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Returning to a sport after injury is a mental game. Here’s how to do it.

Mallory Weggemann, left, reacts after winning the women's 200 meters individual medley at the Tokyo Paralympic Games in Japan in August.
Mallory Weggemann, left, reacts after winning the women's 200 meters individual medley at the Tokyo Paralympic Games in Japan in August. (John Walton/PA Images/Getty Images)

“I was airborne. I was falling off the edge of a cliff. I felt the first impact, then the second, then the third.”

That was how professional ultrarunner and endurance athlete Hillary Allen, who had been dubbed “Hillygoat” for her effortless speed running uphill, described falling 150 feet off a ridge at one of the hardest ultrarunning races in the world, the Tromso Skyrace in Norway in August 2017. Airlifted to a hospital, she had broken 14 bones, including a badly sprained ankle and a serious rupture of a foot ligament, and suffered a concussion and lacerations.

Ten months later, Allen, 33, was back at the start line.

Her recovery went far beyond surgeries and physical therapy.

“In an instant I had gone from being extremely fit and capable to utterly dependent,” she writes in “Out and Back: A Runner’s Story of Survival Against All Odds.” “Not being able to run was devastating and the fear surrounding my return was debilitating, but also forced me to take it easy, look at situations differently, and seek out new ways to engage with myself.”

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Three years before Allen’s near-death fall, swimmer Mallory Weggemann, 32, was preparing for the 2016 Summer Paralympics in Rio de Janeiro when a shower seat broke under her at a hotel, leaving her left arm with permanent nerve damage.

This was especially devastating because Weggemann, who had broken 34 American records and won gold and bronze medals at the 2012 London Paralympics, had already made a years-long comeback. A swimmer all her life, at 18 she became paralyzed from the abdomen down after an epidural injection to treat back pain.

“When you look at the athletic journey and the ups and downs that come with it, it’s not all world records and gold medals,” Weggemann said. She chronicles this journey in “Limitless: The Power of Hope and Resilience to Overcome Circumstance.”

She wrote: “How do you return after those setbacks? The catastrophic injury to my arm brought me to the depths in a way that not even my paralysis did. And then it was ‘Now how do I return to not only this thing that I love but also is part of my identity and my career?’ ”

Allen, too, said that her devastating injuries led her to reevaluate what running meant to her and how she was going to approach healing from a mental perspective, in addition to all the physical rehabilitation and surgeries she would undergo.

It’s not just elite athletes with life-changing injuries who have to confront the insecurity and fear of returning to the start line, whether it’s on foot, on a bike or in the pool. Anyone who has twisted an ankle while running or has had a bad fall on a bike or on a trail run knows what it’s like to be injured and unable to do a sport.

But there are ways of training your mind and spirit and recalibrating your expectations to ease the fear and insecurity of returning to your sport, and enlarge your appreciation of it.

Address your fears

“We have to recognize that mental stress plays a real role in predisposing an athlete to injury,” said Stephen P. Gonzalez, an assistant athletic director for leadership and mental performance at Dartmouth College. “If we have high levels of fear or anxiety returning subconsciously, we are sending signals from the brain to the body that just are stiffening and tightening and bracing one for impact. And all that does is just predispose you to be more injury susceptible.”

Gonzalez helps athletes understand their mental response to injuries with the metaphor of a windup toy.

“Every time you have so much fear and you can’t let yourself know that that’s okay and play fluidly and all you’re doing is turning and turning and turning the key, eventually you’re so tight that you can’t absorb impact,” he said.

Fear and anxiety are protective emotions, Gonzalez said. He said that often people worry about a possible future event, and “we’re not anxious about anything other than the actual act of being anxious,” he said. “And so getting them to really take a step back and say, ‘All right, let’s actually take a look at some things. You’re nervous. But what is the evidence against feeling the way that you feel right now?’ ”

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This mental exploration where athletes can reassure themselves with the rehab they have done, that their gait or flexibility and agility has improved, and that they have been medically cleared to return to their sport, gives them confidence and allays fear, Gonzalez said.

