Recovering from Crashes, Part 1

Crashes – being in them, seeing them, hearing about them – are a part of life for us cyclists. In addition to any physical healing that needs to happen, there are things you can do to accelerate the mental side of your recovery. The quicker you recover mentally, the quicker you’ll be back out there performing at your best.

By Marv Zauderer

In last month’s Sport Psychology column, on Assessing Your Mental Fitness, I explained steps you can take during this off-season to evaluate and improve your mental skills. This month, we add to the advanced skills of the mentally fit cyclist covered in past installments of this column, and begin to explore how to recover – mentally – from crashes, in Part 1 of a two-part series.

It was May 20, 2007. Dr. Prentice Steffen, Garmin-Chipotle Team Physician and Medical Director, had just watched the peloton start a rainy stage 3 of the Tour of Picardie near Paris. Since the team was headed to Spain next for the Volta a Catalunya race, Dr. Steffen figured he’d get a headstart. He swung his car onto the autoroute and headed for Barcelona. Within minutes, he realized that he was in the worst possible spot: stuck behind the peloton, with no good alternate route. He pulled off the road, and decided to wait until the race cleared. He turned on his race radio. Suddenly, the news crackled through: Garmin-Chipotle rider Steven Cozza had crashed. Dr. Steffen sped to the scene, and found Steven face down, unconscious. Calling on his expertise in emergency medicine, Dr. Steffen stayed with Steven as he was loaded into the ambulance and taken to the hospital.

Steven had a bad head injury and serious neurological symptoms that persisted upon his return home: loss of memory, difficulty focusing, trouble perceiving hot and cold temperatures, an altered sense of taste, and problems with coordination and depth perception. He picks up the story:

I wasn’t sure how long the symptoms could last – maybe even years. With a head injury, you really don’t know how long it will take to heal, or if it will. I was really depressed. One week, I was competing with the best athletes in the world and doing well at it, and then I went to not being able to get out of bed. I didn’t know if I would ever be normal again.”

A head injury is bad enough. But research has also shown that the brain can change as a result of emotional trauma – experienced during and after the traumatic event – and depression is a common consequence.

In her landmark book, Trauma and Recovery, Dr. Judith Herman writes,

Psychological trauma is an affliction of the powerless. At the moment of trauma, the victim is rendered helpless by overwhelming force. When the force is that of nature, we speak of disasters. When the force is that of other human beings, we speak of atrocities. Traumatic events overwhelm the ordinary systems of care that give people a sense of control, connection, and meaning.

She continues:

“The first principle of recovery is the empowerment of the survivor. [He] must be the author and arbiter of [his] own recovery. Others may offer advice, support, assistance, affection, and care, but not cure….Trauma robs the victim of a sense of power and control; the guiding principle of recovery is to restore power and control to the survivor.”

According to Dr. Herman, recovery from trauma unfolds in three, often-nonlinear, stages. The key task of the first stage is establishing safety. In the second stage of recovery, the trauma survivor tells the story of the trauma “within the realm of what is bearable.” (Perhaps with others’ help: note that it’s possible to create a story without having any memories of the event.) In the third stage, “the survivor is ready to engage more actively in the world. From her newly created safe base she can now venture forth. She can establish an agenda. She can recover some of her aspirations from the time before the trauma, or perhaps for the first time she can discover her own ambitions….She is ready to take concrete steps to increase her sense of power and control, to protect herself against future danger, and to deepen her alliances with those whom she has learned to trust.

In beginning to assert some control over his recovery, Steven turned to a natural source: the Internet.

“I did a lot of research online, because none of my friends or family had experienced this. I typed in ‘frontal lobe injury,’ and saw all of my symptoms. It made me feel so much better – my symptoms were totally normal. I found that some could go away quickly, but some might never go away….I slept a lot, drank a lot of water….after 3-4 weeks, I started to feel much better.”

He also turned to his coach, Dario Fredrick. Dario recalls that stage of Steven’s recovery:

“Some of the symptoms, such as being disoriented, were very disconcerting for him. Mood swings and depression are very common in these cases, and he’s not prone to that kind of thing; he’s always been a very positive person. Things we take for granted were thrown into disarray…..My whole approach was to emphasize that these things are temporary, to focus him on the things he could do, and to emphasize that his body was healing itself….Mindset is so important to healing.”

But Steven got back on the bike too soon. Dario continues:

“Steven is a very, very proactive kind of guy….he tried to ride, and realized he couldn’t do it yet. I told him as soon as he felt ready, he could ride easy loops with me. [In the meantime,] he started on a trainer.”

Steven explains:

“I put too many expectations on myself. I rushed back into training too soon, and wanted to race too soon. My team was very supportive: no one was pressuring me, and my [personal] doctor was in touch with Dr. Steffen regularly….It’s more important to recover to 100% – or 110% – before returning. But, not training was depressing. Training was helping my mind – just spinning was great. I couldn’t even do an hour at first.”

Once Steven could get back on the road, he started by doing short, flat rides side-by-side with Dario. After Steven felt comfortable with that, Dario had him ride on his wheel, “re-learning the proximity of riding with another rider,” according to Dario, who picks up the story:

“Then, he had difficulty with descending and cornering: his visual-spatial ability had decreased. So, I’d shepherd him down the descents. I told him I’d pick out the line; he just needed to follow my wheel. Gradually, I picked up the speed. Then, as soon as his visual-spatial ability started to come back, I had him lead, and we gradually picked up the speed. It helped him to be doing something that contributed to his recovery.”

Says Steven of working with his coach,

“Working with Coach Dario – I could tell him how I felt, and he could design my training program around that. He really helped me with cornering and descending – I’d just follow him. That helped my skills and my courage.”

Clearly, Steven’s relationship with Dario was critically important to his recovery. This fits with another of Dr. Herman’s central points about trauma:

“The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation.”

According to Dr. Herman, the central task of the third stage of recovery is “reconnection with ordinary life.” Steven began to race again. He remembers:

“It was stressful to race in Europe: more cyclists, more obstacles, the rains – I was having a lot of crazy thoughts about what might happen to me. I set a goal for each race. I told myself that for the first hour, I’d ride near the front. Then I’d put myself on the back for the next couple of hours, and try to go to the front for the end. I’d try to increase the time I was spending near in the front in every race….My physical capabilities are just like everyone else’s, so I have to use my mental strength to get through these races.”

He continues:

“It’s taken me 15 months to finally feel normal again in the peloton….The most important thing is that I truly believe I’ve fully recovered, so I could crash again [and be OK].”

