Managing your return from injury

When recreational tennis player James Coe felt a slight pain in his knee, he dismissed it as muscle fatigue. The pain persisted and James gave his body a few days rest, expecting the niggle to subside. After all, James wasn’t a high-level athlete who pushed his body to the limit; he simply enjoyed playing tennis socially a few times a week. Eventually, James realised his pain was serious and saw a doctor who diagnosed him with patella tendonitis, the same injury that Rafael Nadal struggles with. At first, James was assured his tendonitis was a mild case that could be fixed quickly. However, one year later James still has not returned to the court.

Initially, James was surprised how his lay-off from sport affected him. He found he had too much time in his weeknights and weekends and began to feel down about his lack of activity. No longer crawling into bed exhausted from tennis, James struggled to sleep. The persistent nature of the problem meant he worried he would never play tennis again. Frustration, anger and sadness became familiar companions.

Players at any level, be it professional or recreational, can struggle emotionally when injury forces them off the court. When Maria Sharapova took seven months off for shoulder surgery in 2008, she admitted it was mentally difficult. “It took a lot of time, it took a lot of bad losses, it took a lot of bad days… I was grumpy, I had my tough days and I would yell at people and say, ‘You’re promising one thing, and it’s not happening.’ I certainly had my doubts, but I kept going and didn’t let anyone tell me otherwise,” she later confessed. Juan Martin del Potro spoke of similar feelings when a wrist injury caused him to miss almost a year of competition. These feelings may sound extreme, but they are completely normal. However, if left unchecked normal levels of sadness and anxiety can manifest into something more serious.

The Function of Sport
Sport does much more than help physical fitness; it also helps a person develop a sense of identity and self-esteem. According to Sports Psychologist Dr Joann Lukins (PhD, MAPS), the Director of Peak Performance Psychology, sports enables people to learn about their competencies and limitations, which in turn allow them to set goals and develop self-confidence in who we are and what we can do. A tennis player doesn’t even need to be playing at a particularly high level to benefit mentally from tennis. “Our self-esteem doesn’t require that we necessarily ‘win’ in our sport. However our sense of ability, trying and personal best can contribute to a greater sense of personal self competency,” Lukins explains.

Sport also allows people to make social bonds. Even in an individual sport like tennis, players still interact with opponents, coaches, club staff and doubles partners. In addition to the natural happiness felt from socialising, physical activity produces endorphins which lift our spirits and make us feel happier. Sport is therefore an effective way to cope with stress and lift bad moods.

When Injury Strikes
When an athlete becomes injured, whether professional or otherwise, they will be affected mentally. Lukins reports that an athlete may respond in one of three different ways. Distress is a natural response and evokes feelings of guilt, anger and helplessness. Denial can also manifest as a failure to accept the nature or severity of the injury. Alternatively, an athlete might acknowledge their injury and engage in a realistic and appropriate way of coping. Obviously, the latter option is the way every athlete would like to manage their injury.

How an athlete copes with their injury is partially to do with their personality. “An athlete’s level of resilience, general levels of anxiety and how motivated they are to succeed combines with the factors of everyday life, nature of social support and access to good medical care. Together these factors will influence how a person will cope and the overall impact the injury will have on their self-esteem,” explains Lukins. It is completely normal to feel some level of distress when forced away from play as most people find it difficult when something in life feels beyond their control. The more an athlete defines themselves through their sport, the more anxiety provoking an injury can be.

In the worst case scenario, athletes can develop serious depression. Feelings of distress and denial couple with symptoms such as withdrawal from significant others, rapid mood swings, an obsession with returning to training and statements indicating that they do not believe they will ever recover. If an athlete does reach this stage, it is vital they seek medical care. However, Lukins believes depression can be avoided by using the correct coping methods.

Bouncing Back
Even the most highly strung person can increase their chances of overcoming their injury without falling into the depths of despair by using certain methods. Much of an athlete’s emotional response is actually dependent on the athlete themselves. In other words, no matter how helpless the athlete may feel, they have far more control over their emotions than they might think.

Lukins says that athletes need to acknowledge their injury and find ways to think about it constructively. It may be the oldest cliche? in the book, but seeing the silver lining is a way to avoid depression. Being off the court may allow a student to focus more on their studies, an adult to try a new hobby or craft or to spend more time with loved ones. It is also important to maintain a connection with the sport whether it is by supporting team mates or staying in touch with coaches. Staying hopeful and positive will go a long way to improve moods and aid recovery.

Although rushing back onto the court can be tempting, Lukins says that complying with rehab and medical advice is the key to avoiding re-injury and helping stabilise emotions. It is important to learn as much as possible about the injury by asking questions and doing research. Rehabilitation can be a gruelling, repetitive process so athletes must remain motivated and be prepared to work hard.

James Coe learnt how to deal with injury the hard way. After months worrying about his knee, he finally accepted his injury and began to think positively about rehabilitation. He is now using his free time constructively by commencing study. To feed his competitive streak, he has taken up ten pin bowling. He still longs to play tennis, but he now has the ability to cope with any more setbacks and is feeling positive about the future

Coaching strategies for helping the injured player:

• Talk: Allow the player to debrief. Discuss their disappointment and help them to refocus. Be empathetic and let them know their feelings are normal.
• Support: Athletes can become withdrawn when injured, which can deepen negative emotions. Coaches can help by reaching out to the player to assure them that even though they’re not on the court, they’re still on the coach’s mind. Visit them in hospital if they have surgery and have regular conversations.
• Involve: Do not forget to invite the injured player if the club is having a social night. Keep them updated on tournament results and encourage them to come along to support their team mates. This will help them maintain their sense of identity and feel included.
• Train: Discuss with the player’s doctors and physiotherapists what training the player can still undertake. Many exercises
  can be adjusted for injury and training will help keep the athlete motivated and involved.
• Refer: If an athlete is struggling to cope with their injury, a sports psychologist can help them adjust. Sports psychologists are experts at helping athletes manage pain, injury rehabilitation, surgery and can help them return to play successfully.

If a tennis player develops serious symptoms of depression such as withdrawal, changes in eating or sleep patterns or suicidal thoughts, it is important to encourage them to go to their GP who can refer them to a counselor.

This article first appeared in Australian Tennis Magazine.