THE pop in the knee and the acceptance that you have ruptured your anterior cruciate ligament (ACL) is the first hurdle, but the rehabilitation is a whole marathon. The heartbreak of knowing straight away what has happened is difficult to accept.

ACL injuries happen at an alarming rate in Australian elite netball. For example, Australia’s elite netball competition, Suncorp Super Netball has adapted to how common ACL injuries have become. Since its inaugural season in 2017, there have been 21 ACL ruptures during training, in season games, or pre-season (not including training partners). The most common area of the court was the attacking third, outside of the goal circle, with midcourters being the most common victims.

Dr. Carlee van Dyk describes an ACL tear as “an injury to one of the major stabilising ligaments of the knee”. The job of the ACL is to stop forward movement of the tibia, or shin, relatively to the thigh, and assist with rotational stability.

Elite netball player Reilley Batcheldor is going around the bend for a second time, having torn her left ACL during her match for the Sunshine Coast Lightning in the Australian Netball Championships.

“I kind of knew. It felt like a little explosion in there,” she said.

Having already gone through the ACL rehab process in 2019, Batcheldor is ready for the next 12 months ahead of her, just wanting to tick the boxes along the way.

“If I can take this, I might come out of it super strong, mentally, physically, that’s going to really impact me in the future and how I take on other challenges,” she said.

According to a study from Duke University Medical Centre, women tend to be affected more by ACL injuries than men. This is due to the anatomy of a woman’s lower half as it causes them to have a two in four more chance of rupturing their ACL. This report lists the reasons behind that fact is due to women having a wider pelvis, a smaller ACL, and having a narrower intercondylar notch (the groove the ACL travels through in the femur). This puts an additional amount of force on the knees which increases the strain on the ACL.

Australian Diamonds team doctor, Dr. van Dyk, has worked with many ACL ruptures and describes the athlete experience as a lonely road as teammates play whilst they undergo surgery and rehab.

ACL injuries heavily impact a player physically, but they also have a psychological impact that needs to be addressed.

The KNEE program, designed by Australian Diamonds physiotherapist Alanna Antcliff and co-worker of Dr. van Dyk, aims to reduce the rate of all lower limb injuries. This is done through specific neuromuscular training focused on the lower limbs.

After players recover and return to play, there is always a fear that they will injure their knee again. According to Dr. van Dyk, athletes aged 20 – 25 years who return to sport from an ACL rupture have approximately a 20 per cent chance of re-rupturing their graft or rupturing their ACL in their other knee.

Not all players are able to return to their previous level of sport after their original injury, according to Dr. van Dyk.

Melbourne Vixens sport psychologist Tony Glynn said that return to play for athletes depends on what stage of their career they are at.

Glynn believed that if an athlete is early on in their career, they are keener to return due to a contract period ending, not being able to be selected into a team, or having the drive to heal quickly.

If an athlete is further to the middle or end of their career, then considerations of their career being over is high. More experienced athletes have a better understanding that injuries take time to heal, but the impact of the injury raises concerns of it ending a career or causing long term damage.

ACL injuries expose athletes to early development of osteoarthritis, which will impact their netball and home lives. This can cause athletes to not be able to play with their children or everyday activities such as jumping, walking, and sitting down.

The Lower Extremity Review observed athletes’ post-rehab process and discovered that mental long term effects of an ACL injury include fear of re-injury, decreased confidence levels, and stress.

Batcheldor has full belief in the Lightning staff to get her back on court when she is ready.

“The experience will be good because I’ll have all these teammates around me, and I’ve already got a contract so it’s more breezy and less stressful for me,” she said.

Batcheldor was initially selected for the Australian Fast5 squad but was taken out of consideration due to her injury. Still at the beginning of her career, many fans and ex-players see her as a future Australian Diamond.

The pain of physical rehab is widely known as intense, but the mental rehab can be just as crucial. There is no specific form of mental rehab, but according to Glynn, players can lose their form of identity when having to step aside from netball.

“[Rehab] can be quite confronting because they’ve invested so much time and energy and put so much of themselves into [their] sense of self,” he said. “They can struggle with that idea of if I can’t play netball, then who am I or what am I, what’s my identity?”

Something that players can notice is a lowered mood and a sudden weight change from not constantly being in the gym. Sport psychologists like Glynn will help players return to their previous fitness levels in a healthy way.

“If [the players] have good structures, support teams, good psychology, good coaches, athlete wellbeing and engagement officers, then they generally do better,” he said.

To try and help players through their rehab process, sport psychologists provide a personal guideline for the players to try and assist with where the athlete wants to be at the end of their rehab. This can help the athletes set small goals to try and help decrease the chance of re-injuring their knee.