Have you ever had a major injury?

Can you remember what your body felt like or what went through your mind at that precise moment it happened? That perspective-altering moment, when you enter emptiness, the feeling of shock; it can really feel bizarre.

Perhaps you felt confusion, sadness or fear. Maybe your heart rate skyrocketed and you were so inwardly focused, or in a lot of pain, that you didn’t notice anything around you anymore. Or maybe a mix of all of these things.

When I found myself experiencing my injury, in the initial moments, I found myself in a void. That space between the action and the result. The exact moment that changed the trajectory of my ‘normal’ life. In that void, time slowed down so much it felt like I was inhabiting a single breath. Nothing else existed except me experiencing my body and the void. In the void, I knew something big had happened but I had no comprehension of the scale.

This is not an unusual injury experience.

Shock is a well-known word—we hear it on the news ‘onlookers were shocked…’, ‘authorities are shocked…’—but what is it really when it’s happening to you?

Defining shock depends on the context.

In general, shock is seen as a physical process, triggered by the brain, as a part of our hunter-gatherer survival system. It coordinates our behaviour and physiology to make the most of our limited energy while responding to a threat, whatever it is.

Medical (physical) shock—as referred to in hospital TV shows—can occur as a result of many different influences, from injuries to a heart attack to toxins in the body. It kicks off with reduced blood flow to extremities (hands, feet) to protect the organs but then this process is reversed and blood pressure drops, potentially depriving organs and tissues of oxygen, causing a build-up of waste products. Shock can cause a sense of disassociation. It can be fatal. Shock is generally treated with medications and intravenous fluids but treatment depends on the type of shock experienced.

Ok, so this makes sense, I have always understood the physicality of shock. But I wasn’t prepared for what came next.

More broadly, shock triggers stress and defence responses across our peripheral nervous system (nerves from brain and spinal cord) including the sympathetic (typically fight and flight responses) and parasympathetic (rest and digest) systems.

The mix of responses are physical, somatic (mind-body), involuntary/unconscious and experiential/emotional. They can mean we don’t feel pain, we don’t comprehend the enormity of a situation, or even fear death. These early moments of shock, while evolutionarily beneficial, can be pretty mind-blowing to experience in our usually controlled lives. And these moments of shock can give way to longer term trauma as the immediate feelings go away and we have to deal with the fall-out both physically and mentally.

When I had my accident on the ski field, I knew that my knee had been injured in that split second of impact. However, in the passing minutes, beyond it being too weak to stand on, I didn’t feel pain. I felt completely drained of energy and I just wanted to get away from the situation. I became freezing cold, and not just because I was on the snowfield…

After about an hour in the medical centre, I was told about the extent of my injuries. That I had injured my knee ‘very badly’; it would require surgery and it would take me six months to recover. As I started to vaguely comprehend that my injury would mean that I was on a very long road to recovery including complete upheaval of my lifestyle as I knew it, it all hit me like a tonne of bricks, triggering an onslaught of emotions and feelings.

The layers upon layers of grief, worry, doubt, anger, fear, were unlike anything I had experienced in my life. If indeed I had realised the full extent—that I was destined for months of endless pain and exhaustion; one to two hour blocks of sleep; months in a knee brace using crutches and not able to bear weight on that foot; trouble showering, preparing food and even getting off the couch, let alone socialising or going to the shops—I don’t think my spirit would have been able to handle it.

Looking back I can now see that at this point I was transitioning into a longer-term ’emotional shock’ of the experience. Over the unfolding weeks, I, and others around me, didn’t realise how traumatised I was and that actually my injury was really what psychologists term a critical life event: an occurrence in one’s life that necessitates a large acclimation and the behaviour that goes with it.

From talking to people recovering and also experts plus doing my own research, I’ve learned there’s often a real problem unfolding in the early days to weeks after an injury. And that is: that people who are injured aren’t warned about what comes next; after the period of initial shock… The resulting impact from the traumatic experience.

