From Sidelines to Scrum: Luke’s ACL Comeback Story
Against the odds, this rugby player fought to regain strength and mobility, culminating in a triumphant return to the field. This is how we were fortunate enough to be part Luke’s story…
Background
Luke originally came to us through a referral from a current customer. This was the 19th September 2021 and to set the canvas straight Luke is an avid Rugby enthusiast.
His main goal was to increase his general fitness, get stronger and build back a pathway to getting back into the sport he loves – Rugby.
Luke hadn’t competed in the sport since leaving college years back and so we set out on our quest to achieve just this. To paint an even bigger picture the reason why Luke had stopped was because he had issues with his right knee, particularly tearing his Anterior Cruciate Ligaments (ACL) at college.
After having the surgery, he never really got going again and decided not to play in the sport.
Fast forward many years he stepped into our doors to begin his journey of making a rugby comeback.
As with all our customers Luke went through our assessment process and began training doing gym work a few times a week. His program focused on strengthening his body and building base line conditioning to help his general fitness. After a few months of training, Luke started back at Guildfordians RFC and began playing matches again…Winning!
But then…
After a few successful months of playing, I received a message from Luke saying he had hurt his knee in a match after stepping backwards into a pothole on the pitch. This resulted in his knee swelling up and causing him too much pain to train.
It was suggested to Luke to go and see a physio to get a diagnosis and so we referred him to go see Nick Varnes at Pro Physio Health (we tend to send all our clients here that need help with injuries). After seeing Nick and going through his tests it was suggested Luke should go for an MRI to examine the extent of the damage. The results came back indicating Luke had once again torn his ACL…Annoying!
First Consult
Luke being the legend that he is turned up for his next personal training session on crutches wanting to do upper body work whilst we figured out a process to help him back on the road to recovery. We conducted a screening and listened to the advice of his physio. It was at this point that we hit another roadblock – Covid 19 and lockdowns!
At this stage the both of us were thinking different things. As a result of the inconvenience of Covid, I as the coach was thinking Luke will stop and struggle through his rehabilitation process, however he was adamant this was something he had to dedicate his life to for him to have surgery, rehabilitate and come back better than ever for Rugby again.
Luke was determined as ever to make this positive regardless of the situation he and the country was in. I recall advising him going to see a specialist Orthopaedic knee surgeon to get the lowdown on what was required to get him fixed again.
Luke was sent to Simon Thompson who ran the surgery process. What quite quickly happened is we formulated a specialist team to look after Luke's road from surgery to rehab and back to training again prior to rugby. Between Luke’s surgeon, physio and myself (strength and conditioning coach) we had the perfect team to communicate and execute his best journey back to full health and fitness.
ACL Surgery & Rehabilitation Prep — Part 1
On the 22nd of June 2021, Luke had a first stage revision of his right ACL reconstruction alongside removal of loose body with bone grafts on his femur and tibia plus a clean-up of his lateral meniscus. (Often when you tear your ACL you also damage some of your meniscus). This process was conducted because there was a realisation that the original ACL surgery Luke had years ago wasn’t completed properly.
This meant Luke then had a few months to have his actual ACL reconstruction surgery completed and to see if his body had responded properly to the bone grafts that needed fixing from the bad surgery conducted many years back.
Whilst we waited for this to happen Luke continued seeing his physio and training with myself. We followed the physios’ guidelines for the lower body and continued with our upper body work. Throughout this process Luke remained so upbeat and positive about his journey that he was about to embark on.
Pre-Surgical Phase - Part 2
This phase looked to keep Luke as strong and conditioned as possible prior to his surgeries.
The research is clear.
If this is done correctly, then the person will have the best chance through their rehabilitation.
Old school thought was to rest. However what you tend to find is you not only get the weakness induced from the surgery, but you also get the significant detraining effect acquired by not stimulating for so long. This double-edged sword makes the rehabilitation process so much more difficult and extends the time frame the person has back to full recovery.
On the 10th of September 2021 Luke had second stage ACL reconstruction with a contralateral hamstring harvest.
This meant his surgeries were complete and the rehabilitation process could start.
First 90 Days and Beyond
The first thing I recommended Luke do was ask his physio about a Game ready.
To this day, one of the biggest accelerators to Luke’s journey back to physiotherapy and training was the purchase and usage of the Game Ready compression sleeve.
The game ready is renowned for compressing your knee and icing it. This process is the best way to reduce the inflammation induced by the surgery and speed up Luke’s recovery. Often people decide against this piece of kit as it’s a little pricey, but in my opinion the decision Luke made to rent one was pivotal.
Luke would see me once a week and we would be in contact with Nick his physio on a bi-weekly basis. Nick would set out guidelines that Luke had to meet to pass through each phase of his rehabilitation and we would work at getting him into shape to meet the criteria.
