It happens all the time: you turn your ankle on an overgrown pot-hole in the park and it’s really painful, and worse, that’s your running schedule gone for a burton for the next three weeks. You do the rehab prescribed by your trainer, keep up your conditioning with tough swim sessions, start some gentle treadmill jogging, get back on the road... But it doesn’t feel quite safe – even after a month, six weeks, you are still constantly aware of the ankle, cautious, alert to any sign of pain, and it’s making your running a bit tense and even a bit lop-sided as you strive to avoid other pot-holes that might cause a repeat incident. Your back is a bit achy on the other side. One morning you realise that right now, running is no fun; instead of giving you that great post-run high and deep sense of relaxation, you seem to feel only relief that it’s over and slightly stressed out as you start your working day.

David Joyce, writing in the new SIB, offers explanation and reassurance for this typical scenario. His theme is “reinjury anxiety”. It’s common, a logical result of injury and it can up-end anyone, from jogger to world-class athlete. David’s argument is that the rehab process is not actually complete when the client recovers full physical function, but only when they have also recovered psychologically and emotionally -- returning the brain’s heightened state of alert back down to pre-injury levels.

And it matters, not just because the client doesn’t enjoy running any more but also because they are now at increased risk of injuring that ankle again – the very thing their brain is now so determined to avoid. A vicious circle indeed.

David Joyce explains it thus:

“When we have sustained an injury, the brain focuses increased attention on the harmed area. I liken it to a process of increasing the numbers of CCTV cameras trained on the area of known criminal activity. The brain wants to know everything that is going on around there.

It’s looking after us because it perceives that the threat of further injury (or re-injury) is still high. And these CCTV cameras don’t disappear overnight or even as soon as the physiological process of healing is complete. They remain present for as long as the neuromatrix is concerned about the threat. Rehabilitation therefore is only complete once:

• the physiological process of healing is complete
• physical performance is reinstated; and
• the neuromatrix is satisfied that threat levels have reduced and has “turned off its CCTV cameras”.

So how can the sports therapist help their client to switch off those CCTV cameras in the brain that seem to be working overtime? David Joyce introduces us to a recently devised measurement tool designed to tell the therapist whether their client is heading for reinjury anxiety problems longer term (the “Reinjury Anxiety Inventory”). And he goes on to explain how a more sophisticated approach to rehab, focusing on quick wins, progressive sport-specific drills and a “graded exposure to threat”, can help wind down anxiety and build confidence. He says: “These kinds of progressive drills no doubt do condition the local tissues, but I believe their role in conditioning the mind is just as important.”