If you’ve been in sport long enough, it is highly likely that you’ve suffered some sort of injury. In most cases that injury may mean a couple weeks on the couch and an awkward cast or brace. Sure, it’s painful, and every day you feel like your fitness is slipping away, but you’re back to your old self pretty quickly, and at worst only lose part of your season.
There is, however, another type of injury. The one that most athletes fear. The one that isn’t measured in weeks or months, but years, if not the rest of your life. This is the severe break, loss of limb, spinal cord injury, or lasting head trauma.
Severe injuries may take an enormous physical toll, but they take a mental toll as well. Sometimes an athlete’s body will fully recover, but their mental scars will keep them from ever performing the same way again. A serious injury can lead to losing a sense of self, losing one’s social network, and a decline in emotional health.
In this episode, we talk about the serious injury. We dive into what to do when you or someone you’re with experiences severe trauma, what the first few days after the injury can be like, and how to successfully navigate the years and months of rehabilitation that may be ahead.
We brought in two people who have helped countless athletes navigate through the mental and physical rehabilitation of a severe injury. Dr. Andy Pruitt has experience with many athletes and guided both Taylor Phinney and Chloé Dygert through bad leg breaks. Dr. Julie Emmerman has also counselled athletes through the emotional trauma that comes with physical rehabilitation.
We also hear from Taylor Phinney, a retired elite cyclist who nearly lost his life hitting a guardrail at 50 mph. He shares his experience of both his injury and how he successfully worked his way through it.
Ultimately, we hope you never need to call on the info in this episode!
Trevor Connor 00:04
Hello and Welcome to Fast Talk, your source for the science of endurance performance. I’m your host Trevor Connor here with Rob Pickels.
Intro to Today’s Episode
Trevor Connor 00:11
If you’ve been in sport long enough, it’s highly likely that you suffered some sort of injury. In most cases that injury may mean a couple of weeks on the couch in an awkward cast or brace. Sure, it’s painful and every day you feel like your fitness is slipping away, but you’re back to your old self pretty quickly and at worst, only lose part of your season. There is however another type of injury, the one that most athletes fear. The one that isn’t measured in weeks or months, but years, if not the rest of your life. This is the severe break, loss of limb, spinal cord injury or lasting head trauma. Severe injuries may take an enormous physical toll but they also take a mental toll as well. Sometimes an athlete’s body will fully recover, but their mental scars will keep them from ever performing the same way again. A serious injury can lead to losing a sense of self, losing one social network and a decline in emotional health.
Trevor Connor 01:03
In this episode, we talk about the serious injury. We dive into what to do when you or someone you’re with experiences severe trauma. What the first few days after the injury can be like and how to successfully navigate the years and months of rehabilitation that may be ahead. We brought in two people who have helped countless athletes navigate through the mental and physical rehabilitation of severe injury. Dr. Andy Pruitt has experience with many athletes and guided both Taylor Phinney and Chloe Dygert through bad leg breaks. Dr. Julie Emmerman has likewise counseled athletes through the emotional trauma that comes with the physical rehabilitation joining us remotely we also hear from Taylor Phinney. A retired elite cyclist who nearly lost his life, hitting a guardrail at 50 miles per hour. He shares his experience of both his injury and how he successfully worked his way through it. Along with these guests Wahoo fitness coach Neal Henderson, neuroscientist Dr. Scott Frey and physiologist Dr. Stephen Seiler weigh in as well. Ultimately, we hope listening to this episode proves to be a waste of your time. Now let’s make it fast.
The Paleo Diet Team 02:03
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Trevor Connor 02:32
Well, welcome everybody to today’s show. We have with us two of our favorite guests, Dr. Andy Pruitt and Dr. Julie Emerman. Thanks for joining us and you are here in the studio with us, which we’re excited about.
Dr. Andy Pruitt 02:44
Glad to be here.
Julie Emmerman 02:45
It’s really great to be here.
Trevor Connor 02:46
So I think this is going to be a really fun conversation and I think this is going to be one of those ones where we’re probably going to get off outline quite a lot. Go a lot of different places with this, but I think that’s going to be a good thing. but let’s talk about what this episode is about and I’m going to start with a couple weeks ago, I was on a group ride and guy in front of me crashed, I flipped over him, pulled the rookie mistake of putting my hand out and landed on my hand, I think I might have broken my wrist. That’s an injury and it’s annoying, it’s a little bit frustrating. It hurts, hasn’t affected my cycling too much. I’m still on the bike. I’ll be over it in a couple of weeks. That’s not the type of injury that we’re talking about today. We’re not talking about that. We’re not talking about a sprain where you’re off for a couple of weeks, but you’re gonna get back to it. Today we are talking about that potentially career ending injury or that injury that could take years to recover from or you might never recover from. This is something that I think all athletes fear. It’s something that unfortunately, a lot of athletes have gone through and the reason we have both of you here is because there’s both a large physical impact of this, but there’s also a large mental impact to this and I think, we were talking offline right before the show, as Andy said, you can’t really separate the two. So why don’t we start with maybe Dr. Pruitt, could you define what types of injuries are we talking about here and we talked about these really big potentially career ending injuries.
Type of Injuries
Dr. Andy Pruitt 04:28
I mean, the worst one obviously is head or spinal cord injury where they have a permanent mental deficiency for the rest of their life or spinal cord injury where they have a permanent physical disability for the rest of their life. I mean, that’s true career-enders life changing career-enders and then you’ve got the broken femur, you think about Velocky, you think about Chloe Dygert, you think about Froome. The broken femur, that long bone in your upper leg, injury to that in the hip are tremendously long recoveries and long healing and loss of fitness, loss of who you are and all those things. So, the Chloe Dygert, who broke her femur just above her knee into a compound fracture, transacting her entire quadricep and she started in the women’s wealth the other day, two years later. So we talked about a long recovery with lots of false starts, the mental aspects of all of those from the brain injury, the spinal cord injury to the fractured femur, they’re are different variants of both physical and mental impacts from those injuries and everybody handles them differently. Totally differently. Some people declare immediately that they’re coming back and others go, oh, this might be a good time to sail off into the sunset and drink beer.
Rob Pickels 05:49
Andy, I think it’s interesting that you bring up femur fractures and hips specifically because a broken bone itself may or may not be a devastating injury. To put that into context, I’m somebody who’s pretty good at crashing. That means 50% of the time I crash hard enough that I put myself in the hospital and the other 50% of the time, nothing happens and one of those for me was a broken collarbone that was pretty, pretty severe broken collarbone and five pieces plate and 10 screws later, I was actually racing two months after the injury, cyclocross in Louisville, Kentucky. On the other side of it, I broke my hip snapped the ball off my femur. Andy you know this all too well and that my right leg didn’t touch the ground for three months, literally wasn’t able to put my right leg down on the ground. So when you want to talk about loss of fitness and muscle mass, a broken bone, those two situations are dramatically different.
Trevor Connor 06:45
So I think we explain what we’re talking about. I mean, it’s the as you said spinal or head trauma. It’s major broken bones. I think we can also talk a bit about neuromuscular loss of function and obviously, another one that some athletes have been fortunate to deal with is loss of limb.
Dr. Andy Pruitt 07:03
Trevor Connor 07:04
So are there any others that we can think of that we need to talk about?
Potential Loss of Limb Injuries
Dr. Andy Pruitt 07:09
Well, let’s go back to potential loss of limb for a second. So Taylor Phinney. Everybody knows Taylor Phinney and his horrific crash at Nationals, went into the guardrail. Basically, broke his patella broke his femur, this was a devastating injury and when he first came to see me after surgery, he didn’t really know where he was in his recovery process and he wanted to be back immediately. He was, highly paid athlete, racing professionally for BMC at the time and finally I take him and his mother aside and I said, ‘Taylor, here’s how things went down for you. Their first job is to save your life, it was at risk. Their second job was to save your limb, so that you’ve got something to put in a pant leg. The third job was make that limb functional and lastly,our job was to make that an athletic limb again’ and it wasn’t until he really realized that he was potentially going to lose his life and potentially going to be an above the knee amputee, that he grasped the seriousness of his injury. So it takes a while and I think Julie can speak to this, how long does it take a person for it to absorb how badly they were hurt.
Trevor Connor 08:25
Let’s hear from Taylor Phinney himself what his injury was like and how he came to terms with it.
