The Running Injury Mind-Body Connection: How to Heal Your Body AND Your Brain

Caraway foam rolls her headImagine: you finished your last hard marathon-pace workout and reached the taper unscathed. Woohoo! Only two weeks until the marathon! You’ve worked hard all summer and you earned this rest day. You stroll down the sidewalk, sipping a #PSL and thinking about how much you love fall, when you step on a rock and twist your ankle, spilling coffee all over your boots. You roll your eyes, walk it off, and the next morning you can only hobble and limp because it hurts so much.

What happens next?

a) “Oh well,” you say brightly, because you’re always so chipper in the morning. “Guess I can’t run! It’s so great that I’ll have all that free time on marathon day!” You text your friends and make plans for brunch instead.

b) You experience a violent outpouring of unprintable words, panic, and desperate internal screaming that this cannot be happening.

This happened to me twelve days before the Berlin Marathon. I’d trained for it all summer. I definitely did not opt for option “A” above. I was more like a roiling mass of untamed emotions ranging from toddler-esque internal temper tantrums to sadness attacks to self-blame. I vacillated between being absolutely certain the marathon was off, and engaging in all sorts of mental gymnastics to justify why my foot pain was not really an injury. I iced, wore compression socks, foam rolled, and of course googled All The Things in an attempt to find out how to fix it.

Most injured runners have read obsessively about RICE-ing (Rest, Ice, Compression, Elevation), Graston, Active Release, dry needling, ultrasound and all the other ways to physically treat your injuries. We cross-train like crazy to avoid losing our hard-won fitness, spend hours on the foam roller, or ice the sore spots to the point of frostbite.

So much for taking care of your body. What about all those feelings, though? The sadness at missing out on a goal race, the anger, the anxiety, the loneliness as you miss out on group runs and your running friends suddenly no longer text you? What are you doing with these emotions? These are all very common reactions to a sports injury, and it turns out that our emotional coping styles and other psychological factors like mindfulness and social support are just as important to the healing process as physical therapy.

Nothing more than feelings? The Five Stages of Grief

I was fascinated to find out that there is a whole branch of sport psychology dedicated to athletes’ emotional response to injury. Respecting my own feelings doesn’t come naturally to me – if self-invalidation is a thing, I’ve got it going on – so it’s incredibly helpful to know that while everyone’s a little different, pretty much every injured athlete has gone through similar emotional turmoil as they struggle to accept their injury and work toward healing.

Dealing with a running injury is often compared with the five stages of grief: denial, bargaining, anger, depression, and acceptance. Sport psychologists say the process isn’t quite that clear-cut. How you respond to an injury depends a lot on your personal history, emotional coping style and current levels of life stress. Still, the five-step concept offers a useful framework to assess how we’re dealing with the situation.

Denial

Definitely not just a river in Egypt. I mentioned earlier that when my foot started hurting, it was for some reason incredibly important to me to construct this whole argument that it was, yes, painful, but not really an injury as such. In hindsight, I have no idea why this was a good use of brainpower, but apparently it’s a very common initial response. (FYI, if you ever face the same question, the National Institutes of  Health offer a handy cheat sheet defining sports injuries. Yes, I had one.)

Bargaining

Closely related to denial. It’s that “OK, so I can’t go running – so just let me cross-train for two days! Then it will be fine!” mentality. Sorry: most injuries take more than two days to heal.

Anger

Now you’re starting to see the injury for what it is, and you’re mad as hell. Anger at the unfairness, anger at seeing all your hard training undone, anger at seeing others keep on training, anger at yourself for being stupid enough to get injured.

It’s ok. Drinking a case of beer in the tub with your running clothes on is somewhere in the acceptable range of coping with a running injury.

Depression

All that anger is enough to make anyone depressed! Now you’re just sad and empty inside. The thought of the race going on without you makes you want to cry. Maybe you feel a little guilty now for hating everyone who can still run while you were being angry at everything, and that sense of shame isn’t good for your self-esteem.

Acceptance

OK, you can admit it. You’re injured, and you now see that the only solution is a visit to the doctor and some physical therapy.

