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Back in Action: A Tale of Recovery from an ACL tear

It was a play that felt like any other play on the rugby field, until it wasn’t. I had just caught a pass during a 7s scrimmage from the left side of the field. As I received the pass, I scanned the field looking for gap to take. I saw an opening, jump cut, and then SNAP. A rush of emotions ensued; some of the worst pain I have ever felt. Punching and crawling on the ground I knew it wasn’t good. I immediately thought: “This is it. I’m done. This is how my rugby career ends.” It all happened in mere seconds, but reflecting back, it seemed like eternity.

2nd acl tear 1

Flash forward 10 days, and I am sitting in the doctor’s office. He opens the file, shows it to me, I read it and it says it’s a complete tear of the Anterior Cruciate Ligament. It takes a second to process, and then my heart stops. It was what I had been expecting the whole time, but now it was an official diagnosis. ACL procedures have come a long way, and I knew this was no longer a death sentence, but I needed to develop a game plan.

A week after my diagnosis I hit up Luke and John and looked over John’s Talk to Me Johnnie ACL articles: Training with a Torn ACL and Rehabilitation After an ACL Surgery. With this I was able to develop a solid game plan to survive this injury.

Pre-Surgery

With my ACL torn my training style had to change. Previously, I had been following CrossfitFootball.com workouts. Based off of this, I created a 3 day game plan focusing mainly on my upper body. This involved Seated Press, Bench, Dumbbell Rows, Lat Pull Downs, etc. I figured this was as good of time as any to work on my upper body strength. In addition, I created a plan to maintain as much strength as possible in my good leg with things like Step Ups, Single Leg RDLs, and Hamstring Curls. Continuing to train the unaffected extremity allows one to take advantage of the crossover training effect. “The crossover training effect associates improved muscle activation of an affected or unexercised extremity with physical exercise of the unaffected extremity. The major benefit resides in the strength gain” (Andrews, 51). While the reports on strength gained varies depending on what I read, I knew any strength I could take into surgery was going to be advantageous. I also did what I could on my injured leg which included simple work with ankle weight Leg Lifts, Leg Extensions, Hamstring Curls, and Isometric Holds.

Along with shifting my training focus, I knew that in order to have the best recovery my nutrition needed to be on point. I followed the basic Power Athlete Diet Template. I ate with abandon: meat, fowl, fish, seafood, eggs, vegetables, roots, tubers, bulbs, herbs and spices as well as animal fats, olives & olive oil, avocados, and coconut. I limited: nuts, seeds, and fruit and stood clear of anything on the avoid or grey area list. By following this prescription, I knew I was eating in a manner that wasn’t pro-inflammatory or damaging to my gut health. We know that the gut is the window to our immune system and a compromised gut means a compromised immune system which = no bueno:

“The body is forever in a battle to decrease inflammation globally when we are well. This battle intensifies post-operatively with the body trying to regain a homeostatic balance nutritionally. It is clear that the Paleo Diet can have a profound effect on minimizing the war between elevated levels of insulin, cortisol, glucagon, thyroxine and human growth hormone. [It] allows the body to have an equitable balance without the deleterious effects of high and low hormonal crescendos, which can affect post-operative healing, appetite, sleep patterns, intestinal motility and gastric permeability” (Harrison)

Power-Athlete-ACL-Recovery-Carl-Case-Surgery

Post Surgery

After talking with a number of people who had already gone through the recovery process, I knew there were two things I needed to do:

  1. I needed to be meticulous with my rehab.
  2. I had to be patient.

Whatever the doctor or PT told me to do, I did it verbatim. No questions asked. After the surgery, I wasted no time starting the road to recovery. The doctor told me before surgery the very next day he wanted me to do 200 leg lifts as well as bend and move it throughout the day. So that’s exactly what I did.

