Imagine you are at a sports game and you hear the crowd screaming for their team. Then, you listen to people chanting your name and suddenly you feel the goosebumps of excitement cover your skin. Being an athlete, this feeling is what gets your adrenaline pumping to play the game that brings you happiness and showcases your talent. However, being incapable of doing so from a severe injury is one of the hardest challenges an athlete faces especially when returning back to the sport that made them who they are.

One of the most common injuries athletes’ experiences is tearing their Anterior Cruciate Ligament also known as an ACL. This tear occurs either by a collusion from an opponent or a non-contact incident. Each injury is different because there is either automatic response that the ACL has been torn or a loud pop heard that leads to excruciating pain. ” The ACL acts as a passive constraint on the femurs anterior tibial translation and has mechanoreceptors. The receptors perform as messengers that send information to sensory pathways that result in the reflex of the hamstring and provide protection for the dynamic stability of the knee” ¹

Once the ACL is damaged, athletes experience is as if their knee is not under control and prevents putting weight down on the leg. This is a frightening incident that requires surgery which can impact day to day activities.  There is uncertainty felt by patients with surgery based on the doctor’s preference and what they believe is the most effective. The most common two surgeries performed on athletes are Quadriceps Tendon Autograft and Hamstring Tendon Autograft. Both methods require excising tissue from somewhere else in your body and utilizing it to create a new ACL. Then one week after recovery from the surgery, it is back to square one which is rebuilding your strength back.

Physical therapy is known to be the hardest task people face. I was told by my teammates who also tore their ACLs that it is all mental. Anterior Cruciate Ligament injury is considered debilitating and has long term negative consequences. When I first experienced my injury, I had excruciating pain and lost the ability to control movements in my knee. That feeling frightened me, and it was hard for me to come to terms that my knee was never going to be the same. It not only made me feel physically exhausted but mentally since I was told that soccer is not my number one priority.

Professional athlete Los Angeles Wide Receiver, Cooper Kupp is a great role model for injured athletes because he dealt with missing the remainder of a season due to an ACL tear in 2018. Being ranked the 5th best wide receivers in the NFL, Kupp struggled with the fundamentals of the rehabilitation process. Instead of grieving over the hardships of being fully recovered, Kupp worked with strength and conditioning staff on high levels of intense interval training. When contributing to hard core training sessions it is important to communicate with your physical therapist in order to know what movements or exercises are appropriate for you to be doing. Being in a relationship with physical therapist deals with the how patients handle and behave to certain requests from the therapist. ” This relationship may be utilized by the therapist to study how the patient perceives and responds to expectations, and the confusions in roles the patient may experience” ³ He believed that doing extreme trainings would release hormones to speed up his recovery. Not only did he focus on his knee, but other muscles such as upper body and to develop the mindset to keep moving forward. The Los Angeles Rams posted on YouTube Inside Cooper Kupp’s Rehab After Tearing His ACL in 2018, Kupp discusses the feelings he felt after the surgery and how it is important to get the joint moving even though everything hurts. Kupp states, ” This injury has taught me patience, take the process step by step, and slowly just to check the boxes all the way up to the nine months mark. It gives a refreshed perspective of how important injuries are.” There is always going to be a sense of pain feeling during Physical Therapy but by keeping a positive mentality and putting in the hard work everything eventually pays off. ⁴ After being released to play again, Kupp went on to achieve 94 receptions for 1,161 yards and 10 touchdowns in his 2019 season career.

Cooper Kupp was fortunate to have torn only his Anterior Cruciate Ligament but, for some athletes there are the opposing issues that can push back an athlete from being in a positive state of mind to negative automatically. During my recovery I had faced the challenge of having yet another surgery, which is common with most recent ACL surgeries known as Arthrofibrosis. This condition causes the formation of scar tissue to build up within the joint during the time span of ACL reconstruction surgery. This setback can cause the return to sport (RTS) process to take a longer period of time. The importance of this surgery is to regain the range of motion back in your knee and to not maintain anymore stiffness. ” This degree of fascia engagement explains a limbs restriction of range of motion and indicates manual therapy to be helpful for rehabilitation” ⁵

After several months of physical therapy later, it should be finally the moment to hear the news of returning back to your sport. There is the feeling of relief of finishing therapy but then the negative internal thoughts start to develop. There is the thought process questioning whether or not you, as an athlete are prepared to participate in an intense environment again. This leads to the option doctors give their patients whether to brace or not. Some doctors have it as a requirement but after a period amount of time it becomes the patient’s choice. It can be difficult to decide because this deals with the relationship between your own self confidence versus the injury.

 

” Self-confidence is thought to be important factor in pre-competition preparation with potential side effects on focus, self-efficacy, tension, depression, anger, fatigue, and confusion” ⁶  Not only do these variables affect training but also the feeling of not failing, pressure and coaching. Internal and external factors influence facilitating either success or failure. The breaking point of an athlete’s career is self-doubt in their physicality and fearing re-injury. That is why bracing is a major decision because it dictates whether you feel a sense of safety and comfort when cleared to go back. Bracing can be perceived as negative, but it is an actually a positive reinforcement.

Additionally, going through the protocols of returning to sport after an Anterior Cruciate Ligament surgery requires taking several tests. Such as physical examination, strength, range of motion, vertical, and dynamic stability. In the journal article “The Development of a Return to Performance Pathway Involving a Professional Soccer Player Returning from a Multi-Structural Knee Injury: A Case Report” the article illustrated ” The first priority in the return to sport decision should be the patient’s health and safety, but contextual factors may also influence the timing of return to sport” ⁷  It is essential to ease into a sport cautiously to minimize the risk of re-injury and to make certain to be at the best levels of your health. That is why the test taking is crucial in order for the doctor to evaluate any repercussions. The hardest test that athletes have is the tendency to fail is psychosocial assessment. It is hard to trust your body once again after facing the outcomes of it failing. Several doctors include this assessment to understand their patient’s mentality. In some cases, if still struggling with the aspects of feeling prepared, some doctors or schools require sports physiotherapy or sports therapy. Physiotherapists are defined as the treatment of injury by physical and mechanical means. ” This system of training allows for greater breadth and depth of preparation combined with specific topics applicable to sport, and the care and prevention of sports injuries” ⁸. When going to a sports therapist, it is useful to have someone who can listen to what you are experiencing and can relate since they may have encountered the same dilemma. Mental health is a sensitive topic that is not taken as seriously as it should. That is why it is extremely important for subject to deal with to get  athletes back to playing with a positive and well minded mentality.

An injury is a long journey that requires an abundance amount of hard work to get back to the level you were at before. It is crucial to follow the instructions of your doctors or physical therapist to enhance your physical and mental health. I have had such a challenging journey overcoming my injury and it has encouraged me to keep pushing through all of the pain I have had mentally and physically. I believe it is crucial for athletes to seek psychological help in order for patients to release the emotions spiraling their head and hear reassurance.  It is a hard process; however, when reaching your goal, it will be all worth it in the end. That feeling of passion for your sport will be rushing back and you will gain a sense of pride in the accomplishment you made.