You took a tackle in practice and excruciating pain goes through your leg, or you did a crossover trying to get past your opponent and you felt your knee blow out…….
Now you’re on the mend, recovering from these injuries and about to get into physical rehabilitation to get you back to the field or court. But something else has taken a hold; you’re scared, you don’t want the pain to come back or to have another injury. You want to be better and move on; you want to play the game you loved without worrying about your next step, your next tackle, your next crossover.
Fear of movement, re-injury or pain is a really common side effect of having a significant injury. It can take you out of the game for longer than you need to be, prolong your treatment journey or, in some cases, lead to poorer treatment outcomes. In more extreme cases this fear may mean you can’t get back to the things that you want to do or what you were doing before the injury.
For some people this fear is just a little niggle in their stomach, a bit of nerves when you’re working with your physiotherapist or trying new movements. Maybe these nerves only come back when you’re doing things that seems similar to the injury, but you feel confident and safe everywhere else.
For other people the fear can be debilitating. It’s not just a niggle in the stomach, rather it’s heart palpitations and feeling like you’re short of breath when you think about playing again or trying the new exercises your treatment team has given you. It could be avoiding movements out of fear that it could lead to the same outcomes. This could generalise to avoiding physical rehabilitation all together or being reluctant to progress in treatment. In extreme cases, some people choose not to return to sport, not because their injury means its not safe to return, rather because they don’t want to go through it again.
This can be heartbreaking, and it can lead to secondary effects like impact on our mood, our sense of who we are or where we belong. It can affect our relationships, disconnecting us from our teams or the community around our sport. More generally it can feel like losing a part of ourselves if sport was a way of feeling enjoyment, peace, contentment or a way of managing stress.
It doesn’t have to be this way. The pattern we described above is called fear-avoidance. It’s a common pattern that we see following injury and when people experience pain. While common, left not addressed, it can increase our risk for poor physical recovery, persistent pain, and mental health difficulties. In the least it takes the colour out of life.
So, we encourage treatment and looking at yourself and your rehab in a holistic way. If the descriptions above feel a bit close to home, it may be helpful for your rehabilitation program to look at including psychology input. Talking through some of these fears and figuring out ways to start facing them can help you make the most of your recovery and get you back to your sport.
Some ways that you can start tackling this, include:
1. Calm the body to calm the mind:
When we get scared (nervous, worried, anxious, etc), it activates our threat system. This system is responsible for getting us away from the threat by any means necessary and to do this it changes how our body functions (e.g. increasing tension, changing how our heart beats, shifting our hormones, etc) and how our minds think (e.g. focusing on worst case scenario). This can fuel more fear, and if heightened enough or over a long period, this can slow healing time.
So, its important to help the body get back in balance and one way (of many) to do this is diaphragmatic breathing. This style of breathing can help relax the body which will help calm the mind, leading to less fuel in the fear tank. As a side benefit, a calm body can focus on maintenance and healing, and calm muscles get more out of rehabilitation.
2. Stop stewing on it and ask:
If you have fears about re-injuring yourself, ask your treatment team about it. Learn about your injury and how treatment will help you get back on track and protect you from further injuries. The antidote to fear is safety, and understanding can help our minds and bodies feel safe. So, ask and learn!
3. Focus on the next step:
Often our fears are worried about steps 8-10 rather than focusing on the step that’s in front of us. This is normal, but if we get stuck into it, it drives fear! So if you notice yourself being transported into the future, name it (e.g. “Oh, return to practice is three steps away”) and name the next step (e.g. “Next step is weight bearing!”).
4. Grow your comfort zone:
One way we face our fears is taking a graded approach to facing them. If you are worried about twisting your knee when doing a crossover, you can break that movement down into steps from least scary to the full movement (do this with your physiotherapist). Once you have figured out the steps, start with what feels just out of our comfort zone (i.e. what’s just a little scary) and then do this until it no longer worries you. Then move on to the next step in movement, step-by-step until you are able to do the whole movement.
Our fears don’t have to hold us back from what we love. They are normal and totally manageable with the right support. The suggestions in this post are a few ways you can start and all are doable with your treatment team.
If you need further support, talk with your rehabilitation provider about engaging with a Psychologist as a part of your programme and they can support you to develop these skills.
Author: Dr Tamara Bejakovich
Senior Psychologist TBI Health
