My name is Maryke, sports physio from sports-injury-physio.com, where you can get online physiotherapy
consultations via Skype. If you're new to the group, how these things work is, if you've got any
questions, just pop them in comments. If you've got questions when you're watching this on replay,
please feel free to just pop them in the comments and I'll get back to them. It works really well
if you actually tag me in your comment, because then Facebook shows me that you've commented.
Tonight's topic is all about how to deal with the mental part of being injured. And if you've got
any ideas which you feel I haven't covered, then please let us know how you deal with that. I find
that my patients tend to go through the same five stages that they describe for the normal grieving
process when they go through injury. And these stages are basically denial,
anger, bargaining, depression – which I'm going to call low mood because let's face it,
it's not true depression – and then finally acceptance. Now, these stages are normal,
and all of these feelings are normal, and some people will feel more of one and more of the
other. But the importance is that you don't let it get in your way of recovery, okay. The other thing
to notice is that it doesn't mean that you've got to go through denial and anger bla-bla-bla before
you get to acceptance; they all kind of merge into each other. And I find that people can often
move from acceptance a little bit back into anger, back to acceptance, a little bit into a low mood;
and that's quite normal as the process goes, but it helps if you've got people around you who
can just reassure you and keep you on track with that, okay. So, let me just see … Excellent! Now,
the first point is denial. Now, denial is very natural. And to be honest, it's also a little bit
useful when it comes to injuries, because not all injuries need to be treated by a physio or seen by
a doctor. You remember last week's session that I chatted about how you can actually decide whether
you should be training with a niggle or not? But that can be really useful. So, it's okay
to kind of go, “I'm not sure this is an injury that I should listen to” and just test it a bit.
But don't stay in the denial phase for too long; don't keep on training with pain and training into
pain to the point where you turned a little niggle into a proper injury. Give it about a week or two;
test it gently, and if it doesn't seem to be going away or it seems to be getting worse,
go and seek some advice. I find if people come to me within that stage, I can often just tweak their
training programme rather than stop them training, so that they can recover while they're keeping
active. So yes, while denial can be useful, just don’t stay there for very long. Now, the second
one: anger. I've not met many people who's not been annoyed with an injury. And that can range
from just being fed up with it to being actually really, really angry about it. But the big thing
is, just don't beat yourself up about it too much. Yes, sure, we all make training mistakes. Yes,
it may have been silly to do another round or another lap at that same pace even though you
felt something come on. But it's not the first time and it won't be the last time that you do
it either. The big importance is that you learn from these things. Because if you can then in the
future apply what you've learned, you will avoid it, actually. That moves me on to the bargaining
stage. Now, this is the stage that I actually dread but also enjoy. So, most patients will want
to know, “When can I go back to running? When can I run? Can I still run? Please, can I do the race
in two days’ time even though I can't walk?” So, the bargaining stage of injury treatment can be
a little bit annoying, because people want to do things before they want to do it, but often
also rewarding, because there are things that you can be doing. Now, if you've listened
to my talks before, you'll know that I'm a big proponent of relative rest. And relative rest
is the perfect bargaining tool, because it means that you only rest from the things that really,
really aggravate your activity. And there's lots of research out there to show that that is a safe
way of recovery and that it actually helps your recovery. If you just withdraw from all activity
and you just think, “Right, I'm just gonna rest!” – that doesn't actually do you any favours either,
because you need a little bit of simulation to get your injury stronger and keep your fitness
there. So, relative rest means that … Say for instance you’re a runner. We first of all see,
can we just reduce your training to the point where you can actually keep on running but
without aggravating it? And it may be things like the volume you're doing or the speed you're
running at or the terrain you're running at – all of those things can often be tweaked to allow you
to continue training. Now, if you can't continue training and you have to give up your sport that
you do and do something else, it's really useful to sit and think about, "Why is it that I enjoy
the sport that I'm doing so much?" So, what are your benefits? And I always think that it's a
good idea to list the top three benefits. Now, to give you an example: When I was injured a
few years back – I had an adductor tendinopathy – and I did the classic thing of denying it for too
long and trying to train on it and I gave myself a full-blown one, where I had to stop training. So,
at that point I was searching for something that would give me the same rush, because I
love running, and I realised that I loved running because it really gets my heart rate up and it
makes me work hard but then it's over and done with. The second thing that I really love about
running is that gets me outside; I don't like running on a treadmill. In fact, I tend to nearly
fall off them, because I have no rhythm for them. I like being outside and getting the fresh air in
