I broke my ankle once.
It was late November, 2013, in Cuerden Valley, Lancashire.
I was out with my running club on a Thursday night. I’d sprinted down a hill, trying to out-run one of my faster team mates. At the bottom of the hill, I pulled up too quickly in front of a stile. The ground was uneven. I lost my balance. My foot twisted beneath me. The pain was excruciating. I fell immediately, hit my head on the ground and smashed my head torch in the process.
It was pitch black, freezing cold and we were several kilometers from civilisation. I came round to the sound of pounding feet and concerned club mates. I was helped to my feet but I could barely stand.
My wife was at home, ten miles away, heavily pregnant with our third child. I didn’t have my phone with me.
How I Was Helped
It took a considerable effort to get me out of the valley that night. Initially, there was talk of calling an ambulance. There was mention of the air ambulance. But we were in a fairly remote and inaccessible location.
Fortunately, runners are a hardy bunch; they have a remarkable team spirit too. A plan was formed. A couple of my club mates – who knew the area well – ran off quickly, heading back to our starting point. They would return by car and collect me from the nearest accessible location. Meanwhile, a small number of club mates would work together to help me out of the valley.
A Team’s Rescue Effort
I couldn’t put any weight on my foot so I hopped, limped and was carried. That was me – aged 38 and 6ft3 – injured, hurting and needing help to stay upright. It was a long, disorienting and painful few kilometers back to my heroes’ car. We paused often. My clubmates kept me warm and alert. We had to cross fields and streams. But my journey had just begun. My recovery would be long and complex.
I often think about how differently that night could have ended:
What if I’d hit my head harder?
What if we’d been further in the valley?
What if I’d been running alone?
At the hospital, I was examined, x-rayed and told that I had a grade 2 sprain. I was given a leaflet about sprains and I was advised to take pain killers, if I needed them. Sprains can be complex. The pain can be agony. Sometimes people say “it’s just a sprain”…
A month later, when I was still in terrible pain, with extreme bruising and swelling, and unable to bear any weight, I attended another hospital. A sports physio had urged me to be re-examined.
A new set of x-rays showed a fracture that was about a month old. My lower leg was put in a cast that day. It was New Year’s Eve. I’d been walking (of sorts) and trying to function on my injured leg for over a month. Some strong Co-codamol had eased the pain. Some crutches (borrowed from a neighbour) had kept me mobile. I’d still been in work everyday. I tried not to moan and I tried to mask the considerable pain.
In subsequent medical appointments, the physiotherapist told me I’d been lucky – most people’s feet can’t rotate through the angle mine went through, apparently. The orthopaedic consultant told me I might never run again. There was ligament damage and bone damage. An MRI confirmed that I’d incurred a traumatic injury to a complex part of the body.
No Quick Fix
It was nearly eight months before I could run again. But running wasn’t my immediate goal. Before that, there was extended rest, time to heal and time for regular, intense physio. I learned all about proprioception. Things I’d taken for granted had to be relearned. I needed to regain my sense of balance. I needed to be patient as I cautiously started to drive again. I needed to be careful walking up and downstairs, and when playing with my two young children. I had to be patient walking up the hill on which my split site school was located.
For a long time, I would wake up in pain in the night. In the night…when I wasn’t standing, walking or running. When I was lying down, trying to sleep. Our bodies are good at telling us when things aren’t right, even if we’re not in imminent danger.
Eventually, my injuries healed, I regained my mobility and I resumed regular driving. I went back to exercising too. At first, I could only run on soft grass and level ground. Progress felt slow but the process made sense. Gradually, I increased my distance, pace and duration. Later, I varied the terrain too. Almost a year after my accident, I returned to my running club. I’d lost a year’s fitness. I’d lost strength and confidence too. I would be running near the back of the group for some time to come. Healing takes time.
Treading More Carefully
As the months passed, the pain faded, though it returned whenever I pushed myself too hard. I was grateful to be walking freely, to be independent, and to be running again. I was a little more cautious than before though. My accident had been a reminder that we can all be fragile.