In between catching up on Breaking Bad episodes I would do sets of 10 reps all day until I had reached my rep count. I always put my PT protocols first. Whatever I had planned for that day's training I couldn’t do until I had done my exercises. It was the first thing I did when I got into the gym in the morning and was always done before I went to bed. No way I would miss the forest for the trees, I took it exactly for what it was: a process.

first day of rehab

John always keeping a watchful eye

There were definitely times along the way where I thought to myself: “I’m feeling good! Let’s try to push things. The PT and doctor are just being cautious. They don’t deal with athletic clients very often.” After I thought about it for a bit, I would be reminded to trust the protocol and process. I might get the instant gratification of testing where I am at, but on the other hand, I could easily deliver myself a major set back. Trusting the doctors and working towards the greater reward of being back to training 100% and playing rugby again far outweighed simply seeing if I could do something outside of the plan. This also known as delaying gratification; the act of delaying a smaller but more immediate reward in order to receive a larger or more enduring reward later.

For the longest time my “What are you training for?” has circled around rugby and on field performance. Since it was obviously going to be a long time before I circled back around to on-field performance, I figured it was good idea to define a new WAYTF. Outside the goal of recovery, I felt that shifting my training toward a more gymnastics based program was a good idea based on my situation. This allowed me to have a new training goal and purpose again for training, which helped me keep some sanity. I followed this for the first 5 months after surgery.

Then, after 5 months of diligent work on my recovery process, I was released to start doing some training again. A long time follower of Crossfit Football, I had exhausted the Ameteur progression and had been following the Collegiate strength for quite some time. Unsure of where I should start at, I hit John up for some help and he offered up some great insight:

“I believe the amateur is a great place to start. Just start conservative and make sure you don’t sacrifice movement for weight. As the weight gets heavy you will shift to one side. Back it down and make sure to squat in straight lines. Hammer the hamstrings. Hamstring curls, GHDs, RDLS, single leg RDLs...anything you can do for the hammies.”

For Amateur progression there are 3 key components developed that make it so successful for beginners, which would be beneficial to me coming of a traumatic injury and major surgery.

  1.  INTERmuscular Coordination: when your protagonist and antagonist muscles groups are starting to get coordinated with each other.
  2.  INTRAmuscular Coordination: This can be broken down into three parts:
    1. Recruitment: Your muscles are developing the ability to recruit the individual motor units to produce force.
    2. Rate Coding: “The changing of the firing rate of motor units.”
    3. Synchronization: You are now able to start activating your motor units in a more synchronized manner.
  3. The last key component is Hypertrophy, specifically Myofibrillar Hypertrophy. Myofibrillar Hypertrophy is the enlargement of the muscle fiber through the acquisition of more myofibrils (Kraemer 50, 60, 63). Having lost 3.5 inches of muscle mass on right leg, hypertrophy was something I definitely needed.

Getting started with the Amateur progression I started back with very conservative numbers. This allowed me to make sure I was at a weight where I knew I had correct movement patterns and would allow me to lay a good foundation going forward. I was extremely aware of how I was moving, constantly making minute corrections to make sure that I was moving in a straight line. I would record all my lifts, because what felt like symmetrical movement wasn’t always the case.

Looking back, it probably wouldn't have hurt to just have a mirror in the gym I could use when I trained. And as John said, any time I showed favoritism towards one side I would back down the weight and start back at it again. Dan Coyle calls this process Deep Practice: “ it’s neurologically required: in order to get your skill circuit to fire optimally, you must by definition fire the circuit suboptimally; you must make mistakes and pay attention to those mistakes; you must slowly teach your circuit. You must also keep firing that circuit” (Coyle 59).

For some comparisons, here’s how low I started on my lower body lifts compared to 1RMs: Squat 3x5 @165lbs ( previous 1RM was 475lbs), Deadlift 1x5 @155lbs (previous 1RM was 520lbs), and Muscle Clean 5x3 @ 75lbs (previous Power Clean 1RM was 305lbs).

