ACL Recovery Article - Callum Wilson. (1 Viewer)

[skylark37]

Long and quite in depth article on The Athletic about ACL injuries and how well Callum Wilson has done in coming back even stronger. Have copied and pasted the text here so people not subscribed can read it:
- - -
After two devastating knee injuries and more than a year out, this is how Callum Wilson returned sharper than ever
By Peter Rutzler Oct 23, 2019

Part 1/4

It wasn’t too long ago that suffering an anterior cruciate ligament tear would spell the end of a player’s career.

There were those who would never fully recover, like Chelsea striker Pierluigi Casiraghi. Signed by Gianluca Vialli in 1998 for a statement fee worth £5.4 million, he became trapped in an endless cycle of operations and rehabilitation and was forced to retire in 2002.

“For me, London and Chelsea were a dream. A very serious accident cancelled everything,” Casiraghi told the Daily Mail last month.

“(It was) an incredible physical and mental pain… but now it is useless to go back to thinking about it because it still hurts.”

There are also many players who did make a comeback, but found their careers blown off course.

In a study published last year, Frankfurt’s Goethe University found that more than a third of players who had suffered ACL injuries while playing at the highest level in England and Spain failed to return at the same level. A similar study, published by Swedish researchers in 2016, found that only 65 per cent of players who had suffered ACL injuries were still competing at the same level three years later.

It is a remarkable feat then that Callum Wilson has not only managed to return to the highest level after rupturing the ACL in both his knees, but that he also appears to be improving.

Wilson’s inner drive has catapulted him from non-League loan spells with Kettering Town and Tamworth to becoming one of the Premier League’s most feared marksmen and now a member of the England squad.

On Saturday, he made his 100th Premier League appearance for Bournemouth and looked sharper than ever.

So, how did he do it? The Athletic has spoken to those who helped him return to find out about the challenges he faced and how, remarkably, such devastating blows were used to make him faster and stronger.

The former England and Chelsea full-back Claire Rafferty knows the challenges Wilson will have faced all too well, having ruptured ACLs three times during her playing career — twice in her left knee and once in her right.

“When I injured my ACL for the first time, what I didn’t really understand or appreciate then, was that my career was never going to be the same again,” she tells The Athletic. “Other injuries happened. You’ve got a fake ligament in your knee, your body is having to always compensate, the mechanics aren’t the same.

“I became a lot more conscious about what I was doing, what I was eating, how I was training. When I used to tackle (before the injury) I would throw myself in, and that made me think twice about dangling a leg here and there. I think with the second one, it took a while for me to get back to my normal self. You get cleared to be on the pitch but it takes a long time to get your form back. By the time I got my form back, I did it for the third time.”

Time is a precious commodity to a footballer. Careers are over in the blink of an eye and to be sidelined for the length of an entire season is almost overwhelming. For those with a desperate determination to push on and compete, returning from injury as quickly as possible becomes the number one priority. Sometimes at risk of compromising your own recovery.

This was the case for former Nottingham Forest midfielder Chris Cohen, who Stuart Pearce once said was the most professional player he had ever met. Cohen had an unmatched desire to succeed, so when he suffered the first of three agonising ACL injuries, his priority was returning to play as soon as possible.

“For six years in a row I would play every minute of every game,” Cohen, now a coach with Forest’s under-23s and under-18s, tells The Athletic.

“Then you get injured and all you focus on is, ‘I’m going to get back quicker than anyone else.’ That’s probably the challenge that you set yourself. People try to stop you and say, ‘Look, it’s better to come back stronger. It’s better to take your time with it.’

“The second time I came back (from an ACL injury) I was icing my knee at half-time (of games). It was stupid. It made absolutely no sense to make your knee colder at half-time. The physios told me not to, for obvious reasons. In my head, it was helping me — for me, it was part of the reason I was staying fit. I suppose everyone is different. I never felt the same probably after my last (third) cruciate (injury). After the first two, I felt I was just about back to fully fit.

“But as I said, I was icing my knee at half-time. How could I be fully fit if I’m icing my knee at half-time? I was just so desperate to play football. You’ll do anything to do that.”

After returning prematurely from his second ACL injury, Cohen ruptured the ACL in his right knee for a second time against Derby County just four games into his comeback. Studies now suggest that the longer you take to recover, the better your chance of avoiding re-injuring yourself.

“My advice to the younger kids who have had ACL injuries is always to work as hard as you can, get yourself ready, and set your goals like I did,” says Cohen. “But realistically, the longer you take with it, the less chance you have of doing it again and that’s the most important thing. Why risk playing football for two months when you can be out for another year after?”