Taylor Phinney 08:29
It was a double compound fracture of the lower left leg. So mainly it was the tibia that was broken in half and they were both open compound fractures as well. So they were the bone was coming out of the leg, but I actually made a conscious decision when I was laying on the side of the road, not to look at my leg. I knew that it was something very serious because it was a pain that I had never experienced before and I kind of peeked down and looked and I could just see that my foot was off to the side in a really weird angle and I just, I mean nobody likes looking at broken limbs, but I just made this decision. I said I’m not going to look at this because if I look at it, I’m going to think about it for the rest of my life and I just kept looking up at the sky and I just waited for the ambulance to come, but basically it was open right in the middle of the tibia, with the tibia sticking out and then it was also open at the patella and I severed my patellar tendon and actually took about a centimeter off the bottom of the patella and the impact was against a guardrail. I was going way too fast. I was going about 50 miles an hour and I stopped to zero on the metal guardrail with my lower left leg took everything, but could have been my back, could’ve my neck, could have been anything else and so I was really lucky actually to take it in this kind of, I sort of think of my leg as this spring that saved me that day and took the whole impact. I can run now a little bit and go to the gym, I can ride my bike as long as I want to and so I feel very lucky for sure, considering. I guess a lot of athletes are pretty stubborn. So I honestly didn’t think, really for a second that I was not going to be able to use my leg again, it’s more later that I was actually thinking about what the doctors and what Andy what they were saying to me, but in that in the moment I was and in the days afterwards, I was fairly certain that I was kind of going to be fine, you know, very naively. It wasn’t based on any science, it was just like, ‘What do you mean, of course, I’m gonna ride my bike again and of course, I’m gonna race again, blah, blah, blah’. It’s more something that I think about now and I’m very grateful to modern medicine to be able to look down now and see my leg that it’s straight again and that I can use it.
Taylor Phinney 11:19
So why don’t we jump over there and talk about the acute phase. So somebody has just been injured. Be at a crash or whatever it happens to be. Let’s talk about both the physical and the mental side of this, of what should you be doing and what shouldn’t you be doing right after this happens to hopefully ensure that you have the recovery that you want? The sort of recover that Taylor Finney had and what is the mental impact; how do people process this, mentally when they realize what they’ve just gone through?
Dr. Andy Pruitt 11:52
I think Julie can speak to this, but I believe that’s what that’s what’s inside them. There’s people that might be a great athlete, they got a huge motor and just not mentally prepared to be injured and it takes mental mental toughness, but it takes a while for each individual to find that toughness too.
Can you Mentally Prepare for a Catastrophic Injury?
Julie Emmerman 12:11
I don’t know that anyone’s ever prepared for a devastating or catastrophic injury, for sure. I don’t think many of us would race or do what we do if we had to constantly think about that. Fortunately, a lot of the same characteristics that an athlete needs to be successful also come into play in their recovery process. So the same sort of tenacity, the thinking outside of the box, the utilizing a team, the perseverance, the commitment, all of those characteristics are essential in any kind of recovery. The one thing that also is required that isn’t necessarily spoken about too often is when somebody is starting their career, their athletic career, there’s no guarantee where it’s going to go. You just have this belief, maybe you have some data, you have belief of others around you telling you all systems go, you should keep pursuing this, you have a good chance of success and so you have that encouragement, you keep going, but there’s an enormous amount of ambiguity there that you have to be able to tolerate as an athlete, especially if you’re an athlete that doesn’t experience success right away. If you’re recovering from a catastrophic injury, you have to have the same kind of ability to tolerate an enormous amount of ambiguity because there will be setbacks, there will be false starts. Maybe not always, but often and those can be so hard to stomach and it just requires somebody has that same ability to keep pushing forward while tolerating the unknown.
Giving Structure to the Recovery Process
Dr. Andy Pruitt 13:38
So during that unknown, I tried to give them structure. So they’re an athlete, they’ve had this training program, they’ve got these goals and that was their job. Some of them are in school, some of them are in have other other real jobs, but training was their job with a goal of an A race or Brace or all the above. I tried to make overcoming the injury, their new job and give them structure in that recovery process that mimic the training program because it really is.
Julie Emmerman 14:08
Dr. Andy Pruitt 14:09
My belief is that in recovery, you want the body and the tissues to heal doing the activities that they ultimately want to do. So if you were a runner, with a broken tibia, we’d get them into the gravity reducing treadmills as quickly as we possibly could. The great thing about cyclists is that the bike is never full weight bearing. So we can really get them back on the bike, as soon as they have 95 degrees of range of motion of the knee. We get them back on the bike or collarbone. So we actually put the thing they love to do as part of their recovery structure. I think, so again about tissue healing, doing what we want it to do. We want the severed patellar tendon to heal while cycling. So those cellular structures are actually designed to do, re-heal and redesign themselves to do what we want them to do. So that’s a big, giving them a post injury structure that simulates their training program. really crucial.
Rob Pickels 15:12
Bringing this back to the acute phase of the injury. I almost think in the immediate, the days after the injury occurs, at least in my experience and because I’m so egocentric, I just apply this to everybody around me, there’s a hope. Initially, after the injury, maybe maybe it’s the endorphins flowing through my body or maybe it’s just not knowing what is going to come. It feels like, hey, this isn’t a big deal, I can work through this a month from now I’m going to be back and out there and there is definitely a change, where you give that a couple of weeks, you start getting into the process and I think that that’s maybe where the despair comes because you’re not healing as fast or that doctor’s appointment that was supposed to fix you. That’s not for another month, we all have these things because at this point, you’re now a patient, you’re almost not even an athlete anymore, but immediately after that injury, you still feel like an athlete, you still feel like there’s amazing hope there.
Dr. Andy Pruitt 16:11
I think there’s a mourning process and there’s levels of mourning. So at one point, I told Taylor, that he needed to mourn who he used to be and celebrate who he has become and I think that can be in the short term after an acute injury. That’s I don’t know how Julie feels about this, but you got to mourn the fitness that you just had and lost and that criterium crash. You got to celebrate where you are and look forward to the future and that’s always tried to keep them moving in that in that positive direction, as I may have been off.
Identity as an Athlete
Julie Emmerman 16:45
No, no you’re spot on. I’ll try not to get too philosophical here, but essentially, if you’re considering an athlete in their late teens, early 20s and most people at that age are trying hard to carve out their own identity, a sense of self and so if athletics is the medium through which you’ve been doing that, then you start to feel that you are this person, you are that athlete. So, in the immediate wake of an injury, all of that is tossed up, it’s a It’s tossed salad, it’s all over the place and so your sense of self, your identity is completely in question and it can be very scary to somebody to now have to grapple with, ‘Well, who am I?’ and so Rob, to your point, I just actually said this to an athlete yesterday, who I work with who’s has a long term type of injury situation. Just because you are not able to go to the training camp or do this or race or be on the schedule that you thought you would be on doesn’t mean that you’re not an athlete anymore and that comes back to the question of identity, which I was speaking about earlier, you’re still an athlete, you’re just in a different phase of what it is to be an athlete.
The Paleo Diet Team 17:51
When we were talking with Dr. Seiler, he brought up the parallels between injuries and overtraining, one of the biggest of which is the loss of a sense of self.
Over Training and Identity after an Injury
Dr. Stephen Seiler 17:59
The best conversation I’ve had on that topic was with a former National Team cross country coach here in Norway, named Gerald Jorgensen and he lives here where I live in Christian saw and he’s coached Olympic medalists and he’s also worked a lot with coming back from overtraining syndrome, which is not a specific injury, but it is a very debilitating status to be in and very difficult to come back from and one of his main messages was is that the athlete that has been so fit and so such a high performer, their calibration of themselves is as this unique, highly trained specimen and then they’re confronted with a reality that is almost their brain can’t quite digest, which is you’re not that athlete right now because of a major injury or because of overtraining, you are not that and so you have to quit comparing yourself with that previous version of you and instead, the road to recovery involves comparing yourself with yesterday’s version of you and giving yourself a little pat on the back when you make a nice small progress because that will be the pathway back, but it can be overwhelming to compare yourself with you when you’re at your top after three months of not being able to train. So it’s very much just recalibrating and then you can get back. You can get back, but if you start it’ll just feel like an impossible mission, if you compare yourself with the best version of yourself when you’re kind of at the bottom again. My daughter has faced that too, just after multiple injuries and COVID and everything she said, ‘Man, I finally just had to realize, I’m not going to be raised this season and I got to start from scratch’ and once she figured that out and once she came to grips with that, she was more relaxed and was able to just get on with business and it got better.
The Paleo Diet Team 20:07
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The Road to Recovery
Trevor Connor 20:36
The one study that I found related to this leading up to this episode was actually called ‘Bio-psycho social experiences of elite athletes retiring from sport for career ending injuries’. So it was basically a review of any studies that looked at the experience and athletes and it said exactly what you’re saying. That there were three challenges these athletes faced. One was this loss of self. Second one was lack of support and the third one was mental health decline and they made a big point that having social support is really important and that’s often challenging for athletes because their whole social network sometimes is other athletes in their sport and because they can’t participate, they lose that and the recommendation of the study was build a social network outside of your sport.
