25 March 2011

Recovery from an Injury

"We fall, we get up, and we persist" - Michael Barry 
Chances are we have all been there at some point in our history of being an athlete - the Sports Injury.  Watching the numerous falls during the cold wet stages of Paris-Nice and Tirreno-Adriatico made an impression on me. Fall after fall was occurring in the peloton, yet the riders pressed on to the finish line trying to maintain their concentration, sometimes falling repeatedly, only to get back on their bikes to ride on that day, and the next day.

A handful of riders chose not to get back on their bikes but to instead abandon the race, perhaps not willing to risk the remainder of their season, or perhaps too wiped-out from the day's experience. These are professionals who have dealt with falls repeatedly. How do they bounce back after terrible accidents? I couldn't imagine the pressure if my income depended on a full recovery, as it does for a professional cyclist.

Going from a body in free motion, to a not so freely moving body is just plain hard. There are the first few slow motion moments of "oh no", then there is the wish of "can I please do that over with a different outcome," and then reality sets in as we accept the long period of changed mobility, struggle, and loss of our usual self. The first two weeks might be the hardest, then a new purpose is found in the recovery process. The same determination that gets us out doing our sport can be redirected toward healing our body.

Just as our physical training when healthy is not a steady line to improvement, hanging in there mentally after a fall or crash may require the same attention and reassurance that things will be alright. There are ups and there are downs. I am recovering from an injury. Five months ago I had four fractures to my pelvis from a fall mountain biking in Utah. I often hear, "you are so in-tuned to your body". I imagine most athletes must be just like me. Overly, uncomfortably, overwhelmingly aware of our bodies.

When our bodies don't work as usual we are even more aware. Most of Sports Psychology seems to focus on training our minds to imagine success, to push ourselves to our limits, to have faith in our desired outcome. An accident can change the balance of mind over body, to body over mind. We can no longer do what we want. Even though we are not professionals, the trauma of the accident, the sudden change in mobility, and the unknown of recovery can become overwhelming.

I recently read an interesting article about a man named Michael Ferrara who was a wilderness first responder. For over 30 years he devoted himself to responding to mountain rescue, paramedic service, and ski patrol in Aspen, Colorado. Then one day he could no longer respond. He was a victim of mental injury (not mental illness). Similar to physical injury, mental injury occurs when the mind is left unattended after trauma. If powerlessness and helplessness are two of the worst feelings any human being can experience then there is certainly more than meets the eye to a sports injury.

When I read Jens Voigt's emotional letter about the ban on race radios a few weeks ago, I couldn't help but think, has he gotten over that fall of his last year? It was thought that Joseba Beloki never fully recovered mentally from his terrible accident in the 2003 Tour de France, even though he attempted a comeback. I think there may be a difference in recovering from an over-use injury or miss-use injury (improper fit), compared to a crash or fall in cycling.

"Oh, now that was a crazy fall, that was a crazy fall." ~ Phil Ligget [1993 World's - somebody crashed on yellow line].
Recently I have appreciated the links and visits to my blog from other cyclists, but have noticed when visiting their own blogs, a number of them mentioning "coming back from a recent injury" - a far too common occurrence in this sport. So for those of you interested, as I am myself, in the total package of recovery, I have compiled a number of links to articles written on this topic of injury recovery and Sports Psychology. These articles speak of PTSD and over-vigilance to another fall occurring.

One of my previous Recommended Reading blog posts was this well written article by Michael Barry:  Michael Barry’s Diary: Bite the dust, then reach for the stars 
Toolbox: Recovering from Injury, Part 2
Mind and Body (I) – Psychological Factors for Sports Injury Rehabilitation
Toolbox: Recovering from Injury PezCycling.com
Toolbox: Recovering From Crashes, Part 2 PezCycling.com
How to Keep a Physical Injury from Becoming an Emotional Problem
Lots of great articles on Sports Psychology at Whole Athlete 
Sports Psychology - Tips for Faster Sports Injury Recovery 

A summary of tips for recovering from an injury in cycling:
  • learn about your injury
  • seek out the best practitioners to treat you
  • form a team around you of people interested in your healing 
  • talk about your experiences with people who really know you
  • listen to your body
  • sleep well, eat well, 
  • avoid added stress such as travel or intense exercise
  • mange your stress (find another outlet beside your usual exercise)
  • learn how to describe your pain to others (and ask for what you need)
  • set goals, ask questions, and direct your own care (this is part of regaining your power)
  • create a feeling and environment of safety for yourself 
  • accept that it happened and the accident is in the past 
  • not only meds, but heat, cold, and touch are affective in controlling pain
  • focus on what you can do, and stay present in the now
  • worrying and fear are almost worse than reality   
  • rest and be kind to yourself, healing takes lots of energy
  • don't expect healing to be a straight line up
  • slowly take on only what you can handle, and then a bit more 
  • find other ways to hang out with your usual training partners
  • expect that your mental and physical healing might not progress together
  • don't talk about your injury while riding your bike, save it for off the bike
  • be positive but honest
  • accept that healing takes time and what you are experiencing is normal
  • don't get discouraged when others say "let's go for a ride soon", what they are really saying is that they miss riding with you and wish you a speedy recovery. You'll know when you are ready to return to the group or team ride. 
  • use this opportunity to develop all aspects of your performance, mind and body. 
Follow-up: An intersting post by CyclingTips, a blog that I follow: Crash Prevention March 29, 2011