Back to the Field

Exactly 13 months and 1 week after my surgery I stepped back onto the rugby field to play in my first game. There were a lot emotions going through my head. I had spent over a year diligently working to come and play the game I love. The larger reward I had been waiting for had finally arrived. Of course there was the fear that I wasn’t ready, or I was going to do the exact same thing again. I distinctly remember the conversation going on in my head, “Are we really going to do this?!” Then, the whistle blew.“I guess we are really going to do this.” Once that whistle blew all emotions subdued and it was as if I hadn’t taken anytime off at all. I went on to play all 80 minutes of the six game fall schedule. My first rugby season back had been a success.

first game back

I wish the story ended there and that I could tell you that I ended up play rugby happily ever after. I had what I felt like was a very successful off-season hammering away at Field Strong. I had gained all of my previous strength, was hitting some new lifetime PRs, and felt like overall I was much better than I was previous to tearing my ACL. Starting our spring schedule we had two more regular season games followed by playoffs. As a team, we had high hopes on how far we were going to make it. Our first game was a rematch against a team that was our toughest opponent the previous year.

This time around, they were coming to our field, and things were going to be different. We started the game off strong. I was having a great game; I had a couple big line breaks and even had an assist. Things were looking good. We had just scored and were getting ready to receive. My flyhalf says to me, “If the ball comes to me I want you to loop around me and take the ball.” I was more than happy to do this since I had been having a good game running the ball so far. Sure enough the kick comes to him. I loop around him, catch the pass, get a good 10-15 meter run and see that I have someone coming from my left to make the tackle. I reach out to stiff arm him, he slides down my body, and then all of a sudden “CRUNCH!” Punching the ground in anger, “FUCK” it happened again.

It was a different feeling than the first time, but there was no mistaking what it was. I laid there a bit in disbelief that it happened again. I had done everything right; this wasn’t supposed to happen. As they got me up and drove me off the pitch, my head hung. Maybe it’s just my personality, but I didn’t stay angry for very long. I figured I had my five minutes to be pissed, but moving forward, what good was it going to do me to sit there and sulk. I honestly think my mom and girlfriend were more upset than I was.

In following weeks I definitely started to question a lot of things: Was there a flaw in my rehab protocol? Did my training not appropriately prepare me for this? Did I miss something mostly training alone? Was the surgery poorly executed?

After tossing these questions around in my head multiple times, I came to the conclusion that I and everyone that helped along the way did everything they could. The second time I tore my ACL was a result of contact whereas the first time was a non-contact tear. Non-contact ACL tears are definitely preventable, but I don’t really know how much more I could have done to protect myself from the collision that resulted in the second tear. Maybe that’s just me justifying the means, but I feel I did everything I could.

Because of some circumstances I will not have ACL reconstruction until the beginning of 2016. Knowing this, I knew my training style was going to have to switch up again. I switched over from Field Strong to Jacked Street. In the first month or so I would do the upper body days as written, but on the lower body days I simply resorted back to what I did the first time around pre-surgery. As the weeks went on I was able to add movements back in or do some sort of variation. Presently I am able to do almost 100% of the movements programmed in Jacked Street. The weights aren’t nearly as heavy as I used to be able to do; however, I feel like I am training again.

I do know that at some point I will be staring down the long road to recovery again. As much as it’s going to suck to start all over again, this time I know a lot of the answers.

Will I ever play again?

This is such a hard question for me to answer. Part of me (probably the sane side) says: “two ACL tears; I’m not getting paid to play, and surgeries are expensive.” These are definitely good reasons to walk away. Many of my friends and family would probably agree. The other part of me just can’t let go. It is a game that has been a huge part of my life for so long. I started playing in 2004 and started coaching high school in 2009. Since 2008 my sole answer to “What are you training for?” has been rugby!

Currently I am helping coach the Men’s team. While I am still involved, it’s not the same. Nothing will ever replace that feeling of a solid tackle or ruck, having a nice line break, scoring a try, being in the fight with your teammates, the soreness the day after a game, or just simply the competition. I think one of my friends that I play with said it best: “Competing is what keeps me sane.” But I guess everyone has to say good bye at some point.