Julie Emmerman 21:25
Yeah, I think that’s really important and also very challenging because usually, those are the people that you are drawn to, who you want to be around and you share similar values. It’s a second family to so many people or an extended family.
Dr. Andy Pruitt 21:37
The time commitment to your sport. There’s How do you have two separate groups?
Julie Emmerman 21:42
Dr. Andy Pruitt 21:43
your non-athletic social group and your athletic social group, I would find that, it would be hard. I mean, I had medical and athletic, but most of my medical colleagues were also athletes.
Rob Pickels 21:56
Come on Andy, we all we all cross sides on this one.
Dr. Andy Pruitt 22:00
Yeah, I mean, it was it’s hard. I’m 73 years old and I’m still an athlete. So I mean, it’s part of who I am and I guess along the way, I could have lost that a couple times, but the mental drive to be who we want to be.
Julie Emmerman 22:13
I think it depends on the severity of the injury you’re talking about and obviously, if somebody is now prohibited from doing their sport, then it would be essential to find other connections and other points of contact, that you enjoy, some way somehow.
Dr. Andy Pruitt 22:30
One of the strategies I used was find them an alternative sport, whether it was temporary or permanent. Finding them another avenue for that competitiveness and that athleticism, that worked pretty well.
Julie Emmerman 22:41
Taylor Phinney 22:42
So before we move to talking about the long term impacts, I actually just want to ask one kind of practical question to you, Andy, which is, let’s talk about that scenario, where say, you’re part of a group, you’re out for a big group ride, you’re on a big descent. One year friend’s crash is hard and you realize this is a bad injury, they’ve broken something, something has happened, they’ve injured their spine, what are the things that you can do to help that person, to make sure that at that moment, you’re doing the right thing? So and I think particular, you know, Chris case was leading a tour over in Europe and Ben Delaney had that really bad crash and went down a hill and Chris has told the story of trying to deal with this and figure out oh, my God, he’s hurt. What do we do and I won’t give names, but there was one person who was like, Oh, my God save the bike and ran down the hill to get the bike. So what what are suggestions? What should people do when in that scenario?
Dr. Andy Pruitt 23:42
On that same note, before I get serious, what’s the first question the person asked who crashed? “Is my bike okay?” What’s interesting is I saw in the news last night, where they’re training grade schoolers in first aid because of all the active shooter incidents and mass shootings, they’re training first aid at a very basic level at very young children and some of the parents are saying how they shouldn’t have to be, but I think everybody should know basic first aid. What if you’re by yourself with a big laceration?
Julie Emmerman 24:12
Dr. Andy Pruitt 24:13
Or broken bone, some basic splinting some basic tourniquet. So if you’re an athlete, you better I think, have basic first aid training and that includes you Trev.
Trevor Connor 24:23
The Importance of First Aid and CPR
Rob Pickels 24:24
I’ll agree with that and maybe Andy because both you and I come out of the medical world, it seems so obvious, but I’ll also say that this is approachable for anyone, not just a medical professional to have basic first aid and CPR. It’s really very simple and in all honesty, the courses are tailored away from the medical person so that the layperson gets a lot of value out of it. It’s not too much of a time commitment. They’re not expensive. There’s really no reason not to do it to tell you the truth and this is something where I think it’s important that we all support the riders around rs or the runners around us, the skiiers around us because you are your brother’s keeper and I want people, I want to be able to rely on them if anything happens to me and then I also want them to rely on me in the opposite case and I think that this is a great time to plug. Communication is sometimes the only thing that you can do and oftentimes places that we’re riding, there is not cellphone service and so 95% of the time, unless I know I’m going for an hour just around my house, I carry a satellite communicator with me. They’re relatively inexpensive, they’re relatively small, it doesn’t get in the way and the only time I’ve ever really had to use it was not for myself, but for an incident that I came across, that I shared previously, somebody had a cardiac arrest in front of me and again, you are your brother’s keeper. It’s like carrying that avalanche transceiver for people that do backcountry skiing. In some regard, that’s for saving your life, but it’s also very important to save the lives of the people around you and sometimes the absolute best thing you can do is just is send for help and having the ability to do that is hugely important.
Trevor Connor 26:05
Yeah and the way I look at these things and this is part of why I was asking the question is, if you’re not fully trained, like I agree completely, get the first aid, but sometimes you can do more harm than good. Sometimes you just have to recognize the situations where you go, there’s not much I can do here and if I try to do something, I might be doing more harm and really, my job is to get the experts here as quickly as we can.
The Importance of Making People Comfortable
Dr. Andy Pruitt 26:29
Well, there’s a state law that protects goodwill bystanders that help people. So you’re not going to get in trouble by trying to help someone and ended up making it and making it worse, but making people comfortable is pretty key. Making people comfortable is pretty key, but you’ll learn how to assess head or spinal cord injury in your basic first aid and to know whether or not to roll them over or not. The airway is key. Even if they’ve got a spinal cord injury and they’re on their face, face down or vomiting, there’s no airway. There’s no good end of that.
Trevor Connor 27:02
Julie, this is my opinion, but I’m really interested in here, what do you think I think sometimes the best thing you can be doing is holding somebody’s hand and talking with them because they are going through, they’re in pain, they’re mentally trying to process this and sometimes that’s where they need the most help.
Julie Emmerman 27:18
Right, right. Absolutely. In those situations really, I think everyone’s humaneness would hopefully show through and you do what you can just to comfort, reassure, try to be encouraging.
Dr. Andy Pruitt 27:28
There’s not much difference between an automobile accident and a bike crash. The physiology of the injuries are similar, but the attitude of that person. The athlete has a more positive, go get ’em attitude than maybe I don’t wanna throw anybody under the bus, but somebody’s in a car that’s not, maybe not athletic, not as strong personally. I came across a overturned Jeep one winter night, Tire were still still spinning. So I jumped out of my car and there was a guy underneath the Jeep with a ride arterial bleed. I was coming home from skiing and it was before I-70 was complete and I actually got in the Jeep with him, put pressure on his arterial bleed and lay down beside him to keep him warm, while my brother called 911 and so 911 finally arrives and as soon as you know, I can let go of this guy’s arterial bleed and get out of the puddle, let the trained First Aiders who had real first aid equipment take over. So I did what I needed to do to keep him warm, stop the bleeding and keep him comfortable.
Injuries vs. Death
Julie Emmerman 28:35
Just to pivot a little bit back towards injuries versus situations where people are dying. I do think though, one of the best things about a really good sports medicine doc is the ability to not just address what’s going on physically, but also provide a sense of hope and options for that patient. So there’s a real art there of helping somebody with your medical skills, but also being able to help them feel hopeful about what they can do in the short term and what things might look like down the road.
Dr. Andy Pruitt 29:07
There are practitioners with great bedside skills and great medical skills and there are those with great medical skills who have terrible human relation skills. So sorting through your medical care, it does take a team sometimes and I know surgeons who have really personable athletic trainer assistants or PA assistants that provide the personality provide that warmth and connection that maybe the technical surgeon can’t either he can’t have doesn’t have the personality or just doesn’t have the time to provide those things. So building that team around around the injured athlete is, I think it’s crucial.
Julie Emmerman 29:47
Yeah and at the same time, we all probably know athletes who have had catastrophic injuries and the surgeon says you’re never going to run again. You’re never going to bike again, but it really, sparks a fire under that athlete’s butt and they’re like, I’m gonna prove you wrong and in my experience, I can’t think of one where they haven’t and every single person I can think of, they really have been able to prove that physician wrong.
Trevor Connor 30:12
This is actually one of the reasons I personally when I get injuries like that I gravitate towards seeing a sports, specialized doctor because they’re always about how do we get you back on the bike or get you back to sport? I had the experience, I had a back problem since I was 15 and I was still working with the pediatrician that my mother had found when I was a kid and so I went and saw him and they did the X rays and came back and said, you’ve got a back problem and he just kind of nonchalantly said, yeah, you’ll never do sports again, but you’re a smart guy, so you have other things to do. Don’t worry about and I am sitting there well, what? Wait, what did you just say and that had a huge mental impact on me and sometimes doctors can say things like that very quickly and not realize, oh, that’s going to have an impact on the person. So personally I have gravitated towards sports doctors are like you got an injury, this is gonna be an issue, but let’s figure out how to get your functional again.
Dr. Andy Pruitt 31:09
More than once I was told you’ll never do something and watch me. So I’ve never told an athlete never ever, ever told an athlete or a patient of any kind, they would never do what they want to do again, never.
