Managing the Mental Side of Injury Recovery

She had torn her meniscus, a seemingly common injury with about a two-month recovery.

But for Carrie Jackson, the mental side of rehab years ago proved far more intensive — and informative — than the physical.

“I had a really hard time coming back from that and trusting my knee in rock climbing,” she said. “At a time when athletes typically need the most support, they're getting the least. That's a problem.”

That epiphany, in part, inspired Jackson to pursue her Master’s degree in Sports Psychology.

Years later, after suffering another significant injury to the same knee in a snowboarding mishap, Jackson was far better prepared for the road ahead.

“Recovery is now your sport,” she told herself.

Jackson has used that phrase routinely in her work with athletes across a range of sports and levels. She’s also written the book “Rebound: Train Your Mind to Bounce Back Stronger From Sports Injuries” and has been featured in The New York Times, Washington Post and Outside Magazine.

Best of 7 spoke to her about productive vs. counterproductive goal setting, the importance of honoring adverse experiences, and the three hardiness factors that comprise mental toughness.

This interview has been edited and condensed for clarity.

Best of 7: Carrie, tell me about the phrase “Recovery is now your sport” and its larger significance.

When you have such a high athletic identity, when you're injured, it's such an immediate blow. You feel like if I can't do the sport, then I cease to be an athlete. But that’s not how it works. This just unfortunately happens to be where you're at in your athletic journey.

(The phrase) helps with a recommitment and a shift of focus to the things that are in their control and what they can do versus focusing on what they can’t. It calls on the athlete to change their definition of success in the micro. Making that mindset shift in an intentional and deliberate way is really important in the process. Let’s get to work.

What can coaches do to help their athletes after an injury?

In the language that we use, it’s, “You're sidelined. Head over there. Work with your medical team, and we'll see when you can produce again.” It’s very much cast aside. Athletes feel very isolated, and they also feel guilty that they're not able to contribute to the team. It's a big emotional roller coaster.

Coaches don't realize the impact of their behavior or their words — they have a job to do, and there's more than one athlete involved in that job often. But one of the things they can do is to make sure that your athlete knows you are still on this team, you're part of this team, and here's your workout for today. You’re coming to the field and you're doing your PT here or we're going to work on healing visualization today for your recovery so that they are given tasks and they feel like this is their job now — this is what they need to do to contribute.

Another thing that happens for athletes sometimes is they feel relegated to tasks that are kind of busy work. They do things that feel “less than,” even though they're not. Sometimes, that's the conversation I'm having with the athlete. “How can this contribute to your team? What are opportunities you see that they can't because they're too close to it?” It’s helping them recognize they can still be a leader and that you’re not isolating them — because they’re already often isolating themselves.

You use another interesting phrase: “Honor what you’re going through.” What does that mean?

I'll say to my athletes, “You have to honor what the body needs over what the mind wants.” Because you want to get back out there. You don’t want to have to take another recovery day, especially when you see the light at the end of the tunnel and you're starting to feel better. It’s like, “I'm going to push more,” because you want it so badly.

But being injured calls on you to tune into your body in a different way and honor what is happening in the moment versus fighting against it. Nobody can feel what's happening in your body. It’s up to you to advocate for yourself. If you're feeling something that is true, you are feeling something. That’s the idea.

Should recovery goals be time sensitive?

It's one of the biggest challenges for injured athletes. One of the things to mindset shift is to see them more as guidelines than timelines. Let’s say you’re out six-to-eight weeks, athletes who are dying to get back in there are like, “Maybe if I work really hard, I'll get back in five.” Then, other athletes are really nervous, and their psychological readiness is not matching their physical. “Maybe I'll be ready at 12 weeks.”

Timelines end up being a very significant stressor — and they’re estimates. When the physician gives them that timeline, they carve it in stone, but they don't realize everybody's trajectory is different. Your body is different than the person next to you who had the same exact injury.

What can an athlete do to more effectively respond to setbacks — because I know those can be especially challenging when it seems like he or she is almost ready to return?

We have a negativity bias in the brain, and the brain interprets that setback as a threat. It’s like, “What did I just do? How far did I set myself back?” Instead of like, “Oh damn. What a bummer. I wasn't ready for that.”

But it’s a normal part of the process. I think the other piece is to not over-personalize the setbacks. That’s just a tendency with a negative experience. “Why is this happening to me?” It’s (taking) more of a Buddhist philosophy, like, “This is happening. What do I need to do with the fact that it is?”

Can you share your three “hardiness” factors and explain why they’re so important?

There’s hardiness, and then also the additional piece of psychological flexibility. Those two things together are what make up mental toughness, especially during an injury. The psychological flexibility is really key for the injured athlete, in that, am I able to accept this challenging situation and adapt my behavior and perspective to it

The three factors that make up hardiness are:

1. Commitment. Can I persevere in the face of a challenge? Can I continue to put one foot in front of the other?
2. Control. Do I still feel that I have some influence over what happens to me in this situation and do I understand what's in my control and what's out of my control?
3. Challenge. Do I have the inclination to see this stressor as just what’s in front of me right now and that stressors are an ongoing, normal part of life, instead of that over-personalization piece?

I think the challenge aspect is particularly interesting. I’m curious — what’s the toughest decision you’ve had to make in your career and how did you get through it?

For 20 years, I was the mental training director for an organization called Diabetes Training Camp. It’s a camp for adults with Type I Diabetes, and they’re there for a week and learn how to manage blood sugar. It’s an incredible organization.

I came in and did the mental training piece. It was really meaningful work, but I just knew that I was ready to move into something else and open other opportunities. It was like a five-year process of making that decision to finally leave. My friends and colleagues were so sick of me talking about it, but I think one of the things that really helped me was I had to realize that my emotional response — that I was feeling sad and was going to miss it —  didn't mean that it wasn't the right decision.

I had to realize for myself, it’s O.K. to have these emotional experiences. But that doesn't mean it's not time to go.

What I learned…

We usually associate mental toughness with words like grit, resilience, discipline and perseverance. But I liked Jackson’s additional component of “psychological flexibility.” The ability to consistently re-adjust expectations and remain hopeful after repeated setbacks is a superpower.

Additionally, I felt Jackson’s larger point about the over-personalization of adversity was well-taken. It’s easy to fall into a mindset of “Just my luck” or “Only me” when we suffer some misfortune. But recognizing that, no, we’re not the only person this has ever happened to and it will eventually pass, is a critical mindset shift that prevents us from wallowing in self-pity — and moves us closer to our next achievement.