Lessons from my ACL recovery…

In October 2016, after a particularly physical 11-a-side game, I found myself unable to kick a ball in training, as every time I kicked it it felt like my leg was going to rip in two! This followed several months of my knee buckling on me in games, with it leading me to fall onto the floor a couple of times too. I kept this mostly to myself and strapped it up with some tape hoping it would just get better, which was silly, but I couldn’t ignore the pain I got that training session. Thankfully, an appointment that I was supposed to be having with the physio in December had been moved forward to an appointment with a rheumatology doctor, as they thought looking back on my notes (as I had been to the doctors a few times over the past 2 years or so complaining about knee pain, with several doctors and physios telling me my anterior cruciate ligament (ACL) seemed lax) I should see him instead. When I saw the rheumatology doctor he pretty much told me that it was a problem with my ACL, and even if it wasn’t and I didn’t have surgery I was out for the season given how poor and weak my muscle were. I was absolutely gutted, that was when it really hit me, before this point a private physio had told me it was going to be around 3 months because of my MCL being torn (which it turns out the MRI showed it wasn’t) and so this was hard to take. I then was sent for an MRI and had to wait for a long time until I got the results. In fact, it wasn’t until after Christmas that I got the results over the phone that I had a chronically ruptured ACL. Thankfully, especially given the chronic nature of it, there was no other damage to the knee. I then had to wait a month or so until I saw the surgeon where I actually saw the state of the damage. This last bit of waiting for the surgery was the quickest as I asked to be put on the late notice waiting list, so if someone else canceled their spot I could potentially get it instead – which I am thankful for my self-employment for – and I had the surgery 1 month and a bit after seeing the surgeon, with it taking place on the 5th of April 2017. The journey has been a long one, with many ups and downs, and one that has changed my perspective and identity.

I have now been cleared by my physios to start gradually returning to 11-a-side games after returning to full on contact training and so it is a perfect time to reflect on this process with the new year upon us! In this article, I reflect on some of the things I have taken from the process:

Patience

One of the hardest things you learn through this process is the importance of patience and being thankful of every little step forward you take towards full recovery. For me, it took longer than most, as it turns out I’ve been playing without an ACL for some time and given the chronic nature of my injury it took 5-6 months to work out exactly what was wrong with me and get me in for surgery. Those 5-6 months were so much harder and challenging than the months recovering – well mentally that is. I had to learn a great deal of patience as I battled with feelings of utter frustration, immense sadness and anger, as I was in a situation of limbo where I didn’t feel like I could move forward. To deal with it, I did lots of prehab going to the gym several times a week and doing prescribed home exercises 3 times a day. The ACL Club, an invaluable support group, was so important for me during this time too, as I listened to their podcasts preparing myself mentally for the surgery and recovery, and even messaged the ACL Club website before one of AFC Unity’s, the team I play for, 11-a-side games when I was particularly struggling mentally to face turning up. The support system provided by the ACL Club is something I can’t really put into words and do justice to and would recommend to anyone going through injury recovery.

Humility

Given that you learn how to walk, run, jump and turn again and you need someone else’s help to be able to do basic things such as clean, get dressed, eat and shop for the first couple of weeks or so (or maybe longer), it is a process that really humbles you and really does teach you about the importance of appreciating the things you take for granted and also makes you so thankful for the people that are right there helping you through such challenging times. Little things that I used to take for granted, such as walking, running, jumping, bending down, twisting, carrying and lifting things, dancing, washing pots, hovering, putting my clothes away, sleeping comfortably – they were all made difficult or impossible for a certain time in the process, which is why I found the first few weeks actually better than the middle part of the rehab, as the progress and change is more evident, whereas building muscle back is a lot less noticeable for instance.