The Stages of Grief and How They Play Out
Julie Emmerman 31:21
I mean, the reality is there are situations where people do lose functioning. People lose limbs, people lose just sensations, people lose a sense of balance and in my work, it’s always challenging because I think for every person, it brings up our sense of mortality and that’s always something that’s hard to sit with, but as challenging as that work can be it also is some of the most rich work that I’ve done and have helped people through. I mean, these are devastating types of injuries and being able to sit with somebody for as long as it takes while they’re going through cycles of grief, which just for the record, I’ll list them, but just the experience of shock, I would say more shock and awe and denials, stages of bargaining, anger, sadness and depression and then maybe glimpses of acceptance and resilience and hope, but then all the way back to circulating all through all those stages all over again, as long as it takes and it’s on my side of things hard, but not nearly as hard as it is for the person going through it and I think in these more serious cases where there has been a loss of a limb or they can’t get back to their sport as they once did, it’s just crucial to be able to help that person find joy in either some aspect of sport and activity or joy and connection and other parts of their life. It’s a reality, it’s out there it happens, it’s always sad, but there’s always options for a traumatic growth response where there’s been trauma.
Dr. Andy Pruitt 33:01
You mentioned all the stages and there’s books out there about the seven stages of grief or when somebody dies or divorce. Do you see them happen in relatively normal hierarchy of stages?
Julie Emmerman 33:15
The shock and awe and denial, yes are usually, they’re always the first and then the others in my experience, they kind of experience different stages, but you can experience it express all three or four or five within an hour. It kind of depends on the person, it depends on where they are in their recovery. It depends if something they experiencedtriggers them and sets them back into a state of anger and some people move through in a pretty natural way, but what’s right for one person isn’t right for the other. So it can take any duration of time, but there are situations where some people tend to get stuck, like in an angry phase and then they’d wind up isolating themselves even more and that’s not good because then they’re just continuing this process of withdrawal from their community and so being able to guide them through in those situations is obviously important for their well being.
Dr. Andy Pruitt 34:06
I can see some listener hanging on that, who’s maybe stuck in a vortex of despair.
Julie Emmerman 34:14
Being angry that something happened is often so much easier than feeling sad and really doing the deep grief work around. I’m never going to be able to write with my right hand again or hold the handlebar.
The Paleo Diet Team 34:29
Let’s hear how Taylor Phinney dealt with the grief. His approach was actually pretty unique and in my opinion, very healthy.
The Crash that Changed His Life
Taylor Phinney 34:34
I was 24 years old. I had been racing bicycles for seven years, pretty seriously. I went to the Olympics for the first time when I just turned 18 and I never really had a break from being a professional athlete since I was a senior in high school. So throughout this recovery period, it definitely felt like I was on a track before the injury to go in a direction that was where I wanted to go. I was winning races, I was very fit, I was gonna go do my first Tour de France, hopefully that year and then the crash happened and all of a sudden, I was on this road to recovery, but I accepted it pretty early on, I think I’ve always been good at accepting things that are right in front of my face, that I have no control over and this whole period seemed like a little bit of a break from a very serious world that I had been in for my whole adult life and also, the rehab process was very simple and the routine of just doing my rehab every day and then, of course, it’s not like sunshine and rainbows every single day, but I felt like I was actually quite relieved to have a moment, well, a long moment to kind of wind down a little bit and then that whole process led me to a whole creative side of my brain, which is now what I do and what I follow. So, in retrospect, I’m very grateful that I had this kind of switch and change with a crash.
Taylor Phinney 34:57
So you didn’t really have any really dark moments of what has this done to me, any of the anger that some people experience?
Taylor Phinney 36:39
I will definitely say the first couple of days were really intense. It was kind of like when they were putting my leg back together. There were some periods of time between surgeries, also really long surgeries and the pain medication was messing with my head and my emotional state, but you’re so medicated that it’s kind of very blurry, those first couple of days. The worst moment for me was I woke up from a nap the day afterwards and I was supposed to go get an MRI on the leg, they still hadn’t put the leg back together yet, but they had put this external fixator on which basically, they drilled into my femur and they drilled into my ankle and then they had a rod on the outside that was just holding everything straight. So I went into this MRI straight from the nap and so I didn’t have any pain medication and I remember being in the MRI, just like counting down seconds as if that was going to help the MRI go by faster and my muscles in my quads started spasming and just like it was It got real, real dark in that moment because I was in a lot of pain and really kind of confused, but once it was just a case of rehabbing I felt pretty comfortable in that environment because I felt like okay, well, I’m losing a lot of muscle mass, but I’m just going to have to do the work to bring it back. So I wasn’t grieving in that kind of way.
Trevor Connor 38:22
So something Andy that I really liked that you’ve said a few times and for right now we’re talking about that now you’re looking at potentially years to fully recover is you often will tell these athletes you’re no longer now a world tour athlete, you’re a back patient or your whatever the injury is, you’re now this patient and it’s not to beat them up and go, you’re not a cyclist anymore. You’re not a runner, you’re not a triathlete. To take advantage of the fact that and I’m not talking just high level athletes, but most athletes are very good about saying, I’ve got a plan, I’m going to do my work and what you’re telling them is take that mentality, take that approach and apply it to being a patient because my experience is whether somebody recovers really well or really poorly often comes down to, you’re gonna be given a lot of work to do, you’re gonna be working with PTS, you’re gonna be working with various experts and you got to go do that work. So you need to apply what you’ve done as an athlete to being a patient.
Dr. Andy Pruitt 39:25
I remember saying that to you.
The Paleo Diet Team 39:28
Many times and then walking away muttering all sorts of.
Embrace Being a Back-Patient
Dr. Andy Pruitt 39:32
At this moment, you’re a back patient. Doesn’t mean you’re not going to be a cyclist again, but at this moment, your job is to embrace being a back patient and all that encounters all that encompasses of being a back patient, the rehab, the the mental part, all the different layers of that and then that’s how you get back to being the cyclist again. Yeah, absolutely, but you know, physical therapy is a big piece of this in today’s society sadly, access to physical therapy via insurance is somewhat limited. I’ve got a young, very avid skier who had just gone through ACL reconstruction and she needs an ankle reconstructed that’s going to be done in the fall sometime, she said, I only get 20 pt visits a year. How do I do this? Which is most important? Should I spend them all on the knee or should I save some for the ankle? So she said, Okay, I’m gonna give 10 to each. So I’m trying to get her to think about how do we substitute your formal PT, at home or at the gym, we’ve got to find a way to supplement. So be thinking that I’m going to PT, that’s your job. No, your job is doing that PT on your own every day and making it a part of your schedule and you won’t fall behind that way. If you if you wait to go to PT to get better, it’s not gonna happen. The responsibility is really on the athlete and the athletes close community to help them because some people don’t have access to formal PT at all.
How can friends and family be helpful?
Julie Emmerman 41:03
Right and actually that’s a nice lead into one of the things that we had talked about, as we were planning for this episode, as far as like, how can friends be helpful? How can families be helpful and I hear so many times an injured athlete is really sick and tired of someone just only asking about their injury or nervously skirting around the awkwardness of the situation and I mean, people I think are well, meaning they just are, it’s like I said earlier, any major injury brings up everybody’s sense of immortality and vulnerability, our fragility and so we all want to avoid it and so people even though they’re well intended, say some insensitive things at times and so I think that one of the best ways family and friends can be helpful is simply to just ask, How can I help you? How, what and when can I help you? What would it look like for me to be of best service to you? Do you need help getting to PT, do you need help with me helping you with some PT exercises you’re now doing at home? Do you need help organizing your medical bills? Do you need help with just having a healthy dinner at the table because you are not mobile?
Trevor Connor 42:13
Going back to that study that I mentioned, they talked about one of the big issues is people start to feel socially isolated.
Julie Emmerman 42:19
Trevor Connor 42:20
I would think even if it’s well intentioned, if the people around you are kind of being avoidant and skirting around the issue, that’s going to feel like even being further socially isolated. There’s something about you now that’s making them avoid you. So I think, and I’ve had this experience myself, I would rather people just come and be pretty blunt and say, Hey, what’s going on? How can I help you and talking about it and at least you feel connected with people.
Managing the Psychological Letdown of Injury
Dr. Andy Pruitt 42:46
But as the injured athlete, you get pretty tired of that’s all you’re thinking about? I mean, you need to have some other conversations and other movies, some other whatever to help time move along, that aren’t concentrated on their injury or their or their sport. It’s just community, we keep coming back to it. It’s pretty crucial. The single athlete who lives alone, I can remember my son when he broke his ankle and a bike race and he lived alone and it was encouraging people to go see him to help him, trim his toenails, to change his dressings. So the athlete that lives alone, that can be isolating, for sure.
The Paleo Diet Team 43:28
Coach Neal Henderson has had the experience of a bad injury and he discovered the importance of having support.
