I have had a long time to meditate on my ACL journey. It starts as a spry 18 year old kid in his senior year. The summer was coming and myself and a few friends decided to bail after lunch to go hang out at a friend’s house. He lived on the side of a big hill and had an amazing view of Los Angeles. The best place to see the view was the old tree fort his dad built him as a kid. We climbed to the top, took in the view and started to climb down. As I was about 18” from the ground the termite ridden rung I had put my foot on decided to break and my right leg was driven into the ground. Upon contact I felt a pop in my right knee and it immediately started swelling.
I jumped in my truck and drove home. I found my older brother there and told him what happened. He was home for the summer from college and getting ready to head to work. He took one look at my knee and said, “I think you tore something.” He called in sick and we got into the pool in our backyard. We started to do some manual therapy working my leg back and forth in hopes of regaining range of motion and reducing the swelling.
After 3 days of doing this and icing, the swelling in my knee went down and my knee felt good. A bit looser than I remember, but I was able to cut, lift weights and do everything I did before the incident.
3 weeks later I headed to go play in the “North vs South” California Shrine Game. This was a prestigious high school All-Star Game and I wanted to make a good showing. Upon arrival they put us through a complete physical and I had the orthopedic surgeon check my right knee as I told him I thought I had injured it a few weeks before. He performed the Lachman Test – a quick physical examination maneuver used to assess the integrity of the anterior cruciate ligament (ACL) in a suspected injury. The doc started with grasping my right quad outside the knee to prevent it from moving. Then he grasped my calf on the inside and gave my lower leg a little forward tug towards himself. If the ACL is intact, then the tug should produce a firm endpoint. If no firm endpoint is observed then the ACL is surely damaged.
The doctor tugged a number of times and each time told me my knee felt a little loose but the ACL was intact.
I played well in the Shrine Game, then headed off to play football for Berkeley in August a month later.
College Game Day
My knee seemed fine at Berkeley. I figured the fairly consistent swelling in my right knee was more related to the AstroTurf we were playing on daily than anything. During my third year, I was playing Right Tackle and a play called for me to use a cut block on the 3 technique Defensive Tackle. I was to block down so my Right Guard could pull into the open field. As I went to cut the d-lineman he drove his knee into my forehead and knocked me unconscious for an instant. I quickly came to and got up continuing to play the rest of the series. We had to punt and I came to the sideline not knowing where or who I was. They pulled me for the game with a concussion.
At that time in the football, a concussion did not have the same ramifications as it does today and I played the next week.
During the 3rd quarter of the next week’s game, we ran a reverse that required us to slow play the defense with me pulling around left from my Right Tackle position to lead the reverse. As I was running on the reverse and sweeping upfield, my right knee gave out and I slipped in the grass and felt another POP.
My knee started swelling immediately, and I hobbled off the field. I did not return as the swelling in my knee made it next to impossible to bend.
The next day, the doctor drained the fluid off my knee. He told me before he drained it if there was blood in the fluid, then I had a torn ACL. I watched the doctor flood a large needle with fluid and to my relief, no blood. Turned out I had torn my meniscus. The doctor still proceeded to do the Lachman Test a few times and repeated exactly what I had heard a few years before – the knee feels a little loose but there is an endpoint.
After a few weeks of rehabilitation, the swelling was not going down so they scheduled a surgery to repair the meniscus. I went into the surgery center thinking I would have my knee scoped and be back in a few weeks to start training. Ideal scenario, get a chance to play the bowl game we had in Hawaii.
This was not the case – as soon as I was unconscious the doctor did the Lachman Test again and this time the knee showed no endpoint. The doctor to the initiative to go in and repair my ACL as he fixed the torn meniscus. The doctor chose the middle third of my patellar tendon for the repair. Needless, to say when I woke up and they told me I had an ACL reconstruction expecting I would be pleased, but I was pretty emotional. If I knew I was going to have my ACL reconstructed, I would have reached out to my teachers and informed them I needed to make arrangements for end of the year finals. I got hurt in November, had surgery over Thanksgiving and was in no position to prepare to take a series of in-person finals for a full course load that included Calculus, Economy, Rhetoric, Nutrition and Anthropology.
Had I known I was going to have my knee reconstructed and be laid up, I would have made arrangements to take my finals early or in a take home format. But because this happened so late in the year, my professors were not available to meet with and not willing to make special arrangements this close to the end of the year. The student advisors were not much help as they more concerned with having sexual relations with my teammates then helping me navigate my finals (true story).
Poor Rehabilitation is Costly
I cannot say if my ACL rehabilitation was mismanaged or the information available today is much greater than what we had in 1997. But they were way too aggressive with the approach they took and pushed me back much faster than what we know today to be prudent. And because the knee was not healing at the rate at which they wanted or expected, I developed terrible patellar tendonitis in the right knee. With the right knee not responding and the trainers and coaches not willing to slow down, I kept chugging along and developed severe tendonitis on the other side in my left knee.
