Kate Maroz was training for the 2019 Chicago Marathon during a run on the Charles River in Cambridge, Massachusetts. The 33-year-old theology professor called an Uber to take her home. Later, she discovered she had a hairline fracture in her femur. Two weeks before race day, her marathon plans fell through. It caused such pain that he couldn’t even run.
“I remember missing work one day because I couldn’t run across the street to catch the bus,” says Moroz, who works as a running coach. “When I thought I was knocking out 15- to 20-mile runs a few weeks ago, it was really hard.
Mroz was cleared to run after a 14-week layoff, but the rest of the season challenged her mental health. “I fell into a severe depression that was often unknown except to my husband, who had to live with me,” she said. “I was still doing well at work and had recently published a paper. But inside I was hurt.”
Sports injuries are very common: approximately 8.6 million sports and recreation-related injuries occur in the United States each year. While most athletes know they are at risk for breaks, tears, sprains and the occasional bruise, being on the sidelines can bring many emotional challenges: for some, depression and anxiety; For others, it is a deep sense of loss.
Lucas Bielsa Campo, for example, is an outdoor enthusiast — a trail runner, mountain biker, and hiker — who spent most of his time in nature until he was struck by debilitating back pain. After a misdiagnosis and 11 months of physical therapy, Campo, 33, who lives in the Spanish Pyrenees, is awaiting a diagnosis.
“The hardest thing is my mental health and self-esteem. It’s sad,” he said. “It was hard for me to admit that I was hurt.”
Why do sports-related injuries cause grief?
Although research is limited, there is evidence that sidelined athletes experience a variety of grief-related reactions, such as sadness, anger, confusion, low self-esteem, and denial—as well as physical symptoms such as fatigue, insomnia, and loss of appetite.
“Grief is a complex response,” said Natalia Skritskaya, a research scientist at Columbia University’s Center for Chronic Grief. “It’s the absence of something rewarding at one point.”
Along with causing physical pain, sports injuries can leave fitness-like holes in your life after you’ve filled them with bike trails, race medals, and team runs. According to Matthew Sacco, a clinical health and sports psychologist at the Cleveland Clinic, this sudden change can cause an “identity restructuring.” After an injury, you may be writing a new script for your life — one that no longer includes your favorite pastime.
You may also feel the lack of stimulating hormones. “There are a lot of endorphins and chemical changes in our bodies that occur during exercise,” says Jared Vaguey, a clinical assistant professor of exercise science at the University of Southern California. “If that’s the only way some people release those chemicals, you’ve lost a big part of what makes you whole or fulfilling as a person.”
And recovery itself comes with additional mental hurdles. Damilola Gbolahan, a sports physiotherapist who works with injured footballers, says people often overdo physical therapy in an attempt to make rapid progress. And pushing too hard has harmful effects, such as “frustration, increased anxiety and depression, which can slow recovery,” she says.
Skritskaya says that despite the tumultuous emotions that appear after trauma, our brains are working to regain a sense of order and stability. Here are a few ways to find agency and a little hope while you’re on the mend.
Track your recovery.
“It’s important to understand that you’re an athlete, and now that your recovery is part of your sport,” says Carrie Jackson, founder of the Injured Athletes Club, an online community for people who have been sidelined from their favorite sports.
If you thrive on following a training plan, or if you like to keep track of your gains in a calendar or journal, continue that practice while you recover. That way, you have a record of all the work you’ve been doing—and rehabilitating as an athlete.
Find the community.
Being with people who have gone through similar experiences is a helpful way to navigate any type of grief. “Community is a big part of recovery. Even though we define running as an individual sport, there’s a very defined running culture,” Sacco said. “For the same reasons, there’s a loss of community that comes from not being in the same place at the same time.”
Campo found fellowship in the Injured Athletes Club Facebook group, a group where sports enthusiasts can share their feelings about their injuries and celebrate recovery steps big and small. And Mroz, who will complete the Ironman in 2022, founded a group called Athletes from Nutrition Culture to promote athletics at all sizes and raise awareness about the harms caused by eating and exercise disorders. “The team is still going strong today,” she said.
Be flexible about going back.
Being open to new experiences is a huge benefit for traumatized people, Sacco says. The ability to rethink your life can ultimately lead to a greater sense of satisfaction.
Olympic steeplechase runner Colleen Quigley has suffered multiple leg injuries that have interrupted her training cycles, putting her life at risk. During her recent rehabilitation, she was limited to training sports such as swimming and cycling. Instead of seeing her recovery as a burden, she decided to do all these activities and found that they made her a better athlete.
“I was also having a lot of fun,” she said. Quigley has added triathlons to her competitive schedule and hopes to compete in them in future Olympic Games.
If your injury requires you to retire for good—or at least for the foreseeable future—there’s no going back quickly. But there are other ways you can improve, says Jackson. “You may not know which way you’re going to be thrown, but you’re going to swing,” she added. She suggests exploring what’s important to you and why, so you can replicate that feeling through another outlet.
Expect stress after recovery.
If you go back to your favorite baseline, it’s normal to worry that you’ll get hurt again. Having pain after an injury can make it difficult to participate in the activities you love, even after you’ve recovered.
“You always feel like you’re on the verge of another injury,” Quigley explained. “You can never relax or feel like, ‘Okay, I’m back.’ Always ‘when will it happen?’ It is.”
While there’s no quick fix for the feeling, Vaggy says staying present is an important coping strategy. “I encourage my patients to acknowledge the fear, accept it, and focus their minds on the present.”
A gradual return to activities may also help. Try to hit and complete small goals that will take your mind off of re-injury. For example, doing your first mile at the gym for 20 minutes or jogging on the rocks.
“It’s going to have its ups and downs,” Vaggi said. “But the body is strong.”
This article originally appeared in The New York Times.