Neal Henderson 43:34
I mean, I’ve worked with a few athletes that have been in this boat and I myself had a period of time where I had to completely stop doing the sport that I really was committed to, that I loved because I just had injuries that were amounting to the point where I could not function as a regular person and dealing with those injuries. So number one, there is an aspect of changing priority, especially with with some of those major ones that training no longer becomes the thing to be better day in and day out from an external kind of like an achievement point of view and it’s rearranging your mental energy or physical energy and towards that healing process and getting well in some cases that is time completely off of not doing that sport or activity and that is often the hardest and how do you manage that psychological letdown. There’s often depression and other things that are associated with that, Changing what often has been a driving force in a lot of athletes lives especially when we talk about that very driven high end athlete, elite athlete, it can be catastrophic from a psychological point of view and so being able to reframe and reference things to get to a normal living and state in that way so that the healing can occur. Those things have to work together and so support structures, family, coworkers, friends, all of those are really important folks to be involving in that process to surround somebody in a good way to work through that time period where they may not be able to do their sport in any way and not define everything based on that to what they can’t do. It’s what can you do right now? What is important? What are the focus that are certain active recovery and things like that, that may be part of that rehab, etc, but just reframing some of the things that make them a great people great athletes and being able to stay committed and you know, commit to something and follow through. It’s just changing one of those things. Going to appointments, et cetera, rehab, focusing on nutrition, sleep, quality, all of those things that are still also useful for healing.
Julie Emmerman 45:48
I think in team sports, it’s also helpful. Some athletes want to be around, they want to be on the sidelines and they want to be helping or they want to help the coach or do other things like that and some people don’t. In endurance sports, it’s a little trickier. I guess, if you’re a triathlete, you can choose to go to the pool and help lead, the group swims. You can be in a follow car for cyclists and be a support role in that way. It’s one way to stay connected. It just depends on that person and if they’re open to that.
Dr. Andy Pruitt 46:16
It’s a good thing about triathlon, they got three choices.
Julie Emmerman 46:18
Dr. Andy Pruitt 46:19
So it’s rare that their injury takes them out of all three. That’s how triathlon was born. Bunch of injured runners are riding bikes and swimming. Oh, hell, let’s make this a competition, right? This is all back to what I said maybe half hour ago was finding them an alternative outlet for their athletic endeavor, even if it’s temporary. A lot of injured runners become high quality cyclists.
Julie Emmerman 46:40
Yes and a lot of injured soccer players have become high quality cyclists.
Cycling is the Number One Rehab Tool
Trevor Connor 46:44
Yeah, I hate to say it, but this is something I bring up cycling is kind of the old person sport because there’s so many sports that you can do really well in your 20s and even into your 30s, but you start particularly running. Just so much impact, eventually you start getting more injuries and you see people in their 40s start saying I’m going to shift to cycling because it doesn’t have the impact. It doesn’t have the damaging effects. It’s something I can do the rest of my life.
Dr. Andy Pruitt 47:11
Well, I mean, it is the number one rehab tool for many injuries, ankle, knee back hip. I mean, it is the number one place where we get people moving again, the number one injured body part from cycling is the knee. What is the number one rehab tool used for recovering from a knee injury? It’s the bike. So it’s a pretty safe place to be hooked to injury pretty quickly.
Trevor Connor 47:33
Exercise as a Source of Identity
Julie Emmerman 47:34
I do want to add, though, even though I think it’s it’s always important to bring someone back to emotion and exercise and obviously, for reasons that we know, I worry about some people that kind of exclusively rely on their physical outlet as a source of identity and their attachment to their physical selves as like the one and only thing that brings them happiness. Things are always changing. We age our bodies change, road conditions change except for us. Kidding, but it’s just true things are always changing and none of us really want to accept that and I don’t think most of us are too good at accepting that. So I don’t know, Taylor, for example, personally, but it was obvious that after his injury, he took a big interest in the arts and I think it’s very healthy to always encourage somebody to explore other avenues that can feel expansive in ways that your athletic life has also felt expansive, it’s going to feel different, but it’s nevertheless expansive and if you have more of an expansive view on things versus a rigid, tight connection to this is the only thing that brings me happiness and overall, you’re affording yourself more options for wellbeing in life.
Dr. Andy Pruitt 48:48
Taylor’s interesting guy, I’ve known him since really the day he was born and he had a really well rounded life, amazing parents are well-rounded. His mother is an artist, so he was interested in art. So his injury and retirement ultimately gave him the opportunity, but not that he’s not riding, he’s doing really adventure bikepacking all over Europe. He still uses the bike as a extension of himself. He still in lots of different social medias with his bike, but his art is, is really taken off. He had that avenue. So if you’re a well rounded person, you’re going to have other opportunities. So it’s that singular focused athlete that really is going to need your help.
Julie Emmerman 49:29
Right, right and sometimes people find those other outlets involuntarily, so to speak, by default and some people already have those sort of in the background of their lives. Nevertheless, I think we’re shortchanging ourselves as humans if we only consider that this one thing is only the thing.
Dr. Andy Pruitt 49:47
The Paleo Diet Team 49:48
Taylor did a good job finding an outlet while he was injured. He discovered art. Let’s hear about it.
How Taylor Phinney Discovered Art as a Form of Therapy
Taylor Phinney 49:53
I discovered art and painting in particular, really as a form of therapy. As a form of self expression, I think I’ve always been a very introspective person. I’ve developed an extroverted personality, but I’ve always been an introvert. Somebody who likes to think about things for quite a long time and approach things from different angles and try to make sense of things in a kind of a nonlinear way. Painting presented itself to me as this huge world that I could explore that was without any rules, really or maybe there are rules, but there was no result. There wasn’t a metric that was determining whether I was doing it successfully or not. That has changed now that it’s sort of become one of my professions, but at least starting out, I came from this world where you do this certain amount of watts for X amount of time and you get this result in a race and if you don’t hit the power, you don’t hit the speed, then you’re not going to get the result and painting. I just remember when I first started painting, thinking, who cares if anybody likes this as long as I like it and I don’t even have to like it, but I can put things on here that are deeply personal to me and then I can paint over them and no one is ever going to see them, but I know that they’re there and there was something very therapeutic and liberating about that whole process.
Taylor Phinney 50:14
I’m not sure if the article that you were referencing earlier mentioned any of this, but I also have experienced where people’s faith can really be helpful to them during rough injury experiences. Whether it’s a sense of spirituality or strong sense of devotion to a specific religion, I think that sense of finding a purpose and something bigger and beyond ourselves as individuals can be helpful to people during really catastrophic injuries.
Dr. Andy Pruitt 52:03
Chloe is very religious and very spiritual has been a big part for her if you’ve ever if you’ve watched Chloe Dygert and if you follow her, but that’s part of the community. That’s where she finds non-cycling community.
No Catastrophic Injury is the Same, Does this Make Recovery Highly Individual?
Julie Emmerman 52:16
Dr. Andy Pruitt 52:16
So I do think it’s important I do.
Trevor Connor 52:18
So I want to shift a little bit because we got an email that motivated this episode and so this is getting more into the medical side of it, but I want to throw the question that we got in the email to you, Andy and I know every injury is different. So it’s going to be a very hard question to answer, but maybe we can talk about a few specific cases, but this is was a gentleman named Thorburn who’s from Toronto, who sent this email and he wrote, “I broke my femur in four places during a crash in July and have been undergoing physio for a couple of months now. I can’t really find anything about how to come back from traumatic injury. We all know that cyclists like Barry woods, Froome, etc, came back from broken femurs. We also know Velokie, never did. It would be great to learn more about how they did it. One thing I came to understand is that no femur fracture is the same and that recovery is highly individual”. So what would your response to this be?
Dr. Andy Pruitt 53:15
Well, it’s not just femur fractures that are highly individual. They all are. So it was the ability, the kind of fracture was multi pieced? Was it a single piece of hardware that held it together and the anatomy realignment was normal, that outcomes going to be good. If the femur was shattered and it took multiple pieces of hardware and the ending alignment was less than perfect, then they’re going to have a lesser outcome. So wow. I appreciate the fact that he’s looking for something to grab on to, but I would my encouragement would be make sure that he gets a good medical bike fit because his alignment most likely has changed and that’s going to prohibit his comeback. How much muscle damage was there? Chloe Dygert transected her entire quadricep. So she calls it her baby leg. So is it strong is really strong? It doesn’t look like her other leg. No, it doesn’t, but she’s starting to Women’s Vuelta today. So come back is possible after two years. So your listener who wrote in, they’ve got to keep going. They’ve got to keep going. But they’ve got to check the boxes. Is my alignment different? Do I need a medical bike fit? Is my unilateral strengthening appropriate? Are they work in the one leg, not the two legs? are they? So there’s so many individual aspects of it? Are they getting the right kind of individualized physical therapy guides? So for him, recovering is his job and he needs to make it his job. Can he get back to where he was before? Some of that’s age dependent, so if you get hurt in your 40s it takes you two years to get back. You may not get back to the same level we were before. Chloe Dygert was 23 Trust me She’s gonna get back to where she was before. So there’s lots of lots of physiological factors that are going to play into how your guy recovers versus through me. So look at Froome he’s never going back to the same level. He’s racing world tour. Yeah, but is he winning? No, he’s hanging on for dear life.