I asked Dr. Steffen what he saw in Steven that contributed to his recovery. His view:

“When you reach the level that he’s at, the guys are really motivated to do what you ask them to do – when their livelihood is on the line….He listened very well and really wanted to learn as much as he could….He really wanted to be an active member of the planning team. It was very important for him to be in a supportive environment: his family, his team, JV [Garmin-Chipotle CEO Jonathan Vaughters], and everyone else.”

I asked Coach Dario the same question:

“He’s incredibly tenacious: if he feels he can accomplish something, he will. The key was that he had tangible goals to be back riding again. Also, his general positive outlook, his optimism. He’s always been good at seeing the positive in anything.”

In Part 2 of our series on Recovering From Crashes, we’ll look more in depth at what slows recovery down, and what you can do to speed it up. In the meantime, some closing words from Steven:

“I’ve learned a lot. You only live once, so do what you really want to do in life. I learned how much I really love to race by having to sit out. When I got back to racing, I enjoyed every moment of it. I don’t regret any moment of what I went through; it’s made me a better cyclist, that’s for sure.”

Advertisements

Recovering from Crashes, Part 2

After a crash – whether you’re in it, see it, or hear about it – it can be difficult to get your mojo back. And even when you’ve had a complete physical recovery, the mental side of your recovery can lag behind. When you focus on developing and using specific mental skills, you can speed both sides of your recovery and accelerate your return to optimal performance.

By Marv Zauderer

In our last Sport Psychology column, Garmin-Slipstream pro Steven Cozza, his coach, and his doctor described Steven’s recovery – and lessons learned – from a traumatic crash. This month, we add to the advanced skills of the mentally fit cyclist covered in past columns by exploring further how to recover from crashes.

This week, I heard Terry Gross interview the great comic Robert Schimmel on her NPR radio program, Fresh Air. I laughed and cried as Schimmel told the harrowing and ultimately redemptive story of his near-suicide, near-death and full recovery from cancer. (It’s worth hearing the interview just to hear him tell the story of having his 70-year-old mother, a concentration camp survivor, buy him rolling papers for his medical marijuana.) And of course, another cancer survivor – once near-death himself – is on my mind this week as he resumes his cycling career Down Under.

A crash isn’t always as frightening as being on the brink of death. Or is it?

When you crash, or see one, or perhaps even hear of one, something very powerful can be revealed within you, something that each of us has, something that most of us keep hidden from our moment-to-moment, day-to-day awareness: mortality. And of course, as far as things that terrify us go, that one tends to be way up there on the list. (The eminent psychiatrist Irv Yalom, in his new book “Staring at the Sun: Overcoming the Terror of Death,” explains how the fear of death is at the heart of much of our anxiety.)

But a crash can do more than evoke your mortality. Even if your brain wasn’t injured in the crash, research shows that the brain can change as a result of emotional traumaexperienced during and after the traumatic event. That can make you fearful and anxious, too. And of course, you may simply be worried about feeling pain again (what a surprise, right?), and may act in various ways to reduce the chances of that happening: going slowly on descents, avoiding certain races or rides, backing off during the sprint, and so on. So, depending on your genes, personality, and history, there are all sorts of opportunities for our old nemesis, anxiety, to interfere with your recovery.

You’ll recall from Part 1 of this two-part series that Dr. Judith Herman, in her pioneering book “Trauma and Recovery,” emphasizes restoring both inner and outer strength in recovering from trauma:

“The first principle of recovery is the empowerment of the survivor. [S/he] must be the author and arbiter of [his/her] own recovery. Others may offer advice, support, assistance, affection, and care, but not cure….Trauma robs the victim of a sense of power and control; the guiding principle of recovery is to restore power and control to the survivor.”

You’ll also recall that Dr. Herman identified three stages in recovering from trauma: Establishing Safety, Telling the Story, and Re-engaging With Life. (These stages are usually non-linear, so unlike a stage race, there’s no need to rush!) Let’s take a look at some skills you can use and some steps you can take in each of these stages. We’ll be ably assisted not only by Steven Cozza, but also by my friends and fellow Masters racers Lloyd and Ted, both of whom are recovering from a crash at the moment.

Establishing Safety
As I noted above, a crash can be an experience – literally or internally – of having your life threatened. It can violate your inner sense of safety, and can trigger profound feelings of powerlessness and helplessness. As you experience any new limitations after the crash, those feelings can linger and even intensify. If they’re powerful enough, they can cause and be sustained by depression. To avert all that and rebuild your sense of safety, some or all of the following may work for you:

• Learn, learn, learn. Recall how much better Steven Cozza felt after he spent a ton of time on the Internet learning about his brain injury. With insufficient information, your mind may rush into the void and start catastrophizing (ie. creating worst-case scenarios). And the catastrophizing is likely to create more powerlessness, helplessness, and anxiety. Cast away the catastrophizing, and get busy: Find out whatever you can about your condition. Remember, information is power!

• Bring yourself back to the present when necessary. Countering any catastrophizing is only one of the ways you can stay appropriately focused on what’s happening now. Sure, you’re going to be piecing your story together, and that’s going to require some visits to the past. And sure, you’re going to be planning your recovery, so that’s going to require some future-oriented thinking. But take care not to spend too much time in the past or future; your mojo needs you now.. Recall how Steven Cozza’s coach, Dario Fredrick, helped Steven by modeling a present-centered attitude:

“My whole approach was to emphasize that these things are temporary, to focus him on the things he could do, and to emphasize that his body was healing itself.”

You might not have visual-spatial and coordination problems like Steven did with his brain injury; you might just be anxious. This doesn’t mean you’re a wimp, or a nutcase, or hopelessly broken. It means you’re a trauma survivor. Fight anxiety’s attempt to drag you away from the present.

• Determine your “triggers” and approach them progressively. Particularly when you start to ride again, even on the trainer, certain things – eg., pain, higher speed, higher wattage, potholes, rain, close proximity to other riders – may cause you to become anxious, perhaps unbearably so. The basic strategy: do you what you can until you become very comfortable there, then push yourself a little bit further. Repeat. The technical term for this approach: progressive desensitization. Whether you’re doing the simplest stretches, exercising, or riding, the idea is that you give yourself – over and over again, with carefully increased levels of intensity – experiences of feeling safe. These corrective emotional experiences can be shots of antidote for your trauma symptoms.