and what nature gives me. And the two things that I found that tick those boxes were, one, spinning,
because it was sharp and short and over with, and because I had a spinning instructor I could focus
on something; so, it wasn't like running on a treadmill. And the second was, I could still
go for long walks over the Downs, which meant that I've got out there and I got my emotional fix that
I needed from being outside. So, if you are forced to bargain with yourself and do other activities,
make sure that they tick the boxes. If you're going to force yourself to swim lap after lap
after lap because you believe that's good for you but you hate it, that’s really not going to
do anything for your mental strength. Let me just see if I'm missing out anything there … yes. So,
that's what I would say with regards to bargaining. You can't always continue with
exactly what you want to be doing, but there are ways that you can adapt things. And if you can't
see how you can adapt things, it may be worth speaking to a sports physio or somebody, because
they can help you look at it from a different angle; and also, they understand the injuries,
so they will know what you can still do that will allow the injury to heal. Then, that brings me to
the depression stage or the very low mood stage. The problem with being injured, especially if it's
an injury where you really can't train at the moment, it can really shake your faith in your
body; it can it can produce thoughts and feelings like, “I will never get better again”, especially
if the injury lasts for a long time and you can't get a diagnosis for it or you're struggling to get
a diagnosis. Because I know Julius in the Group is struggling with that at the moment. Then it's very
easy to start thinking that you'll never get back to training. Now, the important thing, first of
all, is to know that most people underestimate how long it takes to recover from an injury. A normal,
simple muscle strain, which is one of the easiest things to come back from, takes at least four
weeks before it's strong enough for you to do full training on. So, that's a whole month just for a
tiny muscle strain. And we're not talking about a proper muscle strain, which can sometimes take
12 weeks or longer. And the reason for this is, whenever you have an injury, the body first has
to absorb the injured tissue. So, it gets rid of all the cells that's been broken and stuff.
And then it's going to slowly repair it. Now, the first fibres that get laid down are not in
the right format; it's not the right type of cell, nor ... it's not as strong as they should be. So,
it needs several weeks to turn over these cells and make them stronger. And they do ... it
does that in reaction to what you use as stimulation to get stronger. So, if you keep on training on
it and push it too hard, then those fibres just break down and you don't get progress. If you do
nothing, then the body just reckons, "Oh, it's strong enough. Don't need to do anything about it."
And again, it doesn't get strong. But if you just gently push it every now and again, a little bit
more than what you could do the previous time, then over time you actually increase the strength
of that injured body part and you heal yourself. So, know that most sports injuries that
I've seen do recover; some of them just take a very, very long time, and it can take two years or
longer. Now, the obvious thing from this is that it really helps if you've got a diagnosis. So,
if you feel that you're falling into despair, go see somebody who can help you get the diagnosis
of your injury and understand what you need to do to get it better, and then thirdly, how long that
will take. So for instance, if you come and see me with … or you consult me for an ankle sprain
or something, I can pretty much tell from how you present on that first day, the test movements I
make you do, and also usually checking how quickly you recover in the first week, I can pretty much
predict how long your recovery time’s going to take, and that's because I've seen several people
in the past with that type of injury. Now, the problem is, I will tell you that it's gonna take
about four weeks at least, or six weeks at least, but by Week 2, you've already forgotten when you
started counting, and you start going, “But aww, it's taking forever! I don't think this is
getting better.” So, make sure that you mark on a calendar when you injure yourself and how your
recovery takes place. Because that brings me to the other important point: To actually keep a
little bit of a diary, week-by-week, of things you can do. Because again, if you're a month down the
line and you've still got pain, it's very easy to think, “This is not getting better”, but then you
forget that four weeks ago you couldn't even put weight on it and you had to use crutches,
whereas now you can actually walk at a brisk pace; so, that's a massive improvement. It's just not
where you want to be yet, but it's actually recovering exactly at the rate that it should
recovering. So, it's really important to map that timeframe for you; and then also, keep up to date
with your “small victories” I like to call them. And celebrate them. When you feel down,
go and have a look, “Where did I come from? What can I do now which I couldn't do last week or the
week before?” Because then that will reassure you that you are getting better. And that leads me
into, what do you do if you don't actually have a diagnosis and nobody can figure out what your
pain … where your pain's from or what's causing your pain? Now, first of all, if you come and
see me and that is your situation, that you've seen loads of people, nobody can diagnose you,
the main thing is, I would want to rule out any serious injury. And it's quite easy to do ... to rule
out anything like cancers, inflammatory diseases, anything that we need people to act about quickly.
