Physical and mental health are closely linked, and the relationship between them goes both ways. Whether an athlete is dealing with acute or chronic injury or illness, it’s important for coaches and caregivers to pay close attention to an athlete’s mental state as they cope with physical issues.
“If an athlete is optimal physically, that is going to enable them to optimize their mental health as well,” says Michele LaBotz, TrueSport Expert and sports medicine physician. “If they’re sick, injured, or otherwise not well physically, then mental health often suffers too.”
Here, LaBotz shares five ways physical health issues can give rise to struggles with mental health for athletes.
“When you’re injured, the risk for depression or anxiety is higher,” says LaBotz. “Being physically well isn’t just the absence of illness, it’s being able to pursue those things that enhance your overall well-being. Activities that enhance physical health, like exercise and good nutrition, generally benefit mental health as well.” Athletes with injuries that prevent them from participating in sport and/or conditioning activities place them at risk for mental or emotional difficulty. LaBotz states, “Most athletes will have some degree of sadness after injury, but for some athletes an injury can precipitate more severe mental or emotional effects, including depression, anxiety and a loss of self-confidence.” LaBotz has even seen athletes experience post-traumatic stress disorder (PTSD) after injuries like ACL tears or severe concussions that can make it hard for them to return to sport.
Mitigate it: Keep an open line of communication with athletes and their families, and “check in” with how athletes are coping with their injury. Encourage athletes to stick with their rehabilitation plan. Many athletes benefit from staying engaged with team activity and should be encouraged to check with their health care provider for any exercise or conditioning they can do during the recovery period. If you suspect an athlete is dealing with a more serious issue like PTSD or depression, encourage them to seek professional help.
“We know that depression and anxiety are eased by spending time in nature and with exercise,” LaBotz says. “Illness often takes away those capabilities temporarily.” Whether your athlete is dealing with a long-term illness like mononucleosis or long COVID, or a short-term illness like a severe stomach bug or flu, it can have an impact on their mental well-being. Short-term illnesses are less likely to be an issue, but if an athlete is out for weeks or months with something more chronic, they’re at higher risk for depression or anxiety.
Mitigate it: Even if an athlete is ill and can’t take part in practice, they can still likely enjoy nature to some extent—and even images of nature have been found to be beneficial for mental well-being. Urge athletes, especially those with more long-term illness, to find ways to get outside and develop a conditioning plan that is doctor-approved and feels good for them.
It’s a cliche, but we do know that hunger can lead to stress and anger. Anyone who’s been on the team bus with hungry teen athletes can attest to this. Research has found that chronic underfueling in and around workouts can lead to ‘increased emotional distress due to hunger, fatigue, and stress related to following an energy-restricted diet.’ And when done for intentional weight loss and body image-based reasons, underfueling may be an indicator of disordered eating patterns or even a more severe eating disorder.
Mitigate it: If you suspect an athlete’s mental well-being is suffering due to underfueling, whether intentionally or unintentionally, ensure that they have access to the help and information that they need. A registered dietitian and/or a counselor or mental health expert can help an athlete work through potential food-related issues and make a plan that optimizes physical health and energy.
As LaBotz points out, overtraining can lead to an increase in the stress hormone cortisol, which can have adverse effects on mental health as well as physical health. “When athletes “overtrain” for brief periods, they will often feel fatigued but can recover quite quickly after backing off,” LaBotz says, but warns that “when overtraining persists for longer periods athletes can develop a true ‘overtraining syndrome’ which can lead to all sorts of emotional and psychological symptoms.” Research has found that overtraining syndrome can lead to various mental health side effects, including fatigue, depression, low motivation, insomnia, irritability, and agitation.
Mitigate it: Recovery from overtraining syndrome can take many months, so prevention is the best strategy. As a coach, you may not be able to dictate exactly how much an athlete trains on their own, but you can make sure that your athletes have a rough understanding of what an ideal week of training should look like for them. Particularly during periods of high intensity training, focus on the importance of high-quality recovery. For athletes in multiple sports and activities, or those who are balancing school, sport, and work, help them optimize their training in a way that prioritizes a balanced lifestyle to prevent burnout.
When an athlete sustains a head injury that causes a concussion, they are at a much higher risk of developing a mental disorder. In fact, a recent study found that one in five people who sustained even a mild head injury would develop a disorder like depression, anxiety, or PTSD.
LaBotz states, “There is a tight link between long-term concussion symptoms and anxiety and depression, and it’s important for coaches and families to be aware of that.”
Mitigate it: First, start by ensuring that if an athlete sustains any head injury during competition or practice, concussion protocols are observed, even if the athlete has no immediate symptoms. If an athlete does have a concussion, follow the most up-to-date concussion protocols around return to play, and ensure that your athlete has access to help if they do notice signs and symptoms of a more serious mental or physical issue stemming from the injury.
Mental and physical health are interrelated and each one affects the other. If an athlete is dealing with a physical health problem stemming from illness, injury, concussion, overtraining or under-fueling, coaches and caregivers should be on the lookout for signs of mental health issues like depression, anxiety, disordered eating, and even PTSD, and should have a low threshold for seeking professional assistance when symptoms are persistent or creating significant issues for the athlete. And, while physical health impacts mental health, the reverse is also true: concerns related to an athlete’s mental health may be the underpinning behind physical symptoms or difficulty with performance during training or competition.