• Treat pain with respect and curiosity. Pain can be a uniquely complex trigger. Ted, who broke his leg severely, advises, “To push through the pain could be disastrous. Let pain become your guide, and try to understand what type of pain it is.” Ensure you can differentiate between injury pain and performance pain. Relearning how to accommodate to performance pain may be part of your progression.

• Notice – and influence – how your body is healing. Particularly if your connection with your body has been a significant source of inner strength for you, you’ll feel safer as your body heals. Even the seemingly small improvements – a little less pain, walking further down the street, getting back on the trainer – can be big contributors to your sense of safety. And, research has shown how the mental side of things – your self-talk, your attitude, your hope, where you choose to put your attention – can have a powerful impact on your physical healing. So, this is another important source of power and control, and thus safety, for you: you can use your mind to help your body heal.

Telling the Story
Recall one of Dr. Herman’s key points about trauma:

“The core experiences of psychological trauma are disempowerment and disconnection from others. Recovery, therefore, is based upon the empowerment of the survivor and the creation of new connections. Recovery can take place only within the context of relationships; it cannot occur in isolation.”

Some things to consider:

• What is your story? You may not know until you start to “give voice” to it (whether verbally, through writing, art….) , get feedback from others, and begin to refine it. Notice that your story may include not just the crash, but certain thoughts, feelings, actions, and events before and since the crash.

• What are you making of it? In telling your story, note the meaning that you’re making of the crash and its aftermath. Your mental/emotional/spiritual response to the crash is going to be profoundly affected by this. (For you technical types, this is known as the “cognitive-appraisal model” of the response to crashes.)

How much of your identity, self-esteem, and self-confidence has been tied up in your cycling? (Check out the article on Recovering From Injury for more on this.)

And, another one of the things you may be wrestling with is: Why did this happen? Are you blaming yourself at all? If so, that’s not uncommon. Dr. Aphrodite Matsakis, in her book “I Can’t Get Over It: A Handbook for Trauma Survivors,” writes:

”Self-blame arises in part from the fact that powerlessness and helplessness are two of the worst feelings any human being can experience. Yet being and feeling powerless or helpless in the face of great danger is the very definition of trauma. However, people prefer to think that they are able to control their lives, so it is easier to blame themselves for negative events than to acknowledge that sometimes life is unfair or arbitrary and innocent people can be victimized for no reason. Consequently, to maintain a sense of being in control, you may view yourself, rather than chance, as responsible for one or more aspects of the trauma – perhaps for all of it. In this way, self-blame can be a means of regaining the power that was lost during the traumatic event.”

“Wait a minute,” you may be thinking, “I was (partially) responsible for the crash.” Maybe. But look very carefully at the bigger picture. Trauma – and sudden threats – frequently create huge anxiety and distort thinking, which can dramatically affect decision-making. If you notice yourself saying things like “I could have….” or “I should have…,” evaluate your guilt against reality. And you may need some help in defining the reality of the situation.

Even if you did contribute to the crash, take care not to restrict your story to that fact. For example, the fact that you did not intend to cause the crash may need to be part of your story. The influences on your contribution – a rock, other riders, the weather – may also need to be part of your story. Certain parts of your story may clamor for all of the attention. Don’t let them sway you. Tell the whole story. In the telling, you may discover more of it.

• Confront what’s difficult or confusing about your experience. Lloyd had been agonizing about the possible contribution one of his fellow riders may have made to his crash. After struggling with whether and how to discuss this with the rider, Lloyd had the courage to have the conversation, particularly since he knew he’d be riding with that cyclist again. The rider agreed to change a particular riding behavior, and as a result, Lloyd’s sense of safety on subsequent rides increased.

Re-engaging in Cycling…and Life
After his crash, Ted not only couldn’t ride, but he couldn’t go to work. A major project loomed the following month. He worked very hard on his physical therapy exercises, accepting them, in his words, as his “new job.” He also wanted to do whatever he could to work out and stay active, so he did core exercises and stretches in bed. The first time he stepped outdoors – with a walker – and saw a sunny day, it was a tremendous boost for his recovery. Ted emphasizes the importance of “small wins” and goal-setting skills in his recovery:

“Prior to my injury, I could set a goal and then choose to achieve it or to let it pass. It was my choice, either way. Now, I make many of my physical [recovery-related] goals with a bit more flexibility. For instance, I might say I want to do a certain race. While I can still attempt to train toward that end, the fact is that it might not happen physically. So, I just do what I can to cheat nature out of my healing time, and learn to accept when I can’t. I think that’s the biggest key to all of this – perspective. Set a goal but keep it flexible, work to achieve it, and then re-focus, re-state and adjust the goal and accept that if necessary.”

Lloyd stresses the need for patience:

“I am definitely forgetting more, sleeping more, and feeling depressed because everything takes me longer to do…I want to recover NOW…I now understand that what I need is patience…When I am patient it makes me much more comfortable and actually seems to diminish the symptoms of the head injury…Getting uptight just makes things worse.”

Speaking of getting uptight: particularly when you re-engage with cycling, it’s very important to have an effective toolkit for managing your anxiety. Effective self-talk – how you coach yourself through your recovery – may be the most important skill of all.

Lastly, if you’re having serious inner distress (eg. depression, recurring nightmares, flashbacks, debilitating anxiety, panic attacks), if you’re using food, drugs, alcohol, or what seem to be other unhealthy behaviors to control your distress, or after all of your work on recovery you still just plain feel stuck, consider seeing your doctor or a mental health professional; asking a trusted friend or family member for their honest perspective on your struggles; reading Dr. Herman’s or Dr. Matsakis’ book, or all of the above.

I’m tempted to end by quoting the wonderful actor Michael Conrad, who played Sergeant Esterhaus on the TV show Hill Street Blues. His signature send-off to the police officers after roll-call: “Let’s be careful out there.” I do urge you to take care of yourself out there, particularly if you’re recovering from a crash. But also dig deep for the courage to fuel an active, tenacious recovery: “play to win,” rather than “playing not to lose.” To quote a favorite saying of that cyclist racing Down Under, Carpe diem! Seize the day!

Living with the Risk of Crashing

The fear of crashing is a basic, normal – but often hidden – fear for cyclists, a fear that has surfaced more prominently in the aftermath of Wouter Weylandt’s tragic death at the Giro d’Italia. The mentally fit cyclist has a variety of healthy ways to cope with the danger inherent in the sport, creating the freedom to experience and enjoy cycling fully.

