Where The Head Goes, The Body Will Follow : A Lesson in Healing

By Carl J. Evans  

Healing an injury will cause an athlete to confront challenges no amount of drills or practice could ever prepare them for. Still, one essential element of the healing process is often overlooked because it is hidden and shrouded in a stigmatized silence.  

We need to talk about the psychological injuries that can co-occur with physiological damage.  

When Pro-wrestler Triple-H (Paul Levesque) suffered a career-threatening complete tear of his left quadriceps, his eventual in-ring return was marred by wounds that didn’t show up in X-rays. 

Even after an athlete obtains the proper physical clearances to get back into their arena of competition the psychological injuries may have gone completely untreated, and can remain or even exasperate as the athlete returns to competition.  

First, let’s be specific about what we mean by psychological injuries which is different from the very important concept of Emotional Health.  

Emotional Health: A solid rehab plan should include strategies for maintaining “emotional health” that focus on preparing the athlete for the challenges of rehabbing. And develops a plan to confront the wide variety of feelings that come from being injured and out of action.  

So emotional health is a mental health discussion focused on having the ‘right attitude’ to follow thru on a recovery process.  

“our #mentalhealth requires the same medical appreciation and healing scope as our bodies do.” 

A psychological injury is a mental health discussion focused on the trauma our minds incur and in this case, we’re talking about when suffering a physical injury.  

When Pro-wrestler Triple-H suffered a career-threatening quad tear in 2001, he would embark on a healing process that would become the stuff of legend in Pro-wrestling lore.  

There was just one problem that HHH wouldn’t reveal for almost a decade.  

As his first in-ring matches approached in January 2002, Paul “Triple-H” Levesque had to combat the psychological injury of being concerned with reinjuring the same body part that had once been damaged. “‘Yes, I returned, but can I still do this, and can I do it where I was doing it before?” Triple-H recalled in his 2010 semi-autobiographic slash fitness book, Making The Game”  

What Triple-H experienced are indicators of PTSD.  

Athletes report fears or having actual visions of reinjuring themselves. Anxiety and fears can come as nightmares and disrupt sleeping patterns. Fears emerge and prohibit an athlete from doing certain movements.  

An athlete’s entire performance and recovery process can be disrupted by something entirely intangible to a medical team.  

It is quite common for an athlete be it Triple-H or an aspiring high school athlete to conceal these feelings and hesitations.  

 These types of hypervigilance, invasive thoughts, and disruptions to the quality of life and recovery driven by fears or constant replaying of the injury are in fact symptoms of PTSD.   

Which is a term not often associated with sports injuries that happen in the regular flow of a game/event.  

“It is very easy to see how the culture of athletics can embrace stigmatized attitudes about #mentalhealth ”  

PTSD is usually associated with things like military combat, or car crashes, or surviving other types of very intense and visible incidents.  

But Triple-H like many other athletes demonstrated symptoms of PTSD in association with reinjury.  
The way we stigmatize mental health in general as a society leads to things like compartmentalizing how we can be impacted by untreated or unrecognized mental health challenges.  

Not appreciating that an athlete of any age or gender can experience PTSD from a sports injury is one of the many ways we stigmatize mental health.   

By creating compartments and hierarchies that say we will only experience mental health challenges in certain situations and that certain mental health challenges like PTSD can happen in a narrow specific set of situations.  

Another way we stigmatize mental health is with how/when to treat it as a medical condition. Historically, people have associated managing mental health with our character, willpower, and personal strength.   

That controlling and managing mental health is about some sort of physical strength or strength of character or willpower to just “get over it” or “tough it out.” And if you can’t then you’re weak and have to go see a “shrink” 

This is false.  

It is false beliefs like that, which lead people like athletes to conceal their psychological injuries in the course of healing their physiological injuries.  

It is very easy to see how the culture of athletics can embrace stigmatized attitudes about mental health.  

As an athlete or coach, it’s easy to have the mindset that you can conquer mental health challenges in the same way you improve a sprint time or a personal best on the bench press.  

But our mental health requires the same medical appreciation and healing scope as our bodies do.  

A psychological injury is akin to a leg injury. It can have a wide scope of severity from a mild sprain to a severe tear or bone break. And without proper monitoring and response be it personal care, or elevated to clinical treatment, a psychological injury left untreated can escalate to a far more harmful state like any other underserved or un-treated medical scenario.  

Re-injury fears, and their impact on the athletes healing outcomes have only recently been recognized as a critical part of the healing process.   

Dr. Melissa Christino, a leading surgeon in the Sports Medicine Division at Boston Children’s Hospital stated:  

Studies have shown that injured athletes with higher levels of stress, anxiety, and fear of reinjury are less likely to fully recover. In one study of ACL reconstruction patients, those with higher levels of fear were 13 times more likely to suffer a second ACL tear within two years of returning to sports than those who were less fearful. 

Treating psychological injuries associated with on-field injuries is a new frontier for both sports medicine and the athlete and their support network.  

In 2016, we reached a new benchmark when the first global summit on Sports Physical Therapy issued a clinical consensus that testing for psychological readiness should be a mandate along with physical readiness for clearing athletes to return to play.  

This recognition is a giant leap forward.  

And we can all be part of the continuing progress to better support athletes’ maximum health by learning how to have open and frank conversations about our mental health and to become proactive in monitoring for mental health challenges.   
Doing these things destigmatizes mental health challenges and creates a space where athletes can confidently communicate their issues.  

Find more from Carl Evans at The Hope for Us Network: https://www.hopeforusnetwork.org/

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