Wilson also fell victim to the temptation of a rushed comeback.

He has conceded that he came back too quickly from his first ACL rupture, playing again after just six months, and that it worked against him. His rehabilitation was not perfect and the consequence was that his runs were now not symmetrical. He was unable to latch onto through-balls from his team-mates in the same way that had done previously. It would take him 10 matches to score again, and he would hit just six goals from 27 matches before being struck down again.

The consecutive nature of his two knee injuries — which came just 16 months apart — left him floored. The first, to his right knee, came as a result of a tackle by Philipp Wollscheid away to Stoke City on September 26, 2015 (below), while the second, to his left, came during a February 2017 training session.

“As I was driving home I got upset,” Wilson told The Guardian. “I was punching the hell out of my car and everything. I got home. My wife wasn’t there and I threw my keys through this window and nearly cracked this door. I went upstairs, lay on the bed, got upset and fell asleep. I was sobbing. I was fuming. There were upset tears — tears for how long it was going to take.”

While it obviously didn’t feel that way at the time, that second injury offered Wilson an opportunity. He was able to rehabilitate again, and for Bournemouth’s medical team, it provided the chance to work not only on the newly-damaged left knee, but the right one too.

 

---

[skylark37]

Part 2/4
Bournemouth’s medical department has undergone a radical transformation since their promotion to the Premier League. It’s a world away from when current head physio Steve Hard first joined the club, in 2006, when he was the only physio on site. But even in the four years since Wilson’s first ACL injury, the club have seen major changes.

“When Callum got his first injury, that was before Craig (Roberts) was here, that was before Jonny (King) was here,” Hard tells The Athletic. “I rehabbed him for the first one. That was our first season in the Premier League so there was a lot of pressure to get back sooner. Then when he did his second one, the specialists, like Jonny, took over the rehab.”

Today, Bournemouth have a club doctor, Roberts — aka “The Doc”— as well as physios who specialise in different areas. King’s specialism is knee and ankle ligaments as well as long-term injury recovery. That’s how he came to work with Wilson after his second ACL rupture.

King worked one-on-one with Wilson on a daily basis, but as part of Bournemouth’s collaborative, multi-disciplinary team approach, which is an innovative way to deal with long term injury recovery.

“Although we have one person allocated, our big thing is a collaborative approach,” Roberts tells The Athletic. “We do like to involve the coaching staff and the manager really early. It’s medical, sports science, nutrition, sports psychology. Everyone’s involved from the early stages in terms of getting him back.”

King was the lead author of a study published in the British Journal of Sports Medicine, co-written with Hard, Roberts and physiotherapist Dr Clare Ardern, which outlines Bournemouth’s approach to long-term injury recovery. It is divided into four habits: empowering the athlete, engaging with them, providing feedback and being transparent. Fundamentally, it puts the athlete at the centre of the recovery process. As “CEO” of their recovery, they hold regular meetings with the medical staff, enabling them to make informed decisions on the best way to progress.

“The most important thing we do as a department, and we do well, is educate the players,” King says. “There’s a stereotype that footballers don’t want to hear the science behind injuries and the finer details of things, but once you have sat the player down and educate them about the evidence behind ACL injuries, about the process, what you need to do to get back and stay back, they do take that information on board.

“So there’s a lot of education in the early phases, and not just the player but the coaching staff as well. If you can get the coaching staff on board and understand that process, then you avoid those return-to-sport pressures from the coaches. They were really supportive of Cal in terms of taking his time with the rehab. That was really important.”

Wilson, as with every injured player at the club, worked through a recovery plan broken up into different phases. The player is only able to progress from each phase once certain criteria have been reached. It’s very transparent, and means the player knows exactly where they are in their recovery and why, if it’s the case, they are not progressing.

The multi-disciplinary team approach means the coaching staff are also fully informed on what stage a player is at during their recovery. Manager Eddie Howe takes a keen interest in his players’ recoveries and actively makes sure to be informed of their progress.

“He (Howe) will sit down with Steve and Doc, and myself, or the other therapists if they’re with another player, and go through all that criteria,” says King. “He’ll know exactly where the player is, why he’s at that stage and what he needs to do. So we remove a lot of those return-to-sport pressures that other clubs have if their manager is not involved in that process.”

After suffering his second ACL injury, one of the first things Wilson did was sit down with the medical staff, who told him he would need to take longer with this recovery. This time, he made sure not to rush back, taking the full nine months.

“I think Callum would be the first to say maybe he thought he knew how to manage himself,” says King.

“I think second time around, Callum will happily say that he’s listening to the advice we gave him. And he’s got a better understanding of the process and what he needs to do.