By Marv Zauderer

In the last installment of this Sport Psychology column, When Things Don’t Go Your Way, we looked at how you can recover quickly from common setbacks in a race or ride: getting dropped, missing the move, puncturing, getting passed, falling short of a goal, and the like. This month, we explore a reality that every cyclist faces – the risk of crashing – and how you can cope effectively with that risk.

Last month, I was out doing tempo intervals on my favorite flat stretch of country road. Go hard for several minutes, recover, look ahead and back, cross the road, turn around, repeat. Recovering after a hard effort, I spun easily past the entrance to a tiny town square, continued for a few hundred meters, checked ahead and behind, turned around, spun for the few hundred meters, and…a cyclist lay in the middle of the road. I slowed to a stop. I took in the people huddled around her, a long line of sports cars stopped behind her, a distraught man speaking urgently on a cellphone, a crowd starting to gather. I asked myself what I could do. I had no answer. I had an urge to see her face, to see if I knew her, to assess for myself how badly she was hurt. Instead, I turned away.

I made my way over to the small group of onlookers, and saw a friend, a cyclist preparing for the SF-to-LA AIDS/Lifecycle ride. She was pale. She explained that just minutes before, the rider had been hit by the lead sports car, which had been making a left turn into the town square. She pointed to the driver: the man on the cellphone.

I talked with her a bit, and then we fell silent. No reason for me to stay here, I thought. I said good-bye and continued on my way, past the stopped sports cars, and started another interval. As I began, I remembered that police officers often sat in their cars a bit further down the road, radar guns trained on possible speeders. Cellphone reception is spotty out here, I thought; perhaps I could send an officer back to the accident. I sped up. Just then, two fire engines, sirens blaring, sped toward and past me on their way to the scene. I slowed. I forgot about the interval.

Suddenly I was aware of something within me: fear. And in that moment, I became fully human again. I thought: What about the driver? What might it mean to him for a cyclist to listen? I turned around and headed back to the scene.

The shocking death of Wouter Weylandt last week at the Giro D’Italia has, for many cyclists, raised fears – of crashing, dying – that few want to discuss. And yet: bringing the fears out of hiding, and focusing on healthy ways to cope, is a path to a better experience in the sport we love.

Coping With the Most Basic of Fears
We human beings walk around with many basic assumptions about life. That a 26-year-old, well-liked pro cyclist with a pregnant wife would die doing the job he loves; that’s not one of them. We assume, as we live moment-to-moment, that we and those we care about – and root for, and even know as acquaintances – will live. Barring anything that brings the possibility of death, the fragility of life, to our consciousness, how could we not? Most of us don’t live with the ongoing awareness that death could come at any moment. It’s too terrifying. And yet, confronting and coping with this fear can help us on (and off) the bike. But how?

We’ve spent quite a bit of time in this column confronting our ageless nemesis, anxiety, and its family of clever siblings: fear, stress, tension, worry, nerves, and pressure. We’ve focused on these foes so frequently because any of them can so easily distort our thoughts, interfere with our performance, and prevent us from discovering more of our potential.

Many prominent psychologists, philosophers, and others who reflect on such things see all anxiety as emanating from the fundamental human fear of death. Sam Keen, in his foreword to Ernest Becker’s landmark work, “The Denial of Death,” summarizes two of the key aspects of Becker’s philosophy:

“The basic motivation for human behavior is our biological need to control our basic anxiety, to deny the terror of death…since the terror of death is so overwhelming, we conspire to keep it unconscious.”

This past week, we have been forced – tragically, and for some, traumatically – to emerge from our denial. And in looking at how you can deal most effectively with the reality of crash risks, let’s start there: with denial. It’s not necessarily a bad thing.

Ronnie Janoff-Bulman, in her book, “Shattered Assumptions: Towards a New Psychology of Trauma,” explores times when our “fundamental assumptions are seriously challenged” and the injuries that can result to our “inner world” during those times. She writes:

“It is probably an understatement to conclude that psychologically, denial has been underappreciated. [During times of] trauma, denial is far from a maladaptive mechanism suggesting psychopathology. Rather, it is a useful and valuable process that reflects the survivor’s extraordinary predicament…Denial enables the victim to reestablish some equilibrium and confront the threatening experience in smaller, manageable doses.”

Trauma is, of course, a very broad spectrum of human experience, from mild to severe. Yet denial and other strategies for coping can be invoked regardless of the severity. Notice that in the experience I described above, I was literally and figuratively quite a ways down the road before I felt anything beyond concern for the fallen cyclist.

Two years ago, this column addressed how to recover if you crash. In Part 1 we explored the experience and strategies of pro cyclist Steven Cozza after a traumatic crash, from Steven’s, his coach’s, and his doctor’s perspective. In Part 2 we looked at ways for you to recover according to Dr. Judith Herman’s nonlinear model of Establishing Safety, Telling the Story, and Re-engaging in Life.

As we (perhaps briefly) emerge from our normal and protective denial, let’s build on the material in those articles and take a look at what else can help you remain mentally strong in the face of cycling’s inherent dangers.

Establishing Safety
Ask yourself: What makes you feel as safe as you want to feel on the bike? Which of those things are within your control, or at least your influence? Here are some possibilities:

1. Bike Fit and Finish. Plain and simple, if your body feels as solid as possible on your bike, you’ll feel safer. If you haven’t already, consider getting a fit from a well-trained and highly-regarded professional. And make sure you know how to assess the state of your bike before you ride. A quick once-over can catch a piece of glass in a not-yet-blown tire, an out-of-true and thus wobbly wheel, a worn-out brake pad, or a cracked spoke nipple. Knowing your bike is solid is yet another source of safety.

2. Physical Skills. Increasing your confidence in your riding – cornering, descending, riding in a pack, conducting yourself in a sprint – can help you feel safer. Getting a coach, participating in skills clinics, finding a mentor in your local club or group ride, and reading about cycling skills are all ways to improve. And of course, getting out there and riding. But as you work to improve your physical skills, challenging yourself may bring on some anxiety. For some of you, the “I’ll just jump off the high dive anyway” types, going for it completely is the best way to get through the fear. For others, a progressive, stair-step approach to the challenges is the best way to go.

3. Mental Skills. Sometimes these are not too separable from your physical skills on the bike. For example, when you decide you need to look behind you while riding, how do you judge when, how, and how long to look back? How is your decision affected by your speed, the road quality, the straightness or curvature of the road, and whether there are riders in front of or behind you? When you take one hand off the bars to eat or drink, is the other hand close to the stem for stability? When you talk to other riders in a group, do you look at them? How do you take blind corners? What steps, if any, do you take to keep yourself safe when you’re passing other riders? How do you assess who’s safe to ride with? All of these things are about your judgment on the bike; feeling solid in your choices is a source of safety.