Isolation

The 5-6 months period where I was waiting to have the steps for my recovery confirmed were the hardest. To deal with the loss of not playing football I started to isolate myself as a player not taking part in activities as a team member. This didn’t help me, and it was due to my partner but also club manager Jay Baker, who was pretty much my rock during this whole experience, that when the new 2017/2018 season started this feeling of isolation reduced as he made sure I took part in as much of the training sessions I could as a player, even if that was just in the discussion element or calling offsides, and this enabled me to feel more like what I did when I played football. Obviously, it’s not the same feeling that you get when playing with your team mates on the field but just being able to take part in trainings, as a player, despite being injured helped so much. It was hard seeing people trial for the club and know that I couldn’t show fully why I should be signed, thankfully I was signed and people were really supportive and never brought the fact I hadn’t trailed like them up. It was hard though. People might argue, well you are the co-founder of the club so what does it matter – but I have never seen this role as justification for me having any more rights than any other team member. Everyone should be treated the same, as that is a key part of the club’s ethos and identity. My team mates helped a lot with humour and talking to me as a player, not just an injured person on the sideline, and for that I am really grateful to them all.

Support System

Linking in with other themes, it really is a process where you appreciate those people who are there helping pick you up from some really low moments. I can’t thank these people enough, and they know who they are – well they should do! I have learnt a lot through this process about how I will be with others close to me if they experience long-term injuries, but hopefully that doesn’t happen. There were so many people that helped me in different stages of the process and I am grateful to every single one of them. I am especially grateful to my closest family for picking me up in those really low moments I had from time to time. I also want to thank The Office and Parks and Recreation for the important role they had in making me laugh in my low moments – I binge watched The Office often during the initial post surgery process!

Fear of the Unknown

Before the operation I was having a bit of a panic attack from the fear of not knowing what to expect. Suffering from OCD made the whole experience a lot harder really, as anyone who knows the illness understands it comes with obsessing about all that could go wrong to the point it feels like it has actually happened! The ACL Club really helped here, as I put the quote “I cannot control exactly what happens in life, but I can control how I respond to it all. In my response is my greatest power” on the fridge, in front of where I did several of my early rehab exercises. I was obsessed with damaging the graft, and the impact this would have on my life given the time it had already taken to get to the point of being on the recovery journey. Walking into a washing machine and slipping in the street when walking on some soggy cardboard resulted in absolute meltdowns, the fear of not knowing if I had done something and the fear of knowing the set back that would result from having to start again really affected me. Thankfully, I had people around me giving me truth bombs and reminding me that it is all beyond my control and all I really can control is my response to this.

Feeling of Loss

This is a feeling that again was worse before surgery; once I woke up from surgery in the recovery room I was crying because of the immense sense of relief that I felt for finally being on the path to recovery – the pain and medication didn’t help either! This feeling of loss reduced but is something that doesn’t ever truly go away. Low days happen, and a feeling of just wanting to be able to kick a ball again has been difficult to deal with. I think if you can replace the feeling you get from playing football with something else – this is something a lot of people who have gone through this process have found helpful – that is great, but I just couldn’t seem to find something that had the same effect or feeling and there was always a hole that I couldn’t fill. I found the worst times being every Sunday morning, when I would usually be getting ready to play football I was getting ready to watch and times like this were the hardest to keep a positive mindset in. I was glad I went to the games though, I have shared some of my best moments in football on the sideline this last season with fellow players and no matter if you are on or off the pitch you are still a team mate and you want your fellow team mates to do well. The football we have started playing as well has been great to watch.

Reflection

The ACL Club also encouraged the importance of daily reflection in this process. I signed up to the ACL Club Journey Journal where I got regular mailout prompts challenging me to write about different things, such as what keeps me motivated, what I am thankful for and what quotes I can use to aid my recovery. I have completed 4 note books, and counting, of reflections during this process and it has helped me keep perspective when getting frustrated on how far I have came, and also helped me process my thoughts and feelings. I really recommend reflection journals if you are going through injury recovery.