“It’s getting the basics right, doing regular strength training, reporting things honestly to us on a day-to-day basis. I think when you’re young as a professional footballer, the tendency can be not to be honest with the medical team because you don’t want to be seen to be weak. We monitor the players really closely now. They understand the importance of reporting stuff to us.”
Spending such a long period of time away from the game offers the chance for improvements that would not normally be afforded to a player during a season. In the early days of his recovery, Wilson met with the medical team to discuss the goals he wanted to achieve during this process.

As part of the holistic approach to recovery, Bournemouth’s medical team emphasise goals outside the game. That might be to take their children to school three times a week or work on a business idea. Changing the focus and occupying their time offers a psychological boost and maintains the morale of the player. Wilson, for instance, started work towards his coaching badges during his time away.

“We’ve had lads do courses at university, as they would otherwise not get the time before,” says Hard. “One did a nutritional degree. They all want to do their coaching badges but they’re close to retirement when they get around to doing it. Some have done some scouting, as in going and watching games for the manager, or to watch teams and see it from a coach’s perspective. It takes them away from their day-to-day rehab.”

Spending so much time on the sidelines is a devastating blow in itself but the rehab process is not much fun either. To help maintain motivation, the club sent Wilson abroad on rehabilitation holidays.

“It’s really hard,” says Roberts. “The public often don’t see what happens in a rehab process. But the amount of work involved, it’s tedious and it’s kind of ruthless. That’s why we try and build in rehab holidays and little carrots to dangle for the player. ‘If we get through this, then you’re going to go away, work with someone else, refresh, come back, kick off again.’ All those little things in terms of keeping the player motivated are very important.”

“Cal, like any player, he had good days and bad days, especially with it being a second ACL injury,” says King. “He had some really dark days at the start, which is normal and you have to be empathetic and understanding as a medical team.

“The club were really supportive of Cal going away, sending him away to various locations to get away from the club, so he could focus on his rehab. A change of scenery was really important to him. He tried to do that regularly and felt a lot benefit from that. Although it was a longer process, in a way the changes of scenery, the change of therapists that he would work with, helped it seem more succinct.”

Wilson went on three holidays in total, which included a visit to a rehabilitation centre in Doha, Qatar and then to Philadelphia in the USA, which is where he met Bill Knowles.

Knowles, president of Knowles Athletic, has worked with many elite athletes, including Tiger Woods and NFL quarterback Peyton Manning as part of their rehabilitation process from serious knee injuries. Closer to home, Watford’s Danny Welbeck, England rugby star Marland Yarde and three other Bournemouth players, Lewis Cook, Simon Francis and the now departed Tyrone Mings, have all travelled across the Atlantic to employ his services.

As did Cohen, although after three ruptures, Knowles’ expertise came a little too late.

“Going to see Bill was brilliant for me,” adds Cohen. “He really changed my mind towards it. I’m gutted that I didn’t see him after the first one, if I’m being honest.

“I ended up retiring with bone-on-bone irritation in my left knee. I’d train a couple of days and then I’d be really struggling to get out of bed, I couldn’t pick my little boy up and things like that, and unfortunately I was nowhere near the same as what I was, even after the first two injuries. I knew it was time.

“When I went to see Bill, we’d be catching American footballs bouncing on the floor, playing tennis, just really getting the body moving. Using fun, different ways, rather than the standard stretching exercises that I had been doing for years or static strength exercises. This was real, functional movement. It really helped me in terms of feeling good when I went out.

“Unfortunately, Bill was just a little bit too late for me. The pain was there no matter what I did to activate it. I was in a lot of pain during games, but after the game and after training sessions I’d be in real pain and that’s unfortunately what ended my career.”

For Wilson, visiting different therapists such as Knowles offered the chance to experience a new approach, while also reinforcing the messages he was hearing from the Bournemouth medical team.

“All of our players, we’ve seen big difference from when they go,” says Roberts. “We time it so that when they come back it’s always a big change in terms of getting the confidence in that final phase, just before they go back to play. Even though it’s only two weeks, we always see big results.”

 

[skylark37]

Part 3/4
Rupturing an ACL has long-term consequences. For Wilson, even when the process of recovery had finished, and he returned to first-team action, his work off the field continued.

“Once you’ve had an ACL injury and had it reconstructed, it’s not a normal knee,” says Roberts. “So it’s trying to get the players to feel as close to normality as you can. We always talk about return to play, but it’s also return to performance. And that always takes significantly longer than return to play. They may be back playing, but back performing? Everyone’s different, everyone’s an individual.