Also, your skills in building and sustaining your self-confidence, managing anxiety, handling pressure, and responding to adversity on the bike all can help you feel safer as well.

Finally, recovery – after, and sometimes during, rides and races – is critically important to your safety on the bike. Fatigue, and of course exhaustion, can decrease your ability to attend, focus, judge, decide, and act. Champion triathlete and coach Sage Rountree, in her new book, “The Athlete’s Guide to Recovery,” writes,

“Your successful approach to recovery will depend on two traits: patience and faith. You need patience so that you can give your body the time it needs to heal itself. Your body is an amazing, complicated, and powerful system, and given time, it will adapt in incredible ways to the stresses you put on it. But you have to give it time. Faith is also critical. You need to trust that time off, even though it might be hard to take, will have a direct, positive effect on your training. In time, you’ll see that it does, and your faith will become tested and proven belief.”

Telling the Story
Usually, most cyclists don’t want to discuss the topic of crashing. Why? Some possibilities:

• It raises a basic fear. Our brain can be highly skilled at shutting down an anxiety-raising step, or potential step, even before the anxiety reaches our consciousness. How welcome or unwelcome is fear, for you? Why?

• It would be embarrassing. If revealing thoughts and feelings about crashing raises the fear that you’ll be judged negatively by someone, your brain may again shut things down. But why does someone else’s (incorrect) opinion of you have such power?

• It increases the possibility of a crash. For those of you who are superstitious, this feels true. But what’s superstition? Could this conclusion be driven by a belief that you can’t manage the basic fear that will arise if you talk about crashing, and if you’re scared you’re more likely to crash? If so, could your skill in managing your fear change?

• It doesn’t seem “worth it.” Given all the possible downsides, why bother? What’s the point?

The point is that, as stressful as it may be, revealing yourself – particularly to those you trust, and sometimes even to those you don’t – works. Telling the story, your story, gives voice to what’s within you. It keeps those thoughts and feelings from endlessly throwing themselves against the bars of a cage in your mind, a racket that you may be tuned into or may have learned to tune out. It can relieve some of that pressure. It can create an opportunity for a basic, normal fear to be transformed into something else – because, with it now outside of you, with someone else hearing it, your relationship to it has changed. And it gives someone the opportunity to share their empathy for you. The eminent psychiatrist Irv Yalom, in his book, “Staring at the Sun: Overcoming the Terror of Death,” writes, “One can offer no greater service to someone facing [the fear of] death than to offer him or her your sheer presence.” Give someone the chance to offer that to you.

It could start with you saying where you were when you heard about a crash. It could start with you talking about the thoughts and feelings that are running through you about your own riding. Or your friend’s. Or your child’s. It could start with you talking about how you cope. It could even start with a be-careful-that-it’s not-insensitive joke. (Woody Allen famously said, “I’m not afraid of death. I just don’t want to be there when it happens.”) Just start where you are. It may feel like a tough climb, but just try to get to that next 12% grade sign, and then the next one. And the next.

(Re-)Engaging Fully With Your Riding
Living with the risk of crashing has much to do with the meaning you make of that risk. If, in response to being confronted with the risk and the feelings associated with it, you allow yourself to move in the direction of “there’s nothing I can do about it,” you may fall toward a state of what the psychologist Martin Seligman calls “learned helplessness,” a state of little or no motivation and a potential precursor to depression. Yalom quotes the psychiatrist Otto Rank, who said, “Some refuse the loan of life to avoid the debt of death.”

On the other hand, after any needed period of mourning or other emotional processing, you can use seeing, hearing about, or remembering the possibility of a crash as what Yalom calls an “awakening experience” and “existential shock therapy.” Any confrontation with death, or our fear of death, can enrich life – if we make that choice. What might that mean, for you? It might mean going for it in your riding, atop a secure base, built from solid physical and mental skills and a good ride. It might mean what Yalom calls “rippling,” which he has found “singularly powerful” to counter our distress at the transience of life:

“Rippling refers to the fact that each of us creates – often without our conscious intent or knowledge – concentric circles of influence that may affect others for years, even for generations….[it] does not necessarily mean leaving behind your image or your name…attempts to preserve personal identity are always futile….Rippling, as I use it, refers instead to leaving behind something from your life experience; some trait; some piece of wisdom, guidance, virtue, comfort that passes on to others, known or unknown.”

And, it might mean one more thing. Ted King, pro cyclist for the Liquigas-Cannondale team competing in the Tour of California this week, tweeted this after Weylandt’s crash: “Prayers going where they need to go. Go tell someone you love them and mean it.” Connecting more deeply with those with whom you are close may be the best move of all.

Be safe, be well, be alive!

Recovering from Injury, Part 1

When you’re hurting from an injury, the effects may not be entirely physical. Especially if you’ve been in a crash, you may be mentally depleted, fragile, or even traumatized. Cyclists who have made mental fitness a priority know how to manage, and at times accelerate, their recovery from injury.

By Marv Zauderer

Last month, to begin our series on Responding to Adversity, I discussed how you can increase your tolerance for suffering on the bike. This month, I explore Recovering from Injury, the second advanced skill of the mentally fit cyclist.

Injury is among the most challenging experiences you can face as a cyclist. When you’re injured, you almost certainly can’t ride in the way to which you’ve become accustomed, and you’re often not able to ride at all. If you were injured in a crash, your mental fitness may have taken a hit; perhaps a big one. While you’re not riding, your physical fitness may be decreasing, and you may be starting to lose confidence in yourself as a rider as well. And if all that isn’t enough, nobody can reliably foretell the path and likelihood of your recovery.

What happens next? (Please don’t answer, “I reach for [insert vice here].”)

Do you become depressed, demotivated, and down on cycling? Do you rush frantically to get back on the bike and your previous level of performance? The cyclist with sufficient mental training can navigate between these two extremes, avoid unhealthy vices, and manage the recovery process effectively. How? As with so much in life, living skillfully with injury begins with self-awareness, and most importantly, knowing the forces that can push you toward the extremes.

Step 1: Understand the Effects of Your Injury

To begin to uncover how the injury is affecting you, some specific questions you can ask yourself are:

• What thoughts are you having about the injury, about cycling, about yourself?

• What emotions are coming up? To what extent are you keeping them to
yourself, leaking them onto other people, or intentionally sharing them with
others?

• How about sensations – pain, weakness, numbness, tensing, spasms?

