Overcoming Race: Day Hurdles: Medical Psychology at the LA Marathon

The mental side of a marathon can look very different when you're watching from a medical tent.

This year, I had the opportunity to work as part of the psychology team in one of the medical tents at the LA Marathon. It was the first year the LA Marathon included therapists as part of its medical teams, following a model that had previously been used at the Boston Marathon.

It was a pretty unique experience.

Normally, when I'm working with an athlete, I'm meeting with them for a therapy or sport psychology session. At the marathon, I was meeting runners for a few minutes at a time, often when they were tired, hurting, anxious, disappointed, or some combination of all four.

Sometimes my role was helping someone use box breathing while they were in significant pain. Other times, I was talking with someone who had just learned that they couldn't continue the race. And sometimes, it was simply being there, talking with someone, and helping them take their mind off what was happening while the medical team did its job.

Being there gave me a different perspective on the mental side of running.

Sometimes pushing through isn't the answer

There were a lot of runners who came into the tent because they were cramping, dehydrated, dealing with an injury, or just not feeling good.

And I kept hearing a similar story:

I wasn't feeling good for a while, but I kept pushing because I thought I could make it.

Some runners were trying to qualify for Boston. Others were trying to set a personal best. They had spent months training for this one day, so it makes sense that stopping would be difficult.

But there's a point where pushing through stops being helpful.

It's easy to fall into all-or-nothing thinking during a race. I've come this far, so I have to keep going. I have to hit my goal. If I slow down, I've failed.

Sometimes the mentally tough decision is actually to slow down or stop.

That's difficult because athletes are often praised for pushing through discomfort. But there's a difference between tolerating the normal discomfort that comes with challenging yourself and ignoring information that your body is giving you.

The ability to recognize that difference is a mental skill, too.

And then there's the magic spray

One of the more entertaining parts of working in the medical tent was seeing just how much "magic spray" was being used.

Runners would come in with cramps or soreness and ask for Biofreeze or some other kind of spray. At one point, I saw a nurse practitioner with a spray bottle in each hand. I asked her how often she sprayed people in her normal work.

She said, essentially, never.

But at the marathon? She was spraying people constantly.

Lydia and I talked about this on the podcast because there's an interesting psychological component to it. The spray may provide some physical relief, but there's also something about getting something done that can change how you feel about your ability to continue.

You got the spray.

You got some tape.

You got a bandage.

Now you can keep going.

Obviously, a spray bottle isn't going to magically fix a serious injury. But our perception of our ability to continue matters. Sometimes that little intervention can give someone enough of a mental boost to get moving again.

The trick is knowing when that mental boost is useful and when it's helping you ignore something you shouldn't ignore.

Not finishing can be its own kind of injury

Some runners weren't going to finish the marathon.

For someone who has spent months training for 26.2 miles, that can be a pretty significant psychological experience.

You're not just losing a race. You may be losing a goal you've been working toward for months. You may have imagined what it would feel like to cross the finish line, what your time would be, or what you were going to do afterward.

And suddenly, all of those plans have to change.

That's a loss, and it can involve grief.

There can also be disappointment, embarrassment, shame, or thoughts like, Why did I even do all of this? Or, Maybe I'm just not cut out for this.

That's where the mental side of athletic recovery becomes important.

The goal isn't to convince yourself that the disappointment doesn't matter. It does matter.

The goal is to be able to experience the disappointment without letting it determine what happens next.

Maybe you need to change your training plan. Maybe you need more recovery. Maybe you need to approach the next race differently. Or maybe you decide that you don't want to run another marathon.

Any of those decisions can be reasonable.

Sometimes the hardest part is what happens afterward

One thing that stood out to me was how easily an athletic disappointment could turn into another all-or-nothing reaction.

I'm never doing this again.

Or the opposite:

Next time I'm going to push even harder.

Neither response necessarily gives you much room to learn from what happened.

Usually, the most helpful thought is somewhere in the middle.

That's true whether you're recovering from a marathon, coming back from an injury, dealing with a bad performance, or struggling with anxiety around your sport.

An athlete can have a difficult experience without deciding that they're a failure.

You can have a bad race and still be a good runner.

You can have an injury and still be an athlete.

You can decide to change your goal without giving up on yourself.

And sometimes, getting back to where you want to be means working through the psychological part of the experience, not just the physical part.

The mental side of athletics matters before race day

One of the things I appreciated about being part of the medical psychology team was seeing how much psychological stuff can show up in the middle of a race.

Some runners were dealing with panic or anxiety. Others were struggling with uncertainty. One runner even asked me questions about whether they were going the right way that seemed, on the surface, like very obvious questions. I wondered whether OCD and doubt might have been playing a role in that experience.

Of course, a medical tent isn't the place to conduct a full assessment or therapy session. My role was to help the person in that moment.

But it was another reminder that the mental side of athletics doesn't suddenly appear when the race starts.

It shows up during training.

It shows up when you're worried about an injury.

It shows up when you're afraid of making a mistake.

It shows up when you're questioning whether you belong.

And it shows up when something doesn't go according to plan.

That's one of the reasons I think sport psychology can be useful for athletes. It's not just about figuring out how to perform better when everything is going well. It's also about learning how to respond when things aren't going well.

The LA Marathon was a great reminder of that.

If you're an athlete in Los Angeles dealing with performance anxiety, OCD, fear of mistakes, injury-related concerns, or other mental barriers that are getting in the way of your sport, I work with athletes throughout Los Angeles through telehealth. We can work on the mental skills and psychological concerns that can help you perform under pressure while still enjoying the game.

Learn more about my services for athletes in Los Angeles.