Injury and illness- where's your head at?

This article came out of a casual discussion with an athletics coach about the thought processes and behaviours exhibited and applied (or not!) by her athletes when ill or injured writes Oliver Johnston, personal trainer at  OWJ Health and Fitness. 

There is, of course, already plenty of research and discussion about this topic out there in the public domain, much of it written by experienced, professionally qualified practitioners in the field or related disciplines.  This article does not attempt to join that pantheon.  Rather, this is intended to explore the themes anecdotally and experientially, and give some food for thought.

We have all been ill and injured at some point.  Occasionally, this will have conflicted with or even obliterated some of our training or athletic goals.  I have been there on several occasions: a shoulder reconstruction not long before my first triathlon (I still did it, though), a missed London marathon through injury, another where my impressive target time was holed by incipient illness that caused me to pass out on Embankment (see runbritain passim).  I saw all of this as part of the ebb and flow of focused sports participation, and dealt with it in a sanguine, if obviously disappointed, manner.

 My perspectives shifted massively, however, following a serious traffic accident in Spain in 2011 on the journey home from a 10k road race in Leon (see /blogs/the-road-to-recovery-continues).  There is being ill or injured, and then there is lying in intensive care with open fractures in both legs, smashed feet, pelvis, ribs, internal bleeding, crushed lungs and on a full oxygen supply.  I could not sit, let alone stand, walk or run.  It was three months before I stood on my own two feet again.  And promptly fell backwards on to the bed.  It was six and a half months before I left hospital.

 In the following couple of years – not days, weeks or months – I buried myself in an endless cycle of treatment, physiotherapy, rehabilitation and training.  In addition to all of the various medical appointments and home therapies (stretches, TENS and the like), I spent two hours twice a day in the gym, pool or on the bike.  Often this was in the knowledge that I was shortly going to lose condition before I regained it, as in two steps forward and one step back when, for example, I underwent further ankle surgery to remove metalwork.

 Eventually I was able, just about, to hobble a 10k race 18 months after the accident, although I was completely hosed with prescription painkillers. 

 

Three months ago I completed my first post-accident half marathon.  In between I have also gone from falling off my road bike because my ankle was too weak to unclip the pedals, to completing 100 mile sportive events in gold standard time.  Despite my now-permanent physical limitations (my calves are wrecked and my balance is shocking) and, yes, disability, I am now a personal trainer and exercise class instructor.

 What the coach wondered was whether I had something else mentally that other people do not have.  Why do some people enter an internal vortex of gloom and believe that the world is conspiring against them (helpful note: life is not fair.  Who said it should be?), while others accept the situation for what it is and do what they can to get themselves out of it, or at least improve?

 While undergoing daily intensive physiotherapy and rehabilitation, putting myself through three hours at a time, I saw so many patients come to the rehabilitation suite, be dropped off, sit around waiting for the therapist, undergo their 45-60 minutes of one-to-one treatment and instructed exercises, and then wait around until they were collected again.  Why did these people not want to do more, to use the facilities and the expertise while they were available, to make the most of their recovery while there was still recovery to be made?

 Whether or not it is something that one is born with, it is something that can be trained, like anything else in sports performance.  While I am very satisfied at how far I have come, let me be clear: there have been so many mentally, emotionally and spiritually difficult moments along the way, apart from the physical catastrophes.  I have worked hard on these aspects too.  Sure, I had the benefit of plenty of time to work out who I wanted to be in relation to my situation.  But I also developed thought processes and behaviours that make me much stronger mentally and emotionally in dealing now with adverse situations.  So when, as this summer, my trisuit zip broke right before a duathlon, leaving me looking like a poor imitation of Freddie Mercury, and then I found immediately before the ride that my rear tyre was soft-flat, it was frustrating but easy to accept and do my best, even if that meant being slower than last year.

