Imagine you are a student-athlete at the University of Colorado. Everything you've ever worked for has built toward this phase in your life, and everything you hope to become hinges on how the next four years of your career will play out.
Now imagine yourself going down during a game with an ACL tear, severe back spasms or a debilitating bulging disk in your lower lumbar. Everything that you've worked to achieve your entire life, all your goals for the rest of the season ...
Injuries are an expected part of the athletic sphere, no matter what sport or at what level you play, but there's more than meets the eye with the effects that certain limitations can have on an athlete.
While many fans experience athlete injuries simply through their absences on the court or field, they might not know that the psychological effects on the athlete can often be worse than the physical impairment itself.
At CU, Sarah Brown (lacrosse), Jeromy Irwin (football) and Josh Scott (basketball) are among the athletes who have suffered the psychological consequences of being injured during the season, and the effects circulated around the overwhelming feeling of having their identities as athletes stripped away.
"Your initial thing is to be depressed and you're missing out on stuff and you're not able to be with the guys and be where you want to be," said Rawley Klingsmith, CU associate athletic trainer for men's basketball. "You get a little mad; some guys are angry. You just try to channel that in the right way."
A couple of years back, the NCAA released an information booklet on health in collegiate athletics entitled, "Mind, Body and Sport: Understanding and Supporting Student-Athlete Mental Wellness," to discuss the many mental health issues student-athletes face in their everyday lives.
In her chapter, "How being injured affects mental health," Princeton University director of athletic medicine Margot Putukian explained that sometimes injuries can cause mental health issues, depression, eating disorders and even substance abuse. Pride and learning to deal with injuries can be difficult to cope with for some athletes, but it often goes beyond that.
"Many student-athletes have not developed their identity outside of that as an athlete. Thus, if this role is threatened by injury or illness, they may experience a significant 'loss,' " Putukian wrote.
She suggested that the best way to combat the loss and depression is for coaches to keep the athletes engaged with team activities and to "give them permission" to seek psychological treatment.
At CU, no matter what the level of contact is for any given sport, the psychological effects of injured athletes have been felt across the board.
Football: 'It was rough'
Jeromy Irwin knows the pain all too well -- a little too well, in fact.
Just as the now-junior offensive lineman was beginning his career as a freshman in 2012, he fractured the fifth metatarsal in his foot and underwent surgery to insert a screw. Six months later, he fractured it again during the offseason. Although he only expected to miss the first few games of his true sophomore year, Irwin was forced to take a medical redshirt and miss the entire season.
Six months after that, he broke it a third time.
"When I broke it the third time, it was just like I did two six-month periods of rehab and it just all went to nothing," Irwin said. "And then I got super strong, got through those issues, and then I was going into my junior season and only two games in: taken from me. It was rough."
At the start of last season, Irwin suffered a much more serious season-ending setback when he tore his ACL. But for him, the mental effects proved much tougher to handle based on the nature of the injury.
"This injury has definitely been the most mentally challenging because it's kind of weird to not walk for a month and then lose your mental connection with your muscle," Irwin said. "But it's a different thing when it's completely gone. You can't even flex it. So that was kind of the aspect that was getting me."
The brutal cycle of injury, recovery and re-injury took a toll on Irwin's psyche as he had to repeat the process four times over. He described feeling frustrated, almost as if his previous efforts at recuperation were useless.
Adam Holliday, CU's head football athletic trainer, said that he saw a distinct difference in Irwin's reaction to each injury dependent on when they occurred.
"Offseason, always it's not as bad as in-season. When you get hurt in-season and it disallows them to compete during the season, that's when it really affects them. Because everything they fight for is to play in games," Holliday said. "Offseason, it hurts, but I think in-season definitely adds another level of pain to it."
In the profession of sports training, athlete motivation and combating depressive tendencies can be just as important as the physical rehabilitation itself. When these challenges face Holliday, he plays into the athlete's nature to make the rehabbing process more bearable.
"Natural nature, especially in these football players, is to compete, so a lot of what we do in their rehab and progression is get them to compete in some way, whether that be with another player going through the same injury, or compete with themselves just to get better every day," Holliday said.
