Psychology of running injuries
The right mental approach will help manage rehabilitation and could even lead to a speedier recovery. Carole gives advice on psychological strategies in recovery from illness and injury.

Psychology of running injuries

For the dedicated runner, getting injured or being ill and not able to run can be extremely demoralising. Many of you will know first-hand the characteristic withdrawal symptoms, including depression, irritability, or lethargy, that injuries can trigger off, while partners and spouses will easily recognise the moderate to severe grumpiness that can be exhibited by their nearest and dearest who has been sidelined temporarily from running by injury or illness. It's definitely no fun being injured, and there are some of us who are real experts at letting people know how we're suffering at these times!

Distress, Denial and Determined Coping can all occur at different stages after an injury

Recently sport psychologists have recognised some distinctive patterns of emotional responses to illness and injury. American sport psychologist John Heil's book, The Psychology of Sports Injuries, describes three particular emotional states: Distress, Denial and Determined Coping.

John Heil's model highlights three important principles:
  • The athlete's emotions can be affected by the experience of injury
  • The athlete's active participation in the work of recovery is something positive
  • Denial can be an important emotional response to injury
Psychologists call a reaction to a new situation such as an emotion like Distress a 'response' because the mind is responding to a situation created by external factors. A positive response like active participation in the work of recovery is called an 'adaptive response' because the mind is adapting well to the new situation. Conversely, a reaction which does not help with a situation such as a throwing a tantrum, or going to the pub to 'drown your sorrows' is called a 'maladaptive response'.

So what can I expect to feel at an emotional level after getting injured?

injured!1. Distress

Heil's model recognises that an injury or illness which threatens the athlete's sporting career will almost certainly be disruptive and disorganising in the runner's life. Emotions that you might expect to experience include shock, anger, anxiety, depression, guilt, worry and feelings of helplessness. These emotions are characteristic of Distress and are probably entirely natural when faced with the reality that you may be forced to give up your favourite activity even if not in the long term, at least for a couple of weeks.

2. Denial

Denial may be reflected in your assurances that you will soon be back on track and in top form! In some situations Denial can be relatively positive, particularly in cases where an illness or accidental injury has an unpredictable or possibly serious prognosis. In other circumstances Denial may interfere with your rehabilitation.

3. Determined Coping

Emotions that you might expect to experience include shock, anger, anxiety, depression, guilt, worry and feelings of helplessness

Determined Coping is described in Heil's book as the 'use of coping strategies in working through the process of recovery.' This reaction is considered by specialists in sports medicine as both positive and adaptive. The characteristics of this response are an acceptance of the severity of your injury and its likely impact on your long and short term goals.

Emotional changes that may affect you when you are injured are not now believed to be random and are usually triggered off by events that are meaningful to you as a person. These might include setbacks in treatment, pain flare-ups, reminders of losses sustained, for example, watching or reading about races that they might have missed or meeting up with running friends.

Immediately after injury

This is probably when you'll feel worst. Denial may be reflected in unrealistic statements regarding speed of recovery. Once decisions have been made about treatment then the most adaptive response is Determined Coping. Immediately following an operation the runner will be under severe physical limitations. Typical emotions at this time may include those of helplessness and depression. For those who have seen surgery as offering a 'quick fix' and 'forgotten' about the constraints to be placed on you by immobility or the necessity for bed rest, feelings of loneliness, isolation and frustration may well be the order of the day. At this time there is a real need for support from significant others.

Middle phase of rehabilitation

Good progress in rehabilitation will increase and enhance feelings of self-control. It may also help foster motivation getting the athlete to stick with the treatment plan and maximise collaboration and co-operation with physiotherapists and doctors. At the same time setbacks during this period may produce transient feelings of anxiety and/ or depression, with the drudgery and hard work entailed in rehabilitation at times leading to increased feelings of anger and irritability. As always, consistent continuing support and encouragement are essential.

The end in sight

As recovery and rehabilitation progress and the treatment received becomes more specific and focused on the possibility of a return to running, more productive patterns of Determined Coping will come to the fore. At this time the need for expressions of confidence is necessary from the significant others, especially coaches, if failure and re-injury is not to cause setbacks.

