Top athletes know competition is a mental game even more than a physical one. What if recovery from injury is also more dependent on psychology than on the degree of physical damage? For many years, researchers have explored the mental component of pain. They have discovered that our perception of an injury can have a stronger influence on how much pain we experience than the actual tissue damage that has occurred.
So how do we maintain the right attitude when an injury results in irretrievable lost training time? When we are frustrated because persistent pain is stopping us from moving, what kind of mental adjustment is required to ensure the mind is supportive of a speedy recovery? This is where mindfulness meditation comes in.
Meditation is not something that only benefits yogis. Meditation gives athletes the ability to stay calm in the eye of the storm, it improves your ability to ignore distractions, and it has a powerful impact on the state of your nervous systems. All of these elements are significant to recovery time.

Don’t Shoot That Second Arrow 

Before examining meditation, let’s get back to the issue of pain and the mind. The meaning you apply to an injury can determine how much pain you feel and the speed of your recovery. The Buddhists have known this for centuries. Here’s a story to illustrate. 
Imagine you are an accomplished archer preparing for the Olympic trials. You’ve been training for years and this is your moment. You are practicing at the archery range and about to raise your bow. Suddenly a searing pain slices your shoulder and you crumple to the ground.
A newbie is muttering, “I’m sorry. I’m so sorry. It just slipped.” As the first aid guy comes to look at your wound, the thought that screams through your mind is, “Why does this shit always happen to me?!”
This frustration continues to kick and wail inside your head so loud that you don’t even notice when the helper says, “Just a scratch. I’ll put a Band-Aid on it. You can resume shooting now.”
The physical pain has abated but resentment wracks your brain: “Doesn't matter where I am, if something bad is going to happen, I'm surely the target! I won’t be prepared for the trials. A once in a lifetime chance at the Olympics thrown in the garbage.” You angrily drive home to lie on the couch and nurse your wound, feeling a need to stop at the drug store and pick up a bottle of extra-strength pain killers.
archer draws his bow
Your response to an injury can enhance your recovery, or it can be the second arrow. [Photo credit: Pixabay]
The Buddhists would say that instead of being hit by a single arrow, you’ve been hit by two arrows. The first was the wooden arrow that slashed your arm. The second was the one with which you shot yourself. You have launched a catastrophic second arrow with your thoughts.
This is a dramatic example, but the point is whether or not you get hit by a second arrow is entirely your choice. It is how you respond to the first arrow that makes the difference.
The meaning you attribute to an injury can affect how much pain you experience. When you’ve sustained an injury in training, what does the injury mean to you? Does it mean wasted time? Does it mean missed opportunity? What is at stake when you can’t train or compete - your future, your finances, your reputation?
Fear and beliefs have an impact on recovery time and pain. Research has found that recovery expectations are a strong predictor of whether or not the pain will become chronic.1 At the same time, positive recovery expectations can lead to faster recovery times.2

The Power of the Brain on Pain 

To gain a deeper understanding of your own concepts of pain, it helps to take a close look at how the pain system works in your body. Lorimer Moseley is a professor of neuroscience who works as a clinical scientist studying pain, specifically the role of the brain and mind in chronic pain. He believes simply understanding how the pain system works can help us to experience less pain.3
Your nervous system is made up of neurons, the spinal cord, and the brain. Pain neurons in your body are programmed to protect you from dangers like heat or pressure. When these pain sensors detect danger or damage, they send chemical and electrical messages up the spinal cord to the brain. Your brain then decides how to respond and sends a message back to the body. The brain might send a message to freeze, pull your hand away from a flame, or run for your life. Of course, the pain system is much more complicated, but the gist of it is that it protects the body from external dangers and ensures our survival.
Here’s the catch: The amount of pain you feel is not solely determined by the pain messages being sent up from the body or the external stimuli (i.e., the amount of heat or pressure). The brain regulates this to some extent also. The brain can decide to send more chemical and electrical messages to increase the pain sensation or choose to send different messages that decrease the pain. 
The amount of pain you feel is a complex blend of:
  1. The external stimuli and degree of danger.
  2. Visual information, everything you already know and have experienced, and your emotional response.
The brain has a lot of power over the amount of pain you feel – whether during an acute injury event or during recovery. If someone perceives the injury is career-ending, the recovery time will be longer.

The Hypersensitive Nervous System

When tissue has been damaged, it is normal for the pain sensors near the injury to remain sensitive for a period of time. This prompts you to protect the site from further damage. However, if this hypersensitivity lasts for too long, it can cause the nervous system to react to non-dangerous stimuli as if they are dangerous.
Think about a time your back was sunburned. Putting on a shirt feels like someone put a blow torch to your skin. This is an example of tissues becoming hypersensitive. Another example of a hypersensitive nervous system happens with fibromyalgia - a gentle touch is misread by the nervous system as danger and the sensors send pain signals to the brain.
When pain persists longer than 3-6 months it is categorized as chronic pain. In this chronic state, there is a risk that the nervous system will shift into a state of hypersensitivity, which involves the brain as well as the pain sensors in the body. The brain adapts and begins to send more pain signals and it sends pain signals when there is no danger or damage. It may also start to spark pain signals in different areas of the body. The pain neurons also go into overdrive, reacting to normal touch or mild heat as if it’s a threat to survival. In this hyperactive state, your pain alarm system starts to get louder and it goes off more often –for no real reason. This tells us that pain signals are not always an indication of actual tissue damage.
The good news is that the brain can be trained so that it doesn’t send more pain signals than are necessary. When the brain is soothed, we can stop ourselves from sliding down the slippery slope towards a state of hypersensitivity. By calming the brain, we can avoid chronic pain and decrease our recovery times.
injured football player
Taking a moment to calm the mind will decrease the amount of pain you feel. [Photo credit: Pixabay]

