The Injuries You Can’t See: How Mental State Impacts How an Injury Heals

In 2015, professional triathlete Linsey Corbin was out with a fractured femur. Although a devastating injury, bones typically heal  in 6-8 weeks. For Corbin, it took eight months. 

“It was a couple of things,” says Corbin. “The physiological stuff that we didn’t address early on, and I cross trained through it.  After four months, I had an MRI that showed I hadn’t healed whatsoever, so I shut everything down for two months.” 

Eventually, Corbin’s bone healed, and for the next five years, she was invincible. Her mental and physical durability led her to five Ironman wins and a host of other top ten finishes. And then, seemingly out of nowhere, she felt a niggle in her quad while on a training run. An eerily familiar sensation, Corbin stopped running immediately and walked home. The diagnosis? A stress reaction in her opposite femur. 

This time, Corbin started her return to activity in the predicted 6-8 weeks it takes for a bone to heal. 

So, what was different? 

From Training Through Injury To  Shutting It Down

In 2015, when Corbin’s overworked bone fractured, so did her identity. Corbin thought that if she wasn’t training then she wasn’t an athlete. As a result of this thinking,  she was back in the pool, on her bike, or in the weight room way too soon. 

“I’ve been a professional athlete for 14 years so that is where my self worth comes from,”  says Corbin, as she reflects on why she continued to train through an injury that is very difficult, if not impossible, to cross train through while trying to heal. “To have that taken away, you’re like, ‘who am I without this sport?’, and those feelings and thoughts overwhelmed me to the point of incapacity.”

According to sports psychologist Ashley Cokey-Cranney, when athletes are only in touch with one of their identities, it makes them more susceptible to doing anything and everything to preserve that identity. 

“If athletes don’t have other outlets, we see them engage in things like disordered eating, over training, and using harmful substances all because they’re trying to protect the one way they see themselves,” says Cokey-Cranney. “It’s a constant balance for athletes to define themselves in more than one way so if one way is compromised, they have other outlets for protecting how they see themselves.” 

Fast forward five years, and Corbin knew that regardless of training volume, she was still an athlete. Because of this, she was able to channel her discipline for training into her recovery. 

“Last time I felt sorry for myself and had horrible anxiety and depression,” says Corbin. “This time I kept myself occupied with other activities, which gave me some self worth and value. I am not out of the woods in this department yet, but I am working on it.”

From Daily Judgement To Weekly Evaluation

In 2015, Corbin judged every sensation she felt in a very black and white way: if she felt pain, she wasn’t healing; if she didn’t feel pain, she was healing. Because healing isn’t linear, Corbin’s emotions soared high when she felt good, and to deep, dark lows when even slight discomfort showed up.  She called her coach daily, often ending in tears. In hindsight, the daily calls were keeping Corbin too focused on her injury and creating additional stress, which in all likelihood, slowed her body’s healing.

Research shows that injury is a biopsychosocial condition. To effectively and efficiently heal injuries, both psychological and medical therapies are crucial, but all too often the former is ignored. Without psychological and emotional techniques, it is not uncommon for athletes to experience anxiety and depression, which hinders our body’s ability to heal. 

“It’s really gnarly what long term cortisol does to you,” says Cokey-Cranney. “When you can accept your injury and be present-focused, your body has freed up resources and is in a place to think more clearly, make better decisions for who it is you want to be, and live in a way that is more consistent with your values. Reducing stress has so many physical and psychological benefits, it’s absolutely insane.” 

(To name a few of those benefits: reduced irritability, increase in feel-good hormones, better decision making, reduced susceptibility to disease and muscular-skeletal injury, and increased cognitive ability). 

In 2020, Corbin moved to a weekly evaluation instead of a daily obsession. Each Sunday, she evaluated her week, making sure to log any gains over the previous week. Doing so allowed her to quantify her progress  and to shift her focus from losses to gains.  All of this, ultimately, reduced her stress levels. 

