Once Bitten, Twice Shy: Overcoming Injury Anxiety

Tearing my soleus – inner calf muscle – was the worst soft tissue injury I have suffered in my life (maybe I’m lucky?).  After skipping for 5min to warm up, I took part in an agility drill that involved jumping over a partner, then dropping prone and crawling under them.  On the third jump I felt and odd “squelch” sensation in my calf and tightness preventing me from extending my foot properly.  I stepped to the side and, thinking it was a simple cramp, I started stretching it out and working the muscle to loosen it, then continued into the next drill. (I found out later that stretching is the worst possible action of can take when dealing with a tear, as it, logically, exacerbates said tear!)

It turns out that tightening your calf/soleus through one activity (skipping), then immediately loading it in another (jumping) is a perfect storm for muscle mangling.  I was also informed, much to my chagrin, that soleus tears are so common in men over 40 that they are referred to as “The Old Man’s Injury” (ugh… time is real!)

Recovery was relatively straightforward; don’t stretch, take it easy for a few days, then slowly strengthen it by way of controlled exercise. I thought it wise to take time off of Krav maga, as bursting and kicking are fundamentals. Nothing too complicated, and not a terribly painful healing process.

On the road to a full recovery!  No problems!

However.

The first day back to training, after four weeks off, I was trembling as I prepared for class.  I felt totally fine on the way to the gym, in fact I was happy to get back at it, but as I took off my shoes to step onto the mats, my hands were shaking.  What if my first sprint sets me back to square one?

Over the years I have encountered many people who cite “fear of injury” as their main reason for not starting to train in the martial arts or self-defence (or to justify avoiding exercise altogether).  I get it; people don’t want to suffer injuries.  But, I’m not talking about “fear of injury” in the sense of “*whiny voice* don’t wanna get hurt”, that is simply good ol’ self-doubt paired with cowardice (let’s be generous and say “self-preservation”), I’m talking about the realistic fear of suffering a chronic, debilitating injury. 

I expect it is often the case that “fear of injury” in the latter sense is more accurately a “fear of re-injury;” you have experienced the physical/mental/emotional pain of injury and recovery, possibly accompanied by a loss of mobility for the duration, and most likely had to stop training, thus you don’t what to go down that road again (or worse, end up with a more permanent problem).

Of course, in the martial arts, or any physical activity, you must accept that there is a degree of risk involved simply from participating (some injuries are caused by partners and are, to a certain extent, out of your control.)  But in many cases the injury, as with my soleus tear, are surprising.  So it may be the unexpected nature of certain injuries that contributes to the onset of anxiety.  Sure, you walked in expecting to be punched, bruised, or, at worst, KO’d, you are at peace with those potential consequences.  But then you pull a bicep.  Okay, it could happen.  It heals, but not quite 100%.  Now you start to feel weaker along the chain or arm muscles.  This leads to you straining you wrist due to weakened overall punching form, etc..  Your willingness to take a punch did not prepare you for being hindered by a common sports injury.  Not only were you unprepared, but now this injury has led to diminished performance in a set of techniques, techniques that, in turn, diminish your overall performance.  Now you are less confident and less likely to push yourself and, by extension, less likely to improve.

When a nonathletic individual suffers an injury, he or she is faced with the difficulty of completing normal daily tasks due to pain and a loss of mobility. Once the person returns to pre-injury level, he or she is still only faced with the challenge of completing normal daily tasks. An athlete on the other hand, is not only faced with the challenges of daily functioning, but also faced with the challenge of returning to the field… the act of returning to play forces an athlete to participate in the exact activity that caused the injury initially.

(2008) “Fear of Injury, Kinesiophobia & Perceived Risk”, p.289, Injuries in Athletics: Causes and Consequences.

Thus the rational fear of injury, gained from experience, can be very real and, if left unchecked, can become a mental/emotional/physical hindrance. (In extreme cases, if your fear or anxiety is allowed to take hold and increase, you could end up with full blow traumatophobia, abnormal fear of injury, or kinesiophobia, fear of moving due to pain, both of which may diminish your quality of life and delay recovery.)

You enjoyed that activity you were engaged in (let’s assume so, otherwise why would you pursue it?), but now your recreation/fitness/lifestyle activity has betrayed you and the joy it provides is replaced by pain and fear.

I’ve been there, twice.  Trust me, it sucks.

So, how do we mitigate anxiety?

First off, when you are injured go see a doctor.  Have the injury treated if it requires immediate attention (eg. cuts and breaks). If it doesn’t require a trip to the Emergency Room, great, but still see a physician to check for related, possibly hidden injuries (eg. concussion).  Furthermore, seeing a doctor will help in determining the full extent and nature of the injury; for example, is it a soleus tear rather than the calf cramp you “expertly assessed” it as.

After receiving a professionally trained opinion regarding your initial injury, you want to take action.  While I am not a psychologist, it stands to reason that exerting or maintaining control and actively engaging in a solution that improves your situation should help reduce the anxiety surrounding the injury or mechanism of injury.  While this may not entirely eliminate the possibility of fear, as some is natural, it should reduce the intensity.  (Be mindful that “control” via avoidance could set you down the path of the aforementioned phobias.)

