It’s the injury all players and coaches fear, and the one that can severely derail careers. John Davidson looks at the rise of ACL injuries and the impact they can have.
It’s one of the old adages in rugby league – injuries are part and parcel of the sport. A tough game played by tough men and women, bodies are bruised and broken in the relentless nature of this collision content.
Since 1895 players have been picking up all manner of injuries, from broken bones and concussions, to sprained ankles, torn biceps and pectoral muscles, cuts, gashes and virtually every type of trauma thinkable. But one injury, perhaps the most devastating, has been on the increase in the modern game.
In past rupturing an Anterior Crucial Ligament, better known as an ACL, in a knee was remarkably rare. Now in rugby league they seem astonishingly regular and frightfully common. And it’s the one word that causes real dread.
Already in Super League this season the likes of Wakefield’s Tom Johnstone and Tinirau Arona, Wigan’s Dom Manfredi, Hull FC’s Matty Dawson-Jones and Hull KR’s James Greenwood have all suffered the debilitating injury.
In 2019 it was Leeds pair Ryan Hall and Kallum Watkins, Hull KR’s Danny Addy, Catalans’ Jodie Broughton and Wigan duo Tom Marshhll and Joe Burgess who were among those to go down with ACL tears. In the NRL in 2018 12 players were reportedly hit with season-ending ACL injuries.
According to Brien Seeney, a Brisbane-based physiotherapist better known by his Twitter handle ‘the NRL Physio’, there are three main factors contributing to their rise.
“Athletes getting bigger/faster/stronger, increased forces in collisions/running change of direction, and the ACL is a ‘skinny’ structure and stays the same size,” he explains.
“Modern day boots are lighter and ‘grippier’, with better traction/surface traction, which gives faster/more explosive play but increases force on knees. There’s actually been studies performed on this and it has shown that greater surface traction equals increased risk of ACL injury, so for example artificial turf has a higher risk of ACL injury.
“There is also better media coverage/more awareness of injuries, where an injury 20 years ago may have been a ‘knee sprain’ now we know exactly what the specific diagnosis is for each player usually.”
What makes it such a damaging injury is not just the recovery time, usually between six to nine months, but the long, painstaking rehab process and the mental toll that it takes on players.
Johnstone knows this all too well. In May 2017 he ruptured his right knee in a match against Catalans.
“I was just cutting back inside and I planted my foot and a player’s come in and tried to tackle me normally, but accidently hit the side of my knee,” Johnstone recalls.
“It wouldn’t have been a problem but with the hard ground the lower leg didn’t move and top did, and it just caved inwards.
“I was just devastated. I’d had some friends who had done it coming through the academy but I’d never picked up a serious, long-term injury before.
“I didn’t realise how tough it was going to be, I just thought it’s nine months we’ll get on with it we’ll get back. But it starts to grind on you as you go along and it’s a lot tougher than you expect.”
One of the most talented young players in the British game, Johnstone’s 2017 campaign was over. He remembers watching his teammates on the field trying to secure a special semi-final spot was particularly difficult.
“The rehab gets pretty tough because you start feeling good as you go along, you feel like right I can get out and do things,” the 23-year-old said.
“But you’re still three, four months away from when you feel normal again. Just sat in the gym doing a gym session and that straight to rehab and doing an hour, an hour and a half there and you can hear all the boys out on the pitch – that’s pretty tough.
“But it’s more, we were playing so well that year and pushing for fifth and we missed out on it by a whisker. That was the hardest thing, week-in-week-out, I couldn’t do anything about it and wanting to be a part of the team.
Johnstone was fortunate that he had his partner, family, the club and his teammates to rely on during his road to recovery. But he admits even then he needed counseling at one stage to assist him.
“I don’t think I would have been able to do it last time [without support], it got quite dark at times,” he says.
“It started to get on top of me a bit but my partner, she carried me through it, through everything, she was the best. My family were there for me and the lads were always checking up on me, putting an arm around me. The club, Stu Dickens, he was massive.
“At one point it actually got too much for me and he put me in touch with someone to speak to and I had some counseling, which really helps. Just a way to deal with it, a way to express and get it off my chest and that helped massively. It picked me back up a bit in the final stretch and got me through.”
Johnstone had the target of getting picked for England and that was his goal in the long days rehabilitating in the gym. The outside back got his wish and in an outstanding 2018 season, made his debut for his country, won selection in Super League’s Dream Team and also scored 24 tries.
“I didn’t want to come back and just play, I wanted to come back and excel,” he explains.
“I did everything I could while I was injured to make sure I came back on form, and make sure that if I did have a bad game it wasn’t because physically I was not ready.
“When I did come back and managed that it made everything worthwhile them last 12 months.”
But disaster struck for Johnstone again just two months ago when he ruptured the ACL in his left knee against Hull FC. In an instant his 2019 season was finished.
“I remember just sitting there saying ‘not again, not again’. And in the initial moment I was just devastated,” he says.
“After last year I just wanted to kick on and do better this year. At the initial point when you realize that’s all taken away from you, I was struggling, I was a bit emotional.
“But as soon as we got the confirmation it was the ACL I just went right, we’ve done it before, look how we came back last time, we’ll just have to do it again.”
Johnstone’s tale is a sad one but one we hear far too often. More needs to be done to ensure players receive the best care and all precautions are taken to avoid this serious injury.
According to medical experts, the risk of ACL injuries can be decreased by players doing plyometric exercises, training drills that require balance, power and agility, carrying out full pre-season training programs, and allowing adequate recovery time between workouts and games.
Making sure the right protective equipment is worn, including footwear, and that pitches are in the proper condition is also very important.
“It’s definitely not something we have to accept, we as a medical community are always trying to combat this,” Seeney says.
“There’s a heap of work going on at the moment into ACL injury prevention rehab training, so exercises athletes/teams can do in the offseason/each week at training to reduce players risk of suffering an ACL injury before they happen.
“There are studies that have shown these programs can reduce the risk of ACL injuries by up to 50%.”
