Beyond Rehab: The Emotional Reality of Knee Injury Recovery

Insights from a Community Survey

As a Registered Clinical Counsellor in Squamish, I have found a niche for my practice in sports and performance psychology. Through this work, you can imagine how many people come through my door that either have or have had some kind of serious injury. Over the years - through my professional practice and research but also through experiences both personal and within my community - it is clear that while physical healing is usually well supported, the emotional experience often goes unspoken. I focused this project on knee injuries due to their frequency and complexity, with the goal of better understanding lived experiences and using those insights to support both injured individuals and the professionals who work with them.

It’s important to note that this was not a clinical or peer-reviewed research study. It didn’t follow controlled research methods. Instead, it was a community-sourced snapshot of lived experience, shared anonymously by people navigating recovery in real time. The survey was distributed through social media, Reddit threads, word of mouth, and clinicians in the Sea-to-Sky region. As a result, the data reflects the people who chose to respond and should not be generalized to the wider population.

Who Took Part

A total of 106 people completed the survey. Ages ranged from 21 to 67, with an average age of 37. The group included a fairly even mix of men and women, with a small number of respondents (1.8%) identifying as non-binary or choosing not to say.

Most participants were based in Canada, with the majority living in British Columbia, particularly in the Sea-to-Sky corridor. A smaller number of respondents were located outside of Canada, including participants from the United States, the United Kingdom, Europe, and Australia. While the sample was geographically weighted toward Canada, people outside the country reported similar emotional patterns, suggesting these experiences extend beyond a single region or sporting culture.

Over 94% of participants identified as athletes to some degree. Some were recreationally active, others competed in organized sport, and a smaller group identified as elite or high-performance athletes. The most commonly mentioned activities included skiing and snowboarding, mountain biking/cycling, running, gym training, and field and court sports such as soccer, basketball, and volleyball. Only a small percentage described themselves as lightly active or inactive. This highlights how central movement and sport were to identity for most respondents.

Something to note: This work represents one slice of experience. Race, ethnicity, and BIPOC identity were not explored, and mountain sports are historically shaped by inequities in access and representation. For future work in this area, it's important to focus on broadening who is seen, heard, and included in research.

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Major Themes

Injury, Recovery, and the Non-Linear Reality

Among respondents, ACL tears were the most common diagnosis (61.3%). Many had more than one structure injured at the same time, such as meniscus damage or ligament sprains. Understandably, these more complex injuries were often linked to longer recovery timelines, higher fear of re-injury, and greater emotional strain.

Survey participants were at very different stages of recovery, varying from months to years post surgery. Across recovery timelines, emotional challenges tended to change rather than disappear. Early on, emotions were often intense and overwhelming, marked by fear, sadness, anxiety, and uncertainty. As recovery progressed and movement returned, emotions became more variable, with moments of hope mixed with frustration, self-doubt, and fear during setbacks or new challenges. Challenges in motivation were also reported. In later stages, distress often softened but did not fully resolve, with fear of re-injury, grief, or identity concerns resurfacing in high-risk or meaningful situations, even years after injury.

“Progress wasn’t a straight line. Every setback messed with my confidence.”

-- Female, 40, Utah

Recovery was rarely described as a linear - many people shared that they felt physically ready before they felt emotionally ready. Even those who had returned to sport often did so cautiously, carrying lingering fear or hesitation.

One consistent pattern stood out: returning to some form of movement, even modified or low intensity, helped reduce fear and rebuild confidence. This pattern signifies that confidence and safety are learned through experience, not reassurance.

“Movement gave me confidence faster than any reassurance ever did.”

- Male, 36, California

Fear Is Almost Universal

Fear of re-injury was one of the most common experiences reported. For many, it showed up as hesitation in movement, lack of trust in the knee, or worry about future pain or setbacks. This fear wasn’t limited to elite athletes or early recovery. It showed up across all activity levels and timelines. Along with fear... over half of respondents listed pain and discomfort as some of the major barriers in rehab motivation. These findings are representative of larger bodies of research in the field (see literature section below).

The Emotional Load Is Heavy

On average, people reported experiencing emotional challenges and exhaustion, even when their physical rehab was progressing well. Frustration, low mood, anxiety, loss of confidence, and loneliness were common. Long recovery timelines, slow progress, setbacks, isolation and identity loss all contributed to this emotional load.

“I didn’t expect the emotional side to be this heavy. I was prepared for rehab, not for how low I’d feel.”

-- Female, 32, BC

"Some days I felt physically fine, but emotionally I was exhausted."

-- Male, 47, Alberta

Additionally, many people are also carrying an under-acknowledged sense of grief. A serious knee injury can involve grieving the use of a body part, missed practices or workouts, altered goals, disrupted routines, or changes in identity. This grief is often subtle and easily dismissed. When grief is unrecognized, it can add to emotional overwhelm and dysregulation. When it is named and validated, many people report feeling less stuck and more able to move forward.

