Cruciate (ACL) Curse - GAA

jpmca89

Hi everyone,

Like many gaa players these days, I've been victim to the dreaded cruciate tear. Unfortunately I've torn my cruciate 3 times, twice on my right leg and once on my left. My first original tear was back in 2010 in a hurling match, had the surgery but tore it again in the same leg 6 months later in 2011, no ones fault but my own as I took part in football training exercises that I should have been nowhere near. After finishing college, I put the head down again following my second surgery determined to get back playing the following summer. In April last year, about a month away from returning to playing a match, I tore my cruciate in my other leg (what I considered my stronger leg) when turning sharply.

As could be imagined, I was absolutely gutted and had my 3rd surgery in May 2013. When I originally tore it the 3rd time, with a heavy heart I said never again would I try to go back playing. Since last year, I have been tipping away training with the lads in the basic exercises involving little or no turning without ever pushing the knees an to be fair my knees feel pretty good.

Recently I have had the notion of trying to return playing again and my question is, has anyone else had 3 cruciate tears and returned playing? I know Colm O'Neill has and as long as I see him playing I still hold hope. Or is it complete insanity to try and return? I turned 25 a couple of months ago so I do feel I have plenty of years left in me. It's absolutely gutting watching the lads play week in week out and not being able to partake. I know I could try and partake in other sports but GAA is really the only one that has ever appealed to me. I think I may thinking with my heart rather than my head but I'd really appreciate feedback from anyone who has had a similar situation.

Thanks

nice_guy80

Man, you've really had bad luck with the injuries.

I'm a firm believer that the modern sand based compacted pitches are a huge contributory factor in serious leg injuries.
Our club has an old fashioned clay based pitch and I cannot remember one person ever getting a bad injury off it. Other local clubs have been cursed with bad injuries and even concussion from the pitch.

There has been virtually no studies done into that area.

Did you do any gym work?

Big Ears

I haven't had a similar situation but I do have something to say.
You describe yourself as unlucky, and in some respects you are, but what you can't do is assume these tears happened by chance, the vast majority of the time there is underlying causes for ACL tears. Seeing as you've had 3 of them this is almost certainly the case.

ACL injuries happen for a variety of reasons, knee valgus is a common cause. This is where the knee falls inward (often during landing or sharp turning) causing undue shearing stress on the ACL and a tear can occur due to repeated stress, or indeed one big impact. Reasons for knee valgus and poor knee stability include poor glute strength (particularly gluteus medius) or poor vastus medialis (inner range quads) strength.
Another primary cause is a poor quad-hamstring ratio, where the quads are disproportionally strong compared to the quadriceps, again this can manifest in putting undue stress on the anterior part of the knee and lead to an ACL tear.

Now I have no idea the extent of your injuries, I'm sure with 3 tears there's likely to be some cartilage damage having gone on there aswell. But what you need to do is find yourself a very good quality physiotherapist, particularly one one has a deal of experience in dealing with ACL tears and successfully rehabbing them. On the off chance you have quite a lot of money get yourself an MRI to get a good look at that knee and see the extent of the damage. If the professionals believe that recovery is possible, then it likely is. But without working with a good quality S&C coach or physio and putting in the rehabilitation and prehabilitation, then regardless of what state your knee is actually in now, the chances of reoccurance are very, very high.

What I will say is I've seen athletes come back from ACL tears and become much better athletes. The reason for their injury in the first place, was inefficiency, poor movement, poor strength, when these things were corrected, they became superior athletes despite the previous injury. But no one on this forum is going to be able to come in and tell you whether your ligaments will be able to put up with the stress you put on them. So please go consult someone who can.

All the best with it anyway, hopefully it goes well for you.

nice_guy80

Big Ears wrote: »

I haven't had a similar situation but I do have something to say.
You describe yourself as unlucky, and in some respects you are, but what you can't do is assume these tears happened by chance, the vast majority of the time there is underlying causes for ACL tears. Seeing as you've had 3 of them this is almost certainly the case.

ACL injuries happen for a variety of reasons, knee valgus is a common cause. This is where the knee falls inward (often during landing or sharp turning) causing undue shearing stress on the ACL and a tear can occur due to repeated stress, or indeed one big impact. Reasons for knee valgus and poor knee stability include poor glute strength (particularly gluteus medius) or poor vastus medialis (inner range quads) strength.
Another primary cause is a poor quad-hamstring ratio, where the quads are disproportionally strong compared to the quadriceps, again this can manifest in putting undue stress on the anterior part of the knee and lead to an ACL tear.

