Coping with mental strain of injury

A minor injury, as the saying goes, is an injury to someone else. When it's your knee, back, shoulder or, in my case, groin that hurts, there is nothing trivial about it. Especially if said injury is keeping you from working out consistently for the first time in years.

I'm not exaggerating when I describe this muscle strain — or whatever it is — as life-changing. Not life-changing like, say, your first child or the new cafeteria here at work. No, it has changed my daily life, my routine, my mood, my body — and none of them for the better.

My weight is up. My motivation is down. So is my energy level. My craving for all the worst junk foods, usually suppressed by vigorous exercise, has intensified as I've worked out less and less.

It is small comfort, but the experts I have consulted say that, psychologically and physiologically, everything I am experiencing is typical and predictable. And there are ways to fight back.

“Here are two parts of your life that have been disrupted,” says Frances Flint, coordinator of athletic training at York University in Toronto and a sports psychology consultant. “That good feeling” from the workout itself is gone, she says, along with the “my time” that I had carefully built into my week, time away from work, phones, e-mails and other stresses.

So true. That simple joy of moving, of washing away the day's aggravation in a shower of sweat, has given way to longer sessions in front of my TV. Gone as well is the camaraderie of long runs on Saturdays with my marathon training group.

“That injury is now defining your day, your social life, your release of stress, your feeling of joy,” Flint says.

What's going on?

Shawn Talbott, a nutritional biochemist, explains that there are two things occurring when we are suddenly deprived of exercise. First, working out helps our bodies get rid of cortisol, a hormone we produce as a result of stress. When cortisol lingers in the bloodstream, it signals the brain to go looking for sweets, which produce the same sensation as exercise. Hence my increased attraction to Double Stuf Oreos.

Second, exercise produces endorphins, the hormones that yield the “runner's high” and other pleasant feelings. The brain responds to it in much the same way it does to cocaine and heroin.

“You exercise and you get this hit of brain chemicals, and it makes you want to do it again and again and again,” said Talbott, a former University of Utah researcher. “And when you can't do it, we have people who literally get depressed.”

About a year ago, as I was working out with a trainer in preparation for the 2010 National Marathon, I felt a tug and some pain in my lower groin. It was, at the time, a small, nagging injury, the kind almost everyone who exercises suffers now and again. It didn't really keep me from doing core work or maintaining my running schedule of 30 to 40 miles per week.

That changed when I slogged through the Richmond (Va.) Marathon in November, with the pain in my groin intensifying and spreading up through my hip. Now I can run perhaps three miles before the discomfort forces me to stop.

My doctors are still unsure what the problem is. Nothing has turned up from an ultrasound, a CT scan or physical examination. Soon I'll be seeing a sports medicine specialist for another opinion.

In the meantime, what do I do? I figured out the most important part on my own: getting my enlarged posterior back in the gym. Flint says it's crucial to continue working out. Any kind of exercise is good, but since I'm a runner, I want to find ways to maintain cardiovascular fitness.

If I were a collegiate track athlete, she says, coaches would have me run in a pool to achieve the value of exercise with little or no impact on the body. I don't have easy access to a pool, so I've been riding a stationary bicycle, which doesn't hurt much but is excruciatingly boring, even with an iPod and a ballgame on. I've also hit the treadmill despite my injury, running slowly for as long as I can. And I've been stretching a lot more, hoping I can work out the problem myself.

It's important, Flint says, to do this at the same time of day that I used to work out. Overall, the effort will give me “the same biochemical effects” as my previous regimen, Talbott says, without stressing the injured area.

(Optional add end)

The other critical move, Flint says, is to take control of the situation. Find out as much as you can about the injury and possible therapies. Become involved in your care, instead of a passive recipient of treatment. Banish “negative self-talk.” Some athletes like to visualize the affected area healing; they believe it speeds the process.

“I want to know as much as I can about my body,” Flint says. “What is the damaged tissue? Why has this occurred?”