I recently suffered an injury during my recent marathon training block. Things were going well; I was five weeks from race day and at peak mileage. A sharp cramp seized my left calf during a usual speed workout and stopped me mid-run. I limped two miles home, cursing myself for my bad luck to have gotten injured during running. What followed was a well-documented journey through the five stages of grief.
In 1969, Swiss-American psychiatrist Elizabeth Kubler-Ross published her Grief Response model in her book On Death and Dying. She developed her model to help medical practitioners understand how terminally ill patients cope with the diagnosis of death. Over time, Kubler-Ross’ model has found its way into other disciplines, including sports injury.
The five stages of grief are illustrated in the below graph.
We can explore the stages of grief using my recent injury. The first reaction is denial. “I am not injured.” “It is just a violent muscle cramp, and things will be better tomorrow if I drink some electrolytes and hydrate.” In this stage, athletes cling to a false, preferable reality and avoid acknowledging the potential for an injury.
Anger is subsequent when the runner realizes that denial cannot continue. For me, this was the next day when my run was cut short again from the pain. Something was wrong, and that was impossible to deny. Runners can become frustrated, especially with people close to them, such as family, friends, and coaches.
The third stage is bargaining. “What if I run easy for a few days? I’ll stop or cross-train on a stationary bike if it hurts.” You can see how this would work. You know you are injured, but maybe you can continue your training block in exchange for a reformed set of actions.
The next stage is depression. I believe this is the most challenging stage; if you are not aware, it can last the longest and do the most harm. In my experience, most sports injuries quickly progress through stages one through three and enter depression. You realize you are injured, and all hard work is seemingly lost. There will be no race day or PR. What’s the point of it all? You will just get injured again. You are too old to run. You were not going to run well anyways.
Do you see how things can quickly spiral out of control?
Before you know it, you will spend much time detaching from the world. You will sleep longer and refuse to spend time with family and friends. Escaping to alcohol will happen sooner in the day or more frequently. What’s the point of engaging with the world if you aren’t chasing running goals?
Moving from depression to acceptance is the hardest action to take in the injury recovery process. Acceptance does not mean you are happy or okay with the injury. Acceptance doesn’t mean you no longer have negative feelings. Acceptance is becoming aware of your behavior. You recognize that you are sleeping longer to avoid facing the day. You slowly begin to reorient yourself to fight against these self-destructive behaviors and focus on moving toward the future, no matter how hard it will be. It may involve seeing a doctor or physical therapist. Races may be rescheduled and expectations adjusted. “It’s going to be okay. If I can’t fight it, I may as well prepare for it.”
If you are suffering from a running injury, I am sorry. It’s easy for me to accept your injury. The challenge will be for you to work through the stages. As I have matured in my running career and life, I do better progressing through the stages, especially emerging from depression to acceptance. It’s never easy, and each injury or setback brings unique circumstances. My best advice would be to acknowledge the natural process, become aware of your thoughts, and focus on maintaining your regular schedule as much as possible (even in the absence of running). If you keep moving forward, eventually, you will make it where you need to go.
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