In the world of Sports Psychology, an injured athlete will go through five stages of emotion before returning to play. The stages include denial, anger, bargaining, depression, and acceptance. The same model is used to describe the processing of grief.
The stages will look different for every athlete and situation. Sometimes a stage is skipped or repeated. Each athlete will spend varying amounts of time navigating the stages. A quick stage for one athlete may seem to take forever with another athlete.
While the emotional processing for injury looks different for everyone, there is one commonality. All athletes will face injury at some point in their careers.
Stage 1: Denial
The denial stage is exactly what it sounds like it would be. The athlete tries to ignore the injury and keep training or competing.
My experience: I remember being annoyed by teammates who complained to the coach about every ache and pain. It seemed like they were just trying to evade workouts. I vowed to myself that I would never be one of those athletes. The pain was part of the job.
To some degree, I still appreciate that mindset. I don’t think we need to dwell on every little thing that feels slightly “off”. However, it’s never a bad idea to keep your coach informed. My issue was that I had a very poor sense of which sensations were serious and which ones were not. I just tried to ignore every one of them.
I feared the idea of missing practice or getting behind in my workouts. Sure, maybe the pain would slightly impact my performance, but at least I was getting it in. What I didn’t realize was that listening to my body could save me a lot of rehab time down the line.
This stage can’t go on forever. Either your coach will notice the limp and see the performance deficits or the pain will become unbearable to you. The issue at this stage is how much damage you caused in the meantime.
Stage 2: Anger
In this stage, the athlete is looking for someone to blame. They may be angry at themselves or at their coach or even their trainer. The situation feels unfair.
My experience: For me, this stage tends to come and go throughout the whole process. I’ve experienced immediate anger after admitting to the injury. Typically, my anger hits the hardest after the bargaining stage. It even integrates itself into the depression stage. If anger wasn’t involved, I believe I’d progress to the acceptance stage much more quickly.
I remember the day that my first metatarsal stress fracture became a big problem. I literally couldn’t apply any pressure on that foot while running. I repeatedly attempted to adjust my spikes, but there was no denying it. I knew I couldn’t do this practice and that I would end up on the bike.
As I approached my coach, I already knew what he would say. The second he told me to see the trainer and finish on the bike, I was furious. I can’t tell you why. I knew there wasn’t another option. I was just mad about it. I was mad at my coach, myself, and the world in general. It didn’t even make sense to be mad, but I just felt so angry.
Eventually, the initial anger subsides and I enter the bargaining stage with a positive attitude. However, towards the end of this stage, the anger reappears with vengeance. I get mad that I’m not healed yet. I’m mad at cross-training. I’m mad at my coach for not giving me enough cross-training or the kind of cross-training that I want to do (which is none, so that’s a lose-lose situation for my coach). I’m mad at myself for ever getting injured. I’m mad at the doctors because I don’t agree with their timelines. I’m mad at my teammates for talking about practice. I’m mad at anyone who mentions the injury. I’m mad at anyone who doesn’t ask me about the injury. I’m just plain mad.
During my first year in Phoenix, it was already quite clear that I had a hip injury. We tried to keep training as normalized as possible. One day I was doing 150’s (which is a sprint) and my times were ridiculously slower than pre-injury times. My coach asked if the workout was hard (suggesting that it was a cardiovascular challenge). Within seconds I had tears flowing and could feel the heat of rage building within me. “NO, I’m sick of not being able to run fast. It’s easy to run this slow.” I wanted to be working harder, but my injury spot just wouldn’t let my leg apply enough power.
I really shouldn’t have been so mad. It was quite clear that I had an injury and all we were doing was trying to get as close as we could to normal training. Instead of being appreciative that I could still run, I was furious that I couldn’t run fast enough.
These emotions shot me into the depression stage. The anger and sadness feed off of each other and exaggerate the situation.
Stage 3: Bargaining
During this stage, the athlete is aware of the injury, but they are trying to resume as normal of a routine as possible. The athlete may continue training with slight modifications or they may try to intensify the rehabilitation. Sometimes during this stage, the athlete seeks other opinions in order to hear what they’d like to hear.
In my experience: For some reason, I love to hang out at this stage for an extended period of time. Many resources describe this stage as an extension of denial. I completely agree.
