Aside from concussions, there may be no athletic injury more publicized and hated than the tear of the Anterior Cruciate Ligament, or ACL. While never personally tearing my ACL, I’ve been fortunate to have assessed and rehabilitated many who were unfortunate to suffer this injury. Through this experience, I have learned a great deal about how to improve my overall rehabilitative approach for all injuries I assist with. As a key part of finishing my Master’s Degree, I completed my thesis project on the “Non-physical Factors of Series Physical Injuries”, choosing to focus on serious knee and back injuries specifically. I learned A TON by simply interviewing a number of people about their overall experience dealing with the injury, with a special focus on the psychological, social, and emotional aspects of their recovery. I gained a much deeper level of empathy for those I worked with.
To start off 2014, I’m presenting a series of three blogs dedicated to understanding the recovery from ACL injury. My hope is that you, the reader, will at some point gain a high level empathy for those who go through these injuries. This first blog will highlight the stories of two of my friends (guest blogs from Veronica and Melinda) based on their personal experience dealing with their injuries, with special attention shown to how they were affected by “non-physical” factors. Next week for part 2, I will present two more of my friends’ experiences (Jen and Nicole), highlighting their recovery while providing some “color commentary”. For round three, I’m going to present my overall approach to rehabilitating ACL injuries which I have continuously fine-tuned throughout my professional career.
First is Veronica’s story. Veronica Dilzer is the lead fitness trainer and owner at Revolution Fitness in Lambertville, NJ, where she specializes in training athletes with a focus on injury prevention/prehab methods with the goal of keeping athletes injury free. The important role that injury prevention plays in her training philosophy can be directly correlated to her own experience with two ACL reconstructions, which altered her athletic endeavors and ultimately her choice of career. Here is her story…
“My first ACL tear occurred the summer before entering my junior year of high school. As we all know, this is a very important year in an athletic career. Before leaving to spend the summer with my sister in Delaware, I was receiving interest from several colleges for my abilities as a soccer goal keeper and javelin thrower. It was a very exciting time! To this point, I had never been injured, except for the occasional bump or bruise. It hadn’t even crossed my mind that my life would be altered by such a thing…
While at the YMCA camp where I worked at every summer, I was chasing the kids around and innocently jumped over a book bag, landed in a divot on the other side, and heard a pop and felt immediate pain in my left knee. The rest of the story is routine, except for the unique fact that my leg locked in 20 degrees of extension, and immediate surgery was performed about a week later. The delay (due to clearances from insurance) was enough time for my leg muscles to atrophy completely. The surgery was followed by very aggressive physical therapy at the University of Delaware. It was painful, and a horrible experience. Everyday I left physical therapy feeling defeated and depressed. When I returned home to New Jersey after a few weeks, I was not prepared for the physical and mental challenges I would face to earn my way back onto the playing field. While all of my friends were going to practice, I was going to finish up my physical therapy. I felt isolated and demoralized. Sports were such a big part of my life that I started to feel like I had lost myself. I missed the entire soccer season, made a futile attempt at the basketball season, and finally regained some of myself during track season but I never felt the control or power that once made me excel. I felt that I had to work harder just to be on an even playing field.
It took me a while, but I bounced back to about 85% and continued to the next level as a nationally ranked junior college keeper. After colleges learned of my injury, the offers all faded away; so I decided to make a name for myself at the junior college level in hopes of being picked up by a college. Halfway through my second season, a girl tackled me from the side and managed to tear my left ACL for the second time. Through stubborn resolve (or stupidity) I finished out the season with a brace and had surgery for the second time. Although it was the same surgery, it hurt less mentally and physically. I had a physical therapist that took me through an easy rehabilitation protocol (which was a complete turnaround from my first experience).
My injuries showed me the spectrum that individuals can experience with ACL tears. The experiences with rehabilitation especially illuminated the inconsistencies in protocols that are followed by physical therapists, and the emotional toll this type of injury can have on an athlete. Although it altered the course of my sports career it also led me into a field I am extremely passionate about. That passion is accompanied by my personal experience and working knowledge of how to prevent injuries like mine, so that I can facilitate athletes to excel to their potential. I would tell any athlete or fitness professional with no personal experience with this type of injury the same thing: With anything, the mind is the key to success. The focus of rehabilitation has to be two fold. Rehabilitate the body but also counsel athletes on the physiological impact it will have on them.
Next up is Melinda. Melinda has a history of tearing her left ACL 3x (twice repaired, six total left knee surgeries including a total knee replacement (TKR). She attributes her TKR to her two prior tears. Here is her story…
“My name is Melinda, and I am a three time recovering ACL patient. My story starts in State College, PA March 16th, 1981. I was unfortunately undercut from the left side, on a fast break layup and my life has truly been altered both negatively and positively from this traumatic injury. Yes, I made the layup. My actual injury was the classic unhappy triad. ACL/MCL/MM. I can attest to the radically different repair / rehab regimens in contrast between my initial repair in 1987, my second repair in 2009, and TKR in 2011. 1987 included a five day stay in the hospital with hip to ankle plaster cast for 8 weeks, followed by a cumbersome brace and PT which is actually fairly consistent with today’s PT, albeit utilizing different equipment. Current ACL surgery is “day surgery” with some weight bearing in three to five days with a brace which controlled my flexion and extension range of motion.
Physically, as with any acute injury vs. planned repair, I struggled with the pain, swelling and immobility from the injury as well as a full length plaster cast in 1981. NOT what one wants to don while trying to negotiate a large, sort of hilly, University campus. The pain and disappointment was furthered when I was required to drop two courses, which meant I would need to matriculate during the summer semester to then graduate in August of 1981, apart from my cohort of classmates and friends.
The second tear happened over time without a particular moment of injury that was obvious to me. I suspect it was largely the result of racquetball and golf, as I gradually noticed increased instability in my knee and no amount of changing my stance or swing would accommodate the internal rotational shift that took place with each swing. This instability enhanced the wear, tears, and damages to my knee joint itself, leading to a TKR in October of 2011.
The positive side of a traumatic injury (multiple times) is that you truly get to know yourself in a way that few get to experience. Pain and immobility, for some, is absolutely a game stopper. For others it can truly be a segue to greater understanding of one’s self and one’s ability to persevere regardless of the circumstances. Choosing to cope and to accept what is, and make it a positive experience enabled me to go through these events. The ability to forgive the person, who initially enhanced my opportunity for injury with a very, very cheap shot, was very difficult until I had my first repair and regained stability in my leg. The overall experience has taught me tolerance, empathy and has resulted in my taking a pretty strong interest in maintaining strength and flexibility in my wheels, that I had taken for granted. Accountability for my own well being has been the culminating benefit of what I have gone through for the past 34 years.
I would share this advice with anyone who suffers an ACL tear: Own it as quickly as possible and focus on where you are going, versus where you were. Engage 100% in your PT activities and get to know your knew knee as fully as you can. Celebrate each milestone as you bring your leg back to full activity.
I thank Veronica and Melinda for sharing their personal stories. Keep an eye out for part two, as we delve into it a little deeper. Coming soon…
Ryan Stevens, MPS, ATC, CSCS