A Pro Athlete’s Insights On Injury and Rehab

Editor's Note: Paige Onweller is a professional gravel rider, winning the 2022 edition of Big Sugar. Paige quit her career as a physician's assistant to turn pro. She'll be contributing roughly an article the month through the remainder of the year.

I’m a professional gravel cyclist in the US. That statement alone should lead you to assume I very much enjoy riding my bike, and I also spend a lot of time doing it. Some would say it’s an obsession or addiction and I wouldn’t argue against that. The definition of addiction is “when you have a strong physical or psychological need or urge to do something” which is true, but the difference is as athletes, most of us (hopefully) have a healthy relationship with our exercise habits . At the professional level, most of my life is centered around my training and I very much adopt the “monk lifestyle” as many of us pros refer to it. Limited contact with social events to avoid getting sick, 20-30+ hour training weeks seamlessly strung together week after week and a strict routine of our daily lives to get all our training, rehab, lift and recovery in.

For some, this may seem boring but for me, I live for this. The long rides on chunky gravel, endless carbohydrate consumption and a plethora of hours bonding with my training partners. Many people often remind me, “Wow, you are living the dream!” But, what happens when a full time athlete gets injured? Well….there goes that dream. It’s easy for our lives to collapse in these moments, so I am going to share some insight into my process and recent rehab journey which can apply to anyone getting injured - whether this is your full time job or not, anyone who loves exercise can understand our need to restructure our minds and habits in these moments.

Maintain a Daily Purpose and Routine

As an athlete we often have structured days and busy lives. We get a lot done when we are motivated to finish a project to go train more. But as most of us have probably experienced when we have more time on our hands, we actually get less done. This feeling of less productivity can be additive to frustrations when you are injured because you already feel less accomplished when you cannot train. For me, what’s helped tremendously is every morning I write out 3 things: my focus for the day, my goals and my emotions. My sports psychologist got me into this habit when the injury first occurred, and it’s helped a lot. If I sat around all day with my injured leg elevated and at the end of the day was getting down about being a bum - my mindset changed when I looked back and saw my daily focus was recovery and my goal was to stay off my feet - well, now I nailed that! It helped me reframe to more positive, self affirming thoughts rather than negative thoughts of laziness or boredom.

Much of my life is focused on my routine of training, which I very much love and I’m sure many of you reading can relate. So when that routine is removed, you often feel helpless, useless or without purpose. So to counter this, I designed a routine for myself that I stuck to. Waking up at the same time, rehab exercises timed out throughout the day and general structure to my day that stayed the same. This got me up, gave me purpose and held me accountable to stay on schedule even if my routine looks drastically different.

Commit to the Rehab

Most athletes are really good at training. We can ride or run or swim all the miles, but at the end of the day most of us neglect the small little things off the bike or in the gym. Well, when you are injured, rehab all of the sudden becomes really important. But let me tell you, it’s not always fun. For me, I am working with a very progressive surgeon (this was intentional) so this means I am doing exercises that aren’t always fun…or let me rephrase this…they hurt like hell and I don’t want to do them. But I do, because I am committed to the rehab process. Currently, as I write this, I am about 10 days after surgery. I do 200 ankle pump motions and 5 minutes of quad holds and a series of ankle mobility which takes me about 15 minutes to complete. I do this 5 times per day in addition to 6-8 sessions of icing for 15 minutes each session. Then, aside from eating/preparing food, my leg is elevated 12 inches above my heart. This means I am lying flat most of the day, which doesn’t lend me to getting much else done. I also do a series of mental visualizations, which are pretty specific and require me to “get dressed” for the session and separate this from the rest of my day. It may not seem like a lot, but it requires me to plan everything out and commit to the process of rehab.

Adjust Your Diet

Prior to getting injured, I had about 4500tss in the 4 weeks prior (about 1225 tss per week for that month before) so without sharing all my training details, it’s safe to assume I was eating a lot. Most days I had about 4,000-6,000+ calories…the many perks of high volume training. Most of my diet was focused on carbohydrates, because let’s be honest, carbohydrates are king. But when you suddenly go from that to a sedentary life, a shift is needed in the diet. The first week of injury, I specifically did not log food and tried to focus on recovery and listening to my body. It was repairing the injury and also from the work of training the weeks prior. I ate when I was hungry and l listened to cravings. Often this meant consuming much more than my output. After discovering the injury would then require surgery and numerous weeks of no training, I got nutritional guidance and transitioned to a high protein diet that included only about 1800-2000 calories per day. Eventually my appetite normalized and the high protein diet really helped with hunger as well.

I had a tendon repair and another connective tissue structure (peroneal retinaculum) surgically repaired. So, I prioritized animal protein as my main source of protein and I did this for many reasons. Animal protein is superior to other forms of protein (soy, plant based options) because it has a higher bioavailability and a higher percentage of EAAs (essential amino acids); additionally, with my increase in the amount of protein animal protein is actually been proven to be more easily digested than alternatives. I aimed to get 2 grams of protein per kilogram of body weight and I made sure that I separated protein feeding windows since our bodies can only intake a max of 40 grams per feeding window. There’s a lot more that I changed in terms of timing of eating, supplements, etc., but in summary here is a really good article about nutrition, protein and timing of everything around a surgery if you are interested in reading more.

Focus On What You Can Do

I think when you are injured it’s really easy to dwell on what has been taken away from you. But for anyone who’s had surgery you can probably relate that in those moments you are painfully reminded of how helpless you are. You need help going to the bathroom, you can’t dress yourself, you can’t prepare your own food….the list goes on and on. But when your independence is stripped away down to nothing, you then start to rebuild again. This last week I finally took a shower on my own and could balance enough on one leg to do that. I celebrated that moment so much; it felt like a huge win. Look at me, showering on my own! I guarantee you do not usually celebrate taking a shower without assistance, but maybe you should. Currently, I take my crutches for a spin outside for a few minutes each day. I could choose to focus on that not really being much exercise, or on the fact that I have bruises under my arms from the crutches, but no - it’s an intentional choice to focus on being thankful I am able to go outside for a few minutes per day. It’s transformative when you focus on the positive and what you can do versus dwelling on what you cannot do or what you are missing.

In summary, I want to end with one of my favorite quotes from Theodore Roosevelt: “Comparison is the thief of joy.” That quote is applicable in many times of my life as an athlete, but even more so now. Don’t compare my current state to what I could do 2 months ago or what my competitors are doing. Focus on what I can do, and stop the comparison. If you can execute this, I guarantee you’ll be happier in the rehab process and you’ll be building joy and confidence vs negativity and doubt which will help you down the road when you start racing again! Best of luck!