In June 2017, 31-year-old Simon Donnelly was playing in a men's league soccer match in Calgary. Donnelly cut right, blew past a defender and kept racing up the field with the ball. However, the man he thought he shook off was in hot pursuit. The defender kicked at Donnelly’s heel causing a significant knee injury.
“I was screaming before I even hit the ground,” recalls Donnelly.
When the other players and referees realized Donnelly wasn’t faking a soccer injury, he was carried off the field. But when he stood up to see if he could walk it off his knee buckled, and his long journey of recovery began.
A torn or ruptured anterior cruciate ligament (widely known as ACL) is one of the most rampant injuries in sports. It affects how you plant your foot and pivot that are common maneuvers used in football, soccer, lacrosse and basketball. The ACL provides stability to the knee joint and allows for dynamic motions.
The website profootballreference.com, dedicated to NFL stats, confirmed 43 players sustained an ACL tear in the 2018 season. With 32 teams, that’s 1.5 ACL tears per team. The severity of the injury requires at least a year to rehabilitate physically. Once the swelling in your knee goes down enough, a doctor can start thinking about surgery, which, unless you are a professional athlete, could land you on a waiting list for anywhere from six months to a year. That situation can cause players varying degrees of psychological stress. Donnelly didn't experience any anxiety or depression prior to his surgery.
“I'm a pretty calm person. My thoughts were like, ‘This happens, so just deal with it.’”
The reconstructive surgery uses a graft to replace the ligament. The most common grafts are autografts using parts of your own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Although the surgery is covered by provincial health insurance, however other aspects of rehabilitation such as splints, knee braces and physiotherapy can be costly if the person isn’t insured.
Psychologically, the injury can be just as difficult to recover from. Medical and health professor Joanna Kvist’s work on fear of re-injury, A hindrance for returning to sports after anterior cruciate ligament reconstruction, examines the topic of kinesiophobia. Researchers defined the condition as “an excessive, irrational and debilitating fear of physical movement... resulting in an avoidance behaviour, namely the expectation that movement can cause re-injury and thus increase suffering, making the patients fear for returning to sports and activity.”
A year removed from reconstructive knee surgery Donnelly is showing some signs of kinesiophobia.
“It’s sad because playing soccer was my favourite thing to do and now I’m too scared to do it.”
To gain a better perspective of how the injury and surgery affect overall mental health, the Calgary Journal’s sports department talked to local athletes who have torn their ACL, encouraging them to share their stories of injuries, recovery and experiences with kinesiophobia.
“The energy of the accident gets laid down in the nervous system and it remains stuck there. So the brain has not only stored the fear but the pain as well.”
—Rea Kowal, sports psychologist
After Donnelly left the soccer pitch that afternoon, then diagnosed with a torn ACL and fitted for a knee brace he had “a grueling summer on essentially one leg” that was capped off with surgery in the fall. Something that Donnelly never let get him down.
“I still went to the gym and did upper body [exercises] and trained my other leg so it didn't get small.”
Kyle Dexter, a lacrosse player in a semi-pro league on Vancouver Island was making a push with his team, the Timbermen, to the postseason. Dexter was feeling hyped up for the game, but unfortunately for Dexter, his knee was not feeling the same vibes.
“I was playing defence, a guy came into the zone, he spun to get away from me and I spun to stay with him. When I planted my foot I felt this snapping sensation in my knee.”
As Dexter was being carried back to the team bus he knew his season was over. A week later, after having an MRI, the news Dexter feared was confirmed — a fully torn ACL. Fortunately for Dexter, he was “fast tracked” because he was an active athlete and only waited four months for surgery. While Dexter recently gotten reconstructive knee surgery in November 2018, he says, “the graft the doctors took from his hamstring hurts more than his knee.”
Sports psychologist Rea Kowal treats the ACL injury like a traumatic experience because it is so life-altering. Kowal says that conditions like kinesiophobia are hard to deal with because “the energy of the accident gets laid down in the nervous system and it remains stuck there. So the brain has not only stored the fear but the pain as well.”
For Donnelly the thought of taking to the soccer pitch again seems impossible.
“I have a huge fear of re-injury. It was really painful and it's been a year and a half of my life. Maybe next summer I might give soccer another go, if I get a knee brace. But yeah, I haven't kicked a ball in a year and a half.”
Ashleigh Mutcher, another sports psychologist, says, “There is a real sense of being lost within oneself and within the world. Athletes feel as if they have no control over certain things that come up and it can really make you feel like you're stripped of choice. That is where the psychological aspect of the injury really comes into play.”
After needing reconstructive surgery in 2012 to repair his collarbone while playing for the Calgary Roughnecks, Dexter says, “I definitely went down a dark path with drinking. While sitting in a basement suite, it was easy to get lost in myself and feel bad.”
Mutcher says that athletes sometimes have a better outlook on their situation and that helps drive their recovery both physically and mentally.
“Setting benchmarks for themselves like getting off crutches and making it through another day of rehab can be painful, but a positive step in the right direction,” Mutcher adds that having a good support system is also a tremendous help.
Donnelly was adamant about getting back on his feet as soon as he could. “I didn't beat myself up over it. I took time to rest. I could still get out there and do everything. I could still walk, I just couldn’t do any extreme shit. You know what I mean? I couldn’t sit around and get fat.”
Fortunately, Donnelly hasn’t experienced a great deal of anxiety or depression due to the injury. Still he doesn’t know if I'll ever play soccer again because he’s too scared to sustain another injury. “That,” Donnelly says, ‘is what really impacted me.”
Dexter says that his girlfriend has really been the difference to his mental recovery since surgery last November. Although his lacrosse career is in jeopardy, he’s not ruling out playing for Team Scotland in the next World Cup.
“That gives me something to look forward to. Then I can quit playing on my own terms, not because of injury, but because I'm done with it,” says Dexter.
- By Peter Brand