Rehab

There is no miracle cure to this process; if anyone was to ask me for my number 1 piece of advice going through this though it would be that you have to work hard, really hard, you have to work hard when you don’t want to too. You have to be prepared to push yourself. I had all my exercises on my phone as notes in a checklist format. For most weeks I went to the gym at least 3 times and up to 5 times, which included a weekly trip to the NHS physio at the Hallamshire. When I woke up from surgery, the first question I asked the nurses was where my exercise booklet the physio gave me before was so I could get started straight away – they told me to relax!

During the first few weeks my rehab was based at home, where I did exercises every hour or so; this included learning how to balance on my operated leg again – the joy that I had when standing on it for 30 seconds was unreal. It also involved regularly stretching my hamstring, trying to encourage the bend to come back in my knee by doing knee slides and also doing my step down exercises, with a stepper I invested in after advice from one of the physios before the operation, 3 times a day to build back the strength in my quad. I also tried to wean myself off crutches – it took me until the end of April until I stopped using crutches – I had a great limp for a good few weeks until I could properly walk again too. I had to do leg extensions using furniture to create a gap that forced my knee down to the floor – to help increase normal movement – which resulted in all the bruising going behind my knee and meaning for a week or so I couldn’t move very well because of the pain in my calf, which resulted me ringing the surgeon’s team as I was scared of having a blood clot – thankfully I didn’t.

I gradually increased my programme in line with what the NHS physios said, going to the gym for the first time on the 2nd of May and keeping up going to the gym at least 3 times a week – no matter how I felt – and doing my home rehab pretty much everyday, except Sunday, several times a day.

The first time I ever did the bike I was crying with how much pain I had and it felt like my hamstring was burning when I got off it. I have now got up to a point where I do 10 minutes before every gym session as a warm up. I also did regular hamstring, thigh and calf stretches and eventually when able I started using the foam roller to help with muscle tightness and pain. At the end of June I started the stepper machine at the gym to get used to running, that was one tiring machine!

In mid July I was able to jog again, building up my minutes on the treadmill – that was such a scary but exciting feeling; I felt so vulnerable jogging but also it was so freeing not to restrict my movements the way I had before. It was a very humbling experience. I also around this time started to do some turning and cutting work, getting my knee used to quick movements again. I still feel humble every time I do the treadmill at the gym, as I am reminded of how long it took me to build up to being able to do the 20 minutes I do regularly now.

When running I had to deal with my right arm seemingly sticking in one place. No matter how hard I worked on this it didn’t go away until I returned to football and I started to forget about it. I am not sure why this happened but it made me feel quite rubbish but my physio helped put it into perspective and forget about it. I also tried running outside when I could to get used to uneven ground, also using the opportunity at training and games of AFC Unity to get used to football surfaces again.

At the start, I was on 20/25kg for single leg presses on both legs and I have now worked up to being able to do 60/70kg on both legs! I never had much muscle in my legs before my operation so this has been a real benefit from this whole process. Other things I did to work on my lower leg strength and control included bridging, moving to single leg bridging, single leg squats, single leg deadlifts, hamstring curls, rower, bosu ball squats, alongside using the cones at the gym to work on movement and control.

In September I started jumping, which was the hardest part of the physical rehab process and it is still something I struggle with whilst working on box jumping and single leg jumping at the gym. I also feel very humble and grateful to be able to jump again. It took me a while to trust my right leg when jumping though, and this really was the hardest thing to re-learn. I am thankful for this though as the physios helped me learn about the best way to land, as my landing previously had poor form and created more chance of injury. I practiced this at home as much as I could too. I also worked on turning in the air and landing on my leg after jumping from a box at the gym – I never really mastered this, it felt too forced and made me think too much about my knee and risk of re-injury.

It took me a while to start dribbling again – I started off doing this too quickly and fast because I was too eager which meant I had to not do any rehab for a week because I was in so much pain, especially with my IT band. After rest, I worked up my dribbling from a walking speed over weeks until it went to a normal speed. That was a really hard process but a very rewarding one. To help with dribbling, I found practicing side stepping, cross stepping and doing hip exercises really helped, as it enabled all these muscles and joints that I needed when dribbling to wake up and start moving better – again these were things I did at home as well as at the gym to try and work on this as much as I could. It just required patience.

