Overtraining and under recovery are common experiences amongst athletes developing fitness and preparing for difficult competition. Endurance sport enthusiasts and elite athletes are amongst the most vulnerable. The margins between optimal exertion and overtraining become quite small, and even a small mistake or unhealthy overuse pattern can result in injury. The frustration, resulting discouragement, and anxiety can become overwhelming and depression is quite common. This article offers some guidelines for the recovery process and for coping with injury. Because injuries disrupt our physical, emotional and cognitive functioning these guidelines serve to address issues in each of these areas.
Self-Care Management in Rehab
Athletes who experience time loss from training and competition are likely to rehab injuries with deliberation and at a level of exertion many people are unaccustomed to. Your PT, Trainer, or Rehab specialist should have experience with your particular injury and you should consider a SECOND OPINION regarding diagnosis and prescribed treatment as ROUTINE.
Keep a rehab journal just as you would a training log. During the session itself, be willing to talk about your sensations. Be descriptive, be specific, and recognize that a certain sensation at one particular point in the range of motion of a muscle can have diagnostic significance. You need to communicate on the rehab process in real time and minimize the chit chat. Log your experiences after each session and before you go to bed at night. Consider sleep, energy level, swelling, throbbing, tingling sensations as providing useful information for both you and your rehab specialist. When asking for a prognosis, ask for a best case, worst case and average time frame for rehab to optimal recovery. Ask about your rehab professional’s experience and ask how many cases they have worked on with your particular injury.
Athletes are particularly motivated patients. Even so, consider the consequences of coming back too quickly. Be particularly sensitive to injuries that may set you up for chronic problems. Ask questions. Study a Clemente’s Anatomy book, or Netter’s Medical Illustration Guide so that you have a clear picture in your mind as to what the injury is and what your recovery will entail. Consider a daily meditation period using mental imagery to visualize and mentally facilitate the healing process.
DO NOT UNDERESTIMATE THE IMPORTANCE OF YOUR OVERALL SELF-CARE. The following categories have been shown to be impacted by injury and oftentimes play a significant role in one’s overall recovery. Whether the injury is a concussion or partially torn ligaments these issues will arise. The more adept you are at managing your self-care during the recovery period the more likely your recovery process will be optimal. Remember to: BE OPTIMISTIC, BE ENCOURAGING TO YOUR SUPPORT SYSTEM, AND BE DISCIPLINED. Rehab requires both COURAGE (to do what you need to do even though you might be afraid), as well as, CONFIDENCE (focus on the purpose of each exercise, be productive with your thinking, and positive in considering what’s possible in your recovery.
It is important to consciously limit demands you make on yourself during recovery. People who strive to achieve or gauge their self-worth by how much they accomplish are particularly vulnerable to exacerbations of depression and anxiety. These emotions tend to make adjustment to injury worse. Fatigue and inadequate sleep frequently accompany injury, and if not managed well, our functioning can go from bad to worse quickly. The following guidelines will help you manage fatigue more effectively:
* Schedule rest breaks throughout the day.
* Plan to do most of your rehab work, thinking and decision making in the morning or when most rested.
* Eat a nutritionally balanced diet, take supplements, and avoid caffeine and sugar.
* Exercise daily (even if a mild walk) – stretch as often as possible.
* Make it a point to experience a deep relaxation period daily.
* Do whatever is necessary to get enough sleep.
* Set limits to avoid overextending yourself.
* Ask for help often.
Managing Memory Problems
When the body or brain is injured or when under extraordinary stress, our cognitive functioning can become impaired. One of the key difficulties we may experience is in the area of memory and recall. These things can be helped to some degree.
Use a calendar, daytimer, or an organizer notebook to help keep track of activities. (Carry it with you everywhere, and be thoughtful when making commitments.)
Write down everything important in the organizer, and, ANYTHING you want to remember. (Keep track of questions you want to ask the doctor- and leave room to write their answers.)
Use an alarm or timer to remind you of things and assess your current abilities. (You can gauge improvement by periodically measuring the time it takes to do something.)
Help your memory by thinking about things in different ways. (See it, hear it, feel it, say it out loud, write it down, enlist others to help you remember.)
Managing Attention and Concentration Problems
When in pain or dealing with frequent distractions it is common to lose our place, forget where we are going or maybe what we wanted when we get there. These problems are common when injured. Acquiring information can be particularly difficult. Reading and rereading material is predictable, so try the following to help you:
Organize your environment as much as you are able to. (Label things visibly. Get help sorting things. Keep the things you use the most closest to you.)
Limit how much you are exposed to. (Wear ear plugs to limit noise, do one thing at a time, turn off the TV or radio, and simplify things.)
Keep your door closed if interruptions get in the way. (Schedule office hours or structure you time with a purpose.)
If you have difficulty driving minimize your distractions. (Limit the number of passengers you take and keep them quiet. Turn the radio off.)
Survey readings entirely before you start to read. Then actively ask yourself questions about what you need to learn while reading. Always review the material before you stop a specific study session. (Review material you need to know or work with frequently, and immediately after initial exposure.)
Managing Overwhelm or Difficulties with Motivation
Things often build up and they can have a big effect on our ability to function. Depression can feel like irritation, agitation, or like we are spinning our wheels going nowhere. Limit these kinds of problems by preventing overwhelm as much as possible.
Make REALISTIC daily schedules and lists of things to do, check them off as you complete them. (Being realistic with your capabilities is more difficult than you think. Donâ€™t be afraid to experiment, your capabilities can be determined through trial and error. Allow more rather than less time to accomplish a task.)
Break Large tasks down into bite sized pieces. (Ask a friend to help you do this if you have trouble yourself.)
Managing Problems Processing Information
Our perceptions of tasks and their difficulty are frequently inaccurate following injury. Unfortunately, we assume that we can do things as we always have. The gap in what we perceive as our capability and in actuality what we accomplish is a trigger for depression and negative feelings. Glitches most often occur when we least expect them.
Write down and repeat back verbal information such as directions and phone numbers. (Remember that organizer and sort information by date needed and cross reference in another place if you think you will use it again.)
Allow more time to complete activities. (The perfect set-up for dejection and failure, accurate estimation of time-on-task is more important than you might think. Estimate accurately, not optimistically.)
Team up with someone whenever it is practical. Having a friend to help us understand, organize or prioritize can help us function more effectively, and, prevent us from making promises we may not be able to keep.)
Copyright Stephen E. Walker, PhD 2007