Like I said before, I hate missing workouts. Although at this point I am well aware of the injury pain, I tend to ignore the consequences of further damage. In one environment, I bargained by overcompensating in the cross-training. I figured this was the best way to avoid getting behind. The cross-training didn’t hurt the injury spot directly, but it did compromise my body’s ability to recover.
In a different environment, I constantly downplayed the pain. The theory in this environment was to keep the injury gap small (meaning do as close to the scheduled training as possible without worsening the injury). With this mindset, my bargaining took off! Yes, I was injured, but I could compensate my way through almost anything in order to get my workout in. Who knows how many times I reinjured the tendon while doing this.
Just like the other stages, bargaining is an important part of the healing process. Unfortunately, excess time at this stage can be detrimental. If you have a tendency to be stubborn, like me, be aware of the temptation to linger here.
I’m sure many athletes can relate to this story. It was the final meet of the year and I just wanted to compete. I had hopes that I’d perform really well in spite of the injury. I loaded up on ibuprofen and went for it. Not only did I perform poorly, I set myself up for years of complications regarding the injury.
One injury can lead to an even worse one. It can put your body in poor postural positions in order to compensate. Those positions get programmed and may remain even once the injury is cleared up.
My advice is to be intentional about identifying this stage. Use your support system to help you safely move beyond it.
Stage 4: Depression
The athlete recognizes the loss. They understand that the injury requires some degree of compromise. Sadness may feel overpowering.
My experience: During the bargaining stage, I tend to hold a fairly positive attitude. The optimism is what keeps me motivated to push through. I think things like “this injury isn’t so bad. I’m barely missing a beat. I can keep working really hard.” When reality sets in, the flip switches. I become angry and then sad as I enter the depression stage.
At this point, I’ve come to terms with the facts. Either I’ve realized my bargaining tactics are ineffective or the repair process (whether that’s surgery, PRP, complete rest, etc.) has begun. The point is, I usually reach the depression stage when it’s sunk in that the injury requires some serious changes.
As a runner, I believe that the lack of running messes with my level of endorphins. The lack of these happy hormones adds to the feeling of depression.
During this stage, I really begin to miss my sport. As hard as it is to look on the bright side, the depression stage helps you gain more appreciation for the little things once you’ve returned to play.
The first time I got a stress fracture, my depression stage was fairly short. It wasn’t during the competition season and I had a great support system around me. The second time I got a stress fracture, it was much more difficult to ward off that “woe is me” feeling.
Eventually, I would get sick of feeling bad for myself and I’d commit to doing the best I could do with the situation at hand. This leads to the final stage.
Stage 5: Acceptance
This is the most critical stage of healing. The mindset of the athlete shifts in a more positive and calm direction. Essentially, they accept that fact that they are injured and focus on the things they can control (rehab). Stress is lessened during this stage, which allows the body to heal more efficiently.
In my experience: While being in this stage is beneficial for your body’s healing processes, it usually took some positive physical signs in order for me to start thinking this way. Once the light at the end of the tunnel became evident, I was able to calm down and block out the negative thoughts.
I hope for any reader that you would be able to enter into this stage significantly earlier. I believe that this stage sets you up for a more enjoyable journey back to fitness. For me, when I was finally able to train again, I lost my confidence and hope pretty easily when things weren’t going well. Frankly, I wasn’t mentally resilient through the injury recovery process.
It’s a skill, but an athlete can control their mind. They can control how long they linger in each stage. In retrospect, I wish I would have moved through anger and bargaining much faster. I believe that time took away from the acceptance stage.
When an athlete enters acceptance, they have chosen to make the best of the situation. They’ve put pride and pressure aside in order to focus on doing the right things for healing. Most importantly, they’ve developed a sense of patience and trust. They do all they can to set up an environment compatible with healing, and then they trust their body to recover in its own time.
In Summary
Injuries are a psychological challenge for athletes. An athlete can’t always avoid injury, but they can train their mind to navigate through the five stages efficiently. It’s normal and healthy to experience denial, anger, bargaining, and depression. If they can recognize the stage, they can deal with it and move on faster. Ultimately, hanging out in the acceptance stage gives the athlete the best chance at a quick, full recovery.
KHO Health was acquired by was acquire by 9INE POINT in the summer of 2019 and is now referred to as 9INE POINT Health.