After surviving the long haul so far, Irwin believes he's about halfway down the road to a full recovery.
"After six months right now, I'm doing pretty good. I'm running, I'm lifting, I'm coming back pretty strong," Irwin said.
Women's lacrosse: 'I was crying'
When doctors found a bulging disk in sophomore midfielder Sarah Brown's lower back last year, she had a tough time adjusting to life off the field while the rest of her team was still competing. Early on, she endured the misery just to do what she loved.
"For a while, I was playing though the pain because I didn't want to have to sit out," Brown said. "It was like a lot of the adrenaline would kind of half the pain, and then I'd stop and it would just be like, 'Oh my gosh. I probably shouldn't be doing this.' "
As a student-athlete, Brown already had a packed schedule with class, practice, games and travel. As she incorporated rehab into what little free time she had left, her stress levels skyrocketed to the breaking point.
"It was very stressful last year," Brown said. "I remember the worst pain was when I was trying to get into my dorm bed -- they're all lofted -- it took me about five minutes. I was crying the whole time just trying to lie down."
Hilary Heinrichs, professional sports medicine intern for lacrosse, said that with Brown and many of her athletes, keeping up that identity as an integral part of the team is key to fueling the recovery process and keeping the general sadness from taking over.
"You always want to keep them involved as much as possible," Heinrichs said. "You don't want to isolate them from the team or let them feel like their injury is isolating them from the team. Helping them feel like an important part of the team is an important part too by keeping them into things mentally."
This season, Brown came back stronger than ever from her injury and played a key role in the CU defense while earning all-conference honors.
Men's basketball: Mental battle
During the 2014-15 season, Colorado basketball star forward Josh Scott sat out eight games because of severe back spasms, which is perhaps one of the most underrated injuries in sports.
Imagine the worst charley horse cramp you've experienced. Now imagine that pain spread all over the muscles in your back, where at its worst you can feel the muscles contracting and releasing.
Now picture a 6-foot-10 big man like Scott, whose game primarily depends on offense and defense in close range to the nylon, getting banged up and tossed around in the post. Back spasms won't take too kindly to that level of contact.
During the first few weeks that Scott battled the injury, team trainers had no idea what caused it but continued to treat it regardless. Scott said that during that period he would often get down on himself for not seeing any improvement and missing out on helping his team on the court.
But Klingsmith was there to pick him up whenever he felt sad about his situation.
"Even when I got down, he kind of always said something to pick me back up and just kept me optimistic about it in terms of getting my body right and making sure I don't push it and come back too soon," Scott said.
In Klingsmith's experience, injured student-athletes have the tendency to focus on the wrong perspective, which can often add to the psychological pain of sitting out.
"When you're hurt, you get so focused on the short term, and you're just getting him to see where the end result is. You're going to have that here and there but you've got to keep that perspective," Klingsmith said.
He said that many of the players often get angry, and his job hinges on channeling that anger in the "right way," to better enhance their rehabilitation.
During his senior season, Scott, unhindered by back spasms, led the Buffs in scoring and rebounding.
At CU, counseling and sports psychologist Chris Bader treats his injured athletes by playing to their strengths and ensuring that the identity that Putukian described does not fall to the wayside.
Just as Holliday suggested, playing to the athlete's competitive nature can make their recovery process more enjoyable, if not a reward in itself. When Bader treats his student-athletes, he also makes a point to remind them of how they got there in the first place.
But in the end, what's most important is that the coaches and staff are there for their athletes during the toughest times.
"For a lot of them, because they're around our staff a lot, it's about sort of noticing day-to-day differences within that same player," Bader said. "Sometimes, it's just asking that question like, 'How are you feeling? Are you feeling down or depressed or sad?' "
When the athlete finally reaches his or her final step of recovery, Bader believes that the athlete's life will return to normal.
"I think it's always possible for recovery (from depression) to happen. It doesn't have to be a permanent state," he said.
Alissa Noe: firstname.lastname@example.org