Three years ago, 37-year-old Angela Bekkala toed the line for a half marathon. She’d been sticking her paces in training and was ready to go, but two miles in, Bekkala began to feel a familiar foot pain. Convinced a former case of tendonitis had returned, she finished the race far off her goal time. When she returned to her physical therapist and talked it over, however, they came to the conclusion that Bekkala was physically fine. It was her fear of re-injury that had held her back.
Like many runners, Bekkala was dealing with the psychological effects of her injury rather than the physical. Just as the mind can play a crucial role in race performance, so too can it wreak havoc on injury management. “I see this quite a bit,” says Dr. Brent Walker, president of the Association for Applied Sport Psychology and associate athletics director for Championship Performance at Columbia University. “Physically an athlete is ready to return, but mentally that isn’t the case.”
When not managed correctly, the athlete’s perception of injury and/or state of recovery from injury can sabotage future efforts in race performance. That’s the bad news. The good news, however, is that under the guidance of the right practitioner, athletes can retrain the brain to allow for full recovery and a return to normal levels of execution.
Winning The Mind Game
Maryland based physical therapist Dr. Gene Shirokobrod says that patients who struggle to recover from injury are often fighting a past bias. “You form a perception based on experience and common sense,” he says. “If you’ve had a sprained ankle in the past, for instance, and then turn your ankle, you don’t want to put weight on it for fear of further injury. But if you then see a PT and after assessment he or she tells you it’s not very serious, you can accept that and begin to move on.”
Shirokobrod will typically listen to a patient’s version of events and then do an assessment to see how the two match up—or not. “I’ll address whatever tissue injury might exist but then slowly integrate them back to normal movement,” he says. “With a graded introduction to movement, I am reinforcing to the patient the belief that he or she is OK.”
A 2011 study, The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress on Chronic Musculoskeletal Pain backs up this approach. The study found that “For chronic MSK [musculoskeletal] pain disorders, there is compelling evidence that an educational strategy addressing neurophysiology and neurobiology of pain can have a positive effect on pain and … physical performance.”
Two-time Ironman finisher and sports psychologist Dr. Jim Taylor says that runners who haven’t retrained their injury thinking often self-sabotage their race results. “Runners can be highly invested in their events and fear failure,” he says. “If they are hyper-sensitive to past injury, they have an out if they aren’t performing as they’d like.”
This was exactly what Bekkala experienced. “I hadn’t had any pain or weakness in my foot for weeks prior to the race,” she says. “But when I came face to face with going after my goal time, fear found a home in my foot.”
Walker says that in these cases, athletes and practitioners need to drill down and determine if the mind is playing tricks on the body. “If all the tests and analysis indicate no injury, then what else is going on?” he asks. “This is where I give athletes cognitive strategies to reinterpret what’s happening and that their pain signals are not real.”
Sometimes, Walker says, patients believe they must feel well to run well, so if the perception is there that something is amiss, performance falls apart. “This is where patients need to reframe situations so that they can run well no matter what,” he says.
Shirokobrod says that patients need to learn to trust their bodies. “If you’ve consulted with someone who tells you it’s OK, you can work on building independence and awareness of your pain perceptions,” he explains. “Once you take control of the situation, it’s empowering and it becomes much easier to manage in the future.”
Since her foot injury a few years back, Bekkala has made real progress in this department—a subsequent injury didn’t have quite the power over her brain as the first. “It definitely surprised me at how much I needed to rehab my mind in addition to rehabbing my injuries,” she says. “It’s easy to do my PT exercises every day. The difficult part is convincing myself that I am OK, strong, and healed. But it does get easier everyday.”