Returning to running

The final stage - the return to running will be a great relief not only to you  but to the significant others involved in the recovery process
The final stage - the return to running wil be a great relief not only to you but to the significant others involved in the recovery process. However this stage can also give rise to a number of negative feelings especially when the runner realises that this is just the beginning of the climb back to the level of performance of which he or she was capable before the injury occurred.

Role of coaches during recovery and rehabilitation

One of the most important people in a injured runner's world will be their coach, if they have one. During the period of recovery after injury, especially during the return to running, contact from the coach to the runner is crucial and neglect of the runner on the part of the coach can lead to frustration and an undermining of the relationship.

Developing the listening skills to really 'hear' what the athlete is saying and coming to a clear understanding of the nature and severity of his or her injury or illness and the implications for future training is essential. To do this the coach may have to go to some trouble to ensure that channels of communication with the runner are maintained at all times.

Psychological strategies in recovery from illness and injury

Goal setting, the use of relaxing and self-healing imagery, positive self-talk and importantly the development of a good network of social support is useful. Recovery from a serious injury or illness can be a lonely and lengthy business; however, the help and interest of good friends can make a significant difference and speed the return of the injured athlete to their favourite outdoor activity.

Practical tips for coping with recovery:

Make an assessment of the situation that is both realistic and appropriate. This will allow you to make the best decisions most likely to bring about the most rapid recovery. Be neither over-cautious nor too stoical. An example of being too cautious might be rushing to phone your favourite physiotherapist at the slightest twinge or niggle, while being too stoical could be letting an injury or illness drift on, getting worse, without taking proper notice of what are signs of significant problems.
You may have rethink your race training if injured
London marathon
For example, what about this scenario?

'I've now got 12 weeks before the London Marathon and my physiotherapist thinks I'll be back running in four weeks time. No sweat! I'll still be able to do the race, although it looks like I'm going to really need to push the training if I'm going to make up for lost time. Perhaps if I doubled up and trained twice a day for the first three weeks that would get me back on track for under three hours!'

A more realistic balanced approach might be:

'I've now got 12 weeks before the London Marathon and my physiotherapist says she thinks I'll be back running in four weeks time. No sweat! I'll still be able to do the race but must modify my goals. I need to go and talk to someone knowledgeable as to how to adjust my training programme.'

At other times a self-help response based on good sense and past experience utilising first aid measures such as RICE can be the best way forward. Alternatively, an early consultation with your GP, physiotherapist, sports injury clinic or, in cases of urgency, with your local A & E department could be a better plan.

What types of responses are not helpful and should be avoided?

Maladaptive responses include those where a runner either conceals or denies an injury, or, on the other hand, exaggerates the injury or illnesses' severity or extent.

Examples include

'I haven't really been training as I should have been. If I do the cross-country on Sunday I'm going to get well and truly walked over. If I tell my coach I've got a problem with my knee I'll be able to get out of running. I'll do some proper training before the race next month.'

'I can't believe I've been selected. Yes, I know I've got this knee problem but that's sure to be better in time. I'll just keep my fingers crossed! I dare not tell the physiotherapist. He's told me already that I actually need to lay off training for at least another month but I'm not giving up my place on the squad, I may never get asked again!'

There are all kinds of reasons for such distorted perceptions and responses and several have been recognised in the sport psychology literature. Consciously or sub-consciously an illness or injury may function in many ways, for example, as a 'get out' of a difficult situation, a 'weapon' against a pressurising coach or parents or maybe as a source of 'secondary gain' or attention.

Frequently other people are more perceptive about you than you are about yourself

Frequently other people are more perceptive about you than you are about yourself. If in any doubt about what is going on, it may be a good idea to talk things through with a trusted friend - particularly if that person can be completely objective because they don't have a vested interest in the situation.


Optimising your recovery from injury requires a balanced approach. In general there's very little you can do to speed up the natural processes that are at work repairing damaged muscles, bones, tendons or other tissues, on the other hand it really is quite easy to hinder or delay recovery if, for example, you neglect advice or try artificially to force the pace of your return to fitness.

To assist these processes it is important to realise you are in control and by watching things like your diet, getting proper amounts of rest or adhering to regimes of exercise you can ensure that you provide the best conditions for recovery. Remember this is a situation where patience and optimism are highly desirable qualities. Remember too that however much you might like to, you can't turn the clock back, but you can learn important lessons about yourself and your approach to your sport!


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