To give myself the best chance of staying strong and protecting my weakened ankle, I did a few things differently. I invested in some new trainers which offered me more support. I wore compression socks to help maintain blood flow. I continued with regular physiotherapy, to keep me in good condition.
Back in the Race
A few years after my accident, I even managed to get new PBs in shorter races. But I found longer runs difficult and hilly runs (I lived in Lancashire!) were painful. I had to listen my body. I was a bit more vulnerable than before. I was a bit more prone to injury. I stopped entering longer distance events even though I would have loved to have run them.
When Breaking Looks Different
For more than a year now, my wife and I have been supporting our twelve year old daughter who became consumed by an anxiety disorder. Our journey has been fairly typical of families in our position. It’s been eye-opening seeing how the world responds to a child with illness relating to mental health, compared with how the world responds to, say, a physical injury.
In my view, health is health. But what we’ve learned is that many people – and systems – treat physical health in a very different way to mental health.
Here are three examples:
1. When bones break, when ligaments stretch and tear, it really hurts. When we see someone with their arm in a sling or their leg in a cast, we know immediately they’ve sustained an injury or have needed an operation. We know there will be pain. We know there will be limitations. We tend to sympathise. We start with compassion. We don’t expect them to keep on running.
When somebody’s mental health is fragile, it really hurts. There can be any number of physical symptoms, and they can occur round the clock. A person can be consumed. Yet their condition is often trivialised (“It’s just worry!”). Where we might expect sympathy, there is judgement and misunderstanding. These are some comments which are often expressed about children with anxiety:
“They just need to develop more resilience!”
“It’s better for them to be in school. If they avoid it, it will just get worse.”
“If your (unwell) child’s attendance doesn’t improve, you will be fined!”
What’s the message for the unwell child and their parents?
“Keep on running!”
2. When you have an accident, you seek medical help. You’ll go through triage and then be sent in the direction of the required support – perhaps to the x-ray department and on to the fracture clinic…or even surgery. Timely support is crucial.
When someone’s mental health is fragile, the road to medical help is long. Very long. In the first instance, it can be hard enough just being listened to and being believed.
The average waiting time for an initial appointment with children’s mental health services is said to currently be five months. A first CAMHS appointment can be two years after an initial referral.
When we self-referred our daughter to an NHS mental health service, it was a month before the first triage phone assessment. After that, it was another month or so before we received a letter telling us the referral had been successful. It was months after that when we met a mental health professional for the very first time. In the intervening period, we’d seen our daughter’s health and well-being deteriorate before our very eyes.
Meanwhile, what’s the message for the unwell child and their parents?
“Keep on running!”
3. When your leg is in a cast or a fracture boot, you might gain some mobility but you can’t walk like normal, you can’t drive a car and you certainly can’t be running a marathon. Rightly, the recovery plan involves treatment, respite, rehabilitation and ongoing care.
When a child is living with anxiety, they can’t function like “normal” or, perhaps more accurately, in the way that society expects. They might be awaiting assessment or professional support, they might be undergoing treatment, but there is much more focus on getting back in the race than there is on addressing the root cause, aiding recovery and building strength.
Injuries can put athletes out of sporting action for entire seasons.
Ill health can cause employees to be unfit for work for many months.
Yet when a child is struggling with their mental health, we have a different message for them:
“Keep on running!“
Prioritising Health above All
It’s early 2024 and we’re facing a mental health crisis on a scale we’ve never seen before.
In 2022, over 1.4 million children and young people were referred to mental health services.
In the four years since the emergence of the pandemic, the number of urgent CAMHS referrals has more than doubled.
Over 600 children a week are known to be in crisis (those are ‘just’ the crisis referral numbers).
Meanwhile 3 in 10 secondary age pupils are regularly missing school and there is an unprecedented attendance crisis affecting children of all ages.
The Department for Education says “Moments Matter”.
We seem to have forgotten that health matters and that Every Child Matters.
It’s time to pause and take stock. With this many injuries, we can’t just say “keep on running!”