There’s so much a person goes through after an injury. From the athlete’s perspective, it could be a life-changing and career-defining experience.
One moment you are at the top of your game; the next, you are at the lowest of low. It’s a gruelling journey from the critical moment of the injury to the initial recovery and the final rehabilitation process. It’s a fight to get back to the top, a struggle not many are willing to take on, let alone overcome.
I know this because I went through it as a young athlete, and now I see on an almost daily basis the battle my patients face. Allow me to draw upon my own experience as an example.
After I fractured my tibia (shin bone) for the second time, I put myself through much physiotherapy to get back to my best. Through the combined efforts of myself and a dedicated team of coaches, I reached previous levels of performance in sports.
Well, that’s one example. The other isn’t a happy outcome. I had undergone reconstruction surgery for my Anterior Cruciate Ligament (ACL). This time, I didn’t put the same amount of effort into physiotherapy.
Although I do participate in sports socially now, I have never been able to return to my previous levels of sports, not even close. These experiences are not unique to me.
Let’s zoom in a little towards rehabilitation after ACL surgery. There’s been much attention to returning to sports after an ACL reconstruction surgery.
Researchers have divided these patients who return to sports into three categories: return to any sport, return to pre-injury level and return to competitive level.
While about 80 per cent of patients have returned to some degree of sport, only about half of those reached their pre-injury or competitive levels. As mentioned above, my case is not unique.
I am the rule and not the exception.
So, how long does the recovery process take? Or how does one know when they’re ready to start participating in sports again? Before that, let us take a few steps back and examine an ACL reconstruction surgery.
Essentially, the gist of the surgery is to recreate the torn ACL. The surgeon will first create tunnels within the knee’s tibia and femur (thigh bone). Subsequently, tendons (various existing forms) are passed through these tunnels and secured to the bone.
The biological healing time for this repair takes nine to 12 months. There are three distinct stages – early healing, proliferation and maturation phases.
So now we understand that biological healing plays a vital role in recovery. It is important because it will be a rate-limiting factor in the type or intensity of physiotherapy the patient or athlete undergoes.
Many other factors could affect the recovery programme. For instance, if there is a meniscus or cartilage repair, the recovery will be slightly slower.
In any case, after an ACL reconstruction surgery, the surgeon will prescribe a brace and crutches to assist with ambulation. The rehabilitation process can be divided into a few phases.
There is an existing rehabilitation protocol. However, most agree that jogging can commence by the third month after surgery, followed by training at around six months and returning to playing sports at about nine months.
In the early stages after surgery, the goal will be to control inflammation and swelling around the knee. Gradual range of motion exercises will begin till the entire movement is acquired. You should start strength and proprioception training by the second month.
This training will be more advanced by the third month, including resistance weight training and more sophisticated proprioception training. Proprioception is an important sensing ability that tells the mind the body’s position within a specific space.
The fourth month should signal the beginning of running and jumping exercises and exercises specific to the athletes’ sporting demands. It progresses until around the sixth-month mark when training for a return to sport can begin.
These include speed, agility, and specific functional exercises. The complete preparation is made by switching from the previous simple direction to a more diverse direction with movements of running or jumping in a more power-driven manner.
Before returning to sport can be recommended after the rehabilitation, the affected athletes’ knees should reach a performance level of at least 85-90 per cent compared to the uninvolved side in tests, such as strength, balance and functional tests.
Some questionnaires can guide in judging one’s readiness to return to sports. The above plays a significant role in rehabilitation, but it will not count for much if the athlete is not psychologically ready.
From personal experience, I can vouch that this is probably the biggest stumbling block. Where before, there was no fear, and you would go sliding into a tackle in a football game or kick your opponents in a taekwondo sparring match, there is no doubt. It is always in the back of your mind.
Overcoming that fear is a huge challenge. Should I go all in? Will I injure my leg again? Luckily for me, after some time, those initial fears eventually disappeared, although never completely.
This part of the recovery is often overlooked, but when you sit down and speak to patients, you see this problem that needs more attention.
It’s never a delightful experience getting hurt. Recovery is a long road ahead. For athletes, there is a little extra on the line. Their aim is not merely recovery but to reach a certain level of performance again.
Many factors come into play to achieve this, all of which have to work in harmony to reach that eventual goal. – The Health
