Some things are not so obvious… Everyone has a story to tell that may have profoundly affected his or her profession. I want to tell my story on the critical role of athletes’ mental health to athletes and sports medicine colleagues out there.
At the beginning of your career as a young physician, you may think that you know everything, and you do not miss any diagnosis. Back then, I was the team physician of my National Athletics Federation. I was so confident thinking that since I came from an athletics background I could handle anything related to athletics. However, this turned out not to be the case for a very successful female long-distance runner whom I had been working closely with for the last couple of years. We also had excellent cooperation with her coach.
Some things cannot be planned
It was in early 1997. The athletes on the national team were preparing for a major championship in August, regional games that were very prestigious for our country. Training camps, target competitions, and the annual calendar had been very carefully planned in detail. Medical checks, physiological tests, and all relevant scientific support were in place for the athlete. Seemingly, she was doing well, and the progression of her training was going as planned.
Nevertheless, after the opening race at the beginning of the season, which was in late March, her times did not get better throughout April and May. The target championship was getting closer, and we started to get worried. Following a medical check-up, it was found that she had anaemia. Oh, this was a piece of cake and easy to manage—so I thought. After consultation with the haematologist, she started iron supplementation and Vitamin B12 for one month. She also took professional advice from a nutritionist.
Expectations of success cause stress
We were expecting better blood values in late June and along with that an improvement in her performance. However, despite all the interventions, there was no change in her red blood cells. She lost her appetite and about 2 kg of weight. At that point, her sleep got disturbed, and she suffered from negative mood changes. Obviously, she was under a lot of stress because of the upcoming competition and her health problems, which affected her performance negatively.
As an elite athlete, there were a lot of expectations from her family, teammates and the Federation. Clearly, all eyes were on her, and she had fully committed herself to win this important race and concentrated on her training. What we missed, however, was to support her mentally and psychologically. It was generally taken for granted that experienced athletes knew how to cope with psychological stress and did not need assistance.
One day, she mentioned abdominal pain and some changes in her stool. At that moment, I suddenly realised that there may be something wrong in her stomach or intestines. After testing for occult blood in the stool, we discovered that there was bleeding somewhere in her gastrointestinal system. The next step was to perform an endoscopy, meaning to check the system from inside with a camera connected to an instrument. The gastroenterologist, a specialist for diseases of the stomach and intestine, found that she had an ulcer in the duodenum, the first part of the small intestine right after the stomach. An ulcer is a sore in the lining of the stomach or intestine that occurs when the body’s normal barrier against the acid in the stomach is damaged. She was bleeding from this ulcer, and this explained the lack of improvement in her blood values and ultimately performance.
What causes ulcers in the stomach and duodenum?
In general, the main cause is a bacterium called Helicobacter pylori. It may result in infection and inflammation of the lining of the intestinal wall. Another relevant cause, particularly in athletes, is the use of anti-inflammatory drugs that you might use to treat an injury. Examples are acetylsalicylic acid and ibuprofen. If you are stressed for whatever reason and do not deal with this stress appropriately, this increases your risk to develop an ulcer.
Beyond that, data suggest that athletes have an increased risk of ulcers. Several explanations are offered for that: Depending on the type of sport you perform, repetitive movements, increased pressure in your abdomen and the body position you adopt may cause mechanical injury to your abdominal organs. Another important aspect is that during intense exercise, blood is shunted away from your gastrointestinal tract to your muscles. This reduced blood flow may also cause damage. Finally, as an athlete, you may use the anti-inflammatory drugs mentioned above when you are injured or feel pain.
Psychological support is critical
Following effective treatment and psychological support, her stress ulcers subsided and blood values recovered. She felt much better just in time before the competition in August. You may wonder about the result: she became the champion.
What did I learn from this lesson? What should you as an athlete learn from it? Never underestimate the importance of your mental state. Even elite athletes may have issues after all the years of experience. Medical treatment is only one part. Psychological factors play a critical role in everything we do and aspire to and may become an obstacle if we do not pay enough attention and learn to manage them. Looking after your mental and emotional health is as important as your physical health. Tell your doctor or coach if you feel under pressure, worried or anxious. These are normal human emotions and not a sign of weakness.
