Beating the Odds Against Chronic Injury

Tuesday, November 17th, 2020

It was a chilly October night in downtown Boston. I looked around as I walked onto the field for one last time. The leaves on the trees ruffled as the cool crisp air blew through them. The lights of the scoreboard caught my eye as I read off the names of my teammates as they appeared. I looked back and saw my teammates walking behind me listening to their music, laughing, and smiling. Across the field, our bench was filled with posters with the seniors’ names on them and other decorations. I caught myself reminiscing on all I had overcome to get to this point in my soccer career. I thought to myself, “I really made it against all odds.”

 

As a child, I, like so many others, had big dreams of becoming a professional soccer player. I wanted to be the next Mia Hamm; I was a good athlete that might have been able to make it if not for my unfortunate circumstances. Even at a young age my parents and coaches recognized I had the natural ability to be a great soccer player. I was skilled on the ball, an excellent passer, shooter, and most of all, I had a passion for the game. By the age of nine, I was recognized by a scout and joined a premier program in my home state where I was able to further my technical skills and advance my talent. I remember being able to play outside midfield and run up and down the field. I would chase down any ball and felt like I could run forever. 

 

After years of consistently grueling practices, fitness sessions, games, and tournaments, my knees gave in under the pressure. During a tournament weekend, I recall an incident where I slid to make a tackle and something happened at that moment that changed my athletic career forever. I felt sharp, extreme pain coming from my left knee and I was momentarily unable to get to my feet. After analyzing my leg with absolute fear I hesitantly got up and began limping down the field, trying so desperately to continue playing. I was extremely concerned about my chance of recovery from this injury because I could tell how serious it was. The thought that there could be a chance I would never be able to play soccer again terrified me. As with any dedicated athlete, this was my worst nightmare becoming a reality. 

 

Fast forward to my sophomore year of high school; I was a three-sport athlete playing soccer, basketball, and track, as well as playing for my premier soccer team year-round. I had been experiencing excruciating pain in both my knees for a while and finally felt the need to address this with my parents. I did not want to go to the doctor. I was afraid to discover what was actually wrong with me. I knew my knee pain wasn’t going away this time. This persuaded me to make an appointment with an orthopedic specialist. After the doctor examined my knees and took an x-ray, I was told I had a condition called bipartite patella. Even before I knew exactly what that meant, I was petrified. What did this mean for my athletic career? Was I going to be able to continue to pursue my dreams of playing soccer at the collegiate level? A million questions rolled through my head as I waited to discover my fate. 

 

As the orthopedic specialist explained to me, the structure of the knee, and how with bipartite patella the kneecap is made up of two bones instead of one. When you are born, your kneecap is made of mostly cartilage and blood vessels. When you are around three to five years old, the cartilage starts to turn into bone and by the time you are 10, your kneecap should be developed into one piece. Most cases of bipartite patella are considered asymptomatic where it is usually discovered incidentally after getting an x-ray or MRI scan due to a separate injury. Whereas, symptomatic bipartite patella can be caused in adolescent athletes from a specific trauma to the patella or overuse. (Christanio, https://www.healthline.com/health/bipartite-patella). 

In agreement with research presented by Ferrari et al. (2017), I was identified as having symptomatic bipartite patella from experiencing anterior knee pain from overuse. I had the option to either have double knee surgery to correct the abnormality or learn to manage the pain through conservative treatment options. Either way, the specialist told me I should consider putting a halt on my athletic career since that would be best for my knees.

 

I decided to limit my athletic career to just soccer in an effort to reduce the strain on my knees. I was simply unwilling to give up soccer, a sport I had poured my heart and soul into, and something that had come to define me. Somewhat against the doctor’s recommendations, I declined to have the surgery. Being so young when facing the option of double knee surgery was overwhelming. I was afraid that if something went wrong, I would lose soccer forever. As an adolescent, I had always thought overcoming an injury only related to the physical pain associated with the injury. However, there is much more to it. The 2015 World Cup Champion Abby Wambach wrote, “For 30 years, scoring goals was my currency, the one skill I could barter for security and acceptance and love. Rarely did I pause long enough to consider what might come next, and how the shape of my life would look without soccer to fill it up.” (Abby Wambach Facebook page) The problem many athletes have when dealing with injuries is losing their sense of identity, self-esteem, and constructive way of coping with stress during the time they cannot play (Goldberg, 2016).