Now I was really in a bad place as I couldn’t bend either knee without pain and periodically my knee would buckle when walking, as tends to happen with tendonitis. But because I was young and figured the trainers and doctors were “experts” I kept on keeping on with a poorly managed rehabilitation plan.
Despite playing on a poorly rehabilitated knee, I started 11 games that next season and really have no idea how I was successful. I think I relied on a big punch and strong hands to lock on a defender and allow my weak leg to make up the distance.
After a losing season, our head strength coach was fired and Todd Rice was hired to revamp our training, our weight room and training philosophy. His philosophy was very different and much of what had been preached up to that point was thrown in the trash and my rehabilitation really began.
The first order of business was strengthening the knee. This required a set of Olympic weightlifting shoes with an elevated heel and working to get as much positive shin angle as possible when squatting, pulling, clean and snatching. I started to front squat to work on that shin angle and focus on torso strength because it was poor despite my numbers.
Rice removed the trainers and football coaches from the weight room and replaced the long 3-5 mile runs with sprints and plyometrics. I took to it like a desert plant to rain and exploded in performance and ability. The training I did my last year was the training I needed to have done after my ACL reconstruction and finally I was on the path to performance.
Three Types of ACL Athletes in This World
In hindsight, I know I tore my ACL when the rung broke. I was able to play at a high level because I am what is known as a “Coper”. An ACL was not fundamental to my ability and from genetics the thickness of the insertion of my hamstrings into the knee is twice as thick as most athletes.
Based on the research from Power Athlete Radio alums Dr. Tim Hewitt (linked below) and Dr. Adam Anz, we know that 1/3rd of the population are “Copers” where the ACL does not reduce function or ability. Another third can manage without an ACL and the final third can’t do anything without an ACL. I fall into that first category and how I was able to play all those years without one.
The tearing of the ACL was not significant in my life, but the ACL reconstruction and poor rehabilitation protocol was. The surgery and timing caused me to barely pass my finals and finish the semester with a C- average. This had lingering effects on my overall GPA being a 3.4 (B+). I was on pace to have over a 3.6 (A) GPA and that one semester was hard to recover from.
Poor rehabilitation also hurt my draft status going into my senior year. I was rated as the 32nd guard on the National Scouting report and I was a tackle. Just for reference the 32nd rated guard doesn’t even get invited to an NFL training camp, let alone get drafted. I played well my senior year but hard to get drafted in the first round with just one year of healthy play. I got hurt towards the end of my sophomore year with the ACL. Struggled my junior year on a poorly rehabilitated knee and was finally able to show what talent I had my senior year making First-team All-Pac-10.
I ended up getting drafted as the second pick in the 4th round with the 101st pick overall to the Philadelphia Eagles. Came in and started the 1st game of the season as a rookie and proved a lot of people wrong by playing for 10 years at a high level. Sadly, I got hurt in my final 10th year playing with the Patriots on a badly damaged right knee that had endured one ACL reconstruction and 4 scopes to clean out and fix torn cartilage.
Had I had the protocols in place today, I could have avoided many of the problems that affected me over the decade I played in the NFL.
This course is that protocol.
70% of all ACL injuries are non-contact. These catastrophic injuries are not “just part of the game”. We’re on a mission to flatten the curve of ACL injuries by giving you a toolkit to buy down risk and protect your athletes.
We will not watch young athletes hang up their cleats early because of AVOIDABLE INJURY and poor rehabilitation practices. This is why we launched an ACL Injury Prevention course on Power Athlete Academy; to empower you with a new coaches eye and brand new programming to reduce injury risk and protect your athletes this summer.
Whether you’re a parent, gym owner, or anyone empowering athletes, this course creates a common language around the ACL injury to communicate with athletes and navigate discussions with other stakeholders around injury prevention and athlete preparation training.
PODCAST: PA RADIO – EP 358: THE ACL EPISODE w/ DR TIM HEWETT
BLOG: REHABILITATION AFTER ACL SURGERY by John Welbourn
BLOG: NOW YOUR DAUGHTER DOESN’T HAVE TO LIVE IN FEAR OF ACL INJURY by Tex McQuilkin
BLOG: A TALE OF RECOVERY FROM AN ACL TEAR by Carl Case
John Welbourn is CEO of Power Athlete and Fuse Move. He is also creator of the online training phenomena, Johnnie WOD. He is a 9 year veteran of the NFL. John was drafted with the 97th pick in 1999 NFL Draft and went on to be a starter for the Philadelphia Eagles from 1999-2003, appearing in 3 NFC Championship games, and for starter for the Kansas City Chiefs from 2004-2007. In 2008, he played with the New England Patriots until an injury ended his season early with him retiring in 2009. Over the course of his career, John has started over 100 games and has 10 play-off appearances. He was a four year lettermen while playing football at the University of California at Berkeley. He graduated with a bachelor's degree in Rhetoric in 1998. John has worked with the MLB, NFL, NHL, Olympic athletes and Military. He travels the world lecturing on performance and nutrition for Power Athlete. You can catch up with John as his personal blog on training, food and life, Talk To Me Johnnie and at Power Athlete.
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