If you’ve been around for a little while, you know that the Precision Team is invested in treating the whole picture of an injury. For many years, the research on injuries has focused on the efficacy of rehab protocol, surgeries, and injections; various biomechanical risk factors for injury; and long-term outcomes after injury. There have not been as many studies focused on how mental health affects an athlete’s recovery from an injury, which is why I was excited to come across this article, Anxiety State Impact on Recovery of Runners with Lower Extremity Injuries by Madsen et al., published in the Public Library of Science in December 2022. This article supports what we have long stood by at Precision – if we only treat the injury, we are missing a huge chunk of the puzzle, and it will take athletes longer to get better. Injuries are biopsychosocial - involving a combination of biology (the actual tissue involved, the body and its mechanics), psychological factors (involving one's mental state), and social factors (the external support, resources, and barriers one faces), and must be therefore be treated from a biosychosocial point of view.
The article looked at recreational runners with lower extremity injuries, and assessed their mental health using standardized tests and questionnaires. These results were used to divide the participants into a high anxiety and low anxiety group. What they discovered is the high anxiety group took on average 7.9 months to return to running (+/- 4.1 months), while the low anxiety group returned to running in 5 months (+/- 3.1 months). Other than the scores on anxiety questionnaires, there were no other significant differences between the groups, meaning that the nearly a 3-month difference in return to run is based on mental health alone!
Looking at more technical gait metrics, both groups improved in many metrics throughout their recovery, but the low anxiety group demonstrated a greater increase in cadence and greater change in stiffness than the high anxiety group, while the low anxiety group demonstrated higher bone impact loading rates throughout the study. The authors suggest that different gait retraining methods be considered when working with an athlete with high anxiety that is returning to run, as well as focusing on improving other aspects of well-being such as sleep, during rehab.
The authors offer some excellent clinical applications for those who work with injured athletes, such as physical therapists, medical doctors, and coaches. First, they suggest that the gains made by the athlete are focused on throughout the rehabilitation process, and that the athlete be as involved with teammates as possible. An example given that I think is a great idea is having the athlete walk or perform strengthening while the team practices and including the injured runner in other team meetings. This helps preserve the aspects of community and belonging that can be lost when an athlete is injured. Additionally, they suggest that members of the athlete’s care team help the athlete implement practices such as goal-setting, positive-self talk, and mindfulness, and make referrals to mental health professionals as needed. A sports psychologist can be extremely helpful to help an athlete cope with the identity loss and loss of stress outlet when they can’t run, and is even more imperative when the athlete has high anxiety. Finally, they recommend using tools to screen for anxiety soon after an injury. Beyond clinical measures of well-being, I think that just talking to your athletes about their mental health and opening that line of communication is imperative. Asking questions beyond “how is your *injured body part*”, and getting into “how are you feeling”, “how are you sleeping”, “how is work/school/family” and letting the athlete know that they are heard and cared for is important.
Now what does this all mean if you’re an injured runner? First, check in with your mental health. How are you feeling? Are you feeling disconnected from your running friends? Overwhelmed and without an outlet to let off stress? Anxious about what this injury means for your running performance? Label your feelings and share them. Let you coach, PT, doctor, or therapist help you through this time. Also, if you don’t already have a mindfulness practice, now is a great time to implement one. Meditation, guided visualization, and goal-setting can all be very helpful. The main takeaway from this article is that your mental health and well-being will affect your rehabilitation from an injury, so it is vital to address!
If you are an injured athlete, or just interested in improving your mental health and mind-body connection, join us at Precision on Tuesday, September 26 at 6:30 PM for a guided yoga flow with Certified Yoga Therapist Amanda Burtch from Kula Wellness! This class is designed to promote relaxation, mindfulness, and well-being. Throughout this Therapeutic Yoga class, you will be introduced to various breathwork, movement, self-reflection, and mindfulness techniques.
Thanks for reading!
Dr. Elizabeth Karr PT, DPT