The Phantom Tug and Tearing My ACL

Jonathan Daniel

A firsthand account of what is usually considered to be the worst of the basketball injuries.

Two days ago, I jogged for half a mile continuously. Yesterday, I ran some very basic-but-limited one-on-one drills.

For me, this was all a very big deal.

Not because I'm horribly out of shape, though I am, but because at the end of last November I tore my ACL. It was, objectively, a pretty shitty experience.

These last two years have basically been an era of torn ACLs. Iman Shumpert, Brandon Rush, Lou Williams, Leandro Barbosa, David West, Rubio, Gallinari, Rondo, Derrick Rose. It seems that at every major point in the season someone has gone down, and fans across the league are watching carefully to measure the success, or lack thereof, in the recovery of everyone, but in the recovery of one superstar in particular.

Everyone is also making judgement calls (Rose should've come back, shouldn't have come back, etc.) without having a real understanding of what tearing an ACL is like; what tearing an ACL implies.

I know what it's like, and I know why Rose hasn't come back yet. I also know why Shumpert has. I'm not going to make a judgement on Rose -- or really anyone else -- one way or another, but I want you to understand what it's like to have put a hole in one of the most important parts of your leg. It really is not, by any interpretation of the word, fun.

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The ACL doesn't actually do anything in terms of motor function. It's a ligament, which means that it's there for protection and support: it's there to make sure that your knee doesn't just fall apart, and to provide stability for your knee when you want to lock your leg. Without your ACL, you can't lock your legs and you run a high risk of doing real, permanent damage to your knee.

The reason that tearing your ACL affects your motor function is that it's connected to your quadriceps. So when you completely tear your ACL, your quads don't immediately know how to function without the ACL supporting it. So, when the quads give out, your legs no longer know how to support you. That said, on a less than complete tear, portions of the ACL are still attached to the quad and you can still move almost normally. That's how Rajon Rondo could play and walk on a torn ACL: his wasn't completely torn and his quads still worked. The reason Rose couldn't move was that his did tear completely, and his leg could physically no longer support his weight.

You can teach your quads to function without the ACL though. I got mine working just fine before my surgery, and Dejuan Blair has been playing pretty well without either ACL. However, doing too much without an ACL is really risky for long term health.

I was playing a pickup game at the main gym of my school. The game was extremely close and our team was one basket away from winning, so after a missed shot by the other team I went up particularly hard for the rebound. So did the man I was defending. He went over my back and hit me right behind my knee. From my understanding of the injury, my ACL tore there: usually it's extraordinary lateral pressure that causes the tear, and I believe that hit would qualify. Apparently, you're usually supposed to hear a loud "pop" when the ACL tears, but I didn't. Maybe it's because the moment was so chaotic, or maybe because the pop was just particularly quiet, as sometimes happens. They say the pop can be as loud as a gunshot, or totally inaudible. Either way, I fell over and found myself not particularly keen to get up.

The most frequent question I get regarding the injury is whether it was painful or not. The answer is a little more complicated than you might think, but my best simple answer is: not really. There are actually (in a normal person) no nerve endings in the ACL, so it shouldn't be painful. Though it's probably worth noting that I also partially tore my meniscus, and that part did hurt. Meniscus tears are extremely painful, but mine was only partial. I wasn't screaming in pain, I wasn't crying. I did know something was really wrong.

My leg didn't work. It felt like there was a gap where something should have been supporting my weight.

I've always been very tolerant of pain, so when I went down I found myself thinking, "wait, why don't I want to get up? I'm sure it's not that bad, I'm just being a wimp. Just get up. Just do it." While I was on the floor, I had the vague sense that something hurt, but somehow it didn't even really register what hurt. Just something. But as I started to get up, it became abundantly clear that my knee was really just sore. Not on fire, not like a broken bone, just like I'd fallen on it oddly, except that there was also the sense that the soreness was wrong. That it wasn't supposed to feel like that at all. My roommate/good friend helped me up. He and the other players asked me to try and put weight on it.

It didn't hurt, but it didn't work. My leg physically wouldn't take my weight or just work at all. I fell over again.

It felt like there was just a gap where there was supposed to be something to take my weight. Like whatever was supposed to support me wasn't there anymore. As it turns out, that's fairly anatomically accurate. I was wheeled out in a wheelchair. Because I hadn't heard a pop, the trainer in the gym didn't think it was anything particularly awful. Obviously, he was wrong. I was wheeled out to my car and my roommate drove me home. Due to the impression that the injury wasn't anything dramatic, I planned on sleeping on it and seeing how I was in the morning.

Then I stepped on it again. It was painful. Excruciatingly so. I went to the emergency room.

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When Gallo went down in the Mavs game this season, every person who'd had a torn ACL knew before most others that he had the dreaded injury. Before he could get an MRI, the doctors did a knee examination that led them to conclude that it "might" be a torn ACL. Lots of people were waiting for the MRI to confirm, but we sufferers already knew. What they don't tell everyone is that those knee examinations, which you have to get time and time and time again when you tear the ACL, will confirm a torn ACL nearly 100% of the time. Sometimes an MRI will tell you that something else is going on, but if the knee examination indicates a torn ACL, there is a torn ACL. Period.

What happened to me after the emergency room was a blur of bad doctors and being stuck on the couch for months. The doctor at the ER did the knee examination, said it was a torn ACL, and referred me to an orthopedist. The orthopedist refused to see me for a while and I wouldn't finally get an MRI done for about 2 more months. The MRI confirmed the tear. I scheduled surgery for January 10th. In the meantime, I was relegated to sitting on the couch for all my homework/passing the time needs until I finally got the rehab necessary to teach myself how to walk without ACLs. Cabin fever set in quickly. I was stifled and suffocated by the imposing sameness of my living room and how its constant presence had become a staple in my day-to-day life. Even worse, I was shocked and scared by how stifled and suffocated I became. I took my finals for that semester on a large dose of Vicodin and crutches. I did better than I might have expected under the circumstances.