From Punishing Herself To Taking Care of Herself

“In 2015, I was restricting calories because it was another form of self abuse,” says Corbin. “I treated myself really crappy. I thought [the injury] was my fault.” 

Although it may seem intuitive to reduce caloric intake when injured because you’re training less, it is not as straightforward as it seems.  According to a study from a group in Scotland led by Dr. Kevin D. Tipton of the University of Stirling Health and Exercise Research Group, energy expenditure may increase by 15% to 50% during the body’s healing process, depending on the type and severity of the injury.  So, while inactivity may result in reduced total energy expenditure, the overall reduction is not as severe as athletes often think.  If restriction of energy intake is too severe, recovery will almost certainly be slowed due to negative metabolic consequences. The takeaway? The single most important nutritional consideration during injury is to avoid nutrient deficiencies. 

The 2020 version of Corbin was well aware of the importance of adequate nutrition, and rather than restrict her calories, she ate extra to ensure she was healing. 

“This time around, I’ve gone the opposite [direction] and put on quite a bit of weight,  but I’m like, ‘okay, it’s healthy, you are letting yourself heal.’ I try to think of it as a positive that I’m resetting my body.” 

From Social Isolating To Staying Engaged with Her Community

“I felt super alone in 2015,” says Corbin. “I thought nobody understood. I was depressed. I cut people out of my life. I didn’t socialize.”

Social isolation is a common response to injury because athletes often feel cut off from their coach, their team, their identity, and their routine. When injured, instead of staying connected via other ways, athletes often retreat into isolation, which can exacerbate the negative effects of injury.

Research has shown that high levels of social support are associated with low levels of devastation and feeling dispirited in response to injury, which are often comorbid with the experience of isolation. Put differently, if athletes can stay socially connected to anyone — your coach, peers, family, athletic trainer — during injury, they will be better off. 

“Athletes who are able to negotiate injury really well tend to have really good support systems,” says Cokey-Craney. 

Despite learning the hard way, Corbin figured this out in 2020. Rather than push people away, she brought them closer. She accepted that her family may not completely understand how she feels or what she’s going through during injury, but that didn’t matter: they wanted to support her regardless. In letting them, she felt better.

Corbin’s Top Tips for Taking Care of Your Mental Well Being During an Injury

1. Let go of all expectations. “Don’t attach any timelines or hope to healing. It’s different for everyone. Just accept that you are injured and turn your mind away from it however you can. Try to get into a few good books or shows on Netflix. Stress in the mind raises cortisol levels which then impacts overall health.”
2. Break your recovery into bite size chunks. “Take your big timeline and break it into one week or five day segments. Stick to a plan for one week and then re-evaluate. Don’t do any evaluating or testing within that week. Then, evaluate: Are you progressing? How do you feel? If you think about the whole injury recovery and process, it’s overwhelming.”
3. Trust the process.  “During an injury, it’s easy to feel like it may never end and that you’ll never be able to run again. You have to ignore thinking too far ahead or getting wrapped up in the past (or how fit you used to be). Trust that you will be back from this, and likely stronger, better, and more motivated than before. Let your body heal and rest to the best of its ability, and know that you will heal. Make it a process versus focusing on the outcome.”
4. Adopt a better attitude. “I adopted a much better attitude in 2020: ‘I am going to do the best job I can at staying off my feet as much as possible.’ I read, worked on side projects, tried to not feel bad for myself, focused on an attitude of gratitude, didn’t worry about if I was healing or not, journaled, and found joy in the small things. The experience was ten times better mentally. And physically I healed much quicker.”
5. Give Yourself Some Distance. “In 2015, I talked to my coach daily, which was really abusing myself mentally. This time, I told my coach that I wasn’t going to talk to him for eight weeks. I know now that daily judgement isn’t healthy, and having some separation from your sport while you’re healing is okay.” 

This story is the fifth segment of PodiumRunner’s The Injuries You Can’t See series with elite athletes discussing how injury has helped them deal with larger issues in running and in their lives. 

Part 1 | Part 2 | Part 3 | Part 4 | Part 6 | Part 7