I had help from Jay, my sister and teammate Claire, and teammates Jodie and Charlotte when it came to getting used to tackling in football again. That really hurt my leg at first but the more I did it the better it felt. As my physio said, you really just need to go for it when doing this, as hesitation or pulling out of a tackle will just make you more likely to re-injure yourself. I really missed tackling during the non-contact phase of my recovery, and will never take the ability to tackle for granted again!

The thing I have struggled with the most is the ongoing nerve damage in my leg, it has had to get used to the new sensations every new exercise and movement created – I still struggle with this but no where near as much as before. My poor bone that was drilled into for the operation also still hurts as it gets used to new loads and impact, again this is something that still troubles me but I know it just needs to get used to things again and get strong again. Patience again is key.

Rehab is also mental as much as it is physical, and this was something I have really benefited from during this experience, as I kept a journal of the process, alongside listening to ACL Club podcasts and studying Dan Abrahams book on sports psychology – all to become a better person, player and also to cope with the mental struggle that came with the injury.

I still continue doing most of these exercises at the gym to keep fit and reduce injury likelihood. I also take my fitness and health much more seriously now and don’t want to be like I was before: weak and unfit.

Opportunity

This injury has certainly changed me as a person. I really got time and space to evaluate quite a lot of things. One of things I spent time working on is my soccer brain, and Dan Abrahams work has helped a lot here. I really got to understand how important the mental side of football is and reflect on how before the injury when I was playing this was the weakest aspect of my game but I never got chance to work on it, but through the injury I got the time and space to really work on this. I definitely see the game differently now.

Learning

I have learnt a lot about myself through this process. I have also learnt a lot about the effects a long-term injury can have. Missing over a year of football through injury isn’t something I wish on anyone, but if it does happen it’s about trying to make the best out of the situation and working on what you can and finding the learning points from the experience.

Be Proactive

Don’t wait for something to happen before you start taking care of your body. The doctor that pretty much told me I had ruptured my ACL, before the scan, did tests on my leg muscles and was astonished at how weak and unconditioned they were. I never took any real care and time to look after my leg muscles or my physicality but this injury has meant that even now I am back I will keep doing exercises that strengthen my quads, hamstrings, calfs and glutes – all so key in protecting the knee muscles. Give your knees the support they need and train those muscles! Don’t think “it will never happen to me” as hopefully it doesn’t, but it could so do all you can to make sure it doesn’t.

Thankful

I am so grateful to all the people that have helped me along the way. The NHS is such an amazing organisation with every single person I have met during this process so incredibly lovely, supportive and helpful – they all need a pay rise and more funding. I am grateful to the people who have listened to me complain, comforted me when I got angry or when I cried and those that have kept me going through making me smile and laugh (including at myself)! Perspective is everything.

Perspective

On returning to non-contact training, after my third session back I lost perspective. I was frustrated at not being able to play at a level I knew I could, passes that I could make before my injury were way off, I couldn’t make any tackles, dribble, shoot – I just felt so frustrated. My knee kept hurting and that added to this feeling. But then after feeling sorry for myself, I remembered how much I would have given just to be able to kick a ball again a few months/weeks ago, and how far I have come. I remembered what Dan Abrahams had said on an ACL Club podcast in that as long as you put in 100% it doesn’t matter if you are 50% of what you can do, it’s going to take time. I remembered that I had to keep a sense of perspective and be proud of getting back into non-contact training and that the rest will follow when I am ready. This was the same attitude I took when returning to contact training – I am rusty and I know it is going to take time to really feel like me again, but how grateful I am to be given this chance to return and play the sport I love. Be grateful, humble, enjoy yourself and keep perspective.

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