Grief from Injury, and the Mental Health Stigma of Athletes

Joanna Diaz
Oct 19, 2022
6 min read

Sure, physical restrictions from an injury suck, but what about the mental aspect? Sports-related injuries are extremely common, however there are so many facets that go undiscussed so let's dive into a few.

Psychological stress that often leads to injury

Many of us have experienced that stress even if it didn't result in injury. For those of us who've played team sports, we've heard the coach yell "head in the game" for a reason. We're unfocused or psyching ourselves out because we think we're unprepared. Best case scenario is we fumble. Worst case, we misstep, make a wrong move, overexert... Whatever it is, and we end up hurt. Interestingly enough, those "unfocused" players are swapped out for the win. Not for their safety.

One of my favorite examples of sports-centric mental health stigma is when Simone Biles made the decision to withdraw from the team finals in the 2020 Olympics stating, "I have to focus on my mental health and not jeopardize my health and well-being.” The public response of judgement and outrage cast a spotlight on the issue -- we, as athletes, are not told to make decisions for our own wellness. We're told to do what's best for the team, and that remains the expectation. Her making that call, especially at just twenty-four (24) years old, took incredible courage and strength, not only to withdraw, but also to handle the backlash. The potential consequences for competing at her level under that struggling mindset could have been life-altering, or worse, fatal.

I don't know about the lot of you, but I saw so many posts in my social media feed along the lines of "she knew what she was getting into," "she's weak," "she's such a disappointment", a lot of them from people I considered close, including family. It was incredibly disappointing to see their negative response to someone taking control and protecting their mental and physical self. It kind of makes me wonder if those are the thoughts that would run through their mind if I were talk about my mental health. Honestly, the cultural stigma is strong, so I still don't even bring up my own stuff to my family.

"Put mental health first because if you don't then you're not going to enjoy your sport and you're not going to succeed as much as you want to." - Simone Biles

Now a mental health advocate, I see Biles as a fantastic role model, not just for the older athletes, but largely for the younger generation who've yet to realize, they, too, can break that stigma and still be successful.

Psychological reactions and the stages of grief

So that you might better understand where I'm coming from, I'm not an injury newcomer.

I wrecked my ankle running down a mountain trail race in 2017. Instead of accepting I needed to sit out the next few races, I continued running regardless because I am a dumbass, denial is a bitch, and adrenaline is an excellent painkiller. Needless to say, it wasn't remotely close to healed when I reinjured it at the North American Obstacle Course Racing Championships. It took almost a year for me to be able to fully bear weight on the ball of that foot.

Off-season began after that race and I couldn't train as I normally did, and with fitness being my primary go-to for mental health maintenance, it kickstarted the ping-ponging between extreme emotions of primarily anger, denial, and depression. I had come across an article that mentioned, “If an athlete sustains a really serious injury, they actually, in a lot of cases, go through a similar process as […] someone who is grieving.” (2019)

In "The Seven Stages of Sports Injuries," McDuff quoted:

"The most difficult part about [the injury] was not the physical scars but the mental ones,” Virji said. “Sport was my form of meditation [….] It was my coping mechanism for everything that life threw at me, and, in an instant, it was all taken away from me.”

This was everything I felt, and I then realized that it wasn't an abnormal thought or emotional process.

Social Factors

I don't think many realize just how intensely social factors influence our decisions while healing from an injury. "Social factors refer to the perception that, in certain societies, continuing to play sports with pain and injury is highly valued; a show of commitment and strength." (Krnjaic, 2019) On one hand, the Obstacle Course Racing ("OCR") community is such an amazingly supportive group. On the other hand, there's the self-imposed stress to further push the limits of an injured body because it almost feels expected. Take Spartan Race and the ridiculous "Spartan the Fuck Up" ("STFU") bullshit. It initially started as a saying meant to suck it up when out of your comfort zone, however that has since evolved somehow to people believing it is acceptable and/or expected to grit your teeth and take on a mountain while still on crutches following a surgery.