 

According to Goldberg (2016), the psychological pain of losing everything you worked for, whether it is temporary or permanent, can be more devastating to an athlete than the physical pain associated with the injury. I used soccer as a coping mechanism to deal with anger, stress, or any other negative emotions I felt. I was now faced with the chance of losing a critical piece of my identity. I was always known as the “soccer girl,” and I felt as though if I no longer had soccer, I’d lose my sense of self. The thought came over me, “Who would I be without soccer?” 

 

To answer this, it is important to understand athletic identity, which is defined as how much an athlete identifies with the athletic role and can be conceptualized as a cognitive structure or plan as well as a social role (Horton & Mack, 2000). By high school, if not college, an athlete should have dedicated enough time and have enough psychological commitment to have a strong sense of identification with the athlete role (Johnson & Migliaccio, 2009). A concern to many athletes, including myself, is what to do after an injury when there is an over-identification with the athlete role? Counselors and sports psychologists working with athletes look to interpersonal psychotherapy (IPT) as a solution because it focuses on how identity influences a person’s roles and relationships. This framework can help athletes who strongly identify with the athletic role cope with a temporary injury, permanent injury, and even retirement from sports. 

 

Having a sense of over-identification towards the athlete role can have negative consequences in regards to one’s social well-being and identity as a whole. Obtaining an injury can lead to social isolation from teammates and retirement from sports, whether it is chosen or forced due to injury. It can also lead to grief and depression. Another adverse effect of having a strong sense of identification with the athlete role relates to help-seeking behavior. Steinfeldt et al. (2009) found help-seeking behavior was the most stigmatized for football players who have the strongest sense of identification with the athlete role. 

 

A tragic example portrayed by Hochman (2010) is the suicide of professional football player Kenny McKinley, former wide receiver for the Denver Broncos. McKinley was depressed over several knee injuries that occurred over a period of eight months and had made statements about not knowing what to do without football. The isolation athletes (who strongly identify with the athletic role) experience resulting from injury can have devastating effects when not treated. Interpersonal psychotherapy can help athletes deal with their losses and hopefully prevent any future situations similar to that of McKinley by exploring the grief the individual experiences, discussing role transitions, and role disputes. (Heird & Steinfeldt, 2013)

 

When dealing with a condition like bipartite patella, it is important to be resilient and to overcome adversity. There were many times on the field that my knees hurt so bad I felt like I could not continue playing, but because I was resilient, I learned to acknowledge the fact that I do have limitations now. Also, I learned it is okay to accept the emotions you are feeling in regards to the injury — anger, sadness, and disappointment are all common and completely normal feelings. Accepting negative emotions allows you to grieve with the loss or change you are facing and is part of the process of overcoming those feelings. Most importantly, remember that you are not alone in your recovery process! Your family, friends, teammates, and coaches are all there to support you no matter what. Feel no shame in confiding in someone for support, because at the end of the day, it will benefit your physical and emotional recovery. 

 

During my ongoing recovery, I used sports psychology to change my mindset and chose to focus on process-oriented goals; i.e. making an accurate pass or having my mark on defense. Goldberg (2016) concluded that changing your mindset and recognizing more realistic or attainable goals for yourself allows for more reward once you reach the goal you set. Instead of focusing on limitations, I focused more positively on the task I needed to complete and made sure I did it. Trust me, the feeling of achieving a goal you set, no matter how small, is enough to keep you motivated to set more goals along the way. Nothing about recovery is easy, but it is important to be positive, patient, and have trust in the process! 

 

Since discovering I have bipartite patella I have had a great soccer career: being on the starting lineup for my high school varsity team freshman to senior year, having a wonderful 10-year experience playing premier with teammates, I was able to grow and develop skills with, and more recently, finishing my soccer career as a Division III athlete where I played in every single game of my four years on the team, as well as receiving athletic honors. I hope you are able to learn that if you are resilient and work with your condition using sports psychology, there are ways to persevere and deal with the long-term effects of injuries so you can continue to do what you love. 

 

I think back to my senior night. During the national anthem, I felt butterflies in my chest for the last time ever and smiled as I thought back on the journey that had got me to that point. During the game I played well, I focused on the task at hand despite the distractions like the internal emotions or any discomfort my knees were giving me. Finally, I heard the final whistle blow and the game came to an end. I was so lucky to have this amazing opportunity and be able to continue on with the journey I started when I was just five years old. In the world of athletics where an injury is so common, resilience is possible — you just need to learn how to cope with the physical and psychological aspects in a way that works best for you.

  • Proud Provider of Services for Athletes in:
  • Premier Sport Psychology
  • 952.835.8513
    7401 Metro Blvd
    Suite 510
    Edina, MN 55439