Tag Archives for " injury "

Mental Moment-grief in performance

Kubler-RossGrief comes in many forms. Usually what most people think of as grief is in dealing with sickness or death however in life and in performance there are many other forms of grieving but the way you deal with it is similar.

In performance situations, performers grieve in situations that include the following: accidents, injury, loss of money, loss of status, ‘losing’ a race, game, audition or event, not playing, being cut and transitioning out of their sport. I find in my work with clients that grief in some situations is easier to deal with than others but it doesn’t mean that you don’t have to grieve. For example, performers get used to ‘losing’ (it doesn’t mean they like it) which makes it more familiar and routine but injury is not which may make it much harder to deal with. Grieving in the former situation generally happens much more quickly than the latter.

The following is the Kubler Ross steps for grieving:

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Whether someone is dying or transitioning out of their sport these are the steps a person should go through to deal with the situation. Again the amount of time it takes depends in the ‘severity’ of the situation and the person.

What happens if you don’t move through these steps? You get stuck in denial or anger or bargaining, don’t move past the stage you get stuck in and are not able to let go of the situation. For example, when one of my musicians loses an audition he stays stuck in bargaining and depression and is unable to get to acceptance. The implications of this are that every time he goes to another audition he’s unable to go through the audition with a clear slate.

These situations don’t magically disappear into the universe. They stay with us until we deal with them.

Happy week!

Dr. Michelle

Photo credit: houseforkim.com

Mental Moment-psychologically proactive

Last night, I was fortunate to be able to give another lecture at SOLPT I got to talk with a group of people recovering from injury and explain some of the psychology behind injuries.

What a highlight it is for me to talk about how an injury is more than physical and that coping with it, is very mental & emotional. People don’t really know this stuff. Sure people understand that pain involves shedding a tear and an occasional four letter word but there is a much larger connection between an injury and what goes on mentally & emotionally. There are issues around motivation, self-esteem, confidence and many other potential psychological barriers to dealing with an injury.

Someone in the group asked how people can be more psychologically proactive. She said she was physically ready to return to rowing but not mentally. This is so common. I told her, yeah, this is a challenge but that if she gets injured again (not hoping that happens) what’s important ,now, is knowing that there are psychological things that she will need to deal with in order to fully heal. In her current situation she’s physically healed but has some lingering psychological barriers to still deal with.

Last night was such a great reminder for me that somehow people need to get this information before they get injured, play their sport or as they are becoming a concert musician. I am committed to doing my part in the education process so that people can be more proactive versus reactive.

Thanks to Tammara & Alexis at SOLPT! Love SOLPT and the work they are doing and am appreciative for the opportunity to work with them.

Happy Thursday!

Dr. Michelle

Photo credit: alevelpsychology.co.uk

Mental Moment-injury

An injury is always a surprise. We don’t know that we are going to get injured and we don’t expect it to happen. Unfortunately sometimes it still does. It’s important to deal with the emotions around an in joy.

Getting injured

As I said, an injury is never expected. When something happens in your life that isn’t expected what comes with it? People go through Kubler-Ross’s  stages of grieving: denial, anger, bargaining, depression and acceptance.

Kübler-Ross noted that these stages are not meant to be a complete list of all possible emotions that could be felt, and, they can occur in any order. Her hypothesis holds that not everyone who experiences a life-threatening/-altering event feels all five of the responses, as reactions to personal losses of any kind are as unique as the person experiencing them.

You must feel and move through these emotions in order to effectively deal with an injury. Why? Think about what it means to get stuck in any of these emotions: denial, anger, bargaining, depression. I have had many elite performers come to me because they get stuck in denial or anger and are not be able to find their way out.

The denial and anger phases make it difficult for an elite performer to get help with their injury. Initially many elite performers disregard the pain and ignore that a problem exists. It’s not usually until an elite performers can no longer perform at all that they stop.

Taking care of an injury

The sooner you realize you have an injury the sooner you can get it taken care of. 🙂 Easier said than done.

Once realized, the  injury causes a performer to feel a sense of guilt that they have not done something they were supposed to do and caused the injury to happen.

  1. A performer will experience a huge amount of anxiety. This anxiety stems from not being able to perform, letting other people and teammates down and fear of the unknown.
  2. A performer will experience stress. What will the performer do? Many performers are uni-dimensional and don’t have other passions or interests because they’ve put all their energy into performing. How will the performer make money? How will the performer pay for surgeries, physical therapy and a performance consultant?

These are mixed in with Kubler-Ross’s stages of grieving but also above and beyond them.

Recovering from your injury

Do you want to be as strong if not stronger after the injury? If yes you need to ride the injury train till the bitter yet sweet end. You need to recover. Half or three-quarters recovery is not going to get you to where you ultimately want to be. Full recovery will.

This is the perfect time to focus on keeping yourself motivated by doing what you can do in preparation for coming back and keeping yourself motivated. It’s also a great time to try something new; pick up a hobby.

Some performers stay in the denial phase through the processes of getting and taking care of the injury. It’s not until they  are recovery that they begin to go through anger, bargaining and depression. It is laden with heavy emotions.