“It’s not a normal knee (after surgery), so they are at a higher risk of injury. You’re always working on what you can do to protect this knee as much as possible, protect the player on the pitch — not only in the game, but also in terms of training, what they do, how much load they take.”

Serious injuries like an ACL rupture completely change an athlete’s relationship with their body, and have implications for the way they approach sport, often for the rest of their career.

For Wilson, Cohen, Rafferty and many others who are joint-compromised, the way they approach training has to be different. There has to be a commitment to extra preparation and activation exercises before every training session and every match.

For Rafferty, who got her second ACL injury before becoming a full-time professional with Chelsea, that meant combining preparation work with a job in the City with Deutsche Bank.

“I was going in to work with a brace on my leg, in case I got knocked on the Tube during rush hour. I kept it on for a quite a long time for that reason. It’s also handy when you want a seat!” Rafferty says.

“It’s like the beginning of the rest of your life. Your daily routine changes instantly, it’s then part of your routine. You have to get to training an extra hour early and make sure you do those activations. It’s almost as if you’ve got yourself to blame if you don’t.”

For Knowles, those activation exercises are crucial. They place greater emphasis on muscle work during warm-ups and on body strength during the season, with particular focus on lower extremities and the torso. Sticking to this advice has ensured that Wilson has been able to kick on since his return.

“It’s a total body strengthening response,” says Knowles. “It’s not knee specific. It’s deceleration and movement specific. So all athletes could do the same warm-ups, but the reality is, the neuromuscular system needs to be heightened a little bit more prior to training for these athletes.

“So getting a little bit of what we like to call ‘pre-pump’ of the muscles, including the glutes (buttocks), hips, lower extremity muscles and your torso, or getting a little more ‘switched on’ prior to getting onto the grass, is very important. And then, keeping a strength emphasis up throughout the season is also extremely important.”

All players at Bournemouth have their own, individualised routines but Wilson has had to change the way he approaches both training and matches. He has his own morning routine, which he will do every day and is specific to his knees. It focuses on his quads, hamstrings, calves and glutes. He has his own routine for pre-match as well.

“For the rest of his career, he will be doing those things before he trains and before he plays,” says Roberts.

“Pre-pumps”, or activation exercises, are key to improving neurological responses following an injury and preventing re-injury. Knowles describes the impact on neuro pathways caused by serious injuries as similar to a “dimmer switch”. When an athlete suffers a serious injury, the formerly bright light drops as the athlete’s neuro-responses reduce. This heightens the risk of further injury.

“And so the activations and everything they do is to keep the dimmer up,” says Knowles. “But when you have these injuries, that dimmer switch drops, say five or 10 per cent. Sometimes you can’t get it all the way back up, for a year and a half to two years. You’re still playing and you’re competing, and you can be scoring lots of goals and be doing well, but down inside, there’s still a deficit, a neurological insult that has taken place.”

In very simplistic terms, by improving total body strength, the athlete can use their muscles to push up that dimmer switch. But one of the best ways to re-open those neuro pathways, is to keep playing at a high intensity.

“Playing the sport helps improve that dimmer switch because it’s so explosive,” adds Knowles. “That’s why guys get better over the course of the season, and even the next season. They’re often in an even better place.

“Some of that is psychological, I’m sure — confidence restoration. But much of it is also that you keep improving the neuro-physiological connection by another two or three per cent, so to speak, by actually being explosive, and training at high intensities. So the weight training, the strength training is a part of it and then being healthy and playing football also improves the situation. And time helps a great deal.”

That’s why Wilson is improving, week by week.

 

[skylark37]

Part 4/4

Ultimately, it was drive and determination that helped pull Wilson through one of the most challenging periods of his career.

“The ones that get back to a higher level, their rehab has gone well,” says Roberts. “But they’ve also got incredible mental strength because there are some pretty dark days, particularly when it’s your second injury.

“You think, ‘Oh no, not again. Here we go again.’ So the mental ability to get beyond that is tough.”

The attributes that have always set former Coventry City striker Wilson apart are his pace and acceleration. The ability to peel off the last defender and break into space is the cornerstone to his game.

“I loved playing up front with him because he’s so quick,” Bournemouth old boy Brett Pitman tells The Athletic. “Defenders are scared of him, so it creates space for someone like me or Yann (Kermorgant) or whoever was playing with him. He’s a threat, he’s hard to mark. I loved playing up front with him.”

What has been so striking about Wilson’s second recovery is that despite now being joint-compromised in both knees, he has not had to adapt the way he plays. His game remains unaltered, and he still causes defenders problems because of his speed.

