Invisible Injuries

by Tim Ford

I like to ride my bike. I really like to ride my bike fast. I have spent so many hours on my time trial bike that I don’t even have to think about it -- hours spent working on holding the most aerodynamic position, money spent on optimising my gear to maximise my performance, all done to make sure when I line up on race day, I get to the run as fast as possible.

All of that work meant that riding my TT bike felt as natural as walking or running. It was like the bike was a part of me.

Until it wasn’t.

The Crash

In October last year, while doing a TT effort I hit a bump that I just didn’t see and before I knew it I was on the ground. My kit was ripped, I couldn’t see and my wrist was throbbing. I had come off my bike at about 42 km/h, and in the process broken my wrist and taken off what felt like half of the skin on my body. I didn’t get back on my TT bike for six months.

In Australia we are lucky to have races happening this year, and I entered a few. I was back riding my road bike and was riding really well. As my first race got closer I would say ‘I know how to ride a TT’ and ‘I will get back on soon… she’ll be right’ and then before I realised it, it was the Friday before my race and I HAD to get on the TT.

I was so scared about that first race for a number of reasons. It was my first event in nearly 18 months, I wasn’t in the best shape and I was worried about riding my TT bike. I got through the event and felt like a weight was lifted off my shoulders. In the lead up to the race I had signed a deal with a new bike brand for the first time in a decade and I convinced myself that a new bike will solve all of my problems.

And Another One

My second race, knowing that I could ride a TT bike, I wasn’t nervous. I came onto the bike and was ripping that bike course apart. I had one little near crash going over a speed bump early but saved it and even patted myself on the back for managing to avoid a crash. I guess my run of bad luck was over.

Then I crashed.

It happened one kilometre from transition and I still can’t work out what happened. I hit the deck hard, got up, checked myself and the bike and carefully rode back to transition then finished the race. I thought it was good that I didn’t spend too much time dwelling on it, and apart from some decent road rash (on the other side of my body this time) I thought I had done well to not be too badly hurt.

The bike was cursed. I would not ride that TT bike again. EVER.

It was fine though. My new bike would arrive weeks before my first 70.3 so I would have plenty of time to get used to it and be comfortable and ready to race.

It didn’t.

One of the problems with COVID-19 is the delays it is causing with bikes and parts. My bike was almost ready seven days before my race and not all of the parts I needed for the optimal position arrived in time. But still, new bike, no problem.

I know all about setting myself up for success. I went to a local velodrome where I knew I would be as safe as possible and genuinely nearly had a panic attack getting on the bike. I forced myself to do the session but could not hold my proper aero position because I was too scared to keep my head down and aero. I am not talking ‘I would prefer to see where I am going’. I mean ‘NO FUCKING WAY AM I NOT LOOKING WHERE I AM GOING!!!” My mind and body were at war.

So this is probably the world’s longest way of getting to the point of what I wanted to talk about.

Can cyclists get PTSD?

Over the last few weeks I have suffered from anxiety about getting back on the bike. The thought of riding my TT bike is keeping me awake at night, quite literally. I have overwhelming feelings of panic when I think about riding on my aero bars and nightmares about my crashes. If my mind wanders to the crash I feel an overwhelming feeling of panic which makes me do whatever I can to not think about it. My heart rate spikes, I start sweating and feel absolutely horrible.

Enter Dr. Google. I started to google my symptoms because I have crashed before and crashed badly before (I nearly got hit by a truck when I crashed in Thailand), but have never been like this before.

Scared.

always wear your helmet

I found an article about post-traumatic stress disorder for cyclists and I read through the symptoms which included:

  • Anxiety or panic attacks about getting back on a bike.
  • Fear of a crash happening again.
  • Flashbacks of the crash occurring.
  • Depression following the crash.
  • Insomnia or inability to fall asleep.
  • Irritability towards friends or family members trying to help.

But PTSD isn’t something that a 35-year-old white guy who rides a bike and lives in Australia suffers from, right? Isn't it something that victims of abuse or soldiers who have been to war deal with?

Apparently not. While there are many different forms of PTSD, this definitely sounds like exactly what I am suffering from. I admit I am not a psychologist, medical doctor or psychiatrist but even if it isn’t PTSD there is definitely something wrong in my head.

I have seen a Lance Armstrong quote saying, “If you’re worried about falling off the bike, you'd never get on,” and that is the struggle I am having at the moment. I am worried about falling off the bike but I am also desperate to get back on.