• Which of your behaviors seem to be influenced by the injury? How are those behaviors affecting your view of yourself and your relationships with other people?

Particularly if you’re sad, angry, or scared at times, it may be helpful to ask yourself this question: What have I lost, even if the loss seems temporary?

You may have lost power, function, and skill. You may have lost a significant source of fun, exercise, and challenge. Go a bit deeper: you may have lost a significant source of social contact, stress/anxiety reduction, and life balance. Go deeper still: you may have lost hope for your recovery, or you may have lost a significant source of meaning and purpose in your life. And finally, you may have lost a big part of your identity.

Psychiatrist Elizabeth Kubler-Ross theorized in the late 1960’s that, when confronted with our impending death, we have a characteristic response: the Five Stages of Grief. The stages, which can be traveled in any order and sometimes repeat, are Denial, Anger, Bargaining (eg. “Just let me live until….”), Depression, and Acceptance. Not surprisingly (at least to me), Homer Simpson illustrates all the stages quite well – after eating a fugu fish and being given one day to live – in Episode 211 of The Simpsons. At any rate, it was later observed that we often go through these same stages when we experience a loved one’s death, and it was then further observed that Kubler-Ross’ model seems to encapsulate the experience of many other kinds of loss.

I’m not suggesting that losing your cycling, even permanently, is likely to have the same effects on you as life-threatening illness or the death of a loved one. However, given that your injury has resulted in a sense of loss – and perhaps, as noted above, a sense of loss that cuts quite deeply – truly accepting what’s happened may accelerate your recovery. In other words, if you’re stuck in one of the other stages, your recovery from injury could be stuck. What might this look like?

• Denial: “It’s not that bad.” “I’m fine.” “I’m still racing tomorrow.” “It’s just a flesh wound.”

• Anger: Repeatedly becoming angry with unusual intensity, frequency, or provocation. Could be anger directed toward self, others, pets, lawn furniture…

• Bargaining: “Coach, just let me do this one race.” “If I do this one double century, I’ll rest for the next seven days afterwards.” “Doc, couldn’t you just give me some pain pills?”

• Depression: Sadness, hopelessness, helplessness, irritability, loss of appetite, sleep disturbance, loss of libido, loss of enjoyment, over- or under-sleeping, anxiety, inability to concentrate, lowered self-esteem.

Acknowledging and accepting what you’ve lost doesn’t preclude working to get it back. (Darn, I wish that worked with loved ones.) But the more clear-eyed and clear-headed you are about what you’ve lost, the less likely you’ll be to fill that space with something unhealthy.

Four More Steps Toward Recovery

Once you’re clearer about what’s going on within you, there are several things you can do to optimize your recovery:

1. Determine your needs and build a team to meet those needs. Perhaps you’re the kind of person who just needs a great doctor. On the other hand, you might benefit from support and guidance from such people as a physical therapist, alternative healthcare practitioners, a coach, a trainer, family and friends, a counselor or therapist, or clergy.

Since it’s critically important to see health care professionals with whom you feel highly comfortable and trusting, you may need to get clearer beforehand on what affects your feelings of comfort and trust. Is it the person’s approach to treatment and recovery? Their bedside manner? The cost? Whether they’re on your insurance plan? Whether they’ve been referred to you by someone you trust?

And don’t forget: you’re on the team, too. How you relate to yourself during your recovery – your self-talk, how you manage your emotions, your expectations – may make the biggest difference of all. Speaking of which…

2. Set and reset your expectations for the recovery process/time as accurately as possible. Having healthcare professionals who you trust will certainly help with this. It may also help you to get educated about your injury via other sources. Arnie Baker’s Bicycling Medicine, Andy Pruitt’s Complete Medical Guide for Cyclists, and Brian Halpern’s Knee Crisis Handbook are examples of books that I’ve found helpful.

3. Minimize any decline in your physical fitness. You may be off the bike, but you may not be completely prevented from doing any sort of physical exercise. Physiologically, exercise will tend to help combat any mood or anxiety problems that you experience as a result of the injury. Plus, if you can see and feel that certain non-injured areas of your body are staying strong, or perhaps even getting stronger, your outlook will tend to improve. For example, I do “superslow” strength training, an approach that not only works for me, but also seems to minimize the chances of (re)injury.

4. Take inventory of your core mental skills and use them. You’re still in training; recovering from injury is just a different kind of training program from the one you’re used to. All of your five core mental skills, some of which may need rehabilitation themselves, can make a big difference as you heal.

Goal-setting: Reset (or suspend) your cycling goals. If they’re out of synch with the reality of your recovery process, you’re likely to create stress, frustration, or even hopelessness. Apply your goal-setting and goal-management skills to your recovery program. And, extending point #2 above, be careful of goal-creep!

Self-talk: What kind of coach would you like to have supporting you every step of the way through your recovery? Shamelessly paraphrasing Gandhi, who said, “be the change you wish to see in the world,” I urge you to strive to be your ideal coach. Encourage and support yourself; don’t decide that’s the domain of other people on your recovery team. As you heal, use self-talk to reinforce your growing confidence and trust in the injured area of your body. If you’re getting down on yourself, telling yourself you can come back sooner than you should, or freaking out because you’re distorting what’s happening (or what you think will happen) in your recovery process, it’s time for an intervention. And you’re the one to intervene. Stop those thoughts, replace them if necessary, and use your anxiety-reduction techniques to decrease the negative self-talk’s fuel. Speaking of which…

Managing Emotions: Injury tends to be a big catalyst for anxiety. You may be afraid that you’ll miss a ride or race, miss the season, or never ride again. As you begin riding during your recovery, you may fear reinjury, a(nother) crash, or not reaching your goals. Your anxiety may be a drain, and your energy, motivation, and confidence may suffer. Remember, anxiety (an “out of control” feeling) and control often go together; turning the screws on your healing process isn’t the only way to exert control. So, if you notice yourself driving too hard to heal more quickly, it may be your unwitting response to stress. You may need to aim your control in a different direction – one that still reduces your anxiety.

Bad crashes can occasionally create a more complex challenge than anxiety: true, clinical trauma. Judith Herman, in her landmark book Trauma and Recovery, notes that “recovery [from trauma] can take place only in the context of relationships; it cannot occur in isolation.” If you feel it might be useful to be assessed for clinical trauma, your friends, your doctor, or (in the U.S.) the free Psychology Today service are examples of potential sources for a qualified mental health professional.

