The Importance of Social Support Following Injury

On November 11, 2015, I sat on a medical exam table waiting for the orthopedic surgeon to return with the results of an MRI. In the span of two months, I went from walking between two and three miles a day to barely being able to walk across a room. The cause of this decline was not clear. The speed of the decline and my lack of physical ability was alarming.

I immediately scheduled an appointment with my primary doctor. I had multiple appointments with different doctors and specialists. I was eventually referred to a neurologist and an orthopedic surgeon. Originally, doctors thought the rapid decline in my walking ability was directly related to my Spastic Cerebral Palsy (CP). A series of neurological tests showed that this condition was not CP-related.

As I sat on the exam table waiting for the MRI results, my mind raced. “What would the tests show?” I was trying to keep my sense of anxiousness under control. The exam room door abruptly opened and Dr. Dixon walked in with the MRI scan.

“What did the scan show?” I asked fearfully. Dr. Dixon’s response made me want to laugh and cry at the same time. “Kerry, you have a broken bone. The pain in your foot has nothing to do with CP.” I felt a simultaneous sense of relief and dread wash over me. The good news was that I did not need surgery. The bad news was that I would spend the next eight weeks in a cast.

I stared intensely at Dr. Dixon and asked “What caused this?” He replied that I had a stress fracture in one of the bones in my right ankle. A stress fracture is a fancy way of saying I had a crack in my ankle bone. Stress fractures are frequently caused by overuse. The exercise program I had worked so hard to master in order to achieve my goal of walking device-free likely contributed to the bone injury. My relentless effort to ascend and descend inclines (Hills) without support may have put excessive pressure on my ankle bones. Dr. Dixon advised me that I should permanently stop aggressive exercises such as hill climbs and descents.

I listened to his expert advice knowing that everything I had been working towards for more than 10 years would now have to change. The future goal of my walking program would shift from walking device-free to consistently improving and maintaining my mobility. I was put in a cast and prohibited from bearing weight on my right leg with the knowledge that my mobility would be restricted over the next eight weeks. I knew I would significantly lose the muscle mass I had worked hard to gain. I also knew that I would lose many of the skills and movement patterns I had worked so hard to attain.

Research clearly documents that participation in exercise and sports increases the chance of suffering an injury. As I watched the cast being applied from the base of my knee to my toes, I realized that I was not at all ready for the recovery process I was facing. I had to be assisted off of the exam table to try to find a new sense of balance with the extra height and weight of the cast. To move, I had to use the strength of my upper body and the poles and drag my foot. Initially I could not stand up with the cast even with the support of my poles.

I understood the causes of injury such as muscle imbalances, overuse, and over-training. What I did not know but learned about throughout this experience was the psychological impact of injury.

Research has shown that when an injury is sustained a person experiences “stress from the activity disruption, a sense of separation and isolation, anger, and irritability.” [1]  Over the eight weeks that I was in the cast, I experienced many combinations of these different emotions. When I broke the bone, I felt restricted. I could not move the way I wanted, or go where I wanted to go. Over the eight week period, I temporarily lost my sense of independence and choice.

Research shows that social reassurance and a support network is critical to the recovery process for an individual or athlete after an injury is sustained. [2] During the eight weeks of recovery, I had family and friends who came to visit regularly and made sure my house was clean and that I had groceries. Family members rotated and rearranged their busy schedules to give me a ride to and from work every day. I was fortunate that I had this committed support to hasten my recovery. However, even with all of this support, I still struggled. I wanted my typical abilities and independence to return faster than it would. Dr. Dixon warned me that my physical recovery would take over three months.

Research shows that a support network including family and friends can help an individual or athlete re-frame and re-evaluate their injury. [3] In my case this meant that people in my support network helped me to remember that my injury was short-term. On those days when I was feeling isolated, anxious, or frustrated, it was helpful for me to hear “Kerry, it is just a broken bone. You will heal.” At the beginning of my recovery, when I heard positive messages such as “the bone will heal”, it reminded me that the injury was indeed short-term. With this positive reassurance, I wallowed less in my feelings of isolation, anger, and irritability.

Social support from my family and friends was also critical at the later stages of recovery. Family members were present at all of my follow up medical appointments. Having people who knew my history and who could reiterate and reinforce my previous level of function was important for doctors who did not know my history. Family members helped me to share factual details with the doctors and also helped me to monitor symptoms, such as swelling, which could impede my recovery.

Research also shows that connecting with a person who has been through a similar injury is helpful. Unfortunately, I did not have connections to people who suffered the same injury. I would have asked “What strategies did you use to get through the injury? How did you handle the mobility restriction? How did you combat the frustration and anxiety?”

I learned many valuable lessons from my injury. One of these lessons is the importance of having a support network. Tell me, Wiley’s Walk readers, who are critical people in your support network? How has your network supported you in a time of injury?

[1] Fernandes, H. M., Reis, V. M., Vilaça-Alves, J., Saavedra, F., Aidar, F. J., & Brustad, R. (2014). Social support and sport injury recovery: An overview of empirical findings and practical implications. Revista De Psicología Del Deporte, 23(2), 445-449.

[2] Fernandes, H. M., Reis, V. M., Vilaça-Alves, J., Saavedra, F., Aidar, F. J., & Brustad, R. (2014). Social support and sport injury recovery: An overview of empirical findings and practical implications. Revista De Psicología Del Deporte, 23(2), 445-449.

[3] Fernandes, H. M., Reis, V. M., Vilaça-Alves, J., Saavedra, F., Aidar, F. J., & Brustad, R. (2014). Social support and sport injury recovery: An overview of empirical findings and practical implications. Revista De Psicología Del Deporte, 23(2), 445-449.

This article was originally published in the “Endless CapABILITIES Blog”, and National Center on Health, Physical Activity and Disability, sponsored by The National Center on Health, Physical Activity and Disability (www.nchpad.org). NCHPAD is part of the UAB/Lakeshore Research Collaborative and supported by Grant/Cooperative Agreement Number U59DD000906 from the Centers for Disease Control and Prevention (CDC).