The Hidden Side of Injury in Endurance Sports

When people think about injuries in runners or cyclists, they usually think about the physical side of it — stress fractures, tendon pain, muscle strains, surgeries, rehab plans, loss of fitness.

But one thing I’ve noticed both personally and professionally is that injuries often bring up a lot of other struggles too. Things that don’t show up on an MRI or during a strength test, but still affect recovery and overall health in a very real way.

For me, a lot of those issues started after I got injured years ago. What initially felt like frustration over not being able to run eventually spiraled into body dysmorphia, anxiety, depression, exercise addiction, and disordered eating habits. At the time, I don’t think I fully understood how connected those things were to my identity as an athlete.

Now that I work with endurance athletes every day, I see similar patterns pretty often.

I think endurance athletes are uniquely vulnerable to this stuff because training touches almost every part of our lives. Our schedules revolve around it, many of our friendships come from it, and a lot of us take pride in being disciplined, productive, or “healthy.” Running or cycling becomes stress relief, structure, confidence, community, and identity all at once. So when injury suddenly takes that away — or even temporarily changes your relationship with exercise — it can feel surprisingly destabilizing.

I also think there’s a lot of pressure in endurance sports to fit a certain mold physically. Even though more athletes are speaking openly about this now, there’s still an underlying message in a lot of spaces that lighter equals faster, leaner equals healthier, and high mileage or excessive exercise equals dedication. Social media definitely amplifies that. You’re constantly exposed to curated versions of people’s bodies, training, and lives, and it becomes really easy to internalize the idea that you should look or train a certain way to be successful.

One thing that helped me over time was realizing that fitness, body composition, confidence, and motivation are all going to fluctuate throughout life. I think a lot of athletes subconsciously expect themselves to stay at peak fitness year-round forever, and when that changes because of injury, stress, hormones, aging, mental health, or life circumstances, it can feel like failure instead of just… being human.

That mindset shift didn’t happen overnight for me. It took a lot of intentional work.

Cognitive behavioral therapy (CBT) helped me recognize some of the thought patterns I had normalized over the years. Seeing a dietician (more than once) helped me improve my relationship with food and understand that underfueling wasn’t making me healthier or stronger long term. I also became a lot more mindful about the kind of content I consumed online. Following athletes who were open about the realities of recovery, mental health, body image, and eating disorders made a huge difference for me.

Allie Ostrander was one of the athletes whose content really helped me feel less alone, and reading Good for a Girl by Lauren Fleshman was another big one for me. There was something really validating about hearing high-level athletes openly discuss struggles that so many endurance athletes quietly experience but rarely admit out loud.

Another thing that helped was honestly just having friends and people around me who reminded me there’s more to life than exercise. When your entire identity becomes wrapped up in performance or fitness, even small setbacks can start to feel emotionally overwhelming. Having relationships, hobbies, goals, and sources of self-worth outside of sport creates a much healthier foundation long term.

I also want to be honest and say I don’t think this is something you just “fix” forever and never think about again. I still have periods where body image is harder or where I notice myself slipping back toward unhealthy habits or obsessive thought patterns. The difference now is that I recognize it faster and have better tools to pull myself out of it before it spirals further.

I think that’s important to normalize too. Recovery in any form — physical or mental — is rarely linear.

As a physical therapist, I care a lot about helping people get back to running, riding, racing, and training without pain. But I also care about helping athletes maintain a healthy relationship with exercise and with themselves throughout that process. Sometimes that means encouraging people to rest more. Sometimes it means discussing fueling, stress, sleep, or body image. Sometimes it means helping athletes separate their self-worth from their pace, race results, or current level of fitness.

You can love sport, be competitive, and still work toward a healthier mindset around it. Those things are not mutually exclusive.

Injuries are normal. Fitness fluctuates. Body composition fluctuates. Motivation fluctuates. None of that means you’re failing as an athlete.

It just means you’re a person doing a sport — not a machine that’s supposed to perform perfectly all the time. The longer I work with endurance athletes, the more I believe that long-term health and performance depend just as much on mindset and self-worth as they do on training plans and mileage.

-Felicia