It’s late morning on the trail and a sudden break in the trees draws the Gore Range into focus, its jagged outline cutting sharply into the smooth expanse of an otherwise untouched sky. I should be basking in the glorious view and endorphins of my ascent, but instead I’m distracted by an undercurrent of unease that’s been following me on my hikes lately. I catch myself startling at every rustle from the undergrowth and gazing nervously over my shoulder, seeking the eyes of phantom predators waiting to pounce. It’s irrational and futile, but after a decade in the mountains, I’ve suddenly taken to carrying a hunting knife, a bear horn and pepper spray.

It all began with a gnarly fall skiing early season powder a couple of years ago that took two knee surgeries to repair. I’ve since regained strength, mobility and coordination, but shaking the lingering psychological residue of my injuries has proven more difficult. What started as a reasonable fear of returning to skiing mutated into a trace of uncertainty in every outdoor pursuit. There’s an unfamiliar hesitancy each time I clip into my pedals, an inner pep talk that takes place before setting off from each trailhead that is disproportionate in relation to my actual injury, an ACL repair.

For my friend and colleague Kirsten Cooper, the psychological collateral from sports injuries is an all too familiar subject. As a U.S. Ski Team athlete, she sustained a mind-boggling catalog of injuries including five labral tear repairs in one shoulder, eight stress fractures, three disc herniations and a spinal fusion, just to name a few.

”I remember very vividly flying through the air (later to find out without my helmet which broke off on the first impact), knowing I was going to fall, and looking ahead of me and seeing rocks and ice. I thought I was going to die. My career ended in that bloody pool on the side of a mountain with a brain injury, no skin on the right side of my face and broken identity,” Cooper says.

Though she received comprehensive physical rehabilitation to get her performance ready again after each injury, no attention was paid to her psychological state. The resulting depression that included intense mood swings, suicidal ideation, using drugs and alcohol and other impulsive behaviors ultimately ended her career. It wasn’t until she started practicing yoga and meditation regularly, in addition to psychotherapy, that she started to heal.

After that day on the trail, I realized things had gotten out of hand for me and wanted to get to the bottom of my irrational fear. In talking to other athletes, I discovered that generalized fear and anxiety are common side effects of injury, and I suddenly found it strange that more consideration isn’t given to psychological recovery. After all, mountain communities boast the best orthopedic surgeons and physical therapists in the world to put our bodies back together again after each tumble, yet mental and emotional support remains absent.

I discovered that generalized fear and anxiety are common side effects of injury, and I suddenly found it strange that more consideration isn’t given to psychological recovery. After all, mountain communities boast the best orthopedic surgeons and physical therapists in the world to put our bodies back together again after each tumble, yet mental and emotional support remains absent. 

Dr Mark Aoyagi, director of sport and psychology at the University of Denver’s Graduate School of Professional Psychology program, explains that psychological injury often occurs as a result of tying our athletic performance up in our own identity: “The first two things that generally happen with an injury are immediate questions and regrets about the past, such as how the injury occurred, what could I have done differently, was it my fault? The next is jumping to the future — will I perform again? If so, at the same level as I was previously? How much will it affect my life, relationships, identity?”

As someone who had hiked, biked, climbed or skied almost daily for seven years, I suddenly found myself in the midst of an identity crisis. More than the physical pain and limitation, I grieved the sense of accomplishment that came from bettering a previous time, the social time spent outdoors with friends and the mental well-being I derived from communing with nature. The result, as I discovered, can be quite isolating and psychologically damaging.

“Many meaningful relationships are formed through performance, and injured athletes can quickly lose touch with their fellow performers and feel like an ‘outsider’ or worse, simply forgotten,” says Aoyagi.

In response to such experiences, Cooper decided to pursue a doctorate in performance psychology at DU, where she is studying the mental role in sports injuries under Aoyagi and was introduced to Acceptance and Commitment Therapy. ACT outlines a mindfulness-based framework for initiating psychological repatterning based on the concept of “psychological flexibility” which presents the idea that we do not need to get rid of fear or anxiety or sadness, but rather that those emotions are inevitable parts of our lives that we can allow space for and still choose to engage in life meaningfully.

“If I had found this work when I was competing, perhaps the attempts to fill the void I experienced when my athletic identity shattered would not have felt so consuming and led me to self-destructive behaviors,” Cooper reflects.

There may not be a standard protocol to provide mental health services during injury rehabilitation yet, but there are simple, effective ways to take action and promote psychological recovery in the entire mind-body complex if you do find yourself on the bench. Aoyagi recommends using your post-injury downtime to build an identity outside of your performance, connecting with fellow rehabbers and friends that have been through similar experiences and reconnecting with other aspects of your identity that are oftentimes overlooked during the intensity of performance, such as relationships, hobbies and spirituality.

Finally, he suggests emphasizing the parts of your practice you can participate in: “If you aren’t physically able to practice yoga, for example, you can focus intently on other aspects such as breathing, mental focus and meditation and mindfulness. This can be very helpful as you ease your way back into physical practice and find that you now have other strengths to rely on. A stressful, busy mind is going to prolong the recovery process. Use your breathing and mental skills to alleviate anxiety and promote healing.”

Photo by Fabio Comparelli.