Concentration: It’s critically important that you stay focused on your recovery plan. And yet there may be more distractors than ever: pain, thoughts fueled by your anxiety, pain, frustration, pain, and that list of honey-do’s that’s so much harder to avoid now that you’re off the bike. Notice when you’ve lost focus (or listen to someone on your team when they tell you), identify the triggering factors (eg. a situation that stresses your injury or evokes your crash), and have ways to refocus that are matched to the triggers.

Communication: This one’s more important than ever. You’ll need to be communicating well with your recovery team, managing the flow of information (and possibly, pressure) with riding partners or teammates, and sharing what’s happening with significant others. Decide who would benefit from hearing about the injury’s effects on you and, as we say in California, share that. Be respectful yet assertive with health care professionals. And be aware that your communication may be affected at times by any stress you experience.

Here’s to your health!

Recovering from Injury, Part 2

After you’ve been injured, it’s natural to focus on the physical side of recovery. But what about the mental consequences of injury, and the steps you can take to overcome them? We talk with Ted King of Liquigas-Cannondale and Dr. Renee Newcomer Appaneal of UNC Greensboro about their experiences. The mentally fit cyclist integrates a variety of mental skills into a complete recovery strategy.

By Marv Zauderer

Last month in this Sport Psychology column, we continued our series on Preventing and Recovering from Injury by exploring a challenge that all cyclists face: living with the risk of crashing. Our series has also included two articles on recovering from crashes: Part 1 related the post-crash recovery of pro Steven Cozza, and Part 2 provided recommendations on how you can recover from a crash.

This month, we return to the more general topic of recovering from any injury – incurred on or off the bike – that gets in the way of your riding. In Part 1 of Recovering from Injury, we identified a five-step process that can accelerate your recovery. Building on that, we discuss the topic with our guest experts:

Ted King, of the Liquigas-Cannondale Pro Cycling team, finished 3rd in the road race at the recent US Pro Championships in Greenville, South Carolina. He is a two-time finisher of the Giro D’Italia, has many successes in his palmarés, and writes a popular blog at IamTedKing.com. Shortly after his podium finish in Greenville, Ted crashed while racing in Philadelphia when he rode into a shockingly-unmarked sewer grate, ending his plans to compete at the Tour de Suisse and for a place on Liquigas’ Tour de France team.

Dr. Renee Newcomer Appaneal, AASP-CC, Assistant Professor at The University of North Carolina at Greensboro, has been consulting with athletes, teams, and coaches for over 15 years. She is a Certified Consultant in applied sport psychology and a member of the USOC Sport Psychology Registry. In addition, she is a Licensed Professional Counselor in North Carolina and a National Certified Counselor. As an educator and consultant, she emphasizes health (stress management, injury prevention and recovery) as a prerequisite for performance excellence. She builds upon athletes’ existing psychological strengths and teaches specific mental strategies to manage stress, recover from injury, and ultimately achieve optimal performance.

Pez: Ted, what injury do you have, and what was your experience of having it repaired?

Ted King: A fractured left collarbone, the second time around…I did it once eight years ago as an amateur cyclist. At that time, I wanted to continue racing… and I didn’t have the surgery. I saw an orthopedic surgeon, and he sent me to one of the best upper extremity docs in the country [in Boston], and we agreed it wasn’t necessary at that time. And now, eight years later, I’ve seen the same series of doctors, and actually saw that doctor in Boston and he’s the one who repaired it this time around. A lot of that has to do with [the fact that] I’m a professional cyclist now, and it’s in my best interest to get back on the bike.

Pez: In the first hours and days after the crash, how were you affected?

TK: A lot of it was frustration, because it was so preventable. If it was a more foreseeable accident, I think I’d be OK with it, but to be frank, it’s the negligence of the race organizers….You elicit a lot of reactions from other people when you say you broke your collarbone. You hear a lot of horror stories. On the one hand, I’m incredibly thankful and grateful that I didn’t crack my head, I didn’t break my teeth, I didn’t have a TBI [Traumatic Brain Injury]. I know it could be worse, and I would prefer it to be better.

Pez: I’d think that part of the experience, given you were headed for the Tour de Suisse, was a sense of loss.

TK: Absolutely….I don’t believe in fate, I don’t believe in things happening for a reason…it’s not going to change what’s happening; accepting it is the best you can do.

Pez: What’s been hard about your recovery?

TK: You get stir-crazy pretty quickly, going from being on your bike 3,4,5,6 hours a day to virtually nothing – that’s tough. I’ve gone through accidents before, got a few broken bones before, so pain is a big aspect of it. This time around, the pain isn’t so bad, which certainly helps the situation.

Pez: Accepting what happened is one of the things you’ve been doing to cope. What else has helped?

TK: There are certainly worse places to be than at home with your family and friends in the middle of summer. This will be one of the first times I’ll be home for the 4th of July, so I really like that. I don’t want to sound cheesy, but [my advice is] just embrace what you have. I’ve accepted the situation and will make the best of it. It’s a beautiful 80-degree day in New England, and yet I’ll be on the trainer for the next few weeks before I get the nod to go outside. Things could be worse, things could be better, but accept where you are and make the most of it. As much as anything, it’s a head game. [But] compared to [early] this spring, when I had tendonitis in my knee, an overuse injury – that was really tough mentally. When you have a chronic injury like that, you don’t know what caused it, you don’t know how to prevent it. You drink your milk and eat your yogurt and cottage cheese, you do everything you can do, and presumably things will run their course. In that situation, you’re pretty heads-down and just sort of blast through that.

Pez: Renee, let’s start more general than crashing. What are the major psychological risk factors for injury in sports?

Renee Newcomer Appaneal: A lot of the research that’s been done has identified that your personality influences the way you cope with stress. The heightened stress response is what seems to be accounting for the psychological or mental influence on sport injury incidence. Obviously, there may be a physical impact of a trauma or collision, but the research over the past four-plus decades or so has shown a strong association between life stress, the presence of stress, and injury likelihood. So those who have a high degree of stress tend to get injured – either a greater degree of injuries or more severe injuries. There seems to be some connection there. Some of the additional research that’s followed that up [has shown that] it’s not just the presence of stress, it’s the presence of stress in addition to not having the coping resources to manage that stress.

Pez: So the higher the stress and the lower the coping resources, the more likely that the stress energy is going to fuel inattention or other risk factors that could result in a crash, or not managing the body’s warning signs effectively, or something along those lines?