Now I have no idea the extent of your injuries, I'm sure with 3 tears there's likely to be some cartilage damage having gone on there aswell. But what you need to do is find yourself a very good quality physiotherapist, particularly one one has a deal of experience in dealing with ACL tears and successfully rehabbing them. On the off chance you have quite a lot of money get yourself an MRI to get a good look at that knee and see the extent of the damage. If the professionals believe that recovery is possible, then it likely is. But without working with a good quality S&C coach or physio and putting in the rehabilitation and prehabilitation, then regardless of what state your knee is actually in now, the chances of reoccurance are very, very high.

What I will say is I've seen athletes come back from ACL tears and become much better athletes. The reason for their injury in the first place, was inefficiency, poor movement, poor strength, when these things were corrected, they became superior athletes despite the previous injury. But no one on this forum is going to be able to come in and tell you whether your ligaments will be able to put up with the stress you put on them. So please go consult someone who can.

All the best with it anyway, hopefully it goes well for you.

That would have been my next post. Great post.
GAA players tend to be very quad dominant (why I asked about gym work), whereas it is rear leg muscles that are required most.

As the previous poster said, find a very good physio and then a strength and conditioning coach who is interested in correcting your wrsk areas, getting you stronger and moving properly.
After that, you can decide if you can return.

Big Ears

nice_guy80 wrote: »

That would have been my next post. Great post.
GAA players tend to be very quad dominant (why I asked about gym work), whereas it is rear leg muscles that are required most.

As the previous poster said, find a very good physio and then a strength and conditioning coach who is interested in correcting your wrsk areas, getting you stronger and moving properly.
After that, you can decide if you can return.

GAA players, soccer players too, really the vast majority of athletes and even normal people who don't train their posterior chain.

Not only is hamstring strength related to ACL issues, the hamstrings themselves account for a quarter of Gaelic injuries (http://ajs.sagepub.com/content/40/9/2113.abstract). This generally occurs during heavy eccentric loading and rapid decelerations, and can be majorly counteracted by eccentric hamstring training and appropriate glute work (weak glutes often being the true cause of the problem rather than the hamstring themselves.

Now all we have to talk about is the ankle joint, appropriate proprioceptive and strengthing exercises for it and we've the lower limbs covered :P. Speaking of the ankle, it can itself be the cause of problems manifesting at the knee, the body is a kinetic chain and problems at the bottom can cause issues further up. But again this illustrates how these problems can sometimes be complex and why it is best to consult a physio and S&C coach. I'd also reiterate to find ones that have proven success in rehabbing certain issues, because the quality of physios and strength coaches can vary greatly. A person with a degree in either area is no guarantee of being a true expert, like any job not everyone is truly dedicated to their craft.

nice_guy80

Big Ears wrote: »

GAA players, soccer players too, really the vast majority of athletes and even normal people who don't train their posterior chain.

Not only is hamstring strength related to ACL issues, the hamstrings themselves account for a quarter of Gaelic injuries (http://ajs.sagepub.com/content/40/9/2113.abstract). This generally occurs during heavy eccentric loading and rapid decelerations, and can be majorly counteracted by eccentric hamstring training and appropriate glute work (weak glutes often being the true cause of the problem rather than the hamstring themselves.

Now all we have to talk about is the ankle joint, appropriate proprioceptive and strengthing exercises for it and we've the lower limbs covered :P. Speaking of the ankle, it can itself be the cause of problems manifesting at the knee, the body is a kinetic chain and problems at the bottom can cause issues further up. But again this illustrates how these problems can sometimes be complex and why it is best to consult a physio and S&C coach. I'd also reiterate to find ones that have proven success in rehabbing certain issues, because the quality of physios and strength coaches can vary greatly. A person with a degree in either area is no guarantee of being a true expert, like any job not everyone is truly dedicated to their craft.

ok, i'm in over my head here.
True statement about the kinetic chain.

jpmca89

Thanks for the feedback lads. In terms of physio, since my second operation, I was going to the same physio as Colm O'Neill, he's also the physio for the Cork footballers. He's very good and did help me a lot, I haven't gone to him this year though as I'm only tipping around but if I was to go back, he would probably still be the physio I'd go to. He's essentially the go to guy in Cork if you tear your cruciate. In terms of proportion of quad muscles, hamstrings etc, I went up to UCD and had an Isokenetic test done, of course this was about a week or 2 before my latest tear so by the time I got the results, they were of no use as I had to go for another operation! The idea was to use these results and work on the areas that needed strengthening although this never materialised.