Coming back

Caution: if you are not mentally and physically cleared for performance don’t do it.

The better your injury feels the better you’ll feel. This doesn’t mean that you are psychologically prepared to rerun. The better the injury feels the more anxious you’ll get about jumping back in. Whatever you do please follow your doctors instructions and that should include coming back slowly.There are also many emotions around coming back. Some performers deal with PTSD, lack of confidence as well as many others.

Here are some things to keep in mind to help stave off injury:

  • Replace shoes and gear frequently.
  • Have your equipment checked by someone else on a regular basis.
  • If for whatever reason you don’t feel ‘right’ on any given day, take the day off. When you don’t feel right everything is off. This leads to frustrating and lack of focus.
  • If you start experiencing signs of burnout, stop, regroup.
  • Once a day check in with your mind and body to see how things are feeling. Be honest with yourself.

You can’t get to complete recovery and back to performance without acceptance and you can’t get to acceptance without all of the other emotions.

Happy Tuesday!

Dr. Michelle

Photo credit: crockettclan.org

Mental Moment-lessons in being sick

I have been sick on my vacation but it provides a lesson in doing the right thing and listening even more closely to what my body is saying. For me there are many mental hurdles in going from being a very active person to not being active at all. Besides getting the flu there are other situations that elite performers should work on developing the ability to take care of youreself: injury, illness and burnout being a few.

Taking care of yourself

Sometimes the the most difficult thing for people is to take care of themselves and as an elite performer this is important for you so that you have the ability to do what you do. I find there are a couple of things that get in the way of people being able to take care of themselves: the negative messages they received as kids about whether or not they should take care of themselves and actually how to do it.

When you were a kid there were all sorts of conscious and unconscious messages floating around. Messages about emotions, food, weight, exercise, academics and self care. Many clients see me to help them bring awareness to the unconscious messages and help rid them of the conscious messages.

Besides the emotional end of taking care of yourself there are so many other aspects of it that you might not think about:

  1. Western medicine
  2. Eastern medicine-what are the many alternatives, what is going to work for your and how do you pay for it
  3. Do you take time off from your art, craft or sport (partially emotional)
  4. Listening to your body (partially emotional)

All of these things can make for a complication situation. Instead of dealing with the emotions and logistics some people shut down.

Coming back

The last very difficult mental and physical challenge for a lot of people is coming back after the flu, illness, injury or burnout. You have to ask yourself some difficult questions when returning to ‘normal activity’: is your body ready to return or are you mentally jumping back in because you can’t stand taking another day off or hearing people ask you when you’ll be ready to come back. This ties back into your ability to take care of yourself: you have to learn what taking care of yourself looks like and then be able to do it.

For me this is the most difficult part of the cycle but it’s not because I don’t know how to take care of myself. I love being healthy and active and when I am not able to feel healthy and be active I feel unhealthy and inactive which feels a bit depressing. I have come to learn that being inactive is an important part of getting back to health so I remain inactive. There have been many times where I’ve jumped back into everything as soon as the fog has lifted: work and training and have been thrown back into being sick. I now wait a little longer and come back gradually.

This week I’ve been in beautiful Manhattan Beach and have been dying to workout. The sun and beach have tempted me to come workout everyday but I held out…at least until yesterday. I held out 9 days and decided yesterday that I would start by walk/jogging with the dog and see how I felt. I felt good and it led into 40 minutes of easy jogging.

There is no perfect system but as elite performers it’s important to develop an awareness around what these situations are for you and how you are doing to deal with them whether it’s the flu, illness, an injury or burnout. It’s important to listen closely to your body and do the right thing. Sometimes that means overcoming mental and emotional barriers to make that happen.

Happy end of the week!

Dr. Mchelle

Photo credit: condenaststore.com

An injury is more than physical

It is estimated that 3 to 17 million adults and children are injured each year in the United States in sport, exercise, and recreational settings. This means that you might be an injured athlete at some point in your career.

Although physical factors are the primary cause of injury, psychological factors also contribute. Recent evidence shows that managing the psychological factors associated with injury and dealing successfully with stress that might contribute to injury, are equally important to rehabilitation and injury prevention. Because of this, it is important to understand the psychological responses to injury and how mental techniques can help facilitate the recovery process.

How injuries happen

As you might already surmise, physical factors such as muscle imbalances, high speed collisions, overtraining and physical fatigue are the primary causes of athletic injury; however, psychological factors also play a role. Two major psychological factors associated with injury are personality traits and stress.

Personality traits are #1 among the psychological factors associated with injury. And although it’s been difficult to successfully identify and measure the specific personality characteristics associated with injury, recent evidence has shown that factors such as lack of optimism, low self-esteem, hardiness and trait anxiety do play a role in injury.

Stress levels have definitely been proven to correlate with injuries. Athletes with higher levels of life stress experience more injuries that those with less stress. It’s important for coaches, family and friends to have good communication with an athlete in order keep up on any major life changes or stressors that athlete might be grappling with. When such changes occur it’s important for athletes to make appropriate changes and carefully monitor what is going on for them and get support from coaches, family and friends.

