Recovering From an Injury? Don’t Forget to Rehab Your Mind

Long before I tore my ACL taking an unexpected cartwheel down a ski run—before I discovered that I actually liked hurtling down steep slopes—I often joked that skiing was just an expensive way to get hurt. The thought of twisting a knee put enough fear into me to keep me cautious downhill—until the worst happened. 

In reality, tearing the ligament turned out to be the least painful part. The mental anguish of getting benched during my first hiking season living in Boulder, Colorado made it hard for me to keep up with post-surgery rehab. Instead of leaning in to painful exercises I knew would benefit me, I gave up.

We often don’t talk about the mental impacts of physical injury. But often they’re just as—if not more—serious than the physical harm, says Sarah Ellefson, a physical therapist who owns Altuis Physical Therapy and Wellness in Avon, Colorado.

“I think that that mental piece is perhaps one of the most important components of the recovery process, and that needs to be factored into a person’s plan right from the beginning,” she says. Often, Ellefson sees patients get discouraged when they compare their own progress against average mobility recovery times. “It’s important to recognize that each person has their own unique set of physical and mental circumstances. Post-op protocols should be used as a sort of a trail map for the recovery process, but each person will need to deviate from that trail now and then,” she says.

I am guilty of that harmful comparison. Pre-surgery, I was proud to see that I had gained more strength and mobility than was expected of me based on those average outcomes, so my confidence took a major hit when, post-surgery, I needed to rely on my then-boyfriend for almost every small task around the house. I desperately wanted to be one of those people who ditches the crutches within days, but I wasn’t. Rather than using them for extra stability to walk a few blocks from home, I just stopped walking unless it was absolutely necessary.

During many weeks of my recovery process, my only rehab came from my actual physical therapy appointments—I did few to none of the required exercises in between. I was embarrassed to take stairs at my office slowly, making sure to go up with my left leg—the injured one—before bringing my right up to meet it. I skipped every little opportunity to make progress that could have helped me get back to hiking much faster.

Over time, the pain in my knee faded and it got easier to walk longer distances, bit by bit. I got tired of being too cautious and too anxious about falling again, got a pair of trekking poles, and started pushing myself outdoors again to regain strength on shorter hikes. By the end of the summer, about four months after surgery, I was able to tackle a 16-mile overnight backpacking trip with minimal elevation gain (and quite a lot of rest stops). 

Now, just about five years out from surgery, I finally have my knees back. They’re not as spry as they once were—I swear I hear them creaking sometimes—but I no longer ask whether my legs can handle a hike. It took years to fully understand the mental impact of that injury, and even to acknowledge that it was ever a problem. So, I asked Ellefson what advice she’d give to others battling the same recovery fatigue. Here are her top suggestions.

1. Choose the right team. If you have the ability to be picky when it’s time to choose a surgeon and physical therapist, Ellefson highly recommends doing so. In her earlier days as a PT, she worked in an office that treated multiple patients in the same large room, and she saw patients comparing themselves with others recovering from the same injuries. Now, she only treats one person in her studio at a time, so no one’s even tempted to see how they measure up. If you live in an outdoorsy area, chances are you know quite a few people in your community who’ve recovered from injuries and gone through PT. Seek recommendations and don’t be afraid to ask your prospective surgeon or PT about their approach to mental health and how they’ll keep you motivated.
2. Ask what each exercise is for. If you understand why you’re doing exercises that may seem totally meaningless, you might be more likely to work on them even when they’re hard or painful, Ellefson says. That’s why she says she always tries to contextualize for patients why she’s making them, say, stand on one foot on a soft foam mat and turn their head. “There’s no reason to go out hiking if you’re not able to look around and see everything around you,” she says. “So the purpose of this [balancing] exercise is to get you to a place where you can safely, and with good alignment, balance on one leg momentarily while you’re looking around.”
3. Be gentle with yourself. “You need to show your body grace and respect,” Ellefson says. “There’s a gratitude practice that goes along with that, in being thankful for what your body can do and feeling encouraged by the fact that your body has the capacity to heal.” She knows this is a lot easier said than done, she says, but if it’s any solace, she needs these reminders sometimes, too.
4. See a sports psychologist if you need one. “There are days when patients come in and I know that they are exhausted, mentally and physically. Sometimes, we barely do any physical work and I just listen,” Ellefson says. “I think that’s just as healing and necessary as anything else.” If you feel you need more mental health support, you can seek out a sports psychologist who can help you work on the mental aspects of rehabilitation and any anxiety you may feel about getting back out on the trails.
5. It’s never too late to go back to PT. Even if it’s been years since your injury, you can always go back to physical therapy if you want to rebuild strength or confidence, Ellefson says. “You can start from square one,” she says, “and say, ‘This is what I want to be able to do. This is where I feel apprehensive. Can we work together to set realistic expectations and goals?’”