Sports Injury: How being injured affects mental health

Injuries, while hopefully infrequent, are often an unavoidable part of sport participation. While most injuries can be managed with little to no disruption in sport participation and other activities of daily living, some impose a substantial physical and mental burden. For some athletes, the psychological response to injury can trigger or unmask serious mental health issues such as depression, anxiety, disordered eating, and substance use or abuse.

When an athlete is injured, there is a normal emotional reaction that includes processing the medical information about the injury provided by the medical team, as well as coping emotionally with the injury.
Those emotional responses include:

  • Sadness
  • Isolation
  • Irritation
  • Lack of motivation
  • Anger
  • Frustration
  • Changes in appetite
  • Sleep disturbance
  • Disengagement

How athletes respond to injury may differ, and there is no predictable sequence or reaction. The response to injury extends from the time immediately after injury through to the post-injury phase and then rehabilitation and ultimately with return to activity.
For most injuries, the athlete is able to return to pre-injury levels of activity.

In more serious cases, however, a student-athlete’s playing career may be at stake, and the health care provider should be prepared to address these issues. The team physician is ultimately responsible for the return-to-play decision, and addressing psychological issues is a significant component of this decision.

It’s important for athletic trainers and team physicians, as well as athletes, coaches and administrators, to understand that emotional reactions to injury are normal. However, problematic reactions are those that either do not resolve or worsen over time, or where the severity of symptoms seems excessive.

One problematic reaction is when injured athletes restrict their caloric intake because they feel that since they are injured, they “don’t deserve” to eat. Such a reaction can be a trigger for disordered eating. When an athlete is already at risk for disordered eating, this problematic reaction only heightens the likelihood these unhealthy behaviors will worsen.

Another problematic response to injury is depression, which magnifies other responses and can also impact recovery. Depression in some athletes may also be related to performance failure. When athletes sustain significant injuries, such as knee injuries associated with time loss from sport, they can suffer both physically as well as emotionally with a decrease in their quality of life.

When Olympic skier Picabo Street sustained significant leg and knee injuries in March 1998, she battled significant depression during her recovery. She stated: “I went all the way to rock bottom. I never thought I would ever experience anything like that in my life. It was a combination of the atrophying of my legs, the new scars, and feeling like a caged animal.” Street ultimately received treatment and returned to skiing before retiring.

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