And that's done via blood tests, it's done through scans and things. And usually, when people have
been struggling for more than a year to get a diagnosis, all of these things would have been done
and come back negative. Now, that doesn't mean that that pain is in your head; it may just mean
that it's a type of injury that can't be picked up by the scans we have. And to be honest, you don't
need a full-on diagnosis confirmed by a scan to get better. If you treat your injury according to
the symptoms and how the symptoms react to your exercise and your strengthening stuff, then you
can get an injury better without ever knowing exactly what the diagnosis was. I know this
sounds weird, but honestly, it does work. So, if you've already ruled out all the nastiness
that the doctors have done, all of those tests, and you're sure there's nothing like that going
on and you're in that limbo of not knowing what my diagnosis is and I can't do my full training,
find somebody who can help you establish a baseline where you can start training from. And
it may not be the sport you want to do, but it's got to be some sort of activity or strengthening,
depending on what it is, and then just incrementally work on that. Honestly, you
don't need a diagnosis for injuries to get better; you just need to understand where that baseline
is where you start and then slowly improve on that. Now, the last stage is acceptance. And
acceptance is a wonderful stage for patients to be in. And my job as a physio is a really easy
job when people come in and they've accepted that they're injured and they've accepted that they would
have to make a few changes to their training and stuff and they're ready to listen to what I've
got to say. Now, that's the obvious bit about acceptance. The other bit I want to highlight
is that acceptance is also about actually having faith in your body and accepting that it will get
better. It's about accepting that you will be able to run fast again even though you can't do it now,
even though you may have to run at an annoyingly slow pace, accepting that you will be able to do
everything if you just take it slowly enough to return to these sports at the pace that
needs returning to. Now, I've got so many examples of people in the past where they've said,
“I'll never be able to do this, or I'll never be able to do that.” And I listen to them, and I go,
“Okay fine”, and I just work on getting that pain better for now. And the number of times they come
back in a year or so from now, after having sworn off running a year ago, saying they will never do
that again, and then go, “I'm training for my half marathon, and I've got this and this niggle.” And you go,
“Oh that's interesting. Because last time I saw you I understood that you would never run again.”
The point is, when you're in that dark, dark, deep moment of being injured, it's really hard to see
a way out. But injuries always get better; it's just about taking the time to actually give them
the rest or recovery time that they need. Some need very little, some need quite a bit. But
if you've got somebody to help guide you there, it can be really useful. So, let me just see if we've
got any questions coming through so far. ... Okay, no. I think I've answered those ones. So, if I
can recap for you: The five stages of crisis that I see people go through when they're injured are
denial, anger, bargaining, mental ... or depression – or low mood, I should say – and acceptance. Now,
denial is useful. Don't always feel you need to run to the physio. Gently test it first,
and if you want to know how to carefully test it, check out my blog post that I wrote last week -
that explains to you how to do it. Anger is okay. It's fine to be angry; we all get angry when we’re
injured, because it's just not fair, is it? But learn from it so that you can actually apply those
things that you learn from the situation in the future. Then, bargaining. Remember relative rest,
it's a very good bargaining tool, and if you apply it right, you can usually keep your fitness while
you recover. And then, to help with the mental side of it where you feel a low mood; make sure
you get a diagnosis, see somebody who can help you understand how long this injury is going to take
to get better. Then map your progress as you go along so that you can see the small improvements
that you make and celebrate those successes. If you can't get a diagnosis, find somebody who can
help you work with the situation you're in so that you can improve that little-by-little, okay. You
don't need a diagnosis to recover from a sports injury; you just need to respect the symptoms and
work with that. And then lastly, acceptance. But remember, it's also about accepting that your body
will heal itself; you've just got to give it the right combination of things. Well, that's my story
for tonight. Let me just make sure that we've covered all of that … If you need any help with
any injuries, you can consult me via Skype; I've put a link in there in the comments. But if you've
got any questions or you've got any comments from of your own, pop them in comments or just feel
free to contact me on Facebook. Take care guys! Thank you for watching! If you would like to learn
more about preventing sports injuries, make sure you hit the subscribe button. See you next time!