ACL Reconstruction Recovery

April 21, 2014 | 11 a.m.

Bethel’s rehab program provides framework for full recovery

Sports | Greta Sowles

The pain was pretty minimal – sudden and excruciating. Then it was over, and I lowered the back of my head to the cold grass, letting my left leg loosen and straighten. The knowledge of what was ahead was more potent that the physical pain inside my knee.  I had been through this twice before, so the feeling of a torn ACL was sorely familiar.

As pools of tears welled in the reservoirs at the edges of my eyes, my fellow women’s soccer players prayed for me, and then I was off to the doctor. Three days later, I faced the heartbreaking news that I had torn my ACL for the third time. My soccer career was over.

The anterior cruciate ligament rupture is one of the most common injuries that occurs among athletes participating in high velocity sports like soccer, football and basketball. The tear in the ligament can be compared to breaking a piece of scaffolding in a system that holds the knee in place.  In fact, the ACL is one of four ligaments that provide stability and support for the highly movable joint. It acts like a bungee cord connecting the femur, or thighbone, to the tibia, or shinbone, preventing excessive forward motion. When the ACL is torn, the knee loses its support system and may often result a “giving out” sensation.

In recent years, ACL injuries have run rampant. According to, there are around 150,000 ACL injuries every year in the United States, costing an estimated $500 million in health care costs annually.

While the severity of this injury may not always equal the pain an athlete experiences, the recovery timeline is an emotional battle. Most ACL ruptures are repaired by surgically replacing the ligament, using tissue harvested from the individual’s patellar tendon or hamstring, or a tissue may be donated. Holes are drilled through the tibia and femur, and the new ligament is passed through the path and anchored with screws. It will eventually become a fully functioning ACL for the patient.

From the day of surgery, the ACL repair is given a six-month timeline. Janet Johnson, assistant athletic trainer and rehab coordinator at Bethel University, has seen patients as quickly as the day after surgery.

I was a unique case, having torn the same ACL three times, but my rehab paralleled that of a typical ACL reconstruction.

Bethel’s rehab program developed a system of functional tests from a group of surgeons and used the phase system as a type of baseline testing. The system demands that the involved leg be 85 percent in comparison to the uninvolved leg before a person may move on to the next level.

Phase one of rehab begins with simple range of motion, balance and strength rebuilding exercises, progressing through further goal-oriented phases.

The second phase looks at muscle endurance and power. According to Johnson, the ACL graft is especially weak from about eight to 13 weeks post operative, although the injured person may feel almost normal.

“That is the time that, mentally, we see athletes starting to get bored,” Johnson said. “ We have to think of creative ways to keep athletes strengthening without going overboard.”

Most athletes return to jogging programs around eight weeks. The third phase is all power related, and the rehab includes doing single-leg, triple hops. There is also a concentration on the quadriceps: hamstring ratio.

At six months, the athlete will likely be back to 100 percent, fully strengthened and ready to return to his or her sport. Johnson added that the athletes’ return to sport is a landmark in their lives – physically, emotionally and sometimes spiritually.

“They have to deal with loss, and sometimes it is the loss of their own identity,” Johnson said.

Many athletes at Bethel do have an identity rooted in Jesus Christ, and that, combined with the social aspect of the Bethel community, makes the rehab a bit easier.

“They are prayed for, and they know they are prayed for when they go into surgery,” Johnson said, adding that the prayer continues throughout their rehab, which she believes makes a difference.

In addition to prayer and social support, Bethel’s program is unique in that it can offer physical therapy directly through the athletic training room because Johnson is a certified physical therapist. She is able to take on a full rehab patient load, working with these athletes directly and doing level testing. Many other schools refer athletes to outpatient clinics, where independence and self-accountability is stressed. The athletes in rehab at Bethel are often joined by fellow teammates, friends and coaches, which isn’t possible at an outpatient clinic.

But perhaps the biggest area of encouragement for an injured athlete is a fellow athlete going through the same or a similar injury. Johnson emphasized that rehab is a long haul and can be emotionally exhausting for an athlete.

“I see it not only with time that they begin to get emotionally stronger… but also if they have somebody to go through the rehab with. That is really helpful,” Johnson said.

I vividly remember the moment my head hit the ground after my career-ending ACL rupture. The powerful, conflicting emotions coursed through my head like blood through the veins of my body. Looking back on the months that followed, there is one thing, above all, that helped me through my recovery: camaraderie.

Senior Rachel Kalk was on a weekend away with some friends in Big Fork, Minn., when she rolled a 4-wheeler, tearing her ACL last fall.  
Kalk did long and triple jump, hurdles and relays for Bethel’s track team over her collegiate career. After the accident, the outlook was grim.

“I went to nationals last year for track, and now they are telling me I might not run this year,” she said in an interview this winter.

Through it all, Kalk has had a positive attitude. “This sucks, but I’m going to get through it,” she would say, grabbing an oatmeal ball and beginning to walk on an inclined treadmill. It was “Treat Tuesday” in Bethel’s training room, and the entire rehab team enjoys a snack provided by one of the trainers.

Kalk underwent the rehabilitation process with the kicker on the football team, Nathaniel Van Loon, who tore his ACL around the same time that she did. Kalk and Van Loon are mutually appreciative of one another and the accessibility of Bethel’s training room, part of the reason they have been successful in rehab.

“The biggest thing is Bethel is here,” Van Loon said. “I can just go in every day, and it’s free, which is nice. I also know all of the trainers. I get to walk into a place I am comfortable with.”

Van Loon also said that it has been a blessing to have someone like Kalk to talk to about similar things and encourage one another.

“It was a blessing we were able to compare and be supportive of one another,” Kalk agreed.

Now six months postoperative, Kalk is not only competing in the outdoor 200s and hurdles, but she was also recently cleared to begin long jumping. In March, Kalk qualified for conference in the hurdles, and is looking forward to the season ahead with cautious expectations.

“I don’t see myself being 100 percent,” Kalk said. “I would like to get very close to that, and I am doing everything that I can right now to try and get there.”

The odds of Kalk running this year were initially pretty low, as her surgeon didn’t think she would be doing much of anything. Kalk progressed through her rehab at exceptional speed, suprising her surgeon, Johnson and her coaches alike.

“Both Coach [Andrew] Rock and Coach [Mike] Fregeau said they were surprised that I was even running right now and told me not to feel bad if I was not where I wanted to be,” Kalk said.

Even with an exciting recovery and a full season ahead, there is one thing missing. Van Loon is currently studying abroad in Guatemala, thousands of miles away from Kalk and Bethel’s training room.

“It’s harder by myself now without Nathaniel. I’m on my own, ya know?” It seems camaraderie is even stronger than we think.


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