The recovery cycle

There are three phases of injury and injury recovery that are of importance to understand. The first phase is the injury phase. In this phase the athlete is dealing with the emotional upheaval that accompanies the onset of injury. Phase two, the rehabilitation-recovery phase; a good time to work on sustaining motivation and adhering to rehabilitation. Lastly, phase three, return to full activity phase, is important to understand that although you might be cleared to return to full activity, recovery is not complete until that participant can return to normal functioning which might take time and patience.  And although the you might be recovering physically the mental side might take much more time to deal with.

Psychological reactions to injury

To give you a better understanding of how athletes react to and deal with injury and to understand the emotional response to injury, the stages have been compared to the work of Dr. Elizabeth Kubler-Ross on terminal illness. Kubler-Ross suggests that terminally ill patients go through five stages in struggling to cope with their illness: denial, anger, bargaining, depression, and acceptance.  

In addition, another study has extended the research on injury to include the cognitions that affect the emotional response to injury. These cognitions were categorized into 4 main themes including internal thoughts, injury and rehabilitation concerns, concern for and comparison to others and looking ahead to the future.

  1. Internal thoughts included worry, concern, time lost from training, and effects to future plans causing injured participants to feel depressed, down, low self-esteem and increased anxiety.
  2. Injury and rehabilitation concerns. There was a struggle to remain positive while dealing with the emotional impact of the now physical limitations. For many, there was a period of time spent reflecting on the cause of the injury, the “what ifs” and self doubts.
  3. Concern for and comparison to others. It’s not uncommon for participants to compare their fitness level and lack of training with others. These thoughts were reported to cause anxiety and tension.
  4. Looking ahead to the future. Although fear of reinjury was not a predominant theme in this study, the reality of participating again brought with it apprehension and hesitation. As a return to participation drew nearer, some participants experience an emotional roller coaster of emotions.

The psychology of recovery

Recent studies have shown that psychological interventions positively influence an injured participant’s recovery, mood during recovery, confidence, and adherence to treatment protocols. Sustaining and recovering from an injury can be emotionally difficult for an athlete and that’s why it’s important to have a basic understanding of the psychological reactions of injury and rehabilitation and to understand that those reactions derive from the cognitive and emotional responses to injury and also important to have an idea of psychological techniques to assist in facilitating the rehabilitation process. Those techniques include: the injured athlete having good rapport with health care professionals, physical therapists and coaches, the athletes needs education about the injury and recovery process, it’s important for the athlete to learn specific psychological coping skills (goal setting, relaxation techniques, anxiety management and imagery) particularly upon reentering the sport, preparing the athlete to cope with setbacks, fostering social support, and learning as well as encouraging the participant to learn from other injured athletes. Effective emotional management of injury is essential to efficient recovery.

Happy Wednesday!

Dr. Michelle

Photo credit: womenssportsfoundation.org

What will Radcliffe need to do mentally for London 2012

Paula Radcliffe is on her way to another Olympic’s after making Britain’s team for the 2012 Olympic Games. Although Radcliffe has had many career successes she has also had many challenges due to injury. Generally when a runner sustains multiple injuries during a career this is because her body is breaking down due to over-training.


Paula Radcliffe has been running for a long time. At 38 she’s had a lot of experience running which has led her to a lot of success. A marathon world champion in 2005, three-time winner of the London Marathon and three-time champion of the New York City Marathon, Radcliffe is training to banish those Olympic memories (AP).


But she’s also had a lot of injury. In 2004 in Athens, she withdrew three miles from the finish because of a stomach problem. She was diagnosed with a stress fracture in her left femur three months before the 2008 Beijing Games and limped to the line in 23rd place. Radcliffe completed her first marathon in two years in Berlin in September. After a series of injuries and a 19-month break in which she had her second child (AP). 

Injuries and over-training

Although physical factors are the primary cause of injury, when an athlete continues to get injured this usually means they are not following treatment protocol to fully recovery. This generally stems from a mental need to get ‘back in the game’ particularly when that athletes identity is tied being a 2012 Olympian.

Unidimensional identity

Professional athletes or in the case Olympian’s are often identify so much with their sport that it’s as if there is nothing else. These athletes tend to have no balance in their lives and spend a majority of their time training which again leads to injury but also isolation, loneliness, depression, etc.

Mentally what will Radcliffe need to do

In her own words: “I have become — not totally philosophical and laid-back about it — but a bit more relaxed about it,” Radcliffe said. “I’ve seen ups and downs and I’ve had a long career. I’m able to step back and be thankful for the success I’ve had.

“But part of me still hopes there is a little luck owed to me in terms of staying healthy (AP).”

In order for Radcliffe to avoid injury and do her best in London it seems as though a little bit of a relaxed attitude, some balance and being realistic are a necessary part of her mental game plan. It’s also important for her to step outside of what she’s always done and find a little bit of a different way of ‘being’ in the sport so she doesn’t get injured.

Good luck Paula!

Happy Wednesday!

Dr. Michelle

Photo credit: Sugar Pond