Many years ago, after having experienced several fairly benign injuries that just seemed to drag on until my race had been and gone before I made a miraculous recovery, I decided to investigate the question of whether our mind can influence the rate of recovery from injury.
What I found was that this relatively simple query had not been adequately researched for a complete answer, but I was able to draw some conclusions that should make any athlete think twice before heading into the realms of depression during the inevitable time off from their sport. That was almost 20 years ago and although the question has still not received a great deal of attention, sports psychologists are now visibly linking positive psychological strategies with a faster return to sport.
Injury is one of the biggest challenges that an athlete (whether elite or a weekend warrior) will face in his or her athletic career. It is a barrier to successful athletic performance. The ability to resist injury and to rehabilitate well when injury occurs is fundamental to longevity in sport and to the full realisation of athletic potential. Although it is also recognised that psychological factors affect the susceptibility to injury, the question that I will focus on here is; do psychological factors influence the speed of recovery from injury?
The Stress Response of Injury
In the journal Applied Sport Psychology: Personal Growth To Peak Performance, it has been recognised that the psychological state of the athlete is as important and sometimes more important than the athlete’s physical state and furthermore, his or her mental state can influence physiological function. Because athletes are so dependent upon their physical skills and because their identities may be very much intertwined with sport, injury can be an extremely threatening process. According to the The Physician and Sportsmedicine, athletes tend to be more motivated than the general population to undertake rehabilitation therapy, but since they perceive the injury as a bigger loss, they are more likely to experience a greater stress response. Additionally, according to Athletic Training, athletes low in self-esteem and those who have low expectancies of success in rehabilitation are more likely to experience high levels of stress.
The work of Elizabeth Kubler-Ross on the emotional recovery from a loved one’s death (grief response) has been applied to the athletic setting: the emotional processes that were suggested to follow a sports injury include the stages; denial, anger, bargaining, depression and finally acceptance. This progression was supported years later in the book The Sport Psychologist, which demonstrated a progression from a negative to a more positive mood state as the rehabilitation process continued. According to the International Journal of Sport Psychology, the length of time it will take for the athlete to move through each stage depends on a number of factors, including emotional stability, importance of the injury to their career or life plans, severity of the injury, the time of season and the reaction of critical others.
Vigorous exercise has been shown to decrease anxiety and depression and people who exercise regularly are thought to have better self-concepts than non-exercisers. When runners were asked to miss a run or a series of runs, symptoms experienced as a consequence of the abstinence included; irritability, anger, restlessness, frustration, depression, insomnia and muscle tension, according to the Journal of Sport Psychology. It therefore appears that regular physical activity can play a central role in your psychological wellbeing. An athlete forced to stop exercise due to injury, or any other reason, may need to develop alternative means of dealing with their emotions.
Psychophysiology of Injury
It has been suggested that for every physiological change that occurs in the body, there is an equivalent change in mental state and for every psychological change there is an equivalent physiological change: the ‘psychophysiological principle’. In other words, the mind and body is an integrated system which maintains an internal stability in the human body. It is quite clear now from the field of Psychoneuroimmunology that the emotions of the mind, including feelings, attitudes and beliefs, can influence the physiology and therefore positively or negatively influence recovery from injury or illness. Very old studies revealed that chronic stress can suppress the immune system, which can inhibit the healing response to injury and that vasoconstriction in the vasculature that results from stress, can interfere with the blood flow to the injured area which is thought to prolong the recovery process.
A review was conducted in 2012 where the researchers considered 11 studies that had evaluated 983 athletes and 15 psychological factors in the recovery from injury. Motivation and confidence were strongly associated with a greater likelihood of swiftly returning to pre-injury levels of participation, whereas fear was a predominant negative response to returning to sport, although this generally decreased as recovery progressed. It has also been noted that greater confusion results at the onset of an injury in individuals more heavily involved in sport and therefore with more to lose.