomes rather than negative ones. Finally, acceptance of what has happened and what needs to be done to get better (which is often, making the best of the rest time). Understanding the stages as you go through them can be very helpful.
Throughout this process, there are a few strategies that can be very helpful.
1. Learn about the injury. When I was suffering from head injuries, I read everything I could about the injury. The more I understood, the more in control I felt of the situation.
2. Try setting appropriate goals for yourself in your rehab. Once I get out of my cast, I likely won’t be running that week, but maybe I could start with walking 1/2 mile or maybe even a mile.
3. Keep up some type of modified training if possible.
4. Maintain a positive attitude and stay connected with your athletic community. Simply because you are hurt doesn’t mean you can’t contribute to the team or community in some way.
5. If dealing with the injury becomes too difficult for you, seek counseling.
While I have experienced the healing process many times before, it always helps me to be reminded of these things that I have written about in this article. I can see exactly where I am in the process and I still have a little ways to go before I have even fully accepted my most recent injury. Remember that an injury is not the end of everything-it is just a setback, part of the territory of being an athlete. Reach out to your fellow athletes and friends as you heal. Keep your chin up and have a speedy recovery.