RNA: Yes. There’s a pretty well-known stress and injury model [to explain the] mechanisms for how that happens. Your increased stress response can affect your attention, and that can interfere with coordination and movement. There have been some studies that have looked at attention, being able to recognize and identify relevant cues in your peripheral vision, and how that narrows under conditions of high stress. So there’s some consequences for focus and attention, and recognizing and reacting, in a stressful situation. There’s any number of things that can contribute, collectively and independently, to the likelihood of an injury.

One of the interesting things in health psychology that has occurred outside of sport that has just now started to show up in our field is the contribution to psychological stress to physiological healing and recovery. So even on a biological level, when the body needs to recover from trauma, even if it’s micro-trauma – an intense workout, travel – psychological stress will delay and prolong recovery. There’s an analogy where it extends your window of vulnerability.

Pez: What do we know about the personality factors that contribute to injury prevention?

RNA: A number of them focus on self-awareness of stress, and building/broadening the coping resources to manage that stress. Developing skills such as accessing social support, relaxation, cognitive skills such as focus and attention, to be able to buffer adverse consequences of stress. There are a few studies that have looked at stress-management interventions and the effectiveness of reducing injury risk. Those have all reflected a cognitive-behavioral stress-management program.

Pez: What are some of the key psychological consequences that we see athletes struggling with after they’ve had an injury?

RNA: One of the main things is that stress response. For injuries that are more severe, that preclude an athlete from participating in their sport or even being physically active, it can be incredibly challenging. For a lot of elite athletes, training and engaging in competition is actually how they cope with stress. You kind of get a double whammy: you get an injury that prevents you from doing what you enjoy, and also what you use to cope and manage stress in life or in your sport.

Pez: And then if your stress is increased, your recovery time may be longer.

RNA: Exactly. Psychological stress tends to interfere with the healing process – not just the biological and immune response systems, if you’re depressed, or anxious, or worried, or fearful about the injury, or in a lot of pain, you may have sleep disruptions, and a lot of the restorative recovery processes after an injury occur during sleep.

Pez: So unless you have other coping skills for the stress, you’re going to be more at risk.

RNA: Yes. It’s going to be a lot more challenging for individuals who use physical activity to cope with stress. With intervention following injury, the goal is to look at how they cope with stress, and try and develop their strengths, and adjust it to the kind of situation [they’re in]. So how can we use their approach, the way they might attack training, how can we use that to focus their energies and attack rehab and recovery.

Pez: Please go a little further with that – steps that help athletes recover.

RNA: One of the things that tends to be a focus of my work is building the coping resources. I do that in four areas. One is through social support: looking at how an athlete is using their resources. Are they engaged with their physician or their surgeon, maybe a physical therapist or trainer, are they actively involved in that program and asking questions? There are a number of ways to get social support, and the tendency is for the athlete say, “Oh, I don’t really need support.” When you’re injured, you need a lot of specific types of support that you may not have. I have to work with athletes to help them learn how to do that, similar to how they might reach out to a coach. If you don’t have experience being injured or dealing with this new stressor, you need input, just like you’d get input from a nutritionist or a specific sport trainer. Techniques and strategies – this is no different. We really work on building that social support network – existing support and also support in the medical community which they may not be used to dealing with.

Pez: It’s really about assembling the kind of team that you need.

RNA: Yes. And they may not have access or relationships with the medical community that focuses on rehab. [The medical people they know] might focus on training and performing at top levels, but not necessarily for rehab and recovery, which is a different goal.

The other thing is looking at coping and how they [the athletes] manage stress. If they use physical activity as a way to cope, are there ways to modify or use that – are there other things they can do to be active in coping with what they’re dealing with? If athletes have used mental skills, such as imagery or relaxation, then they have some foundation skills to develop some healing and recovery imagery, or even mental rehearsal, when they can run through long-term goals – where they hope to be. They can imagine being back in a particular race, or if they have goals, say, three months out, envisioning where they are [in three months] to help build confidence and maintain motivation. If imagery is something that an athlete is used to using, I’ll build on that existing strength and apply it to anything – from immediate healing imagery to focusing on developing confidence and mastery, seeing themselves recovered and strong and performing well down the line…figuring out what they use to perform well and what can apply to recovering well.

Pez: So social support is the first of the four areas, and stress-management patterns is the second….

RNA: We tend to think of coping as adaptive or maladaptive: avoidance or denial, venting, seeking information, or actively trying to solve problems. We all have different tendencies or preferences for how we like to cope with challenging situations. A lot of what I do is try to get a sense of – not just with the injury, but in life and other situations – how does the athlete typically cope, and is that something that’s appropriate for this situation that we can apply, or are there other choices that we need to be more mindful about.

The third area is the self-regulatory skills – the mental skills. The mental skills that they were already using, such as imagery, can be applied to recovering from injury. And then self-care: making sure they’re sleeping well, that they have adequate caloric intake, they’re hydrating, the kind of things that support healing and recovery, just as they would for training at top levels.

Pez: Unlike many athletes, cyclists live with the risk of witnessing or experiencing severe traumatic injury, even death. For those of us who follow pro cycling, that’s been on our minds recently. Given that reality, what unique considerations might there be for cyclists after a traumatic injury?

RNA: I like to find out more about how they experienced fear and anxiety before the injury became their focus. Fear is actually a good thing – one of the things I try to help athletes understand and recognize is that the goal is not to have no fear, but to have a healthy respect for it. If you recognize fear and anxiety, you can look at that and examine it: does this mean there’s something I need to be paying attention to that I’m not? Is there a decision I can make, do I need to be more vigilant, do I need to be more focused on being relaxed? The idea is to be able to recognize an appropriate, normal, transient fear versus the exaggerated, emotionally charged, fear of reinjury after being injured or after seeing a [traumatic] injury….the exaggeration is the reaction to the [normal] fear.

Pez: What are the biggest missteps athletes make when they’re trying to come back from injury?

RNA: The tendency is to not recognize or appreciate the impact of the mental recovery. There’s a tendency to just focus on the physical recovery – that’s more easily observable. If you’ve been able to get back on the bike, to get back into competition, to return to participation in whatever sport you’re engaged in, the sense is, “allright, I’m back.” We unintentionally send a message that if physically you’re able to do it, you should just be able to do it. We know that there are mental, psychological, and emotional things that can interfere with your ability to perform, let alone the emotions, reactions, or sensations that you’re trying to manage when you’re coming back from an injury.

Many thanks to Ted and Renee for sharing their experiences with Pez, and I encourage you to click on the links in this article for more tips on building the mental skills you need to accelerate your recovery. Be well!