A psychologist shares her tips on getting back to your workouts if an exercise injury has made you be anxious about hurting yourself.

A few years ago, there were a number of fitness influencers I followed who all, in separate instances, injured themselves doing box jumps. They had similar stories about missing their footing and slipping off the box – and they all shared video evidence of their falls.

Those injuries didn’t even happen to me, but to this day, I am terrified of jumping on anything that’s higher than knee height. Yet the people who hurt themselves from the falls, with injuries varying from a deep scrape to surgery-requiring fractures, went back into the gym and back to the box jumps.

These women aren’t alone – every day, athletes and exercise enthusiasts hurt themselves in their training and, after some recovery time, go back to the very activity that caused them pain. Like snowboarder Katie Ormerod who broke her heel in half at the 2018 Winter Olympics and, in a recent interview, told Stylist: “I actually just see [injuries] as an inconvenience more than anything, and they’ve never made me want to stop snowboarding.” 

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Or recreational runner Charlotte Malpass, who during her training for a half marathon pulled the tissue in her IT band “that meant I struggled to walk, let alone run even 5k”. Yet she managed to cross the finish line of her 12-mile race a few weeks ago. “I don’t think you ever get over the fear of an injury,” she says.

And she’s right: the psychological impact of returning to a workout that hurt you can’t be underestimated. It’s thought that between 5-19% of injured athletes report psychological distress levels similar to individuals receiving treatment for mental health problems after an accident. 

Even if your injury isn’t bothering you to that level, studies show that physical injury in people who play sports leads to anxiety, depression, frustration, tension and decreased self-esteem which impacts how you return to the sport.  

Recovering from an injury is rarely just about getting over the physical pain, but also developing the confidence to do the thing that hurt you.

“It’s natural to be scared or nervous when returning to physical exercise and it’s important to understand that there is a reason behind those emotions,” says BACP accredited psychologist Nicola Vanlint. “Our body evokes a protection mechanism that makes us anxious about returning to something that once caused us pain. It is a response to trauma like a physical injury, and it’s done to protect us.”

The fear doesn’t have to come from big accidents like the one Ormerod suffered. “Any experience of pain, physical or mental, has a psychological effect. We as human beings are wired to look for danger and our body’s response to the danger of an injury means our nervous system shuts down into a dorsal vagal state. 

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“This state intends to facilitate healing, which lowers our energy levels leaving us feeling unmotivated, bored and can sometimes leave us feeling depressed. It can occur after any injury, big or small,” says Vanlint.

How to psychologically recover from injury

Listen to your body

“Acknowledging those emotions is the most helpful thing you can do, so my number one piece of advice would be to listen and be kind to your body. You’re going to feel anxious about returning to exercise; that’s natural, so prepare yourself for that,” says Vanlint.

One way to work out if you’re actually ready to return is to consider the questions on the Injury-Psychological Readiness to Return to Sport Scale that was developed in 2009 by sports scientist Douglas Glazer and published in the Journal Of Athletic Training. It is designed for use by professional psychologists and athletes, but there are some useful questions to consider if you are planning your return as a recreational exerciser. These include:

1. How confident are you in your desire to participate in the sport? Ask yourself if you actually want to go back to the session right now, or you are doing it because you feel you have to.
2. How confident are you to train in the current conditions? For example, if you’re a runner, you might not want to return on a rainy and slippery day – and that’s OK. You can wait until the conditions of play change to suit you.
3. How confident are you to not concentrate on your injury during the session? If your fear is going to be all-consuming, it’s probably best to leave your return a little longer. 

Do the work

Rehab may be physical, but it’s also a sign of respect for your body. “I had to start steady and swap runs for gentler cross-training sessions to get my strength back, focus on lots of stretching and used my massage gun to release the tension in my hips and glute,” says Malpass. She found that time frustrating but thinks that knowing she had to rebuild her physical foundation meant she had more trust in her body when she finally went back to running.

“The problem after having an injury is that you worry about every little pinch or niggle,” she says. “But knowing I’d done the physical preparation meant I could stop the mental stress when I felt twinges around the half marathon course.”

Find support

Joining a running club also helped Malpass feel more confident about getting back to running. “I’ve had so much great advice from the team and seen such improvement in the last year. I think it helped to know that if anything was to happen to me, people would be around to help. And it meant that they were keeping an eye on me so I didn’t overdo it by running too fast,” she says. 

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In the gym, working with a spotter who can take the load off you is proven to increase self-efficacy, according to a 2019 study. And if you can’t work with someone or a team directly, then signing up for a programme or guide written by an expert (ideally one focused on building strength for returning athletes) can assure you that you’re on the right path.

Go slow

“Problems arise when people don’t acknowledge or recognise their anxieties as they can push too early, causing additional physical trauma,” says Vanlint.

Even if you’re physically ready to get back to it, don’t jump straight in at the deep end. By building up bit by bit, you “let your mind and body know that the trauma has passed,” adds Vanlint. “Take a step back if you’re feeling overwhelmed and remember not to push yourself too hard – that could only lengthen your recovery time and could also lead to resentment since your body isn’t working as it used to.” 

Images: Getty

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