The Five Phases of Injury Recovery
Coming back from debilitating injury can be one of the most emotionally difficult things that an athlete will ever have to do. To suffer a major injury means losing one’s identity, one’s daily routine, and a major source of one’s sense of self-worth. Last year, a professional 400m hurdler I was working with on some technical issues, Alvin Miles, tore his acl, ending his 2015 season, and sending him into surgery and extensive rehab. Just this past month, Niklas Rippon, a post-collegian out of Michigan who competed for Germany last year and almost made their national team, broke his ankle after a fall in a meet.
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In both cases, these were athletes who devoted themselves 100% to the hurdles, who made tremendous personal sacrifices in order to train, travel, and compete on a regular basis. In talking with Niklas shortly after finding out he would have to undergo season-ending surgery, the disappointment in his voice was palpable. It got me to thinking that it will be a long time before he will ever get back to being his old self again. A hurdler who can’t hurdle is gonna be a grouchy dude.
It got me thinking about the grief process in general, and how it ties into major injuries for athletes, as major injuries certainly feel like a form of death for the athlete in his or her prime years of competition. Right now I’m teaching the book Tuesdays with Morrie to my sophomores. The book, written by ESPN sports analyst Mitch Albom, tells the story of when he reunited with his former sociology professor, Morrie Schwartz, sixteen years after graduating from college. When the book begins, Schwartz has been diagnosed with Lou Gehrig’s Disease. Mitch flies in to visit him, and goes on to visit Morrie on a weekly basis – every Tuesday. Throughout the period of their meetings, Morrie teaches Mitch many life lessons.
One of the life lessons has to do with dealing with loss. Morrie explains that one has to let go, surrender to the reality that one is facing. In reading this book, I couldn’t help but think that the grief process that occurs after the death of a loved one is very similar to the grief process that an athlete goes through after suffering a major injury. So I did a Google search on the stages of grief, and indeed found that there is a clear connection.
In an article at grief.com by Elizabeth Kubler-Ross and David Kessler, the two authors list and describe the five phases of grief:
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
Anyone who has lost a loved one knows that these stages are accurate. And any athlete who has gone down with a season-ending injury has gone through these stages as well.
For the athlete, denial is the stage of disbelief. How can this be happening to me? Why did this happen to me? You find yourself replaying the moment the injury occurred in your head over and over again. You find it hard to fathom, hard to accept, that one mis-step, one instant, can have such a shattering effect on your life and career. As the authors state, “we wonder how we can go on, if we can go on, why we should go on.” The authors also state that this denial is actually healthy, that too much acceptance too soon can be overwhelming, that denial is needed initially in order to move past it. But you can’t bypass it. You have to go through it.
Denial leads to anger. Once you realize that this is your situation, that this is your new normal, you feel angry. Life isn’t fair. My life has just fallen apart and no one cares. Everybody’s just going about their business like nothing happened. When you can’t do what you love, you feel bitter toward those who can, and you feel resentful toward those who are living what appear to be meaningless, vapid existences, yet tragedy never seems to befall them. Everyone in the world become an antagonist to you, the protagonist. When people offer you sympathy or encouragement, it just makes you angrier. You just want to be left alone in your misery. The authors advise that it is important to own one’s anger, to not try to suppress it or feel guilty about it. No honest emotion should be suppressed. “Underneath the anger is pain,” the authors say, “your pain. It is natural to feel deserted and abandoned.” Only by embracing the anger, by allowing the rage to filter through, can one move past it.
Bargaining consists of the “what if” hypotheticals. “What if” in regard to the past and “what if” in regard to the future. Miles injured his knee late in the workout, after a series of reps, and he just wanted to get in one or two more before finishing up for the day. What if he’d just stopped when his body had told him to? What if he hadn’t pushed past the point of fatigue? Those are the what-ifs of regret, of the past. As the authors state, “We want to go back in time: find the tumor sooner, recognize the illness more quickly, stop the accident from happening.” The what-ifs of the future sound more like, What if I come all the way back and then injure myself again? What if I’m never able to get back to where I was? Such doubt must be faced openly and honestly. These are not “negative” thoughts, but honest concerns.
Depression is what happens when you come back to the present. Between regretting the past and worrying about the future, you take note of the fact that in the here and now you are living in a personal hell. And there’s no easy way out. It’s going to be a long, slow climb out of this dark pit. There will be many days throughout the rehab process when you’ll wonder if all this work will prove to be worthwhile. Instead of saying, “I’m an athlete, I’m a hurdler,” now you are no one. You don’t exist. From the authors:
“Empty feelings present themselves, and grief enters our lives on a deeper level, deeper than we ever imagined. This depressive state feels as though it will last forever. It’s important to understand that this depression is not a sign of mental illness. It is the appropriate response to a great loss. We withdraw from life, left in a fog of intense sadness, wondering, perhaps, if there is any point in going on alone? Why go on at all?”
Many spiritual traditions refer to this state of depression as “the dark night of the soul.” And it can be very real for the injured athlete. That’s why it’s important to allow oneself to be dark when one feels dark. Don’t try to be “positive” if you’re not feeling positive. Give yourself time.
Acceptance, the final stage, is not to be confused with happiness. Acceptance means acknowledging that this “new normal” is here to stay, and that even if life can never go back to how it was, a stronger, even more authentic you can rise up from out of these ashes. You learn to treasure all of the life lessons you’ve learned throughout your journey into the abyss. And you arrive at a certainty that, as the fictional character Santiago says in Ernest Hemingway’s Old Man and the Sea, “A man can be destroyed, but not defeated.”
As the authors emphasize, the five phases don’t necessarily occur in order; instead, the injured athlete will experience all of them at different times within a day, week, month, or year. But yes, acceptance is the stage that you want to be constantly moving toward. Perhaps the most important lesson you will learn is that you never stop being a hurdler, that you were never not a hurdler, even when lying on the couch with your foot elevated, your entire leg in a cast. Sho nuff.
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