Wilson appears to have come back a stronger player after the second injury, with his pace in particular unaffected.

“If you understand the reconditioning process well, there’s no reason athletes need to come back any slower,” says Knowles. “In fact they can come back faster and stronger because you have had a significant amount of time to improve it and work on it.”

To do that, though, requires an immense focus on recovery. It is testament then, to Wilson’s mental strength that he has not only returned to Premier League football, but appears to be taking his game to the next level.

Last season, he scored 14 goals and made 10 assists. He is already a third of the way to beating that goal tally this time around with just a quarter of the season gone.

Howe, whose own playing career ended prematurely because of knee injuries, last month paid tribute to the work Wilson has done to return: “It’s very hard to do (to rediscover your goal scoring knack), especially on the back of the injuries, but I think Callum’s got that very strong will to improve. He’s showed that ever since he signed here.

“He’s also got an incredible confidence within himself. He believes when he steps onto the pitch that he will score. That he can make the difference. That’s a massive quality. Long may it continue, from my perspective. We want to him to continue to score goals we want him to continue to help the team and perform well for the team, but he’s in a very good place at the moment.”

With goals now coming at an average of one every other game, it has been little surprise that rumours have surfaced about potential suitors for Wilson’s signature. Manchester United are one club who have reportedly noted the forward as a potential remedy to their sudden lack of attacking options.

At the age of 27, Wilson is in the prime of his career. If he were to make a move, you would think that now would be the time. But he remains determined to help Bournemouth make the step up from being Premier League also-rans to an established, top-half club. To that end, he signed a four-year contract over the summer.

He is also eager to ensure that new upstarts such as Chelsea’s Tammy Abraham don’t take his place in the England set-up longer term.

“For me I want to be playing more football at international level as well,” says Wilson. “I’ve just got to really focus on myself and my performances, making sure that they are top notch, week in week out.”

Given the determination it has required for him to reach this point, you wouldn’t doubt Wilson’s ability to do just that.

(Photo: Alex Pantling/Getty Images)

- - -

 

[better days]

Great article

 

[SBAndy]

Brilliant read.....until the last segment which suggests he won’t be leaving Bournemouth any time soon and we won’t get benefit of our sell-on clause!

 

[Somerset Sky Blue]

Great article - hopefully our medical team will be trying something similar with our cases!

 

[better days]

Brilliant read.....until the last segment which suggests he won’t be leaving Bournemouth any time soon and we won’t get benefit of our sell-on clause!

Ultimately Andy if he continues his success they will get an offer they can't refuse financially and Wilson may think he has a better chance of winning something at a club with more resources

 

[cc84cov]

Ultimately Andy if he continues his success they will get an offer they can't refuse financially and Wilson may think he has a better chance of winning something at a club with more resources

Has to leave the lad should be playing champions league football can’t see him staying past this season before someone comes in for Him

 

[skylark37]

Players who receive this kind of injury are fortunate to be around such high quality medical teams and jetting off to see specialists etc. It had me thinking though - what happens if you play for like... Bracknell Town, or any club right down in the lower leagues...and you do you ACL? Surely the resources and cost of seeing specialists just wouldn't be there. If you're a part timer then you would at least have some fallback anyway.

A high profile player that gets an ACL injury will still be paid - but his profile is at risk of dropping as he spends time recovering.
A much lesser known player gets the same injury and his entire career in the game and income source is threatened ... but he has way more time to recover because he has essentially no footballing profile. It's just the money won't be there to get him the best recovery even if he could in theory wait 2 years plus and then re-enter football.

I wonder if - due to the clear increase in frequency of this injury (and certainly from a Sky Blue perspective), there should be some kind of special 'ACL fund' across the football pyramid, set up so that players at much smaller clubs can get access to a certain level of medical care. Joe Bloggs has knees just as much as a Sergio Aguero or Sadio Mane does.

Fascinating that they approach the recovery with such detail and strengthening the rest of your body, also putting emphasis on overcoming that phycological deficit. I hope Callum Wilson gets many more caps for England and if somebody came in and paid big money for him (which we are obviously also hoping for due to the sell on clause), at this stage you have to say he deserves it. "Mentally tough" should be written in large lettering at the top of any scout report for him, which is clearly such a vital quality.

 

[skyblue025]

My son snapped his cruciate 14 months ago and is still waiting for the op. Disgracefull really.

 

[Fergusons_Beard]

Great article and interested to note the obvious line about those that take longest to recover and are not rushed back-are the players who don’t suffer a re-occurrence.

Sort of chimes with what Robins said about knowing if new signings had had ACL’s previously.




Sent from my iPhone using Tapatalk Pro