 In this way, in a small way, illness and injury can be a good thing.  Perhaps it can allow you some time to think about other aspects of your sport, particularly the mental facets and how you want to approach them.  For my part, as a personal trainer, injury does not 'need' to happen, but it does, especially if you are training hard at the competitive or elite edge where severe strain is placed on muscles and joints working at the extreme end of their capacities.  For example, see Andy Murray, who withdrew before the French Open in 2013 (when does Murray ever want to miss a major?) with a recurrence of his back injury – on which he would later have surgery – but went on to win Wimbledon for the first time in the same year.  Or Alistair Brownlee, who underwent surgery on an ankle injury exactly a year before the Rio Olympics this year, putting his qualification for the men's triathlon event in jeopardy.  He went on to win the gold medal, of course.  So, accept it. 

Likewise illness happens, even to professionals.  Come on, you know this.  Think James Cracknell before the 1996 Olympics.  A dream shattered, but look at the golds that he went on to win in 2000 and 2004.  For me personally, I see illness as a helpful indicator that something is wrong, that my body is out of sync and needs to re-adjust.  Presently I seem to have an annual episode of total physical breakdown.  I take this as a sign that I have overdone it and pushed my body too hard.  A good week of sleep, rest, food and drink invariably sorts it out and I come back fresher and more energised than before.  We all know deep down that this can and does happen, that we will feel better than before the malady, so why beat ourselves up about it?  Embrace it and go out for coffee and cake, or binge-watch a box set.

Think what you can do, not what you cannot do.  Depending on your injury (or illness), there is still so much that you can do.  Be constructive.  If you have pulled a hamstring, then you can work on upper body strength and fitness (you know that you need to swing the arms for an efficient stride).  Or get in the pool for some of the so-called poor man's physiotherapy, and work on your cardiovascular fitness and respiratory efficiency.  Similarly, you can work on your core strength in this situation.  I am not talking (just) about knocking out a few sit-ups but seriously focusing on the many smaller and often ignored muscles that wrap around the abdominal contents but which are so vital for any sport.  The core is implicated in any stable efficient, effective exercise movement, but properly honing this muscle group often falls way down the order of priority.  A good option here is a Pilates class.  Try it – done properly, it is harder than you think.

Following on from this is flexibility and posture.  The lower back area and erector spinae can and should be included in any core work out, since the muscles here are also important for good posture and stability.  There is much that can be worked on at home, from basic stretches to using a good quality foam roller to perform myofascial release.  You can even combine this with your binge watching (I watched surely the entirely back catalogue of MacGyver while performing resistance band stretches and strength exercises on a sofa in Spain once released from hospital).  So why don't you do this, if you really want to do something while you are out of action?  Note, you do not have to; again, you can embrace the break from training, but it does not have to be the catastrophe you may believe it is.  As Eddie Jones, the England rugby union coach, is fond of saying, 'I can only control what I can control'.  So true, so believe it, internalise it and act upon it.  But this really does mean believe it and act on it, not just pay lip service to it.

While I do not think that I had a particularly special approach to injury or illness before my accident, it was balanced and healthy enough, certainly not a cause for mental implosion.  What has happened since has, though, given me something that frequently only people who have been through such an experience can really get, which is perspective.  It is easy to say this, but having lived it makes it easier to walk the talk. 

And I do not mean that only my particular situation provides the perspective.  My eyes are now more open and understanding of other people's unfortunate, horrible life situations in many other contexts away from sport.  This was a thought that the coach at the top of this article mooted, whether those who have been through some kind of adversity are mentally stronger and more able to cope with minor setbacks than others.  Having reflected on this, I think it must be true.  What I think is also true is that all of us have the capacity to cope with these setbacks (more) effectively and focus on the positives, what we can do and influence.  It just takes some knowing, doing and realisation, preferably without a horrible car accident or other catastrophe to discover this.  Work on it, find a mental approach, a thought process and associated behaviour that works for you and reap the rewards.  As a starting point, I recommend reading The Chimp Paradox by Dr Stephen Peters, the acclaimed sports psychiatrist.  Several of his ideas found their way into this article, and via others mentioned in it.  I think it helps, and while you are injured, you will have plenty of time to read it!

P.S.  And in case injury really does strike at just the worst possible moment, the climax of all your hard training, then you can do worse than follow the example of Derek Redmond in the 400m at the 1992 Barcelona Olympics.  Determination, courage and dignity; this is not failure.  Truly inspirational.  Everything you need is already inside you; you just need to find it.