Meditation Reveals the Truth 

Mindfulness helps with recovery on two levels:
  1. Mindfulness meditation can help you recover from injury by changing your perception of the circumstance/trauma/event. It enables you to see the truth of a situation rather than letting emotion skew your opinions and reactions. You can look at the reality of how much tissue damage occurred. You can come to know if pain is authentic or based on fear. You can take an honest look at how much you are building up the meaning of an injury and causing yourself more pain. You can direct your mind towards what is important, rather than being distracted by irrational worries and beliefs that are based in fiction or illusion.
  2. You calm the nervous system. This aids in recovery by stopping all the fight or flight reactions you impose on your body when you catastrophize (such as increased cortisol, tense muscles, lowered levels of dopamine and serotonin, inhibition of digestion, reduced sex drive).
Mindfulness enables you to check your perceptions against an objective assessment. So when you have to spend time sitting around while recovering, you can make it productive instead of wasted - you can practice mindfulness meditation.

How It Works

One time, I fell and broke a rib. It wasn’t a training injury or a spectacular accident. My rib broke when I slipped on wet stairs and cracked my back on the step. While I was on my hands and knees at the bottom of the stairs trying to catch my breath, a slew of panicky anxious thoughts went through my head.
Once I caught my breath, I slowly crawled up the stairs and cautiously slid into bed. The mental catastrophizing continued until suddenly a new thought arose, “STOP! I teach yoga and meditation. Now is the time to put my methods to the test.” I combined deep breathing with mindfulness to calm my mind and nervous system enough that I fell asleep within minutes (without any drugs or painkillers).
Here’s what I did:
  1. Breathe slowly. I began to focus on my breathing and slowed it down, inhaling through my nose instead of my mouth. Rather than quickly gulping air in through my mouth, which sends a signal to the body that it is an emergency, I breathed slowly and softly. This change to my breathing sent a message to my nervous system that it could relax the muscles, slow the heart rate, stop producing stress and pain hormones, and start producing relaxation hormones.
  2. Observation. Using mindfulness techniques, I moved my awareness to the spot where the pain was most intense. I began to examine and study the pain through the eyes of a neutral observer.
  3. Labelling. Rather than labelling the physical sensations as ‘pain’, which has negative and emotional connotations, I gave them a neutral label. I called it heat, tingling, pulsing, movement, swirling, or contraction. This calms the brain. When the brain relaxes it sends out a message to the body that it can relax too. Body and brain learn from each other.
Through these actions, I told my hyper-excited nervous system that everything was going to be okay. It only took a few minutes to fall asleep, which was exactly what my body needed in order to begin the healing process.

Retrain Your Nervous System

Anyone can use this technique, whether recovering from an acute injury or experiencing chronic pain from an old injury. You can take control of your body, brain, and nervous system. Just like with any skill, your ability to apply mindfulness improves with practice. I attribute my ability to apply mindfulness during a meltdown moment to a consistent practice of meditation.
I was able to stop myself in the middle of an emotional and painful experience and apply the techniques. I liken it to being at an accident scene and remembering how to apply first aid skills. There’s a reason we have to renew our CPR training every few years – it’s the practice that enables us to jump in and do it by rote in the middle of a highly charged situation. Thus, it is beneficial to practice meditation even when we are not in pain.
To practice meditation, start with 12 minutes, twice a day. Consider it training for your nervous system. If you’re not sure where to begin or feel like your mind is too distracted to start on your own, you can find mindfulness courses online if there aren’t any available locally. Gradually work your way up to 15-20 minutes, twice a day. Or even better, try an hour, once a day.

Mindfulness Is Not Ignoring Pain

When applying mindfulness in injury situations, you are not ignoring the pain, or working through the pain, or suppressing the pain. It is critical to listen to pain signals. Sometimes a pain signal is your body saying, “Hello, you must listen or bad things will happen.” When the pain signal is an accurate indication of tissue damage or a biomechanical problem, your body is telling you to stop moving those tissues and address the damage. However, as illustrated above, pain signals are not always an accurate indication of actual damage. That is where the mindfulness techniques can help.
Through mindfulness we listen closely to the messages from the body. We become better judges of what is real and what is being exaggerated by our emotions. We also calm the nervous system so it doesn’t create unnecessary pain or keep the pain occurring long after the tissue damage has healed.
As you recover from an injury, remember what it's like to feel healthy in the area that was injured. Pain is not your normal state. The human body has an amazing capacity to rejuvenate and your brain can either hamper its progress or help it. You get to decide if you shoot that second arrow or not.
How do you change your mindset while you're sidelined?
1. Boersma, Katja, and Steven J. Linton. "Expectancy, Fear and Pain in the Prediction of Chronic Pain and Disability: A Prospective Analysis." European Journal of Pain 10, no. 6 (2006): 551. doi:10.1016/j.ejpain.2005.08.004. 
2. Cole, Donald C., Michael V. Mondloch, Sheilah Hogg-Johnson, and Early Claimant Cohort Prognostic Modelling Group. "Listening to injured workers: how recovery expectations predict outcomes—a prospective study." Canadian Medical Association Journal 166, no. 6 (2002): 749-754.
3. Moseley, G. Lorimer, and David S. Butler. "Fifteen Years of Explaining Pain: The Past, Present, and Future." The Journal of Pain 16, no. 9 (2015): 807-13. doi:10.1016/j.jpain.2015.05.005.