Athlete Depression After Injury to Musculoskeletal System

Injury and elite athletics go hand in hand. No matter how well conditioned an individual may be, pushing oneself to the limits on the court, track, field, arena, and stadium will invariably lead to a strain, sprain, fracture, or tear of some type. Some are able to manage their time away from the “game” and focus on physical recovery with an understanding that it’s the cost of what they do. Others, however, face a threat that lies deeper than a compromised bone, ligament, muscle, or disc. Research shows that nearly 22% of injured athletes struggle with depression. While it’s easy to draw a straight line between a head injury and depression, it’s injuries to one’s musculoskeletal system that often go ignored when it comes to mental health.

The signs and symptoms of depression can complicate the life of an elite athlete more than the physical injury itself. These symptoms include (but are not exclusive to) the following:

  • Feelings of helplessness and hopelessness
  • Loss of interest in activity
  • Unhealthy changes in appetite
  • Unhealthy weight loss or gain
  • Insomnia and poor sleeping habits
  • Anger and irritability
  • Self loathing
  • Reckless risk-taking behavior
  • Loss of concentration and focus
  • Aches and pain not directly related to a physical injury
  • Thoughts of suicide and self harm

You can see how depression can be career ending (or worse) for an elite athlete if left unchecked.

Understanding all of the above, it’s clear that mental health support should be integrated into athletic injury recovery strategies at all levels. However, a deeper dive is required to provide a better understanding of why athlete depression after injury to any part of their musculoskeletal system occurs. Further, there are harmful responses to being injured that can promote a vicious cycle of depression that elite athletes (and their support staff) need to be aware of. Below if a breakdown of everything you need to know.

Why Elite Athletes Experience Depression After Musculoskeletal Injury Along with What Not to Do (and what do to) During Recovery

Link Between Inflammation and Depression

The association between injury based inflammation and depression is bi-directional. For one, research has shown that inflammation related to physical trauma increases the development of depression behaviors. This occurs because inflammation and subsequent pain can create neurotransmitter imbalances, hormonal disruption, neuroinflammation, and oxidative stress. On the flip side, the anxiety and depression an athlete feels after sustaining a significant musculoskeletal injury can result in increased production of inflammatory cytokines. This worsens inflammation in the body and perpetuates a cycle of inflammation that is hard to escape without targeted intervention at a physical and emotional/mental level.

Fear of Not Being the Same Again

One of the first things that an elite athlete thinks about after sustaining a serious injury, is how it may impact their future. They wonder if they will ever be the same again and be able to live up to their potential, which causes anxiety and stress about the future. For some, an intense fear of failure known as atychiphobia creeps in. The Cleveland Clinic reports that atychiphobia can lead to depression among other mental health concerns.

Elite athletes who had high expectations thrust upon them, only to succumb to career altering injuries, have served as unfortunate examples of how athlete depression after injury have occurred. It can happen early in one’s career, or may impact a seasoned veteran as well. A young Zion Williamson’s mental health struggles that followed his injuries have been well publicized while veteran Serena Williams also opened up about battling depression during the injury lay-off that sidelined her after winning Wimbledon.

Personal identity is also a factor to consider. Elite sportspersons have a hard time identifying as anything but an athlete. If that is all that they are (as they see it) an injury could alter how they perceive themselves which can lead to feelings of depression when their career is compromised. Studies have shown that this occurs even at an early age. The stronger one’s athlete identity is, the greater the risk factor for more severe depressive symptoms after sustaining a musculoskeletal injury.

Public Scrutiny

This carries over from the fear of not being the same ever again. It’s one thing to think it, but another to constantly hear it from the media and the general public via social media. It’s worse when opinionated onlookers blame a lack of mental fortitude. The latter was indeed a part of what the likes of Zion Williamson had gone through. So not only do athletes require mental health intervention to address their own internal struggles, they must be better equipped to handle harassment from the public as well.

Preexisting Vulnerabilities to Depression

A number of athletes who exhibit depression after sustaining an injury may have had a preexisting vulnerability to depression. All that was required was a trigger (an injury, in this case) to initiate change in their mental wellness. Mental health problems and disorders commonly experienced by athletes that cooccur with depression including the following:

  • Anxiety
  • Stress
  • Eating disorders
  • ADHD
  • Problem gambling and gaming (more on these below)

What is the benefit in getting a professional diagnosis of any of the above, where applicable? Confirmation (or otherwise) can guide the way to a more comprehensive, customized, and effective treatment plan.

What Not to Do During Recovery

Athletes may turn to a variety of activities as coping mechanisms to bury the emotional and mental toll that an injury has taken on them. Some of these activities may appear to make them feel better on the surface, but in reality that can be more harmful to their wellbeing. Moreover, as an elite athlete they may have a predisposed inclination to participating in these unhealthy activities. For instance, injured athletes may turn to casino gaming and online sports betting as a coping activity. While it may feel like a great escape, it’s important to note that athletes have a significantly greater propensity to developing gambling disorder compared to the general population. The same concern exists for the seemingly harmless act of video gaming, as studies have found an association of problematic gaming in elite athletes. Another escape for injured athletes dealing with depression may be compulsive sexual behavior. Research has shown a concerning relationship between porn and sex addiction among elite athletes. All of these activities that may lead to compulsive behavior (gambling, gaming, hypersexuality) count depression as a symptom, which makes matters worse for an athlete attempting to claw back from injury.

There is one coping mechanism, however, that injured athletes should participate in. Please keep reading.

Importance of Mental Health Support During Recovery

This action item circles back to what we stated in the introduction. Professional mental health support must be integrated into all injured athlete recovery programs. It should be initiated at a high-school level, be carried through into collegiate environments, then on to professional athletics, and even into retirement.

Kindbridge Behavioral Health is America’s preeminent online counseling support platform for athletes. In addition to our counseling services we have developed a partnership with Momentum Labs. Momentum Labs can supplement our efforts by working with athletes to tap into their mind power to recover from injury. Whether an individual athlete, or representing a team, reach out via the contacts provided below to discuss a customized mental health strategy to combat depression and more.

Athlete Depression After Injury

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Athlete Depression After Injury