“People kept telling me I’d be back soon, but no one talked about what I lost in the meantime.”

-- Female, 31, Oregon

One final, yet fairly intuitive observation on this theme: the majority of individuals who identified as having existing mental health conditions reported symptoms worsening during recovery. This table represents answers when participants were asked "how much did previous mental health conditions worsen during recovery?"

Identity Loss Runs Deep

One of the most impactful findings was the extent of identity disruption. Nearly three-quarters of respondents said their injury changed how they saw themselves. This was especially true for people who strongly identified with an athletic identity.

“I struggled with who I was if I wasn’t training or competing.”

-- Female, 28, Washington

Identity disruption of some sort was reported by 93.5 percent of participants. as often coming with a loss of confidence, reduced sense of self-worth, difficulty finding purpose, and feeling disconnected from previous versions of oneself. This experience was universal across all levels of athletic identity, indicating that identity loss is not just experienced by elite or competitive athletes.

“I didn’t realize how much of my identity was tied to being active until it was taken away.”

-- Male, 39, BC

Support Makes a Real Difference

People who felt supported consistently reported lower fear, greater confidence returning to movement, and better ability to cope with setbacks. However, the nature of support is an important nuance. Individuals reported feeling more grateful for people who focused on listening instead of trying to "fix" or give advice.

"The people who helped the most weren’t the ones giving advice. They were the ones who just listened.”

-- Female, 44, BC

Support mattered regardless of injury severity or athletic level. Even those who were physically progressing well struggled emotionally when they felt alone. In contrast, people who felt isolated were more likely to report persistent fear, loss of confidence, difficulty trusting their knee, and feeling stuck or emotionally drained. Additionally, being unable to participate in sport led many to lose an important source of community and connection.

"Feeling alone made everything feel heavier, even when my rehab was going well.” -

- Female, 26, Germany

Movement Helps Heal the Mind

Returning to some form of movement, even with limitations, was linked to lower fear and higher confidence. Movement wasn’t just physical rehab. It was described as a mental healing tool, helping rebuild trust in the body and restore a sense of agency.

“Once I started moving again, even gently, I felt more like myself.”

-- Female, 45, Ontario

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What Does the Literature say?

Recent peer-reviewed work lines up closely with these survey results but also provide some nuances. Here are some examples of where the research relates and differs.

Recovery is rarely linear. Qualitative studies describe rehab as a shifting, stop-start process where confidence can improve and then drop again after setbacks, pain flares, or new milestones (like running, jumping, or return-to-sport testing). Patients describe psychological responses changing across phases rather than steadily improving over time (Longo et al., 2023)

Fear and re-injury anxiety are central barriers. Recent literature emphasizes that psychological readiness (often measured with ACL-RSI) and re-injury fear/anxiety are major reasons people don’t return to sport at their previous level, even when physical rehab markers look “good.” (Faleide et al., 2023).

Emotional distress is common during recovery. An even more recent study shows meaningful rates of anxiety and depressive symptoms after ACL reconstruction. In this study, 1 in 5 participants reported anxiety or depression symptoms. However, an interesting nuance is a higher BMI was the only factor associated with severity of anxiety or depression symptoms. (Grover et al., 2025)

Identity and meaning matter. Newer work continues to show that athletic identity can shift throughout recovery and is linked to adjustment, coping, and return-to-sport processes. This particular study actually demonstrates that while athletes are more likely to lose identification with their identity after knee injury, those who recover athletic identity the best may also cope most effectively with the stressors induced by injury. (McGinley et al., 2024)

Psychological readiness can be a double-edged sword. Some recent discussions in the literature note that people who feel more confident and ready may also return sooner and participate more, which can increase exposure to re-injury risk. This adds nuance to the “confidence is good” message. Additionally, researchers maintain that the relationship between psychosocial factors and physical function is highly complex and more research needs to be done to develop standardized interventions for injury recovery. (Momaya et al., 2024)

Readiness is measurable and can identify people at risk of struggling. Several 2023+ papers emphasize that tools like the ACL-RSI and measures of kinesiophobia can help clinicians spot who may look physically “on track” but is psychologically not ready, which supports points that time and strength alone don’t resolve the psychological side. These researchers also suggest clinicians target interventions aimed at reducing kinesiophobia, such as guided imagery, positive self-talk and graded exposure. (McAleese et al., 2025) (Butler et al., 2025)

Support influences readiness, but the pathway isn’t always simple. Other research suggests social support enhances psychological readiness and athletic identity but people benefit through multiple pathways (safety, co-regulation, reduced isolation, practical help, meaning). These researchers also maintain that (Liu & Noh, 2024)

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What This Means If You’re Recovering

Focus on what you can control during recovery to strengthen your internal sense of agency. While injury often brings uncertainty and loss of control, directing attention to actions (like following your rehab plan, using emotional regulation skills, sticking to routine, and asking for support) can reduce helplessness and improve coping. This shift supports a stronger internal locus of control; the belief that your actions and choices influence outcomes, even in difficult circumstances.