People who are injured aren’t warned about what comes next, after the period of initial shock.

According to Abra Garfield, a sports and performance psychologist frequently working with injured people, this is not uncommon.

‘Many people in the medical field don’t consider the relationship between injuries and grief, loss and trauma,’ he said.

‘When someone is badly injured, they can be faced with a future that can be daunting and overwhelming. It’s like they are being forced to climb up a mountain that they never chose to conquer.

‘And there are no nice views! There is a lot of stress and long term exposure to stress is unhealthy,’ he said.

Injuries are tough going; there is no doubt about it. In many cases, the impacts are far-reaching through many aspects of life from day-to-day lifestyle, relationships, work and financials, to mental wellbeing.

Through my own experience and talking with others, I know that many people are not provided with the support and knowledge that would help to make the experience less awful. This is my attempt to help.

Here are ten things you need to know:

1.      Traumatic experiences are actually pretty common

There are range of situations that can be traumatic to experience. Experts generally report more than 50 per cent of people will suffer from a traumatic experience in their life, for example an assault, rape or life threatening accident.

Australian researchers reported that almost 65 per cent of men and almost 50 per cent of women say they’ve had at least one traumatic event happen to them. Of course, not all injuries will become traumatic for people but the point here is that traumatic experiences are unfortunately part of life for the majority of people.

2.      There’s a whole lot going on

Experts used to believe that reactions to trauma were physical. Then a focus on mental symptoms emerged. But nowadays neuroscientists say that trauma often elicits a mix of both physical and psychological symptoms and there is no standard response among us diverse humans.

Basically, our brain, the main controller of our conscious and subconscious activities, gets very active, but a little confused, when traumatised. Neuroscientists believe the function of, and coordination between, our thinking and emotional parts get disrupted.

This affects a range of functions like our adrenaline levels, emotions, behaviour, motivation, long-term memory, and even our sense of smell. And our more unconscious defence mechanisms (mentioned above: fight, flight, rest, digest) can keep firing, pumping out emotions, which make us feel awful, and cause more physical symptoms, and some people believe, illnesses. The physical symptoms then feedback and affect our emotional wellbeing.

It’s complicated! But why should anyone who’s injured care about this? Because if you’re understanding what’s happening to you, you can make a choice to change it by yourself and with help from your support network and professionals.

So, I am very well aware that my injury wasn’t life threatening (although the risk of blood clots is high), yet it was traumatic for me. After the initial emotions passed on the day I was injured, I felt exhausted and troubled. That night I barely slept as I had frequent flashbacks to what happened and I felt a lot of fear and anxiety both in my mind and in my body, through an upset stomach. I didn’t really recover my appetite for at least three months!

Despite the assurances of ‘you’ll be alright’, ‘you’ll get over it’, ‘there’s many people worse off than you’, I did not bounce back physically or mentally over the dragging weeks. While many of these assurances may well be true, it turns out they are awful things to say to someone going through this kind of thing. When you’re right in the middle of a traumatic experience, logic alone rarely makes you feel better.

3.      Acknowledging and accepting that it’s likely going to be hard helps

One of the things I wish someone had told me: that it is completely normal and OK to feel a range of strong emotions and physical reactions as a result of a traumatic experience.

So I want to reassure you. Significant injury, even if it is temporary, can be traumatic and hard to cope with and you are allowed to feel how you feel. From all angles: emotionally, physically, financially and socially…

Significant injury, even if it is temporary, can be traumatic and hard to cope with and you are allowed to feel how you feel.

Acknowledging this and accepting it can help you move on from the initial shock and grief.

‘There will be roadblocks in recovering as injury is connected to grief, loss and trauma,’ said Abra Garfield.

Injuries come at inopportune times (is there ever a good time?), are painful and exhausting. They require you to change many aspects of your life, often isolating you from your friends, work, hobbies and those enjoyable spontaneous experiences.