Of course, the five-step framework leaves out other common emotions

Anxiety

Anxiety about the injury healing (or not healing) properly, and about re-injury, is very common. So is anxiety about “losing fitness”, which can prompt all sorts of intense, sometimes misguided and even counterproductive cross-training sessions. Runners who use running for weight loss or weight control worry about regaining. Saltines who have recovered from an eating disorder say that an injury can trigger disordered thoughts. Also, if you identify yourself as a runner, who are you if you can’t run? You might feel like you’re losing part of your identity, which is anxiety-producing. Finally, I use running to control my general anxiety levels. I don’t sleep well and feel grumpy if I can’t run.

Loneliness

If you’re used to running with a group, or even just with a friend, the sudden loss of that interaction can make you feel isolated. And if you don’t feel you can talk to anyone about your injury, you are bound to feel lonely.

First aid for your feelings

How you deal with your feelings about being injured is key to getting back to a full training load. So, what is the mental equivalent of RICE-ing? Science says the key is to be aware of your emotions and accept them. Easier said than done! Here are some ways that can work:

Mindfulness

We’ve evangelized it before, and when you look at the studies that have been done on mindfulness and sport, it seems like there isn’t anything mindfulness can’t do, including help you through an injury. In a nutshell, mindfulness means being aware of the present moment – both your surroundings and your internal world – observing it, and accepting it without judgment. The easiest way to cultivate mindfulness is to practice meditation. If you can’t seem to shut your brain off long enough to meditate, there are apps like Headspace that provide guided mindfulness meditations to help you chill.

Journaling

Studies have found that journaling significantly reduces stress in injured athletes. Let it all out on the page. You don’t have to write for an audience, or even go back and read it later. Just the simple act of writing down what you feel can be cathartic.

Social support

Support from friends, family, teammates and medical providers has been shown to have a positive impact on injury rehabilitation. Conversely, reluctance to speak about an injury or reveal one’s feelings about it is associated with slower healing and less chance of returning to your sport. Even if the thought of talking about it makes you want to hide under a rock, find at least one person you trust enough to tell them what you’re going through.

I was so grateful to have friends to lean on who just get it (shout out to the other Salties!). Even friends who think I’m a little crazy for doing all this running understood how hard I’d worked to get ready for the marathon and how bummed I was about not being able to run it.

Self-compassion

Relative to all of the other things happening to people across the world, having a sore foot and skipping a race is very minor. It’s easy to castigate yourself for being down about it. Still, my disappointment at having to give up a goal I’d pursued for so long was valid. In contrast to my natural disposition, which is to function as usual even when I’m suffering on the inside (good way to eventually have a total breakdown, by the way), I gave myself permission to have those feelings without judging them. And, I gave myself a break.

The day I officially decided not to run the marathon happened to be my free day, so I ditched my to-do list and scheduled a good wallow for the rest of the afternoon: sofa-sitting, cat-patting, venting. Self-indulgent as it seems, I believe those few hours of wallowing had a lot of therapeutic value, helping move me along toward acceptance and sensible injury management.

Have you ever been injured? How did you cope?

I'm a 41-year-old living in Berlin, Germany. I run because I can't not run. I write about training, mental training, momming, and the odd rant.

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13 comments

  1. Reading this made me realize I went through every one of those 5 steps with my current injury. Hoping to get cleared to do more than pool running and stationary bike soon! Friends and family who understood my feelings and didn’t brush them off helped so much. And yes, big picture, it could always be worse.

  2. Yes! This was basically my entire Summer!
    Great plug about self-compassion at the end- I have a draft about self-compassion and running that needs finishing!

  3. This is a great post, Caraway. I have been dealing with a hamstring injury to various degrees for a year now, and I don’t think I’ve gotten past the denial stage, which is probably why I’m still mildly injured and more-than-mildly burned out. This is good encouragement for me to try to accept it, work through it, and move on!

  4. What about body mechanics that just make running extra hard? I’m dealing with that. Can I foam roll my pelvic tilt? I might be able to help it with lots of time with the osteo, though. Just learning about this. Great post.

  5. Yes!! This has been me all summer. I tore my ACL and meniscus 4 1/2 months ago. I’m just getting back into running now. It’s been so hard.

    1. Sadly, I can’t take credit for the beer bath idea (that’s Barley) but you better believe that is now on my list of coping mechanisms for next time!

  6. Good post! I tend to stretch out the denial phase for waaaay too long, particularly for injuries that are enough to be painful, but not enough to be debilitating. The emotional side of injury is the worst!