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Then you realize that your leg really, really, really, really hurts even through the Vicodin and local anesthetic.

The way they do the surgery is actually pretty cool. They take a piece of dead tendon and literally just screw it into the bone where the hole in the ACL is. They don't put the muscle back together or anything. Apparently, your body does that for you, it just sews the muscle together again. The human body is amazing.

This is Day One.

The dead tendon can come from one of three places: either from your patellar tendon (the muscle right below your knee, on top of the shin), your hamstring, or from donated muscle from a cadaver. For most patients, the cadaver makes the most sense (quickest recovery, much lower risk of side problems), but some people get the heebie jeebies about putting someone else's dead muscle in their leg. I was not one of those people.

The reason ACL recoveries take so long is that the ligament that you screw in is literally dead. As in, dried. The replacement ACL works a lot like a dry twig; if you bend it too much, it just snaps and tears again. The body takes at least 8-12 months to re-hydrate the ligament enough to where it functions just like any other ligament.

Perhaps the most important part about all of this is that the state of "readiness" of the ACL is totally independent of how hard or effectively you rehab. It just always takes about a year to rehydrate. It's how everyone's body works. If anyone comes back to sports after an ACL repair before one year has passed, they are at a greater than average risk of re-injuring themselves, even if that risk is slight. Anyone can be fit and strong by the six month mark, but the ACL is just not hydrated enough at that point to be safe, regardless of how strong the muscles around it become. It's probably worth noting that the one year anniversary of Rose's surgery just passed two days ago.

The other thing that the doctors neglected to tell me is that the post-op is significantly worse than the actual injury. They did say that the first two days would be horrible. That may have been an understatement. The day of and after surgery, you're groggy and confused and tired, the local anesthesia actually lasts for days and the leg is heavy and basically dead weight. As you start to sleep off the general anesthesia you realize that your leg really, really, really, really hurts even through the Vicodin and local anesthetic, and the knee is swollen up by literally 10-11 inches and you can't move and you're basically stuck in bed howling in pain for several hours.

This is day one.

Img_0569_medium Day two Post-op. Notice the crutches, allergy-alert wristband, and especially the straw in the Coke can. I could not trust my body to function well enough to try and drink without a straw. Also, the similarity to my cat is apropos. I was not functioning any more highly than him at the time, and he's an extremely lazy cat.

Day two is better, but still miserable. No one could expect to be out of bed any earlier than a week after surgery.

The other thing that no one talks about is the Vicodin. Over the whole course of the injury I was going on and off of it (on when I went to the ER, off as I rehabbed the leg before surgery, on again after surgery, off again after some rehab), but essentially I was taking Vicodin for something like 3 consecutive months. Now, I didn't get addicted per se: when I went off I did so without any qualms or concerns or personal issues or any real skittishness about stopping the Vicodin. That said, my body had gotten so used to the presence of it that I went through withdrawal, the main symptom of which was major league level anxiety attacks.

I have no idea how people manage anxiety disorders. I effectively had one for a week during this Vicodin withdrawal and it absolutely broke me. It may have been one of the hardest weeks of my life, emotionally. I don't know how to describe the experience without it sounding corny and generally doing a disservice to the helpless, awful, misery of feeling trapped by what is ostensibly your own mind, but feels like something much greater. I could, at any moment, become completely incapable of action for no reason. I was trailed by the constant sense of having a giant invisible hand pressing me down while a voice whispered, "you can't do anything" over and over and over again. I felt claustrophobic and like I was being pinned down by the space around me everywhere I went, though it was predictably worse in my own apartment. My total immobility didn't help. I would wake up to the complete conviction that there was no way I could leave bed. It wasn't like this was something I was controlling in my head, I just would feel, as if by some bizarre divine force, that I was physically completely incapable of leaving bed. Which was terrible, because I couldn't sleep, and nothing felt more oppressive or claustrophobic than my bed. I was being brutally and completely dominated by own sense of space. Then, there was the anxiety that began to develop about the anxiety that just kept coming at me until I was a useless crumpled ball of tears and frustration and anger crying into a gross old dishrag, lying on the floor in my kitchen next to the dishwasher while my confused roommates just tried not to make it worse.

This was just a side effect of the injury.

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Once I got over the anxiety attacks, it was more or less "all downhill from there." I was basically walking -- albeit slowly and with a cane -- and I could get to and from classes without too much hassle.

The thing about the rehab is that after about 3 months, you look normal. But from immediately post-surgery to...I don't know when because I haven't gotten there yet, every step you take is followed by a slight pull of the muscle from right under your knee. It's like having a little kid pull at your pant leg after every step you take to remind you, "you're not perfectly healthy." Step. Tug. Not healthy. Step. Tug. Not healthy. And so on.

People don't see this and they're surprised when you tell them that your leg probably isn't up for something. The looks of incredulity I get when I say, "I can't go to the mall, my knee really hurts" are subtle, but they're there. People just don't entirely believe that I'm not healthy when they look at me, but I'm reminded with every step. Tug. Not healthy.

I've been out of surgery for a little more than 4 months now.

I imagine that around the 6 month mark or so, that pull goes away. Probably even earlier for the pro athletes who get to rehab their atrophied muscles all day, every day until they're back to playing. But I can imagine the ghosts of those billions of tugs weighing on the mind even after the tugs go away.

Step. Phantom tug. Not healthy.

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