Sports’ cruel injury: the long road back from an ACL tear – Chicago Tribune
When Cubs left fielder Kyle Schwarber collided with Dexter Fowler last month and was carted off the field with a torn left ACL, it was a reminder of one of sports most painful truths.
“It’s a cruel, cruel game sometimes,” manager Joe Maddon said afterward.
There was another reminder this spring when Illinois wide receiver Mikey Dudek tore his right ACL for the second-straight season during spring practices. Shortly after, running back Dre Brown tore his left ACL, also suffering the same injury that will sideline him for a second-straight season.
“The game sometimes can be cruel,” Illini coach Lovie Smith said, echoing Maddon.
And after Derrick Rose tore his left ACL in 2012 a year following his MVP season, he said it was “the closest thing to death.”
What makes an ACL tear so devastating isn’t the pain or surgery. It’s the recovery, which for athletes is often isolating, grueling and psychologically difficult.
“Every game I wasn’t playing in was really tough,” said former Northwestern receiver Christian Jones, who tore his right ACL as a high school senior and his left before his senior year with the Wildcats. “When you get to camp you take the mindset of this is it and then to have abrupt change of plans, it plays with your mind. It really was a hard transition.”
Two days after Schwarber’s injury, he vowed to return “bigger, faster, stronger” to the team. “You have to face it head on,” he told reporters in early April. “I’m not going to back down from it.”
It’s a good mindset, but it’s a hard one to maintain through recovery, which takes six months to a year.
“It’s also how you define recovery,” said Brian Cole, Bulls team physician and orthopedic surgeon at Rush University Medical Center in Chicago. “The lay person will say it’s when they can get back to the sport. But it’s not just when they can just get back but when they perform at the level they did before their injury. It depends on their sport and the position that they play.”
Schwarber’s ACL was reconstructed and his LCL repaired by Daniel Cooper, the head team physician for the Cowboys, and the procedure did not reveal nerve damage. ACL reconstruction surgery replaces the ligament in the center of the knee, which keeps the shin bone in place, with a graft either from one’s own body or with a cadaver ligament.
The ligament, one of four major ones of the knee, is vital to athletes because it prevents forward movement of the tibia and provides roughly 90 percent stability in the knee joint, according to the Centers for Disease Control and Prevention.
During rehabilitation, the first goal is to regain range of motion in the knee. An early indicator of success is a patient’s ability to achieve full extension, Northwestern athletic trainer Tory Lindley said. Athletes then move on to increasing strength with their foot off the ground, then putting weight on it and then progressing to sports specific movements.
Keeping players motivated through rehabilitation is difficult, Lindley said.
“It’s like the seasons of a year,” he said. “At first, it’s a novelty, then you deal with winter, then you get to spring … and now (after progress) we have to work on the opposite and hold them back from their own competitive nature.”
Returning to competition is difficult, said Jones — the former Northwestern receiver — because teammates have made progress on the field while the patient almost solely has been rehabilitating. Then there is trying to forget about the risk of re-injury.
“You just have to trust the work you did,” he said. “It’s in the back of your head but then you get in heat of moment and at some point you say, ‘(Expletive) it.’ You can’t hold yourself back.”
It’s particularly difficult for female athletes who have a rate of ACL tears anywhere from two to eight times greater than male counterparts, according to studies. Former Sky guard Jacki Gemelos can relate — arguably more than anyone who has ever had an ACL tear. She has had five.
The first was the last game of her senior year of high school, then at USC she needed four more reconstructive surgeries. Three were her right knee and two were her left.
Gemelos spent six years at USC but played in only 57 games. She finally made a WNBA roster last season with the Sky before being waived last week.
“I was a mess pretty much,” she said recently. “That’s probably where I grew the most as a player, mentally having to go through that injury constantly. There were a lot of lows and not many highs. For me, I would be cleared for a month or two and then tear it again. It was hard.”
Studies show anatomy plays a part in the amount of ACL injuries females suffer.
Women tend to have stronger quadriceps than hamstrings and are more likely to use the quad to slow down, which causes instability in the knee, according to multiple studies.
Some studies also show that differences in hormones like estrogen and relaxin, which give ligaments strength and flexibility, are factors.
The approach to ACL injuries has changed significantly over the years.
In the 1960s and ’70s, doctors would put the leg in a cast after surgeries.
“Your leg would turn to stone,” Cole said. “You would get stiff and potentially get arthritis. We’ve come a long way in terms of understanding the rehab, the timing of surgery, the surgical techniques based in part on what we’ve learned in the laboratory, in terms of how we position the grafts, the choice of grafts, looking at outcomes.”
According to the CDC, as many as 250,000 Americans suffer ACL tears yearly, resulting in health care costs exceeding $2 billion annually. Some medical experts attribute that to overtraining and year-round athletics among the nation’s youth, especially females who are playing at a greater rate than ever.
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