This joint approach is the formula we used to get Luke back to the rugby field again.
We split the rehabilitation program into 5 phases:
Stage 1 – Post-surgery (1-2 weeks)
The key goals here were:
reducing knee swelling
returning to normal range of motion
restoring full quadriceps function
returning to normal walking gait
Pros
Luke moving and channelling his energy to a comeback again. This phase signified the start of the comeback. The Game Ready was pivotal in supporting here.
Cons
Often pain would dictate how we executed training sessions. Daily this would vary for Luke based on factors surrounding the individual. This meant patients and reassuring support was vital here. Crutches needed.
Stage 2 – Post-surgery (2-12 weeks)
The key goals here were:
returning knee strength
restoring flexibility and range of motion
continuations of phase 1
*All guided by the level of pain and swelling Luke was in
Pros
Weekly gains in strength and range of motion as well as less discomfort than in the previous phase. Crutches eventually are not needed.
Cons
At times still slow progress and lots of frustration because of it.
Stage 3 – Post-surgery (12-16 weeks)
The key goals here were:
progressing on the above by developing the level of difficulty through volume and intensity and exercise complexity
Pros
Training started to have some competitive structure back to it and performance markers started to look more like a normal gym routine again. This change sparked the motivation in Luke to make his Rugby comeback.
Cons
The importance of keeping the handbrake on with training so Luke didn’t get carried away and do anything overreaching. Work still had to be done at this stage.
Stage 4 – Post-surgery (4-6 months)
The key goals here were:
Advancing the gym program
Practicing change of direction work and landings
Including training drills specific to rugby
Pros
Athletic movements starting to return to Luke’s training. Rugby drill work returned also.
Cons
Although Rugby was back on the menu it was still very cautious and isolated for Luke. Drills were strict and this meant no contact. Important for him not to get carried away.
Stage 5 – Post-surgery (6-12 months)
The key goals here were:
sports specific activities and drills
advancing gym program further
non-contact training
returning to contact
returning to rugby
Pros
Luke began contact rugby again and returned to games. His gym program was pretty much back to normal by the end of the 12 months, and he was signed off by his surgeon and physio. Luke started his first game on the 17th of September 2022 and won. This made him and I incredibly happy.
Cons
From month 6-12, there were criteria Luke had to meet to get signed off.
At points Luke failed and this meant he had to stay mentally focussed to overcome these hurdles as well as trust the process. He overcame them, so patience was the only challenge here.
Injury Timeline
16/04/21 – ACL injured
23/04/21 – First consultation
01/05/21 – CT scan & MRI
07/05/21 – Review of scans – set date out for first operation
08/05/21 – Prehab for op begins
22/06/21 – 1st Knee operation (bone graft) to fix old operation damage
23/06/21 – Post operation ice and movement rehab
08/07/21 – Bandage and stitch removals
13/07/21 – Physio begins
05/08/21 – Review of first operation, MRI & CT scans
11/08/21 – Review of scans & rehab
26/08/21 – 2nd operation booked
10/09/21 – 2nd Knee operation (ACL reconstruction)
11/09/21 – Post operation rehab + Game ready usage
23/09/21 – 2 week follow up and bandage removal
24/09/21 – Physio work begins, and rehab work begins properly
21/10/21 – 4 week follow up with surgeon
02/12/21 – Follow up with surgeon – every 4 weeks, rehab continues
03/03/21 – Follow up with surgeon
10/03/22 – 6 months post 2nd operation, physio now every 4-6 weeks, rehab continues
01/09/22 – 1 year follow up with surgeon
05/09/22 – Return to play – testing assessments completed
17/09/22 – First Rugby match back - WON
Summary
Today Luke is back playing rugby for Guildfordians RFC.
He’s fully engaged in the season with his club, starting matches and completing them without injuries to his knee.
He continues to train with us on a weekly basis, but with new goals in mind.
This time performance-based to help him push on in his sport.
Weekly we squat, hinge, push, pull and rotate heavy things with an emphasis on rugby conditioning work too.
Luke has been and is a pleasure to work with. He’s proof that you can achieve anything if you put your mind, soul and a little patience into it. Set your goals, surround yourself with people who can enable those goals, then trust the process.
A special thanks goes to Luke’s surgeon who conducted a phenomenal job, and Nick (his physio) who I worked with closely throughout the process.
Sound familiar?
If you’re experiencing a similar situation, I hope this goes a long way in helping you through your journey. Mindset clearly plays a big part but seeing little wins along the way helps to drive that feeling of progress.
Just remember to set your goals, break them down into manageable steps, then surround yourself with the right people who can enable those goals. Finally, the hardest part of it all…trust the process.
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