I fully appreciate that someone can't just come on this forum and say "work away, it'll be grand", but what I was hoping is maybe someone who has had a similar situation to myself could give their experience with getting back playing or oppositely having to deal with giving up totally.

Thanks

Rd1983

Hey lads,I got tore my acl last year,got surgery done last August 2013.like your yourself,I was telling myself that I'd never go back again,too many commitments like work and family to risk being out of work again,but just over a year on im getting the itch to go back again.

Just wondering how some of ye felt at the 1year mark after surgery.i built up the muscles quit well and did kettle bell classes along with road training,but I still find that my knee is stiff,as in when I try and bend it back to my ass,it's very stiff.loosens after a bit of stretching but still doesn't flex as much as my other leg.maybe 90%.

Anybody have similar condition?

jpmca89

Rd1983 wrote: »

Hey lads,I got tore my acl last year,got surgery done last August 2013.like your yourself,I was telling myself that I'd never go back again,too many commitments like work and family to risk being out of work again,but just over a year on im getting the itch to go back again.

Just wondering how some of ye felt at the 1year mark after surgery.i built up the muscles quit well and did kettle bell classes along with road training,but I still find that my knee is stiff,as in when I try and bend it back to my ass,it's very stiff.loosens after a bit of stretching but still doesn't flex as much as my other leg.maybe 90%.

Anybody have similar condition?

Hi there, I definitely think you shouldn't rule out going back anyway, I know a lot of lads who've torn it once but have managed to get back playing with no further repercussions. Once you're disciplined enough and maintain the muscle around your knees, you should be fine.

If you are considering going back, I would strongly recommend going to a physio who has dealt with knee injuries before as they should be able to give you guidance regarding exercises and timeframes.

Regarding not being able to bend your leg all the way back, I wouldn't worry too much about that, when I tore my cruciate the first time, I couldn't do that either now that I have it torn on both my legs, I can't bend either of them back fully. I'm no expert now but regarding stiffness, from my own experience, I think that's something you're probably always going to have, the more stretching you do, the better it will probably get.

If you have any questions or want more info, let me know anyway.

sann

Rd1983 wrote: »

Hey lads,I got tore my acl last year,got surgery done last August 2013.like your yourself,I was telling myself that I'd never go back again,too many commitments like work and family to risk being out of work again,but just over a year on im getting the itch to go back again.

Just wondering how some of ye felt at the 1year mark after surgery.i built up the muscles quit well and did kettle bell classes along with road training,but I still find that my knee is stiff,as in when I try and bend it back to my ass,it's very stiff.loosens after a bit of stretching but still doesn't flex as much as my other leg.maybe 90%.

Anybody have similar condition?

Hi there. Just wondering how you have progressed since. I seem to be in the same boat as yourself regarding flexion. I can get 100° at a push and that's after stretching for 20 mins. I still have problems defending stairs. It been just over 14 months since my operation which was carried out using a patella graft. I have had two rounds of manipulation under anaesthesia with very little improvement. At this stage I have lost all confidence in my consultant and I am seriously thinking about getting a second opinion. Hopefully your recovery is going alot better.

nice_guy80

sann wrote: »

Hi there. Just wondering how you have progressed since. I seem to be in the same boat as yourself regarding flexion. I can get 100° at a push and that's after stretching for 20 mins. I still have problems defending stairs. It been just over 14 months since my operation which was carried out using a patella graft. I have had two rounds of manipulation under anaesthesia with very little improvement. At this stage I have lost all confidence in my consultant and I am seriously thinking about getting a second opinion. Hopefully your recovery is going alot better.

Padraic Murray, Galway Clinic

CailinGaillimh

nice_guy80 wrote: »

Padraic Murray, Galway Clinic

Did you see him? Did you have follow up? I met with him pre surgery (once) and the day of surgery, that was it...