By Matea Wasend

In the early overtime minutes of her team’s first conference match of the year, Macalester women’s soccer midfielder Emily Humphreys ’13 went down and knew she wasn’t getting back up. “I was running to go get the ball and on the way I stepped in a divot and just went down,” Emily told me, months later, in an email. “It was like the feeling of walking down the stairs when you think you’re at the bottom but there is still one more step to go, so you hit the ground with your leg fully extended.” In the third game of Macalester’s football season, inside linebacker Levi Brown ’14 left the field after his knee gave out during a tackle. “I got off of the field without any help and as soon as I sat down it began feeling much better,” Levi said. “The trainers put a brace on my knee and I was running around on the sideline so I was cleared to go back in, but before I could make a play my knee gave out again on the field. The pain was ten times worse.” Early in the Macalester volleyball season, outside hitter Mattie Hill ’13 hit the ground after landing on the other team’s right-side hitter. “When I went to turn, I couldn’t pivot and my knee rotated without my leg rotating with it,” Mattie wrote me. “I knew right away.” What Mattie knew was that this moment wasn’t one she’d soon forget—because like Emily, Levi and at least five other Macalester athletes, she’d just torn a ligament crucial to her knee, the anterior cruciate ligament (A.C.L.). She knew that her season was over before it had really begun, because she’d soon be navigating on crutches and making daily visits to the training room. She knew that as soon as her swelling went down, she’d be scheduling reconstructive knee surgery. And she knew that after surgery, she’d be back in the Leonard Center every day, slowly rebuilding her strength on a four-to-six-month road to recovery. Mattie had torn her ACL before, during her freshman preseason, so she knew all of these things. That didn’t make it easy. “The night I tore it, I was really, really upset,” Mattie said. “I took a long shower and tried to pull myself together and kind of stumbled home. When I got to my house some of the girls were there waiting for me been just as supportive through it all.” Emily, Levi and Mattie’s stories are unfortunately common among Macalester’s fall 2011 athletic teams. At least eight athletes among Mac volleyball, football and men’s and women’s soccer tore their A.C.L.s during scrimmages or games, an uncommonly high number by the standard of past years. This semester, women’s soccer saw three of its starters go down with A.C.L. tears over the course of the season, including two-time All-Conference defender Kat Lenhart ’13. A season-ending injury For all of these athletes, the injury was a season-ender. The A.C.L. is a small, elastic fiber attached to the femur in the upper leg and the tibia in the lower leg whose function is to stabilize the knee. An A.C.L. “tear” is really more of an explosion; the ligament pulls away from the femur and then dissolves into a viscous liquid. About 80 percent of A.C.L. tears come during a routine non-contact movement, like a misplanted change of direction. Sometimes it’s a matter of an unfortunate collision. “I went in for a tackle and a girl ran through my leg,” Kat said, describing the moment she tore her A.C.L. in a game at St. Kate’s, halfway through the women’s soccer season. “It felt like the bottom part of my leg detached from my knee and wiggled around a bit, which I guess actually is kind of what happened.” With no way of determining what the injury was, the St. Kate’s athletic trainer suggested it might be a bone bruise. But an MRI confirmed what Kat had suspected from the moment she went down—that her A.C.L. was torn. Like many athletes, Kat has seen and heard about her fair share of A.C.L. tears, which are particularly common among female soccer players. And she heard the infamous “pop” when she went down, a loud noise accompanied by a shifting feeling that is perhaps the most notorious marker of the A.C.L. tear. Left alone, most knees with torn A.C.L.s will eventually regain some stability. For people who don’t have much pain or trouble walking after a tear and who don’t participate in a sport that involves jumping, cutting or pivoting, going without surgery is an option. But sports like soccer and football are impossible to perform without an A.C.L., so for the eight Mac athletes I talked to the A.C.L. tear meant surgery. It also meant spending the rest of the season on the sidelines. In the case of men’s soccer defender Cole Erickson ’15, the rest of the season was the whole season. Cole tore his A.C.L. during a preseason scrimmage in late August, about a week before his team’s opening game. “I have never been out for multiple months with an injury, so this would be the first,” Cole said. “I think realizing that I wasn’t going to really be playing any sports was the most difficult part of the injury.” Of course, it wasn’t just Cole who struggled with that revelation. As a probable defensive starter, Cole left a gap in his team’s line-up that required shifting to fill. Every injured player leaves a breach in a team, one that coaches and teammates are often hard-pressed to fill. “I think any season ending injury disrupts a team, both in terms of lineup and spirit,” said women’s soccer coach Jemma Perkins. “But,” she added, “you have to keep pushing forward.” Few common threads There are surprisingly few commonalities between athletes who tear their A.C.Ls. Certain strength deficiencies or imbalances can make athletes more prone to tears, said Strength and Conditioning Coach Steve Murray; for instance, a weak core leaves athletes less capable of sticking a stable landing. Running, cutting and jumping form—what Assistant Athletic Trainer Matt Seamon called “biomechanics”—can play a role. Some athletes are simply more genetically disposed to sustain an A.C.L. injury. (Women’s soccer forward Maggie Molter ’14, who tore her A.C.L. for the second time in two years in November, lumps herself in that category.) Being female also substantially increases the odds. Researchers have found that females are up to five times as likely to tear an A.C.L. as their male counterparts in the same sports. Nobody knows exactly why; it’s likely a combination of factors like anatomy, hormones and bio-mechanics. For