Trevor Connor 55:19
Dr. Andy Pruitt 55:19
So thermal fractures they’re an individual, tough, tough, tough thing, no doubt.
Trevor Connor 55:25
When you’re talking about at that high level, like somebody like Froome, he might have gotten back to 95% of his previous level, but they’ve always said the difference between the winner of the tour and the lantern rouge is about 5%.
Dr. Andy Pruitt 55:37
Trevor Connor 55:38
Another aspect of this is dealing with the pain of the injury. So let’s hear from neuroscientist Scott Frey who studies pain.
Making the Decision to Not Run Again
Scott Frey 55:45
I underwent a knee surgery in 2017 after running competitively and doing triathlons for a long time, a number of decades and I had a choice to make of trying to come back and be able to run again, which was really near and dear to my heart or really letting that go and I made the decision that from then on, I wouldn’t be a runner anymore, in any capacity. It’s a hard thing for an athlete to have to realize that they’ve reached the point where they’ve got to make a major change in something that has been important for structuring their whole lives and, of course, as an amateur, it wasn’t nearly as big a thing for me as it would be for somebody who’s earning their living doing their particular activity. You can’t probably manage too much the pain of coming back and working through all that rehabilitation and physical therapy, that’s going to hurt, but you can start to try and look at that as a sign that you’re making progress, that you’re moving in the direction that you want to go. You don’t have a lot of control about the sensations that you’re going to be having, but you do have some control over how you frame them and how you choose to interpret what they mean. It’s really humbling, we have the luxury of being healthy and engaging in pain that we choose to inflict upon ourselves, essentially, but anyone with any kind of medical condition with which pain is associated, is in a very different situation, it is not a choice and unfortunately, in the medical side of things, our ability to manage pain is not great. We have an opioid crisis in this country because we essentially went down that direction of treating pain way too much and way too liberally with very little caution. In fact, there are consequences to people’s lives for undergoing pain treatments. We don’t have a magic bullet for pain right now that has no consequences that isn’t going to make you feel diminished in the rest of your life. So working on the psychological side of things is an important component of this, how you frame that experience of pain and again, I’m a neuroscientist. I go back to what is the underlying physiology and these behaviors that we engage in are all coming from brain physiology, but the really cool thing about your brain is the behaviors you choose to engage in how you choose to think about something is also changing that physiology.
The Paleo Diet Team 58:11
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Never Settle for Medical Care
Rob Pickels 58:46
I think something that’s important in this is as an athlete going through recovery, to never settle, but I’m going to use that in the context of your medical providers. Andy is speaking as somebody who is extremely knowledgeable, especially in the world of cycling. From both an education and a personal experience standpoint and I know that not everybody has access to the absolute best medical provider for them, but most people live in a community that has more than one doctor, more than one physical therapist, more than one sports psychologist and it is imperative that if this doesn’t seem like the right person for you, find somebody else because that next person might hold the key. That next person might share your experience, that next person might have the same enthusiasm that you do and I’ve certainly seen doctors that have looked at me and said, ‘You’re an athlete, this isn’t a big deal. Maybe you can’t ride your bike as much as you used to and move on’ and Trevor, you kind of brought this up before, but I think even within that was a Sports Med doctor that had said that to me, that was a Sports Med doc that didn’t have the passion for cycling that I had. So I do believe that the care that you get and reaching out and getting that care sooner rather than later is probably beneficial as well. These things don’t feel like much, but I think in the end, the result is hugely different. As starting therapy a month sooner, whether that’s a mental therapy or physical therapy can have a drastically different outcome. Just like having that therapist or that doctor who does things just a little bit different, that can be drastically different. Three 6, 12 months down the line.
Not Being Able to Get the Care You Need
Dr. Andy Pruitt 1:00:32
I agree and there’s nothing worse than a patient slash athlete showing up on my table and I’m the 15th guy he’s seen. He’s doctor shopping, looking for someone to tell him what he wants to hear. That’s not what Rob’s talking about. Rob’s talking about looking for, adding to their medical team. Even sometimes that’s a partner in the same practice might be a better fit for you. So you inherited this doc and the ER and they’re caring for you and you’re just not be getting that right feel and you hear a reputation of one of their partners in the same group. Is that going to hurt somebody’s feelings? Who the heck cares? Hurt their feelings. If you want to see somebody different, they should accept the fact that there’s for some reason, you’re looking for something else and to move on and that’s okay. That is okay to move on and not once you get to the point where your doctor shopping ad if five guys tell you the same thing, it’s probably true.
Julie Emmerman 1:01:29
If it’s okay, I just want to add from a patient’s perspective to do that, it’s not necessarily okay, within a medical practice for you to do that. I’ve personally experienced some difficulty with things like that and I also I just think we should mention that depending on if you’re in the United States, or in Canada or somewhere in Europe or anywhere else in the world, listening, your access to medical care, obviously is so different than the time that it takes to get into see a physician takes substantially longer and many cases.
Dr. Andy Pruitt 1:01:55
But if you experience something inside of a particular practice, I can think of one here in Boulder, which is to try to move around inside that practice is awful, but most are like, Okay, you want to see, you should see my partner, he’s a really good guy, he might have something to add to this or she’s a really good girl, I’m not sure gonna have something to add to this, but if you’re having trouble moving around inside of a particular practice, I’d get out of that practice.
How to Identify a Good Therapist?
Trevor Connor 1:02:17
I think the challenge here is be able to identify who’s a good therapist and who isn’t and I think in my own experience, as I said, I developed a back problem at 15 and I saw a therapist for a decade who, Andy, if I told you, her approach to back treatment, you just cringe. It’s completely against what the science says now, but at the time, I had no idea that she wasn’t good and I can understand a lot of athletes would struggle with that as I go on, I don’t know if I’m actually getting good therapy or not and I think that’s where a good coach or a good expert, who has had a history of helping athletes return to sport is a good person to go to and say, they might not be the expert, so for example, with my back issue, you don’t specifically treat back problems, but if I was looking for somebody to help me, I would come to you, Andy and say, who would you recommend I see?
Dr. Andy Pruitt 1:03:09
Right, I tried to be the hub in the wheel and tried to know as many people in the community as I could or even globally, I’ve sent people to surgeons in Belgium. So I tried to be that go to, come see me, if I if I can’t help you, I probably will know someone who can and that’s really important not to hold on to a patient beyond your skill set. Hard to do.
Scars and Tattoos Importance
Trevor Connor 1:03:31
So going back to the example of Chloe, I think this also gets back to the the mental side, I remember you telling me that she had a pretty big scar on her leg and you talked to her about getting treatment to remove some of the scar and she said, Why would I do that scars are cool and well I’m not promoting a try to have as nasty a scar as you possibly can, it showed her mindset. She was being very positive about this and not what was me and looking for the best in the whole situation. I think that probably helped a lot. Would both of you agree?
Julie Emmerman 1:04:06
Yeah, yeah, I think scars are the tattoos of life. I have plenty of scars. One from the same day that Taylor crashed actually teaching nationals years ago.
Dr. Andy Pruitt 1:04:17
My wife and I, we keep threatening to have a contest and measure all of our scars and see who wins.
Julie Emmerman 1:04:22
Trevor Connor 1:04:23
This is a tangent, but I was on another podcast and apparently this host at the end of every episode asked the guest. What’s your favorite tattoo that you have and I don’t actually have any tattoos, so I got hit with that question and my just my response was my tattoos are blood and scars because you earn those.
Rob Pickels 1:04:39
I have a funny scar story. I broke my hip in Fruita, Colorado. I had an ungraceful dismount off my bike and oops, I broke my hip and the last thing I said to the surgeon as I was on my way into surgery before they gave me the gas or whatever to knock me out. I said ‘can you give me a lightning bolt scar’ and then I go under, I wake up. I see the surgeon for the first time and I said, ‘so did you give me the scar?’ He turned white, his mouth dropped open. He was like, you were serious about that. I was like, Yeah, of course, I was serious about that. He’s like, Oh, man, I just thought that was the drugs talking. No, all you have is a hockey stick. I’ve never been so disappointed in my life. I hadn’t even seen my leg yet, but to know, I only had a hockey stick. Oh, so lame.
Trevor Connor 1:05:32
Rob, you do know that makes it a little bit more canadian, right?
Rob Pickels 1:05:36
I guess it does, I guess it does.