Fear is normal (and good). It’s not a flaw or sign of weakness. It’s your nervous system trying to protect you. Understanding fear's utility and finding ways to create cues of safety can make a meaningful difference. Some coping strategies to help increase a sense of safety are simple breathing techniques, safe-place visualization, co-regulation and positive self-talk.

Confidence builds through experience. Small, safe movement successes teach the brain and body that movement is not a threat. Gradual and progressive exposure is key. However, in the same vein, too much confidence can also be dangerous and expose individuals to risk of re-injury while some fear can be helpful in protecting people from overdoing it. Those in recovery need to work closely with clinicians to find a balance between confidence and fear.

Emotional regulation is a key part of recovery. Many people experience emotional dysregulation during injury recovery, particularly low mood, frustration, anxiety, and fear. Healing requires a huge amount of energy from the body, leaving less capacity for emotional regulation. At the same time, emotional demands are higher, and one of the main coping tools, movement, is often restricted. This creates a negative feedback loop and highlights the importance of targeting emotional regulation in recovery through simple practical tools and strategies.

If you have existing mental health conditions, it can be expected that symptoms might return or worsen during injury. Stay consistent with medication, routine, mental health support and tools and strategies that work for you.

Support matters. Let people know what actually helps and what you need. Often, it’s not advice or fixing. It’s presence, listening, and connection. Co-regulation is a useful strategy if you have people in your life that create a sense of calm and safety. Build a team of professionals around you - (doctors, physios, counsellors etc) that you feel connected to and trust.

Injury can be an opportunity to broaden identity. Worth is not lost with injury. Diversifying identity is important for enhancing mental flexibility and resilience and is something you can do before injury occurs too. One way to do this is by identifying your core values and use these as a compass to guide you. A multidimensional identity means gaining a sense of purpose and meaning from multiple areas of life. For more inspiration, lean into creative outlets and hobbies you enjoyed when you were younger.

An important nuance is that having a strong athletic identity can be both positive and negative in injury recovery. The negative side is that those with a strong athletic identity are losing a large part of themselves when injured. The positive side however, is that folks with a strong athletic identity can be a significant motivator for rehab and recovery discipline. (Brewer & Chatterton, 2024)

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What This Means for Clinicians and Coaches

Use a holistic lens - recovery works best when the whole person is addressed, not just the knee. Take time to understand the person and not just the injury.

Normalizing emotional responses helps people feel less helpless. Emphasize that for those with existing mental health concerns, increase in symptoms and severity is extremely common. For these individual it can be helpful to highlight tools, practices and routines that have worked in the past and remind clients of previous times of stability. Additionally, understand existing mental health conditions as a risk factor for heightened emotional dysregulation during times of injury.

Bring grief into the conversation. Help clients identify symptoms of grief and educate individuals on what grief processing looks and feels like. I try to avoid the Kübler-Ross 5 Stage Model and lean more towards Stroebe and Schut’s Dual Process Model of Grief which captures the non-linear and complex nature of grief.

Understand the role that movement and sport plays in the individual's life. This will help you recognize the impact of grief and identity loss.

Help clients expand their identity through values work. Start encouraging this work with before they get injured as a protective measure. This includes making sure individuals have a variety of coping mechanisms that don't depend on their physical body as well as a diverse range of social connections that aren't solely rooted in sport.

Gradual, predictable exposure to movement builds confidence. Work with client to ensure a healthy balance of fear and confidence.

Encourage connection and support networks, especially when withdrawal and isolation are common.

Autonomy and agency is important. Helping people track small wins and enhance an internal locus of control can help significantly with motivation.

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A Final Thought

I learnt a lot through this project but also reinforced a lot of what I already knew. There is no one-sized fits all approach to healing in any capacity so meaningful work involves trying a variety of things and seeing what works. It’s a process that benefits from patience, respect for your body, and a compassionate approach.

If you are reading this and you are struggling, know that you're not alone. I encourage you to reach out to a mental health professional, friends and family or even a crisis line in your area.

*Crisis support is available 24/7: in Canada and the U.S., call or text 988. In the U.K. & Ireland, Samaritans are at 116 123. In Australia, Lifeline is 13 11 14. In New Zealand, call or text 1737. Across Europe, local crisis lines can be found through the International Association for Suicide Prevention (IASP) or by contacting emergency services. If your region was not listed call your local emergency and ask for assistance.

If you need help accessing resources or have questions or concerns about this article, please reach out to Tori Wood at toriwoodwellness@gmail.com