Tips for good a readaptation of an anterior cruciate ligament injury

Many athletes, especially soccer players, have to deal with anterior cruciate ligament injuries. It is a painful injury that requires a long recovery. But, which are the elements necessary to play or not relapse again? Which is the readaptation process that must be followed? And, no less important, how can athletes manage the frustration of not being able to play for seven months? To answer these questions, we have talked to the Bewolfish soccer player, Joel Fernandez, who has just returned to the training sessions of the juvenile of Nàstic de Tarragona; with his physical trainer and Bewolfish technical director, Marc Madruga, and with the sports psychologist, Nathalie Garcia.

When we started the conversation, Joel explained that he was injured on April 2 and was not operated until June 2. From the operation to his recovery, he spent seven months on readaptation. He admits that when he was injured, he suffered a lot of pain due to an unlucky shock during a match. After the initial pain, he remembers feeling impotence because he knew it was not an injury like the others. Although the physicians and physiotherapists of the club warned him that it could be ligaments’ injury, Joel admits that he did not want to believe it. With the resonance, the worst prognoses came true. At first, he was disappointed because he knew that he was going to be many months out of the field. But the negative thoughts vanished quickly because he wanted to do everything he could to come back to his maximum potential the sooner. He admits that he faced the readaptation process with no fear. He also admitted that the work with the physical trainers and readaptators helped him physically, but also mentally.

The first phase of the readaptation began before the operation. According to Marc Madruga, the preoperative is often forgotten, but it is very important. This phase minimizes postoperative muscle atrophy by carrying out structural force tasks. It benefits the athlete because it allows recovering the physical shape after the operation in a faster and more effective way. “So they end up working out better after the operation”, points out Marc Madruga. According to Joel, “this work was very useful for me because after the injury I did not feel starting from scratch and it allowed me to adapt to post-operation exercises more easily.” After a month of preoperative exercises, on June 2, Joel Fernández went to the operating room. “I was nervous because it was my first operation, but it went very good,” says the young soccer player.

It was summer and it was very hot when Joel had to overcome the biological healing phase in when oedema must be reduced and all the structures that are operated must be cured. In this phase, the athlete has to start the work with the physiotherapist. “It was difficult for me because I don’t like to stay home. But I knew what I wanted and what I had to do, so I did it,” admits Joel. Sports psychologist, Nathalie Garcia, explains to us that one of the main problems for athletes during injuries processes is the loss of control. Therefore, it is very important that all the specialists working with the athletes give them all the information to avoid the uncertainty and emotions that are generated. If the athletes know at all times what to expect and how to act, they regain control, even though the treatment implies to rest. Give them all the information will influence directly in their adherence and involvement in the readaptation process.

Also in this phase, it begins the functional readaptation in which the work of the physiotherapist is complemented with the physical trainer to gain amplitude of movement. According to Marc Madruga, the neuromuscular control work of consciousness and functionality is very important at this stage. Then, the structural stage starts to increase muscle mass, without neglecting neuromuscular control so that athletes improve their balance and coordination. Marc Madruga thinks that it is better to start with the neuromuscular work and consciousness controls and, once finished, focus on the structural. Thus the athlete wins more muscle mass and adapts better to the workloads that are added later. In addition, he also thinks that it is a good way to reduce the risk of suffering problems associated with the injury such as tendinopathies. Finally, it starts the stage of readaptation to the training and competition in which creativity is key to designing tasks that contain these structures. “We seek to minimize relapses of the injury, a key work considering the high percentage of relapses in athletes who have suffered a previous cruciate injury,” Marc points out.

We asked Joel for the exercises of this phase and he explained to us that the machines he used during the readaptation and the exercises that Marc designed for him were new to him. “Not only did they help me recover, but now I feel even stronger than before the injury,” points out Joel. “I can not imagine going to the gym alone and designing my routines, simply because I have no idea how to do it. After working with them I’ve realized the importance of working with specialists in such serious recovery processes such as cruciate injuries”, he adds. Finally, the last phase, in which Joel is currently working on, is the return to competition. Joel explains that he faces it with great enthusiasm. “Step by step, I felt more comfortable and I hope I can play again soon,” he reflects. Once this phase finishes, Joel will continue to carry out an optimizing-preventative work to prevent and maintain the adaptations achieved.

After our conversation, Marc Madruga admits that Joel has been keen on the whole process and that this has been a key element in his recovery. According to Marc, it is important to ensure that the athlete is always emotionally prepared to continue working. We asked Joel how he experienced the whole process emotionally and he explained to us that he set goals week by week. According to Nathalie, by setting up small goals, the athlete sees easily the progress. And thus, increase their motivation, confidence and they are focused towards the steps to follow in they readaptation. Joel also admits that the last months were especially hard for him because he believed he was already prepared to play, but he still lacked weeks of readaptation. Marc Madruga tells us that it is normal for an athlete to think that is ready and that the desire to play can tempt them to skip steps. But all stages must be fulfilled. In this sense, Nathalie warns us that, even if an athlete is recovered from an injury and is physically ready to play, he must also be psychologically prepared. Otherwise, it is possible, for example, to be injured again for modifying technical gestures as a result of attentional changes derived from the emotional management.

Finally, Joel adds that he is very grateful for the work of his readaptors and physical trainers, Marc Madruga and Raimon and Marc A. from ReQ Amposta, who have helped him a lot on a physical level, but also on a personal level. “As an athlete, living this whole process is very difficult. It has been very important to have these professionals around me,” he admits. “I consider that the injury has helped me to mature a lot and to value the simple fact of walking. In addition, I had the pleasure of meeting wonderful people. In the end, I always think that everything happens for a reason, so I am not sorry for having suffered the injury. I keep all I’ve learned and matured, personally and in the sports level”, concludes Joel.