The good news is: I still have over a year before I have to answer that question.

Sources

Andrews, James Rheuben and Harrelson, Gary L Physical Rehabilitation of the Injured Athlete. Elsevier Saunders. 4th Edition. Philadelphia, Pennsylvania. 2012.

Coyle, Daniel. The Talent Code. Bantman Dell. New York, New York. 2009

Harrison, MD, D. Levi. The Benefits of the Paleo Diet in Post Operative Care.

Kraemer, William J and Zatisorsky, Vladimir M. Science and Practice of Strength Training. Sheridan Books. Michigan. 1995. 2nd Edition

Carl Case

Carl Case has been an athlete his whole life, playing both football and rugby in high school. After high school, he directed his focus to rugby where he went on to become a collegiate Midwest All Star. Carl continues to play rugby on a mens team near South Bend, and was part of a National Runner Up team. He found CrossFit and then Crossfit Football as a way to fuel his rugby performance. He has been following the CrossFit Football program since it’s launch in 2009 and attended his first CrossFit Football seminar in August of 2009.

After an introduction to CrossFit in 2007, Carl became a certified coach in 2009 and co-owner of CrossFit South Bend in 2011. In addition to coaching CrossFit and CrossFit Football classes at the gym, Carl has been coaching high school rugby since 2009. He uses the CrossFit Football and Power Athlete concepts to help his young athletes identify their goals and provides pointed instruction to help achieve those goals.

Posted in Blog, Featured, Injury | Tagged , , , | 8 Comments

8 Responses to Back in Action: A Tale of Recovery from an ACL tear

  1. Carl – great post, I feel for you brother. I’m also a men’s rugby player, 10 years and 9 seasons in (1 lost to torn labrum). Taking a new job with frequent overseas travel and facing down my first season with reduced involvement not due to injury. Definitely struggling with the “WAYTF?” aspect, good to get the direct perspective from someone tackling the question under way more difficult circumstances.

  2. Tw1989

    I feel for you mate,i’m 5 months post op and working to get back on the field for next year,your positivity is inspirational……..whatever decision you make will be the right one but i hope you get back out there with the boys
    All the best

  3. DD

    Carl,
    Great article!! You are correct, you did everything you could. I am an Athletic Trainer in Kansas and see this multiple times a year with high school athletes. I have incorporated CFFB/PA/FS into all of my rehab protocols to great success. If you do decide to continue on, go into surgery as strong as possible. The stronger you are going in, the stronger you are when starting rehab. Echoing John, hamstrings hamstrings hamstrings! Don’t be afraid to pull bigger weights in anything involving the posterior chain, but please follow form guidelines to minimize the possibility of damaging surrounding structures (meniscus, articular cartilage).

    Wearing a custom or OTS de-rotational knee brace could have helped with a contact injury, but depending on the level of padding needed to cover the brace for the safety of others when attempting to play a non padded, collision sport could have been cumbersome. Check with the rules and regulations of the Rugby league to see what is recommended. Worst case, wear them bilaterally for prophylactic protection of the non injured side.

    Please feel free to contact me with any questions as well.
    Keep up the solid work. Thanks again for the article.

  4. Chris

    Good article. I feel for you but I know you will play again. I’ve went from playing D1 football (essentially getting paid) to club rugby and I have had my fair share of injuries, all of which during rugby and not football….right ACL tear, right achilles rupture, broke my left humerus in half, shattered finger, broken ribs, etc. And they all have healed and I came out stronger on the other side. I don’t get paid either, so why? Because I love it. Period. And where else can you hit someone as hard as you want without pads without going to jail?

    • Thanks Chris. Sounds like you definitely know how it is, and know the love of the game is a strong force. I remember being told the same thing when I was in 7th grade football and has always stuck with me.

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