Trevor Connor 1:05:38
So Julie, when we’re talking about this recovery and it’s a long term recovery. Are there any other things that you see mentally with with these athletes when they’re they’re struggling with the fact that they aren’t fully functional, that they’re in a long recovery,
Normalize the Experience of Depression and Despair
Julie Emmerman 1:05:53
I would just like to normalize the experience of depression and despair, the sense of loss, feeling like you’re a victim, whether you really were a victim in a scenario or you took yourself out from an accident on your own. It’s all a normal process of what you’re going through and it’s your body’s way of trying to protect yourself from just the sheer loss that you’re experiencing and it’s okay to feel angry, it’s okay to feel that sense of loss. It’s natural, but it’s also really important to have people around you, who can help you feel empowered, who can give you different ideas, help you think outside the box and give you that boost of empowerment and encouragement when you need it.
Dr. Andy Pruitt 1:06:32
Positive attitude in the community. I’ve had lots of talks with mothers, especially that parents, aside from the athlete, I remember taking Connie and Davis aside after Taylor got hurt and said, Look, guys, I know you’re mad. I know. You guys have got to be so positive. You got to be so positive. So I was giving him some bad news and Connie said to me, you’re not positive. I’m just telling him the truth. You guys have to be the ones that are, but a caregiver with a positive attitude goes a very long way.
Julie Emmerman 1:07:07
On that same note, I think parents and loved ones are in a unique role where when somebody’s in, for lack of a better word, say the angry phase and if that person is just lashing out and they are inconsolable and just a real pill for seemingly ever. I mean, you want to give that person time, obviously they need time, but I think it’s also at some points, it’s okay to say, look as somebody who really cares about you, you need to try to come to grips with at least how you’re expressing this because you’re going to further alienate yourself. So for parents, for example, to try to put up some guardrails around their child’s behavior if they’re getting stuck in the wrath of what they’re going through.
The Athlete’s Head is in the Clouds
Rob Pickels 1:07:50
You know, Julie, I think that that’s a great point, right because the athlete, they’re in their own head. All they care about is what’s going on in their world in their life and sometimes that’s very beneficial because it helps them make progress, but at other times, I think that that can spiral out of control. One negative thing, one little setback PT didn’t go well, one day, end of the world. PT goes great, you’re on a high. The athlete is going through both of these phases and for somebody on the outside the caregiver, they can see the overall picture, they can see what’s happening. They might know what the athlete is experiencing, in some regard more than the athlete knows because the athlete is just so caught up in their internal, that I do think that it’s important that the outside caregiver calls out that athlete and says, Hey, gives him a little check to say, Listen, I understand things aren’t going well, but you’re quite angry at the moment and maybe let’s talk through this at least be aware of it. I think that can recenter the athlete, bring them back into a good place because they just need that cue.
Loss of Income Affecting Mental Health of an Pro Athlete
Julie Emmerman 1:08:53
Yeah, yeah. A cue is a good way of saying it and it really needs to be done compassionately. I just always tried to remember this person is trying to establish equilibrium, after being so rattled and so derailed and taken off the narrative of the what they thought their life was going to be for the next season or the next year or the next couple years. They’re doing the best they can. So the more compassionate you can be, the better.
Dr. Andy Pruitt 1:09:14
I’ve got a question for Julie. So Julie works with all levels of athletes with some really highly paid professionals. Are they more or less fragile at a time of devastating injury because they’ve got a loss of income, potentially. Do you treat them any differently?
Julie Emmerman 1:09:33
In my experience, the professional athletes that I work with, I would say they’re just as fragile to all the emotional cycle that we’ve been describing, but they also tend to have more resources and access to a lot of different medical options. Whether it’s an NHL player or an top endurance athlete, so they have more freedom I think to devote all the time and resources to their healing process. So I don’t think I treat them differently. I’m just aware that they are more privileged to be able to put that type of energy towards their healing.
Trevor Connor 1:10:06
I think that’s a really good point because those elite athletes know that a good team is taking care of them, it’s going to take care of them right away, I’ve talked to a lot of amateur athletes who get an injury and they don’t know where to start and they don’t have an experienced team telling them what they need to be doing.
Julie Emmerman 1:10:22
Right. So for example, a female pro cyclist, now it’s better, but 10 years ago or so, or even five years ago, or four years ago, here, or even today, if you’re still on a smaller team that doesn’t have, if you’re not getting paid and you have injuries, you’re really stuck, you need help and you’re stuck financially. It’s not a good situation.
Dr. Andy Pruitt 1:10:44
Just because you’ve got a pro contract doesn’t mean you’re making a lot of money.
Trevor Connor 1:10:48
So I think the final place we need to go, and we’ve actually been quite positive here. So I hate to kind of take it a slightly negative direction, but hopefully we can finish with a positive take on this is sometimes people are just never the same after an injury. Either physically, they don’t fully recover or I know athletes that physically are back to 100%, but mentally are never quite the same after that injury. Let’s talk a little bit about that. What’s your experience working with athletes who have had to face that? How do you approach it?
Never Completely 100% after a Catastrophic Injury
Dr. Andy Pruitt 1:11:23
I think this is mostly Julie’s area, but for me, again, it’s that mourning who you were and celebrating trying to celebrate who you are now. Is it a fear of getting hurt again? Is the reason they’re not back on the ice or back on their bike. That injury hurts so bad, I’m afraid of it or they can’t compete to the level they were. So for me and I send them to Julie, you’ve got to mourn who you were got to celebrate who you’ve becoming and here’s a name and a number for you. Yeah, so it’s all yours.
Julie Emmerman 1:12:01
Yeah, fear of injury, reinjury is a whole topic unto itself, but I mean, there are other reasons why people tend to hold themselves back after coming back physically. It could be that they no, they don’t have that many years left in their sport. So they don’t feel like risking as much as they used to. They could be a contract here. So they feel like they want to be more conservative and less risky for those reasons, too. I mean, certainly, the trauma of such a severe impact is a major reason that tends to hold people back and there’s a lot of different types of work you can do with trauma and trauma related responses that help somebody heal and it takes time.
Dr. Andy Pruitt 1:12:39
Well, like Rob, I broke my hip, but I broke mine in Moab and a year later, I said, I have to go ride that section again. The old get back on the horse. I’m 73. So I’ll ride mountain bikes. I still ride a lot, but I don’t ride sections like I used to with the same throw caution to the wind, but I had to go back and ride that section. I have ridden it multiple times since so. I don’t know, that was just me having to go back. Do it again.
Rob Pickels 1:13:08
Yeah, I think it’s important that people go through the process that they need to mentally get over that and the reason I say it is that initially I didn’t and I broke my wrist a month or two after being on the bike after breaking my hip, specifically because I got a little bit scared before a technical section and I was going too slow and I fell over and in all honesty, it’s a section that I’ve ridden 100 times, that I’m probably the only person that’s ever broken their wrist on it, to be honest and it was all because I was in my own head. So we do all have to go through that process. I think that talking with somebody like like Julie, Dr. Emerman individuals might not have the ability to do it themselves and working with somebody who is a professional in that area makes huge, huge strides and if you are trying to do it yourself and you’re not making the progress, then you really need to take that step and talk with somebody who does know how to help.
The Danger of the Sport
Julie Emmerman 1:14:06
But the other thing is, I think in the world of elite sport, we all need to accept and that person needs to accept that injury is a part of it and so the chances of you having another devastating horrific incidence is pretty small. The chances of you having something like a collarbone or another smaller issue or setback is probable, depending on how long you’re in the sport, but I think incorporating that like this is part of what you’re signing up for.
Dr. Andy Pruitt 1:14:33
Isn’t the danger of some of the sports, what draws us to them.
Julie Emmerman 1:14:37
I think we’re all trying to experience what our limits are. Just wanting to push them and figure out what they are.
Trevor Connor 1:14:42
I’m sure both of you had the same experience. When I was racing full time. I went into every season accepting the fact that I’m going to crash. I’m going to crash multiple times this season. It’s just a question. Am I just going to take some skin off or am I going to be spending time in the hospital, but you just had to come to terms with that. It’s going to be happen.
Dr. Andy Pruitt 1:15:00
Pretty tough race bikes and not occasionally take a soil sample.
Trevor Connor 1:15:06
So maybe the way to finish this out if you’re willing to talk about this Dr. Pruitt is obviously you had a life changing injury in your youth and went on to be a very high level, accomplished athlete. I’m wondering if you have any wisdoms to share from your experience if you’re willing?