“You learn a lot about yourself whenever you have injuries and moments like this,” he said, citing the athletes he works with and his own injuries as an NCAA Division I distance runner at the University of Pittsburgh and in marathons and trail running with Dartmouth ski teams. “You see that just because it happened once doesn’t mean it’s going to happen all the time.”

Fear or injury that comes from an unexpected fall — “a freak accident” — he said, as opposed to one that comes from a more traditional drill or exercise, means that it’s useful for an athlete to mentally prepare and visualize what’s ahead.

No matter its source, fear needs to be addressed if athletes are going to return to their sport, said Julia Kim, a clinical psychologist at Hospital for Special Surgery in New York.

“If you’re afraid, you’re afraid,” she said.  “If you’re not going to acknowledge it, you’re not going to address it and soothe it. But if you acknowledge it, then you can choose how you want to act.”

Kim said people need to ask themselves: “What do you want to do with the fear or anxiety? Ultimately, you have to choose how you’re going to live. You’re either going to live by avoiding your fear or are you going to live by trying to achieve your goal?”

Understand your 'why'

Part of finding that path back to your sport is also remembering why you are doing it, she said. Some play a sport by choice while others see it as a core part of their identity.

“People who do reasonably well do so because they can adapt,” Kim said. “It’s because they’re not doing it because they need it.”

If you see sport as the only way to feel good about yourself, you could benefit from developing other ways. If physical activity is your outlet for stress, find other outlets, Kim advised.

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“We should all have several ways in our tool kit on how to cope with stress,” Kim said. “Because if you take one away, let’s say you’re sidelined, then what? And typically, we actually need several backups.”

Kim understands the frustration of injury. She is a longtime cyclist who has had many surgeries. She said she is frustrated when she cannot bike.

“But it’s not that it affects who I am or how I think of myself,” Kim said. “It’s that ability to adapt. You’re not going to adapt when you feel you have to have it.”

Accept and adapt

She said she has worked with many athletes who took a long time to accept that they need to adapt to other sports or activities.

One was a runner who took several years to get over multiple injuries and learn that they could not run as much and in the way they wanted to. Kim had suggested cross training, biking, swimming and other activities but was met with resistance. “Later, this person discovered biking and can now bike and run,” Kim said. “It has reduced injuries, but it took years.” 

This acceptance of being on a journey back to your sport and the twists and turns it can take is something that Carrie Jackson Cheadle, a certified mental performance consultant and co-author of “Rebound: Train Your Mind to Bounce Back Stronger From Sports Injuries,” advocates through her work with athletes and as the co-host of the podcast, “The Injured Athletes Club.”

“You’re still an athlete, right?” Cheadle said she asks those who are sidelined from their sport. “This is just part of your athletic journey.” She asks them to step back and look at it from further away. “I equate it to the hero’s journey,” Cheadle said.

She advises athletes to use everything they were putting into their performance into their recovery.

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Cheadle said our culture has started to remove the stigma of mental health struggles more generally, and professional athletes and other public figures are sharing their difficulties publicly. This has led to a greater understanding of the mental as well as physical parts of preventing — and healing from — injuries.

She also credits Olympian and gymnast Simone Biles for withdrawing from the 2021 Tokyo Olympics because she wasn’t in the “right head space.” It was reaffirming for athletes at all levels who are learning to do what’s best for them, Cheadle says.

There is “this very romanticized view of what it means to push through being injured, which is a narrative that I want to change,” she said. “There’s a disconnect between people not recognizing had Simone Biles pushed through, she could have sustained extreme, terrible, catastrophic injury. But we want to see the hero rise to the occasion and overcome.”

Allen said her hero’s journey back to running felt like putting on armor and discovering how she was strong in ways besides running.

“I realized the strength in asking for help and relying on a community and the process of healing and training,” she said. “And you know, to me, that almost means more than a finishing time.”

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