I decided to pull out of my race. Not because I didn’t think I was going to go as fast as I wanted or because my body wasn’t ready. I actually think I am in red-hot shape. But the way I am thinking of it is that if I had a shoulder, knee or foot injury I wouldn’t be racing. I have an injury. It might not leave a scar or be treated by massage or taping it up, but it is stopping me from performing – much like a physical injury would.

Making this decision has been so hard for me. It makes me feel like I am being ‘soft’ or ‘weak’ with some people saying to me, ‘You just need to get back on the bike and tough it out’. I don’t think I can do that. As much as I love this sport and how racing makes me feel, it is a hobby. Something that I do for fun and at the moment, the thought of forcing myself to race isn’t too much fun.

So you can call me weak, or a coward or tell me to harden up. I guarantee you someone will. But just because you can’t see an injury someone has doesn’t mean it isn’t just as real. Maybe it is your friend who is scared of putting their head under water because they nearly drowned as a child, or your friend who is self-conscious about wearing skin-tight Lycra because of how it makes their body look.

Mental wounds leave deep scars that if untreated can become big big problems in the future.

Moving Forward

I want to get better and think the whole point of what I wanted to write about was to give some advice (so maybe I will follow it myself) as to how to make sure I do.

I am seeing a psychologist about my issues and working with him on trying to overcome my fears and anxieties. If you are suffering from an invisible injury, you should consider reaching out to someone too.

I am taking small steps with my TT bike. I am currently riding in a closed velodrome; I will do this until I am comfortable. Then I will go to a local regatta centre (where I had my big crash in October) and ride until I am comfortable and then I will take the bike out onto the road.

I am talking with other people about my problem and taking their advice on board. My natural instinct is to pretend like it isn’t a big issue and that I can figure it out myself. The reality is that one of the hardest parts is acknowledging you have a problem.

I am doing things on my own time frame. I am not going to be rushed. I am not going to put myself into a position that could potentially cause more harm than good. When I crashed a few weeks ago the first thought that went through my head was ‘I don’t want to do this anymore’ and I want to make sure I don’t have those thoughts again.

In writing this article I reached out to a number of people in the MX Endurance community for their advice and support and have been blown away by not only the support I have received but also the incredibly sophisticated and nuanced responses I have received. This isn’t meant as a plug for MX, but to all of you who I have spoken to or reached out to about my issues, thank you for being in my corner.

Invisible injuries are hard because so often people will just tell you to harden up or get over it. I am here to tell you all that it isn’t that easy. Trust me, I have tried. So take your time when you are fighting a battle no one else can see. Remember that working through your issues and resolving them will always be better than simply avoiding them altogether.

Good luck!

A Note about Post-Traumatic Stress Disorder

From Dr. Nikita Fensham MBChB (UCT)

Trauma in mental health terms refers to damage to psychological or emotional well-being as a result of an event. These events pose an actual or perceived threat to one’s life or safety or to those in one’s life. Importantly, what constitutes a threat to one person may not be the same for the next.

In order to classify as a traumatic event in terms of a diagnosed disorder, the threat must have a physical element; thus, retrenchment or relationship termination, for example, would not be included.

Early after an event, it is normal to experience symptoms of psychological stress, anxiety, sleep disturbances, and change in appetite. If this persists longer than two days and interferes with daily functioning, a diagnosis of acute stress disorder would be considered; after a month, this would fall into post-traumatic stress disorder territory.

Acute stress disorder is diagnosed if a person meets the criteria outlined in the Diagnostic and Statistical Manual-5 (DSM-5), which includes having nine or more symptoms in total, such as intrusive thoughts, nightmares, flashbacks, sleep disturbance, negative mood, and avoiding reminders of the event.

Post-traumatic stress disorder (also diagnosed using the DSM-5), where symptoms persist after a month, requires one to have a certain number of symptoms in each of four distinct categories, namely:

  • Re-experiencing or intrusion (e.g. flashbacks, nightmares, physiological reactivity on stimuli exposure)
  • Avoidance of reminders or thoughts
  • Negative cognition/mood (e.g. unable to recall aspects of event not due to head injury, distorted blame, feelings of shame or anger, diminished interest in activities)
  • Arousal (e.g. sleep disturbance, hypervigilance, easily startled, irritable)

Following a thorough clinical assessment and consideration of other potential diagnoses, further management would be advised. Psychological treatment and/or pharmacological treatment (e.g. selective serotonin reuptake inhibitors) are in line with current evidence-based recommendations.

Medical disclaimer: This content is for informational purposes only. It is not intended to be a substitute for professional medical advice and should not be relied on as health or personal advice. Always seek the guidance of your own doctor or other qualified health professional with any questions you may have regarding your health or a medical condition. Never disregard the advice of a medical professional, or delay in seeking it because of something you have read here.

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