How do elite male rugby players manage ACL recovery & rehab
‘Oh no, looks like he’s done his ACL’
Within competitive sport, there is nothing worse than watching a player leave the field with a suspected Anterior Cruciate Ligament (ACL) injury. Spectators, teammates, coaches, sponsors, partners and most importantly the player themselves- hold a collective breath until the results of an MRI are known. This is because the gravity of this injury among professional athletes can be significant, and sometimes- career ending.
Once a player has been diagnosed with an ACL tear or rupture and surgery is completed, months of sports rehabilitation commences- often outside of the public eye. So how do elite sportsmen emotionally and psychologically process this injury and the long journey ahead?
This article examines a study from South African researchers who wanted to explore the psychosocial experiences of six competitive male rugby players following an ACL injury.
ACL Injury Study
The 6 participants in this ACL injury study were all male, with a mean age of 22.3 years.
All were rugby union players; 3 players had competed within the Super 18 tournament and 3 were high-level college players.
All players had ‘sustained a first unilateral ACL rupture and underwent reconstructive surgery less than 12-weeks before’ this research study commenced.
The researchers interviewed the rugby players at seven timepoints along their treatment and recovery journey over a period of 14-months.
Timepoint 1: Day of the Injury
Players reported confusion and uncertainty at the time of the initial injury. One player said (all quotes taken verbatim from text),
“I was in denial and I thought, no, it’s not so bad, and it’s three months and then I’m back… I didn’t think it was an ACL.”
Most players emotions at this time were negative and fearful,
“I was pretty scared, because I didn’t really know if I would play rugby again and how big the operation would be.”
The physical nature of the injury, required some to require immediate practical support,
“I called my parents, they came and looked after me for the rest of the evening… I needed to shower and eat. They helped me with that.”
Timepoint 2: Pre-surgery
The upcoming surgical date was foremost in the thoughts of the rugby players. Concurrent thoughts which occupied the minds of the players involved when they would be able to successfully return-to-sport (RTS).
“…out in the news and everyone sending me messages… I think that’s when it really hit me that this was something serious. I wasn’t doing so well in that week leading up to the operation.”
Some reported feelings of optimism in the surgical and rehabilitation process, but also the need to consult other specialists regarding the treatment and prognosis.
Timepoint 3: Acute recovery (Week 1 post-surgery)
Feelings of a sense of loss of control and agency were expressed by some men,
“I could not drive or could not go anywhere, and they (his teammates) were telling me about all the places or the parties they were going to go to and sent me pictures…Obviously, I was like, I wanna be there, be with my friends…”
Fear was present, but reassurance was received from health professionals involved in the recovery phase,
“…he [the surgeon] said everything is fine and that I can start with rehab after a week or two. It was just small movements, but even that was something big for me, because I could do something again.”
Timepoint 4: Repair (Week 2-6 post-surgery)
Frustration was often the dominant emotion during this phase as the realisation of the long road to recovery set-in,
“…you are very limited to what you can do, so it was sort of just… just very boring the whole time.”
However, sources of great support came from other players who had gone through same rehabilitation process in the past,
“(Name of the national team captain) gave me a call and said he ‘did his ACL’ as well, and he continued to play… that was a big deal, especially a guy like him, calling me and wishing me well… it was a very big deal.”
Timepoint 5: Remodelling (Week 7-16 weeks post-surgery)
During this timepoint in the recovery phase, players were conscious of ‘the grind’ of rehabilitation. Some players found this period tedious while others seemed to appreciate the effort required,
“I’m still positive, because I want to recover. The rehab sessions are tough, but I enjoy them, because I know that is what I must do to fix my knee.”
By now, many rugby players were spending time online researching their own rehab progress and benchmarking against others who had sustained the same injury,
“I educated myself. Every time I checked YouTube or when I Googled ACL at five, six weeks, not once was there something that I didn’t do or wasn’t on par with… that I didn’t do or did too late.”
Some men perceived that coaching staff appeared more distant and removed from them and their recovery,
“I wouldn’t say there’s much interaction between myself and the coach. We just walk past each other in the passage, you know. How are you, how’s the injury? You know? That sort of thing. But I don’t think there’s much of an interaction… it doesn’t go further than that.”
Timepoint 6: Before RTS (timeframe subject to meeting RTS criteria)
During this Return-To-Sport (RTS) phase the priority for these rugby union players was to regain lost self-confidence and competency. Prior to one player’s first game post- injury, he said,
“…stressed, because it was my first game in a very long time. I didn’t know what to expect and I was nervous. I remember the night before; it was as if I was playing my first game of rugby ever. I was just thinking, just overthinking everything really. A lot of bad thoughts went through my mind.”
Whilst feeling of trepidation are not uncommon, some players were excited about the challenge of returning to the code after a long period of absence, “I’m very excited for what’s to come.” The return to club land, gave the players additional layers of social support and safety in familiarity.
Timepoint 7: After first post-injury competition
Returning to the field and completing the first session of full-contact, was a milestone for the players. A mixture of fears and anticipation were present,
“It’s a scary moment. I remember the first time I was tackled. The guy was coming from my right (injured side). When he tackled me, I stayed down on the ground. I reached for my leg, and I felt my knee, straightened my knee, and realised I’m good. I got up and felt really good about it. I had my first contact… I remember being so happy that I got through it.”
The resumption of football activity after a leave of absence resulted in emotions of gratitude by the players, “I started appreciating what I have and what I could’ve lost.”
Timepoint 8: Reflection
Players were asked by the researchers to reflect on the total journey from initial injury to surgery and rehab. Players still retained the burning desire of competitive sport,
“…everyone who plays rugby in South Africa wants to play for the Springboks… so that’s still a big dream of mine.”
However, a sense of balance and self-reflection following the ACL recovery process were seen as a long-term gain by players,
“…we get so caught up in being rugby players, we forget what it’s like to just be a normal 23-year-old guy, …of being a rugby player and playing for the (name of Super Rugby team), that you don’t see what is happening on the other side.”
Another player noted, “I can’t be on the field, so I don’t break my mind about not being able to play. At the end of the day, rugby is only a part of who I am. The rest of my life can’t stop when one-part stops.”
Rugby ACL Study conclusion
The study concludes by noting that all the men in this study ‘successfully returned to sport, between eight and 11 months after the injury’. This study is informative from an elite professional athlete’s perspective on the rollercoaster of emotions they experience with an ACL injury.
The growth in gratitude and self-reflection over the recovery journey, demonstrates a maturity in the player as a person, within a competitive environment.
