Do you know there are 5 stages to a sports injury?
- First stage: Denial. It is a just a scratch. It will be fine.
- Second stage: Anger. Stupid referee. Didn’t you see I went for the ball but he went for my shin??
- Third stage: Bargaining. Maybe I will just need some ice.
- Fourth stage: Depression. OMG. I will never play again in my life. The pain!!!
- Fifth and final stage: Acceptance. Fine!! I will see a doctor
Let me tell you a story. Kyrie Irving, a veteran point guard for the Dallas Mavericks had a knee injury on March 3 during the game. He was fouled on the play, but was in excruciating pain, almost not able to take the free throws for the foul committed on him. Yet, he did. Because if there was a chance he could come back in the game after sometime, he needed to take the free throws. Little did they know the injury was an anterior cruciate ligament (ACL) tear which will put him out for the rest of the season.
And this is not the first time an athlete has experienced this kind of pressure from today’s sports community. Kobe Bryant was in a similar position after an Achilles tear mid game and had to play on for 5 more minutes. We all know how we feel when Jaspreet Bumrah announces that he is injured once again. What do you think this kind of pressure does to someone’s mental health?
The first 6 weeks are the most probable time for a person to experience symptoms of depression after an ACL injury. Symptoms are more pronounced in professional athletes than non-professional ones. Anxiety levels usually shoot through the roof, anger & negative emotions increase while self-esteem decreases.
Let me list a few symptoms:
◦ Depressed mood. Sadness, emptiness, hopelessness
◦ Diminished interest or pleasure in activities
◦ Significant unexpected weight loss
◦ Inability to sleep or oversleeping
◦ Psychomotor agitation or retardation
◦ Inappropriate guilt
◦ Diminished ability to concentrate or make decisions
◦ Fatigue or loss of energy
◦ Recurrent thoughts of death or suicidal ideation
The last one of course is the biggest red flag, but there are 2 more athlete specific symptoms I would like to mention:
◦ Fear of re-injury: Burnt child dreads fire. This is an evolutionary response that is suppressed by athletes or people in professions like military or firefighting, so as to excel in their work. But during vulnerable times, everybody gets back to regressive behaviour. And that might lead to poor participation in rehabilitation.
◦ Overtraining: Sometimes the anxiety of losing place in the team, sometimes fear of losing physical conditioning or sometimes the pressure of today’s sports community (as noted in Kyrie Irving’s example) the athlete might start training earlier than advised or overtrain which can lead to dangerous consequences.
Some orthopaedic surgeons have gone as far as to label this entire malaise as the “ACL depression syndrome” which constitutes 40% of all patients undergoing ACL reconstruction. Wow!! That’s a big number!
So what can be done? As orthopaedicians, physiotherapists, and nutritionists, we must ask the client to seek help as soon as we spot any of these symptoms. Most of the times, the client knows they need help, but a professional telling them gives validation.
Once a patient is referred to a sports psychiatrist or a sports psychologist or any mental health professional, she will device a custom therapy they need based on their needs, environment & behaviour patterns. Somebody might be suited for cognitive behaviour therapy; somebody might show better results with dialectical behaviour therapy. But counselling would be mainstay for athletes. Goal setting as to when to walk, run, and train can be done in liaison with orthopaedicians & physiotherapists. Anti-anxiety medication in short bursts and low doses can be tried, especially during off season or non-playing times. World Anti Doping Agency (WADA) specified medicines can be used even during competition.
In conclusion, I want to say that as doctors, our ability to cultivate the innate abilities of optimistically talented people defines the level and speed of recovery. Every athlete is going to get injured sometime or the other. The best athletes use the injury as a platform and come out better than ever before.
Thank you.