Know that, in the vast majority of cases, you WILL heal, you WILL get back to doing what you love.  Don’t give up, don’t stop taking care of your mind and body!  A positive mindset and an active participation in your own recovery will, logically, make it easier to face the injurious activity once more in the future:

1. Get Checked Out – After the initial injury, you will want to see both a doctor and a physiotherapist, preferably a sports focused one (if you can, everyone’s resources differ.)  I say both because doctors are great for diagnosing and treating acute injury, but physio specialists are better for helping you develop and execute a recovery plan.
2. Understand Your Injury – You don’t just want to heal your wounds and get back at it; you want to understand why and how you were injured, in order to reduce the chances of a re-injury and so to your fear of re-injury.  Take the responsibility of learning about the anatomy and physics that got you into trouble in the first place, and then get better.  Sometimes this means understanding basic kinesiology, sometimes it means learning to keep your hands up in sparring.
3. Set Rules and Expectations – Be honest about your limitations and create guidelines for yourself in order to stay active in a safe manner.  Everyone is different, and every injury requires a different approach to healing and rebuilding.  Here are some general considerations:
   • Modify Activities – Go slower, engage in reduced intensity or lower impact versions of exercises/techniques/drills.  It is in your best interests to be honest and realistic. For example, in the martial arts, it is unlikely that you can train throws, takedowns, or groundfighting while recovering from an injury. But, again, it varies based on the nature of the injury. Talk with your instructor, any competent one will be able, and willing, to accommodate you.
     • Are you allowed to “audit” classes?  Ie. Attend class to watch and listen, but not participate.  This is a good way to stay in the headspace of your activity while healing.  Plus you will be surprised how much knowledge you pick up by watching others
   • Be Realistic About Severity – Be aware of how limited you are in range of motion and level of exertion. Are you able to participate safely (for yourself and others)? Will one wrong step re-injure you, or worsen the severity?  It may be that some time off is required.  Talk with your instructor!
   • Know Thyself  – Yes, more, deep self-reflection is required!  Are you the type of person who can actually sit on the sidelines, will you follow your own rules?  If you are like me, possessed of a sometimes reckless willingness go harder than you should, let those around you know your self-imposed limitations and let them help you stay accountable.  If you cannot keep yourself reined-in enough to train safely, maybe do something else to keep fit while you recover?
4. Keep Active! – Don’t fully stop unless you really have to.  “Stay off it” isn’t always accurate, scientifically informed, advice, even coming from a doctor.  Broken arm?  Focus on your lower body, or use this as a time to start engaging more cardio work. I find that Humans have a sort of mental inertia, stopping fully will make “getting back on the horse” much harder.  Additionally, your removal from any activity allows you way too much time to think and creates a void for negative memories of the injury to grow and exaggerate, impacting your comfort level with said activity when you return, thus increasing the possible onset of fear and anxiety (if you return at all).
5. Re-Check – Reassess the injury as it heals, then reassess the plan for recovery in parallel.  Also, don’t neglect your mental well-being throughout the process!  Consider how you are feeling; what are your thoughts regarding your return to action, do you feel a creeping dread, do you feel fine until it it’s “go time” (like I did)?  Should you see a counselor to help with overcoming the fear of re-injury or the anxiety of returning to 100%?  There are sports therapists who specialize in “Sports Counselling (Mental Strength Training).”

At the end of the day, you have to decide your own path.  I assert that if you be truthful with yourself, take an active role in your recovery, even if that means modifying exercises or sitting out on certain drills, you will be able to ease back into your favoured activity while you heal.  Yes, I have a hard time sitting on the sidelines, and too many times I have said “of course I’ll spar!” when I know I shouldn’t, and set my healing back a week.  So, for me, injuries often mean time off to protect me from myself.  (Honestly, if I was into mountain biking or rock-climbing I’d probably be in a wheelchair or a pine box by now.)

But that doesn’t mean I quit!

I’m currently dealing with a back injury.  But I’m actively dealing with it! When I’m not training Krav Maga, I’m doing my physio-assigned back exercises, I’m reading about self-defence theory, I’m working on basic kicks and punches with my daughters (“To teach is to learn”), I’m running, I’m working with a personal trainer for core strength, I’m focusing energy on changing my diet to improve my physical performance.  And before I know it I’m back into the lower impact basics (“Defence”) classes.  Those go well, so then I’m planning ahead for where my back needs to be in order to ease back into the “Warrior” classes. (and I probably should be auditing the “Novice” coloured belt classes)

Adopt the mindset that this is temporary and you WILL overcome it as you would any physical challenge.  Some people say “I was injured while biking, I’ll never get on a bike again.”  But, in my opinion that leaves behind a part of your life that you enjoyed, it narrows the breadth of your experience and allows you to give into living based on fear.  That’ a slippery slope, and life is too short!

Written by: Corey O