Corey is an 18-year-old hockey player whose dreams of turning pro started at the age of 5. At 16, he was drafted by an NHL team, and his dreams became more than just possibility – NHL ice was within reach. For Corey, his recent severe shoulder injury isn’t just a physical setback – it’s an existential crisis.
The timing couldn’t feel more cruel. How could this be the result after years of early morning practices, countless sacrifices by him and his parents, the euphoria of being drafted, and the full time devotion to developing his skills over the past two years? For Corey, this felt like a cruel joke or a bitter nightmare.
As a psychiatrist who has lived in a world of elite athletes and athletics, I want to explore the psychological landscape that Corey and others must navigate and how we can best support his recovery.
Immediate Impact
After what seemed like a fairly minor check into the boards, Corey experienced sudden intense burning pain in his shoulder that radiated into his back and down his arm. Never before had he experienced such pain. Holding onto his elbow to support himself, and not wanting to ask for help, he skated off cradling the injured limb. Immediately, he knew he was badly injured. Beyond the physical pain, Corey felt an overwhelming sense of fear and uncertainty. How bad was this really? It couldn’t be as bad as it actually felt. He tried listening to the trainers and the doctor as his teammates flooded into the room after the game, attempting to reassure him that he’d be fine. Deep in his body, he knew differently.
This is not unexpected in his sport, or even unusual. He had seen teammates go down with similar injuries. Yet he played without fear, consciously believing that he wouldn’t become one of the people heading to the hospital. Yet, that’s exactly where he was headed. A battery of tests confirmed the worst: He had sustained a shoulder dislocation with a rotator cuff tear and a labral tear. He would require immediate surgery.
Upon hearing this news, questions began to plague his mind: “Will I ever play at the same level again?“ “Will the team give up on me?” “Was this my only shot at the show?“ Postoperatively, these questions became more than fleeting thoughts – they grew into all-consuming fears that felt paralyzing.
I have worked with many young athletes facing potential career-ending injury, and in fact, experienced my own injury that ended my Olympic career just weeks before the games. We share these common experiences:
– A profound sense of identity disruption (“who am I if I can’t play?“); how do I organize my thoughts and actions without the rigorous focus on my sport? Lacking this focus, the mind will naturally start to collapse into a deep and overwhelming darkness.
– Intense isolation as they’re separated from teammates and regular routines. A day now consists of something completely different than what they’d been used to for years.
– Anxiety about their future in the sport. Although athletes are experts at blocking emotions and pushing down questions such as these, invariably these fears grow real psychic roots.
– Depressive symptoms, particularly as they watch peers continue to progress. I have yet to work with an injured athlete who does not show some signs of depression.
– Anger and frustration at the timing of their injury. This gets manifested in changes in mood, irritability, difficulty sleeping, and in fact can intensify pain.
The Hidden Struggle
What makes this situation particularly challenging for young male athletes is the sports culture they’ve grown up in. They’ve been conditioned to “tough it out“ and maintain a stoic exterior. This makes it especially difficult for them to acknowledge and express their emotional struggles during recovery. Buried struggles only help to keep them away from consciousness for the time being. However, if not given air and light, as well as understanding, these struggles lead to real lasting emotional turmoil and delayed recovery.
Building a Recovery Framework
When it becomes clear that the athlete will be able to recover and return to their sport, the psychological recovery needs to be as structured and comprehensive as the physical rehabilitation. In my years of practice, here is what I have developed and refined for the injured athlete:
1. Immediate phase (first month or so postop).
Focus on helping the athlete form a trusting relationship to feel safe in. This is the time of most vulnerability, and the sense of safety is required in order to begin processing the emotional impact of the injury. By doing this, a sense of control can begin to be reestablished. Some of the specific steps include:
– Encouraging and validating their feelings without minimizing the challenge ahead.
– Creating clear, achievable daily goals for self development that are unrelated to hockey or the specific sport.
– Teaching mindfulness techniques to manage anxiety and pain.
– Maintaining connection with the team in ways that are appropriate that don’t involve a lot of talk about the sport.
2. Early recovery phase (2–3 months)
As physical therapy progresses, psychological support should too.
– Teaching visualization techniques for maintaining sports specific mental skills
– Ensuring a state of mind that accepts the injury and begins to see what can be gained from it. This includes building a broader self identity beyond hockey. But also, watching video and beginning to think how one’s game can be improved once the shoulder is healed and the return to ice begins.
– Developing a realistic but optimistic recovery timeline in conjunction with the trainer or physical therapist
– Ensuring regular check ins with coaches, players, and team management to ensure the all important emotional connections are maintained.
3. Return to sport phase
This critical period requires careful attention to build gradual confidence through progressive achievement of small goals daily.
-Beginning to address fear of re-injury, while managing expectations of healing and recovery.
-Beginning to develop specific mental tools for handling setbacks
-Creating a support network that extends beyond the medical team. Other trainers, rehab specialists, school, friends, and extended family members can be brought in. Each of these have a specific role to play:
- Family members who should be brought in to understand how to listen and support to create emotional stability.
- Teammates who maintain normal social connections, even when the sport connection may be lost temporarily
- Coaches who demonstrate continued investment in the athletes future
- Mental health professionals who guide the psychological recovery
- Physical therapist and rehab specialist who understand and can communicate with mental health professional about the mental aspects of rehab.
Looking Forward
While a serious injury at this career stage is always traumatic, going through these steps allowed Corey to avoid letting the injury define his future. With proper support he was able to emerge from this experience with greater emotional resilience. He felt a sense of grit and strength from getting through “the toughest time of my life“. He also felt increased strength through his mindfulness and mentalization techniques. He was able to take and broaden these to an overall enhanced self-awareness in his life. This set of improvement skills allow him to handle adversity going forward in his sport and in life. What Corey learned during his six-month recovery allowed him to have a more balanced perspective about sports and life as he was able to develop other interests and broaden his sense of identity.
Final Thoughts
The path back from a serious injury is never linear. There are good days and setbacks. What matters most is creating an environment with Corey (and any young athlete) to feel supported, understood, and confident in his ability to not only return to the sport they love, but also to persevere through other challenges. By addressing the physical and psychological aspects of recovery, we give them the best chance at not just returning to play, but returning to a life, stronger than before.