Dr. Pruitt’s Experience within the Sport
Dr. Andy Pruitt 1:15:25
Well, I sure don’t talk about it much, but I suffered a gunshot wound to the lower right leg when I was 14, lost the lower part of my right leg and have ridden, been athletic with the prosthesis for almost 60 years now. So I didn’t have any role models. The Paralympics didn’t exist. The Vietnam War was going on, but they they weren’t coming back yet. So I had zero role models and my first prostess told me that I would never run again, I would never go barefooted and that I could have a brown pair of shoes and a black pair of shoes. Well, don’t tell me never. So I would go barefoot just to wear out feet just to piss him off. I high jump, I wrestled. I immediately started to look for my next sport. When I woke up from surgery, I mean I should have died, but when I woke up, I said, will my new foot have toes and when will I run and that was my attitude and that’s been my attitude for the rest of my life. So again, I think attitude and personal chutzpah has a lot to do with how people accept and go forward with life changing injuries. It’s driven my whole life. It’s made me who I was.
Julie Emmerman 1:16:37
Just want to add, I’m extremely grateful that you took your experiences and made your career to be in line with some of your experiences because I remember coming to you when I was just a very motivated, quite ambitious mountain biker starting out my whole cycling career. I can’t remember what the injury was at this point, but I just remember feeling like, this is where I belong. You’re the right person, you’re giving me tools, you’re giving me a plan, just all the things that you said. It wasn’t like life is over because I had this injury. It was no, no, here’s the way you’re gonna see yourself through this and move forward.
Julie Emmerman 1:16:49
Most of my patients never knew I was an amputee, but I had only use it at a time when I felt like it was a card I needed to play for this individual.
Julie Emmerman 1:17:18
Yeah, I didn’t know for years.
Dr. Andy Pruitt 1:17:20
That’s a compliment. So you go on a bike ride, think, oh, wait a minute.
Trevor Connor 1:17:27
Yeah, I look, I’ll point out, we both been doing the Cherry Creek time trial, which is this Wednesday series here or in Denver, a couple of weeks ago was my first night there and I’m, let’s say still young ish. You’re in your 70s and I think we had virtually the same time and the time trial.
Dr. Andy Pruitt 1:17:47
Cycling for me. So my whole concept of alternative sport comes from personal experience. So I was a football basketball, traditional sport player. So I had an immediate, height is it high jumping? Is it wrestling is whatever? I found snow skiing and I could snow ski like everybody else and they said, Well, you need to ride a bike all summer to train for the ski season. Well, boom, I became a biker. So finding alternative ways to express yourself and cycling let me be normal, which was my whole goal in life. I mean, yes, I’ve won Paralympic World Championships, but the results that are closest to me are able bodied state medals and that kind of stuff. Yeah, for an injured person to achieve some type of goal or some type of normality, I think is crucial and how we find that is partly guided by people like Julie, partly guided by me, but I think a lot of it’s inside. I think it’s a lot of what’s inside.
What is Kintsugi and Why is it Relevant?
Julie Emmerman 1:18:46
So there’s the Japanese term called Kintsugi and I apologize if I’m mispronouncing that, but time and time again, I find this term is relevant in my world because I think so many athletes and so much about being an athlete tends to be about striving for the sense of perfection, whether it’s physical perfection and performance perfection, which just doesn’t really exist and then especially when you add to that the scars and experiences, the sandpaper of life comes into play and we we have these setbacks. Kintsugi is a concept in Japanese culture where you have a bowl and you fill in the broken parts of the bowl with gold flakes and it’s a beautiful piece of artwork and so your story about your experience with your leg just reminded me of that because look at all the renewal and the various incredible ways and how many people have benefited from the ways that you have just manifested your whole experience from the time you were 14.
Dr. Andy Pruitt 1:19:45
You’re very sweet and I am very aware of that. I have a framed card on my desk with a gold repaired bowl and it makes the piece of art more beautiful because it’s been repaired right. It’s part of its whole story.
Julie Emmerman 1:19:59
Yeah, I mean you’ve impacted people worldwide in incredible ways. Thank you.
Trevor Connor 1:20:04
And I don’t think we have anything to say after that. Let’s shift to our one minutes and Julie you might say that was your one minute take home, but do you have anything else you’d like to say?
Dr. Julie Emmerman’s Takeaway
Julie Emmerman 1:20:16
Yes, I think that I would just like to impact upon people the strength of our resilience as humans and you don’t have to always find that resiliency alone. It can be really hard to find that resiliency alone, but as people in general, we are remarkably strong and resilient creatures, both physically as well as mentally and so just give yourself and others around you the benefit of that doubt.
Trevor Connor 1:20:40
Dr. Andy Pruitt’s Takeaway
Dr. Andy Pruitt 1:20:42
Finding caregivers that you can communicate with and who listen. I don’t think credentials hanging on the wall are necessarily all you should look for in your care team. It has to be somebody who you personally can communicate with well, who you feel like are listening to you. You need to be an active participant in your own care and not be a labile participant. You need to be an active participant in your own care and find that right individual or team of individuals that you know you’re communicating with, but second part of that is, don’t be afraid or inhibited by seeking professional psychological help. There’s a barrier, a social barrier I think that some people have and when they’re struggling with their comeback, they need help. Whether that’s the mourning process or the moving forward process. The arms I had to twist to get people to go see Julie or someone like Julie, but get over yourself, go get help.
You Need to Have the Dedication to Yourself
Trevor Connor 1:21:49
Rob, I’ll throw in mine and then let you finish his out. So mine is all of you listening, whether you’re a world tour athlete, a top runner, a world champion triathlete or a recreational athlete who’s just going to the local group ride on the weekend. All of you have been practicing how to maximize your performance, how to get your body to the best that you can get it to. You’ve been doing that through your training, through your planning through listening to shows like this and building your skills. Those are the exact skills you need to apply when you are injured. You need to do the same thing, you need to have a plan for it, you need to have a team that is supporting you. You need to figure out what are those. When you’re optimizing your body or thinking of what am I intervals, well the equivalent to your intervals or what is your PT? What is the work you need to do to recover and you need to be as dedicated to that as you have been to your training and to me that is the best way to make sure that your body comes out of this and the best place it can be. Rob.
Advice for Recovering from Injury
Rob Pickels 1:23:00
Recovering from injury is hard. So just don’t get hurt. No. Short of that, because sometimes we don’t have control. I think that preparing to come out of an injury preparing to recover starts long before that injury ever occurred. As we talked about on the mental and the emotional side of things, being a well rounded person gives you other activities, it gives you other frames of reference for your life. Then you have to begin establishing that years before you ever get hurt. Same thing we talked about coming up to an accident scene and what can you do to help in that situation? Well, you need to be prepared ahead of that situation as well with things like First Aid, CPR, carrying a satellite communicator. So today is the first day that you should begin getting ready to recover from that injury. Even though that injury, it might be tomorrow it might be next year or hopefully it’s never. At least you’re in the position to do as well by yourself as you possibly can.
Trevor Connor 1:24:01
Finally, let’s give Taylor his chance to give some take home advice.
Taylor Phinney’s Takeaway Advice
Taylor Phinney 1:24:05
Acceptance is the first step for me thinking about my experience of really thinking about this pivot and it’s hard to tell yourself to think a certain way. Like, you can’t say, oh, I’m just gonna think. I’m just gonna say that I accept this now, but there are certain practices that you can explore, like meditation, that can help you when you start to recognize that you’re thinking about the past or you’re fantasizing about something being different than it is now. So I think focusing on practices that can help you to accept your situation, if you’re having a hard time with that aspect of it. That’s going to help you out a lot and then just like love the routine that is involved with the recovery from these kind of injuries because it really can be quite simple and straightforward. It can also be complicated, but at the root of it, doing your rehab every day, like don’t stop doing the things that you know you need to do. Just make space for them, prioritize them And it doesn’t, you don’t have to do rehab for six hours every day, but get your 30 minutes, 20 minutes, even if it’s 10 minutes. Just like applying the mental energy to what you want to do with your body to what you want to heal, I think is if you can make that a routine and stay on that then that’s, that’s what’s going to help you out in the long run.
Trevor Connor 1:25:47
Well, fascinating conversation as I knew would be whenever we get the two of you on the show, so really appreciate having you here. Thanks for taking the time. It was a real joy having me on the show.
Julie Emmerman 1:25:58
Dr. Andy Pruitt 1:25:58
Thanks. Always great to be here.
Julie Emmerman 1:26:00
A pleasure and an honor. Thanks.
Trevor Connor 1:26:02
That was another episode of Fast Talk. Subscribe to Fast Talk wherever you prefer to find your favorite podcast. Be sure to leave us a rating and a review the thoughts and opinions expressed on Fast Talk are those of the individual. As always, we’d love your feedback. Tweet us at @fasttalklabs, or join the conversation at forums.fasttalklabs.com Learn from our experts at Fast Talk labs.com Or help keep us independent by supporting us on Patreon. For Dr. Julie Emerman, Dr. Andy Pruitt, Taylor Phinney, Neil Henderson. Dr. Scott Frey, Dr. Stephen Seiler, and Rob Pickels. I’m Trevor Connor. Thanks for listening!