Everyone responds differently to traumatic experiences. People commonly experience grief and loss. Some may experience sadness, shock, disbelief, anger, sleep disturbance, fear or anxiety and they may experience these things straight away or sometimes much later.

The fact is that even if we think we will be ok when something happens, we often overestimate the strength of our emotional reaction whether positive or negative; even if we know ourselves well. This means that you might be like me—someone who thinks they’re pretty resilient and stable emotionally and would stay happy even in hard times—but then you find that isn’t the case.

Acknowledging feelings, whether they are negative neutral or positive, then letting them go is crucial. In the book The Mindfulness Solution to Pain: Step-by-Step Techniques for Chronic Pain Management, the authors recommend the mantra ‘this too shall pass’ to help you feel the feelings then reassure yourself in the moment.

You can find out how you are really faring by taking a Kessler test. (Find it in the download below). It’s a widely used and validated test that helps determine the level of psychological distress relating to depression and anxiety and it is the same test that doctors use. It is also promoted by organisations such as Beyond Blue.

Over the weeks following my injury, if I had done a Kessler test, I am sure I would have been surprised with the results!

4.      Be aware of the (completely normal!) symptoms of trauma

There is no right way to react or to grieve for what you have lost through your injury; each person experiences their own experience. Here are some common symptoms of trauma:

Physical

• Excessive alertness and feelings of being on-edge
• Being easily frightened or startled
• Fatigue/exhaustion
• Disturbed sleep
• Loss of appetite
• Aches and pains
• Muscle tension

Cognitive (thought processes)

• Intrusive thoughts and memories of the event
• Visual images of the event
• Nightmares
• Poor concentration and memory
• Disorientation or confusion

Behavioural

• Withdrawing socially
• Avoiding the places or activities that remind you of the event
• Loss of interest in normal activities

Emotional

• Fear
• Powerlessness
• Numbness and detachment
• Depression
• Guilt
• Anger and irritability
• Anxiety and panic.

Sources: Raphael 2010, Australian Psychological Society, Sane Australia.

It is completely normal to have these and other reactions. But if the turmoil persists for more than a couple of months or significantly impacts on your ability to return to your usual activities you should get help.

5.      Support and professional help is important

Talking about what’s going on in your head and body can often be extremely beneficial to enabling you to let go of stressful feelings and resolve issues. Getting support from friends, your community, turning to religious and other belief systems, and talking with others are widely used ways of coping. Sessions with a trained professional, such as a psychologist, can help you cope more effectively. It’s important to take a longer term view and commit to the process though as psychologists believe that light-touch, single interventions or debriefs after a trauma don’t work for everyone.

As time goes on the emotions, physical feelings in our injured body and how we mentally respond can mean we feel cloaked in feelings of unhappiness, being unsettled or simply unlike your usual self.

Feelings associated with anxiety and depression can develop after an injury and it is my belief that many people are suffering after injury and not getting the support they need. I’m not talking about getting help once you’re diagnosed with a mental illness. I’m talking about getting help as soon as possible to stop the unpleasant feelings dragging on, digging in and growing roots, and, quite frankly leading to a troubling experience where you don’t feel you’re living life to the fullest!

Beyond just feeling ‘really awful’ for a while, Sane Australia says that about 25 per cent of people exposed to traumatic events develop post-traumatic stress disorder (PTSD). PTSD is classified as an anxiety disorder but it also includes symptoms associated with depression. It is characterised by re-experiencing the original trauma through flashbacks or nightmares, avoidance of stimuli you associate with the trauma, and increased arousal—such as difficulty falling or staying asleep, anger, and hypervigilance.

Despite my searching, there doesn’t appear, in Australia, to be any tracking of mental illness that lasts less than twelve months, let alone tracking of how people feel after injuries. However, with over 450,000 Australians each year admitted to hospital after injuring themselves, we can assume that a significant number of people suffer symptoms of trauma, be they at a ‘sub-clinical’ or non-diagnosable level.

