MORGANTOWN, W.Va. — The traits that help make a successful athlete can become a liability when that athlete gets hurt.
An injured player told to run a mile who instead runs several might appear exceptionally dedicated. But Dana Voelker, director of the School of Sport Sciences at West Virginia University in Morgantown, says excessive exercise during injury recovery can instead be a warning sign of a deeper struggle involving body image, eating and pressure to maintain an athletic physique.
“A lot of times, we look at these behaviors and see a sign of a great athlete,” Voelker said. “But if someone asked to run one mile runs a lot more than that, it’s a red flag.”
The concern is part of a broader problem Voelker and fellow researchers examined in a recent study of athletes who reported that an injury had affected their attitudes or behaviors concerning their bodies, food or exercise.
“Injured athletes can’t be active in the way that they were previously, and when they’re pulled away from competitive play and practice, it’s often not only a threat to their physical self but their psychological identity as well,” Voelker said. “That’s where a range of mental health concerns, including exacerbated body image concerns, can emerge.”
Injury can change how athletes see their bodies
The study included 158 current and former athletes who had sustained an injury within the previous five years that affected their attitudes or behaviors related to their bodies, food or exercise. Participants retrospectively reported that body pressures, body-image concerns, eating pathology and dysfunctional exercise were more frequent and intense during injury recovery than before their injuries.
Athletes in so-called lean sports, where low body weight or aesthetics are emphasized, reported the greatest body pressures while injured. Researchers also found that body-image concerns mediated the relationships between body pressures and both eating pathology and dysfunctional exercise.
The findings do not establish that athletic injuries generally cause eating disorders or dysfunctional exercise. Because researchers specifically recruited athletes whose injuries had affected their attitudes or behaviors involving their bodies, food or exercise, the results should not be generalized to all injured athletes.
For those who do experience such pressures, however, an interruption in normal training can introduce concerns beyond whether an injury will heal or athletic performance will return.
“In addition to concerns about potential declines in technical performance, injured athletes may also become concerned about ‘How am I going to look in this uniform when I return? What will my coaches, teammates, or competitors think about changes in my body? What if I gain weight or lose muscle? What if I don’t look like the ideal athlete in my sport?’” Voelker said.
Dedication can disguise a warning sign
One difficulty in identifying a problem is that the behavior can resemble the discipline athletes normally celebrate.
Voelker said compulsive overtraining can occur when an injured athlete exercises beyond rehabilitation requirements. Other warning signs can include increasingly negative comments about weight, shape, or appearance; anxiety about how uniforms fit; and repeated fears of judgment by coaches, teammates, parents, or peers.
Another behavior, known as body checking, can involve compulsively monitoring appearance in mirrors or other reflective surfaces and frequently weighing or pinching skin or fat. Food-related changes can include restrictive eating, avoiding meals, hiding food, binge eating, or purging.
“Most observers don’t acknowledge a need to intervene until an athlete looks visually unwell or performance suffers,” Voelker said. “But a host of psychological and behavioral signs and symptoms occur before these physical and performance changes and would support prevention and early intervention if detected.”
Athletes may not get the support they need
The researchers also found a more complex relationship between recovery and social support than expected.
Participants reported receiving mostly what researchers characterized as esteem support, while wanting more emotional support related to their bodies, food, and exercise. Family members were the primary source of support, while coaches were the people athletes most frequently wanted such support from but did not receive it.
More support was not necessarily associated with better outcomes. Researchers found that greater perceived support unexpectedly amplified the relationship between body pressures and body-image concerns, suggesting that the kind or quality of support an injured athlete receives may matter.
That finding reinforces the importance of communication among the people involved in recovery, Voelker said. A coach, athletic trainer, nutritionist, mental-performance consultant, and strength coach may each observe different changes in an athlete.
“When an athlete’s behaviors diverge from their normal, there’s reason to explore further,” she said. “That’s the value of multidisciplinary support. If a coach works in isolation from the athletic trainer, nutritionist, mental-performance consultant, or strength coach, they lose valuable perspective.”
For Voelker, the larger lesson is that recovering from a sports injury involves more than healing the injured part of the body.
“Athletes are whole human beings who participate in sports, not just bodies that exist to perform,” she said. “When an athlete talks about returning to their sport after injury, we need to pay attention to their whole selves, including physical and psychological recovery.”
The athlete’s relationship with food, exercise, and body image, she said, should be an intentional part of that recovery.
“Caring for and working with the body you have is part of the true beauty of sport—maximizing the potential to do amazing things while supporting a healthy and positive experience for all who participate.”