Wimbledon 2017 ~ the growing injury list
The Wimbledon Championship has featured a significant number of injuries this year. On the same day we lost Djokovic and Andy Murray, the former retiring through injury, the latter struggling with hip pain. Sadly for British fans and tennis fans, the intensity of the pain prevented him from progressing. Murray was obviously struggling to move normally as his body shifted into a state of protect.
Why do players breakdown at the tournament?
There are several reasons. The game has become increasingly physical together with the pressure to perform in tournament after tournament. Everybody needs recovery time, and some players may simply have figured in too little within their schedule. It is not just the game time that requires subsequent recovery, but also the training: on court, strength and conditioning etc.
One must ask about the pressures to play, both financially and to achieve a ranking. To earn money, and this is a job that pays the bills, and to be ranked, players need to play. They are also driven to be the best that they can be, which means pushing oneself. The cultural meme in sport ‘no pain no pain’ exists and anyone involved in any kind of physical activity knows that intense play hurts. So when is it normal and when is it a problem?
It is somewhat easier to make that judgement in amateur sport when the stakes are not so high. Your career does not depend on playing that extra game. In professional sport, understanding pain is absolutely key in making this all.
This week a commentator pointed out that all players have some kind of injury and that no-one is 100% fit. What is 100% fit anyway? This will mean different things to different people. Do players feel aches and pains everyday? Yes, everybody does to a greater or lesser degree. Life hurts! But in many cases, the pains come and go, and do not impact upon life or performance. If a pain repeatedly occurs and does have an impact upon performance and life, this is something that does need to be addressed.
Acute injury vs persistent injury vs persistent pain
It is interesting that most of the injuries we have seen this year have not been acute. In other words, the players knew about the problem beforehand as it has been rumbling on for some time. Murray reported that his hip has been something he has been dealing with for years.
This is with the exception of Bethanie Mattek-Sands when her knee injury happened there and then, taking everyone by surprise. This is one of the reasons it was so shocking, because no one expected it, least of all Bethanie herself.
There is a difference between an injury moment and a pain moment. Pain and injury are not the same. Pain is part of the way we are alerted to being in a state of protect, a great motivator compelling action, and an injury is when there is a disruption to our body. An injury can often hurt but it does not have to, and the extent of the pain varies enormously depending upon a number of factors.
Pain and injury are not the same – read here
The terms pain and injury are often used interchangeably and this is not correct. Persistent or chronic pain and chronic injury are not the same. A chronic injury would mean that the healing process has not completed, taking longer than would be expected. Persistent or chronic pain is not well related to the tissue state, instead being a reflection of an on-going state of protect. There are a number of reasons why the state of protect persists and these are a main focus for the treatment and coaching programme to overcome the problem.
Murray’s hip pain
Whether Andy Murray has an injury or a pain problem we do not know. I hope he knows because this will determine the treatment and the training needed. Undoubtedly when a player is training and playing as often as Murray, there needs to be down time. Has he had this time? Federer took time off and appears to have benefited.
No-one can keep going at a high pace in life without recharging. We all must figure in refresh and renew points through each day, learning how to switch to ‘care-giving’ mode. In this state, our body systems are doing all the vital things for long-term health and well-being. Without this we burnout: chronic pain, poor sleep, low mood, depression, anxiety, irritable bowel syndrome, fertility issues etc etc, many of the common, modern day ills.
A person who presents with a long term hip pain needs to tell their complete story. From there the key points and ‘primers’ are identified. In essence the person does not feel themselves and the aim is for them to be able to say, ‘I feel myself’. In fact, when we feel ourselves and get what we expect, we are in flow and do not really think too much about how we are doing things. They just happen. We do not normally think about walking, but if my hip hurts I will scrutinise every step, the pavement, others walking towards me, hills, steps etc. The world looks different and I feel different. Normalising these is key.
Let’s hope that the nature of the problem can be truly established and then dealt with effectively and with long-term results in mind. Hips, like any body area, are not in isolation to the whole, and typically relate closely to the back and pelvis. Murray has had back issues before, a very common problem in both athletes and the general population, so I am sure this will be considered as part of the bigger picture.
What is your picture of success?
We all have our picture of success and should know what that looks like. This vision becomes a reference point and an orientation as we follow the necessary training programme and learn along the way. One can check in and ask: ‘Am I heading in my desired direction or am I being distracted?’. For Andy Murray, I would imagine his picture involves him consistently playing his best tennis. The key is to focus on what we want rather than what we don’t want. When I ask patients ‘what do you want?’, they often reply at first, ‘I don’t want this pain’.
Whilst this is an understandable response, the pain is actually what you do not want rather than what you do. This may sound all rather semantic, however there is an important practical difference. What we focus upon, we get more of. Think about what you actually want, crystallising the image and doing your utter best to get there.
“Don’t think of red elephants
Andy Murray, like all sports people, has a coach. His coach will work together with him to tap into his ‘greatest self’ so that Murray can achieve his best results. It is no different with overcoming pain. The person suffering chronic (on-going) pain is coached to be their greatest self. They are coached to become their own coach. In other words, because the person is with themselves consistently, they need to know independently how to orientate their thinking and what actions to take to get the best results. On the strong foundation of understanding pain, coaching provides a structured way onwards, carving out a fulfilling life.