While not all traumatising experiences will embed themselves within people’s psyches, it is a risk not worth taking. The key point here is that if you are feeling that you are still suffering after many weeks or a couple of months, don’t ignore it. Get some support to work through it in the short term so it doesn’t turn into a longer term problem.

The good thing is that if you feel that you need a bit more support than what you can easily find around you there are many people out there passionate about helping injured folks.

6.      You can use your body to help you feel better

You might have more control than you realise. The body and mind are linked and there is feedback between them. Physical signals are constantly coming in to your brain and your brain interprets these and adds its own flavour of meaning affecting how you feel.

Exercise is a brilliant way to make you feel good. It encourages the release of serotonin (the ‘feel good’ chemical), norepinephrine (the ‘anti-stress’ chemical) and dopamine (the ‘reward’ chemical). Researchers have also found that when mice run on those cute mouse wheels, they generate new brain cells!

Of course, depending on your injury, exercise may be difficult but perhaps if your shoulder is damaged, you can do some lunges and if your leg is in a brace, you can do some bicep curls.

Breathing techniques (making sure the out-breath is longer than the in-breath) and relaxation activities (such as yoga, pilates, Tai Chi) help the body relax and this in turn helps the brain calm down. As stress responses elicit shallow, quick breaths, the opposite will calm and balance the mind.

All-body muscle squeezes can also make you feel amazing. Sit in a chair and squeeze the different parts of your body starting from either feet or hands. For example, clench your fists for a few seconds then let it go. Hunch your shoulders and squeeze your arms into your body, then let it go.

According to Debbie Hampton, from Best Brain Possible, stimulating the vargas nerve, located through your upper body to your brain, can help make you feel better. This nerve controls a whole lot of unconscious responses including your heart rate, breathing and digestion.

Find the things that work for you to connect the body to the mind.

7.      It’s good to think less!

Counterintuitive I know. As with anxiety and depression, the thought processes we have to deal with in our day-to-day life or with our injury specifically, can determine how we feel.

I worried so much about the changes to my life, the impact on others, what medical procedures I was going to have to go through, the pain… All of this worrying, and general grieving for what I was going through, made me feel worse. While I tried to employ techniques to stop my mind taking over, it was very difficult.

Being mindful is the best way to break the thinking trap and get into simple awareness of what is happening in the present moment.

Letting your mind wander, even if you’re trying to think happy thoughts, can contribute to unhappiness according to researcher Matt Killingsworth in an article in Mindful magazine.

‘We found that people are substantially less happy when their minds are wandering than when they’re not, which is unfortunate considering we do it so often. Moreover, the size of this effect is large—how often a person’s mind wanders, and what they think about when it does, is far more predictive of happiness than how much money they make, for example.’

Eckhart Tolle, in his book The Power of Now describes too much thinking as a disease.

‘The mind is a superb instrument if used rightly. Used wrongly, however, it becomes very destructive.  To put it more accurately, it is not so much that you use your mind wrongly—you usually don’t use it at all. It uses you. This is the disease. You believe that you are your mind. This is the delusion. The instrument has taken you over.’

In an inspirational article, Consciousness – The Way Out of Pain, he talks about how the mind can add to pain and suffering.

Obviously we need to think through what is happening to us when we are injured so we can make good decisions about treatments or finances, but what Tolle is talking about is the incessant thoughts, worries, judgements throwing us off course and taking us further away from inner peace.

Escape the endless ruminating however you can to be in the moment. Read a book, listen to music, paint, watch the clouds float by, meditate.

8.      Channelling positive emotions works

Research shows that positive emotions can help reduce levels of distress following a traumatic event through quieting or undoing negative emotions.