The dynamic biopsychosocial model as developed by Wiese-Bjornstal et al. 35 Weise-Bjornstal DM, Smith AM, Shaffer SM, Morrey MA. An integrated model of response to sport injury: psychological and sociological dynamics. J Appl Sport Psychol. 1998;10(1):46-69. Copyright ? the Association for Applied Sport Psychology, www.appliedsportpsych.org, adapted by permission of Taylor & Francis Ltd, http://www.tandfonline.com on behalf of the Association for Applied Sport Psychology.

I will admit, a few weeks ago I was running in the Obstacle Course Racing ("OCR") World Championships 15k when I fell from an obstacle, injuring my good foot, and triggering that chill of panic with the possibility of another round of months-long healing. With the team relay the following day, a competition a week later, and a twenty-four (24) hour race in two months, I went into a full-on meltdown as I limped to each obstacle that followed and was eventually talked into pulling myself out of the race and walking off the mountain.

I had been feeling off leading up to race day and I just wasn't excited day-of. Add to that my stressing over having to do the obstacle where I had injured myself years before. I could go down the rabbit hole with what-ifs on the impact of those stressors, but I am going to save myself the unnecessary overthinking. Sometimes shit just happens and it's ultimately up to us how we handle it (with or without professional guidance).

I know I made the right call, but sometimes I still feel extremely disappointed in myself for quitting, especially when the injury is the only thing limiting the body from achieving something it's able to do. They can tell me otherwise, but in addition to letting myself down, I felt like I let my team down after having to pull out of the relay. On the positive, a replacement was found, but with that came the painful realization that they were better off with someone else (Don't fight me on this. It's how I feel). Watching my friends achieve their impossible was amazing, but trying to smile to join in celebrating those achievements while with a broken heart was extremely difficult. The battle between wanting to show support and trying to keep from losing my shit when I was already barely hanging on...

The athletic community fails to acknowledge that having the ability to do what we do is a privilege and that injury is a huge loss. This loss among athletes is rarely considered a risk for mental health, despite said loss having a huge impact on our identity. Going from training several times a week to a sedentary life while healing is a huge mindfuck. The "FOMO" of your friends tackling a course while you're home nursing an injury, able do nothing more than view photos on social media of a great time and scroll yourself further into a depression.

I didn't isolate nor did I self-medicate. I did, however allow myself to feel whatever it is I was feeling and released it all in waves. Small wins, I suppose. Injury is that scary realization that we are not invincible, and that we can quite easily be sidelined at any time. Keeping it smart and not jumping back in too soon is the hard part. There needs to be more awareness and acceptance surrounding the mental health aspect of healing from physical injury, if for nothing more than to understand it takes time, isn't linear, and we're not crazy for fluctuating between emotions at varying intervals.

2020 Tokyo Olympics women’s gymnastics: U.S., without Simone Biles, takes silver, ROC wins gold in team final. (n.d.). CBSSports.com. Retrieved October 19, 2022, from https://www.cbssports.com/olympics/news/2020-tokyo-olympics-womens-gymnastics-u-s-without-simone-biles-takes-silver-roc-wins-gold-in-team-final/live/
Bregman, S. (2021, October 10). Exclusive! Simone Biles on sparking mental health conversation: “We’re going through it together.” Olympics.com. https://olympics.com/en/news/simone-biles-exclusive-mental-health-advice-future
Krnjaic. (2019, July 19). The Psychology of the Injured Athlete. Marbella International University Centre. https://miuc.org/the-psychology-of-the-injured-athlete/
Wiese-Bjornstal, D. M., Smith, A. M., & LaMott, E. E. (1995). A model of psychologic response to athletic injury and rehabilitation. Athletic Training: Sports Health Care Perspectives, 1(1), 16-30. https://www.researchgate.net/publication/341193911_Wiese-Bjornstal_D_M_Smith_A_M_LaMott_E_E_1995_A_model_of_psychologic_response_to_athletic_injury_and_rehabilitation_Athletic_Training_Sports_Health_Care_Perspectives_11_16-30
(2019, April 10). The seven stages of sports injuries (E. McDuff, Ed.) [Review of The seven stages of sports injuries]. The McGill Tribune. https://www.mcgilltribune.com/sports/the-road-to-recovery/