many athletes, the tear seems to come out of nowhere. “Looking at the different A.C.L. tears we’ve had [this year], there’s no common thread,” Murray said. “They were all on different field surfaces. All were wearing different types of shoes. It definitely wasn’t an endurance thing.” “We’re doing the right stuff,” Murray added, referring to the A.C.L. injury prevention program he has incorporated into warm-ups and strength training, a combination of jumps, stability movements, running form exercises and core strengthening. A knee specialist, who met with Murray and the athletic trainers after the A.C.L. tears kept coming this fall, gave the program a nod. But both Murray and Seamon said there is always room for improvement. “To all of a sudden have a higher spike like this—it creates an awareness,” Murray said. “We re-evaluate every year: what we’re doing, what we can do better.” They’re not alone. A.C.L. tears have become a spotlight injury among college athletes in recent years, and schools, teams and injury prevention groups across the country are coming up with new and better prevention techniques all the time. The most cutting edge research has come out of the Santa Monica Sports Medicine Foundation, which designed the “Prevent Injury and Enhance Performance” (PEP) program from which many schools, including Macalester, take core components. In a clinical trial in 2000, the foundation found a 74 percent reduction in A.C.L. tears among 37,000 young athletes who regularly did PEP exercises compared to the control group. Unfortunately, most athletes don’t see any type of A.C.L. prevention training until they reach college. Many young athletes grow up with improper running and jumping techniques that leave them vuln
erable to A.C.L. injuries. Girls are especially prone to poor athletic form, like overly upright running postures and knocked-knees, but rarely receive any corrections until college. “It’s important moving forward that coaches that work with young athletes are doing this type of thing: teaching proper techniques and doing things to balance out the body,” Murray said. Murray takes the approach that every athlete coming into Macalester is at high-risk for an A.C.L. tear, and tries to get them all on the prevention track. He said one of his biggest challenges is making sure athletes are consistent with the program. It’s easy in-season, when many teams perform Murray’s suggested dynamic warm-up movement-for-movement before practices and games. In the off-season, there’s less accountability. “In order to have successful prevention, all the exercises we’re suggesting have to be done at least three times a week,” Murray said. “Whether it’s academics, studying abroad or going home for breaks, there are several times throughout the year when athletes don’t have the time and space. We’ve got to continue to find ways to make it easier for athletes to do these exercises consistently.” The healing process. If these eight injured Mac athletes are united in anything, it’s in their drive to get back on the field or court. “I’m going to work really hard to get back in time for the season and be able to compete with confidence,” Mattie said, echoing the other seven. Although they’re all in different stages of recovery, rehab is now the name of the game. But the game isn’t easy. Most A.C.L. tears are immediately followed by swelling and restricted motion, which generally puts athletes in a large knee brace and on crutches. Athletic trainers start athletes on pre-surgery exercises almost immediately, basic movements to increase range of motion, strength and stability as much as possible before going under the knife. “The stronger you go into surgery, the stronger you’ll come out,” Seamon said. “It’s a very painful surgery,” he added. “Very uncomfortable.” That’s partly because the A.C.L. is impossible to repair. It has be replaced by a graft from another part of the body (commonly hamstring or patellar tendon) or from a cadaver. Post-surgery, the new A.C.L. must be slowly teased to life in a daily routine of bending and straightening and simple muscle strengthening exercises. At about two-to-four weeks after surgery, most people can hit the exercise bike. Bodyweight exercises like squats and step-ups are introduced around the fourth week, light running around the eighth, and more functional movements like plyometrics and ladder drills around the twelfth. It takes anywhere from four to eight months for most athletes to make a full return to their sport. Rehab is a mental game as much as a physical one at practically every stage, and Seamon knows it. He and the other athletic trainers work directly with campus counselors and try to elicit honesty from athletes about what they need to keep their spirits up during long recoveries. In many cases, Seamon said, athletes who have suffered similar injuries tend to coalesce into a kind of informal support group, swapping stories and ideas; this fall, A.C.L. tear sufferers had no shortage of peer support. For most athletes with a new A.C.L., recovery doesn’t end with the first step back onto the field. “You get to 90 percent really quickly,” said Maggie, who suffered her first A.C.L. tear just before the high school season of her senior year and rehabbed in time to compete at Macalester as a freshman. “The last ten percent is what’s super frustrating. Your brain still thinks that you’re as fast and as strong as you were before.” Some athletes can be at 100 percent in their first game back, Seamon said, and some simply can’t. Often, there’s a “mental block” that they’ll have to push past. Many opt for the added physical and mental support of anti-rotation braces, which are large, bionic-looking strap-on contraptions that prevent the knee from rotating and hyper-extending. “There is a process of regaining the mental confidence that their bodies are strong and that they can rely on them,” said Perkins. “For every player, it’s a different length of time, but there is a multi-game process to coming back at full strength.” But Maggie knows the process and the struggle are worth it. In her fight to find a positive in being a second-timer, she’s discovered a reason to rehab all the harder. “It helps to know that I did it before and it was fine and I got back and got healthy,” Maggie said. “I still got back and had success. I’m just doing it again.”