There are many ways to increase your positive emotions such as doing something you enjoy. Maybe you have music that is guaranteed to make you feel awesome? What about drawing, watching some comedy, or being kind to yourself with a relaxing bath?

Do whatever it takes to create some positive emotions. They can’t wipe out all the negativity and stress associated with an injury but there is proof that they can improve your physical and mental wellbeing.

The Black Dog Institute has a fabulous fact sheet on positive psychology practices to try.

9.      Come to terms with taking or ignoring time

Time is a funny thing. When an injury happens, all of the timeframes you might have had for yourself change. I was due to take an overseas holiday three days after my injury. I had to cancel it. This was upsetting for me and my partner, who’d been really looking forward to it!

It’s important to accept the ‘time reset’ and take life day by day. Some days will be good and others will be sh*t. That’s ok. Just focus on what you can do day to day, rather than what you can’t.

Some days will be good and others will be sh*t. That’s ok. Just focus on what you can do day to day, rather than what you can’t.

By focusing on the small moments, this will help to reduce worrying or catastrophising about what the future holds.

Psychologist Abra Garfield recommends thinking about injury recovery in cycles that are no longer than a month long.

‘Cycles of two hours might be needed in the beginning. For example, aiming to feel more comfortable at the end of that two hour period,’ he said.

‘Then take each day as it comes. As you get more into your rehabilitation if will be better to stretch out your focus to a two to four weeks. Benchmark what you need to do and focus on two weeks out and just keep working on it without judging yourself day by day.’

10.  Boosting your resilience can lead to a positive mindset

Resilience is defined as: the process of negotiating, managing and adapting to significant sources of stress or trauma. In other words, ‘bouncing back’ in the face of adversity. There are a range of factors contributing to this including the ‘assets and resources’ you have within yourself, in your life and the environment. And your ability to tap into your resilience will change over your life.

We all know people that are extremely resilient and some that seem not to be. Estimates vary but between 25 per cent and 84 per cent of the population are resilient.

A commonly referred to tool to test your resilience is the Resilience Scale. Individuals can figure out where they fit on the scale and see how their rating compares to the general (or a specific group within a) population.

According to Dr Gail Wagnild designer of the research-based Resilience Scale and author of True Resilience, you can boost your resilience by working on your:

• Purpose: connect with the reasons for getting out of bed in the morning. One study found that people recovering from adverse situations with greater purpose in life could “reframe stressful situations more productively,”
• Perseverance: tap into your determination and grit to not give up.
• Self-reliance: believe in yourself and all you have to offer to the people around you and the world.
• Equanimity: balance and harmony.
• Authenticity: accept yourself for who you are and express yourself with truth.

So how did I cope?

In a nutshell, over the first few months, I:

• cried a lot (at least this helped to release some emotional energy)
• talked about my fears with my partner and close friends
• spoke to a couple of coaches (mindset and spiritual)
• wrote down the emotions I was feeling so I could better process whether they were indicators of wider issues or simply feelings stirred up that I just needed to release
• took things day by day rather than thinking too much about things in the future that I wanted to do but couldn’t (for example, going to the beach or travelling overseas)
• was grateful every day for what I did have
• did an abridged form of meditation twice a day that focused on sending positive energy to my injured knee
• connected with a little bit of spiritual guidance to remind myself that there is light and dark in life and that by experiencing the dark I will really appreciate the light.

Do I think I coped well? Not particularly. I wish I had seen a psychologist or professional counsellor early on and regularly. After going through this injury I believe that if I had greater mental and spiritual strength and more tools to adapt then I wouldn’t have suffered as much as I did.

Final word

Sustaining an injury can change your life. You may go through shock and transition into ongoing trauma. But it doesn’t have to be like this. Your experience can be better through understanding the challenges you face and by getting support. If you are currently struggling to cope with the fallout from an injury, reach out for help.

If you’ve been injured, did you feel that you got the help and support you needed in the unfolding hours and days? Let me know about you experience.