October 10, 2013

ACL Confessions

Four stars share their experiences with the most dreaded injury in lacrosse

by Clare Lochary | LaxMagazine.com | Twitter

Michelle Tumolo tweeted this picture when she returned home from surgery.
©Twitter

It happens without warning, usually as the result of a very common sequence: plant, pivot, explode and... pop.

"It wasn't super-painful, but I knew it was not normal," former Syracuse attacker Michelle Tumolo said. "My knee just buckled. Something weird had happened."

It happens in practice. Jen Adams was five shots into her first training session of the summer with the Australian national team on July 4. "I planted, like I've done 17 billion times before, and just went over the top of it, felt it go. It felt like I'd broken a bone in my shin," said Adams, also the coach at Loyola.

It happens in games. Shawn Nadelen was playing for the National Lacrosse League's Philadelphia Wings, trying to pick up a loose ball near the boards with two Boston Blazers closing in. He planted his foot and tried to cut back against his opponents.

"I felt a real nasty crunch, and felt the strength go out of my leg," Nadelen said.

Shannon Gilroy, now a junior midfielder for Florida, was in overtime of a six-hours-plus high school state championship.

"Two minutes left in the game, I intercepted a ball and went down the field, and as soon as I shot it, I jumped. The moment I came down, I knew it. I heard it, and I could feel it. My knee just buckled," Gilroy said. "I was an emotional wreck. I couldn't even take the bus home, because I couldn't bend my knee."

It was a torn ACL.

The Prehab

First, you wait. An MRI is necessary to diagnose a torn ACL, and the procedure can take a day or two to schedule. Sometimes a player needs swelling around the injury to subside or to have a doctor drain his or her knee.

Nadelen had remarkably little swelling, which made him and his wife, Mary, an athletic trainer at Towson, hopeful that it wasn't a torn ACL. "We had the films in our house before anyone had read them. I remember holding them up to the light in our dining room," Mary Nadelen said. "That's when I went into 'go mode' as an athletic trainer."

Shawn Nadelen did not want to lose his place as a defenseman on the 2010 U.S. men's team. Typically, ACL recovery requires at least six months. He had almost exactly six months between the injury (Jan. 16) and opening day of the world championship (July 15). He underwent surgery Jan. 27, 2010.

Sometimes, doctors and trainers recommend a longer period between injury and surgery, called "prehab," to strengthen the leg muscles and increase flexibility in the injured knee.

Personal concerns also factor in the timing. Adams' tear was so close to the start date of the World Cup that she had no hope of playing, but she didn't want to miss the event. She scheduled her surgery for early August. Tumolo, injured in April, had some mobility and wanted to get through the summer camp circuit (she's now an assistant at Florida) before she went under the knife Aug. 13.

"I was really nervous at first," Tumolo said. "But once I got there, I was smiley. It was like, it's happening. I can finally get into the recovery stage."


This article appears in the October issue of Lacrosse Magazine, a special sports science and safety edition.

» Lasting Impact: The Brad Ross Story | Just the Facts, Please
» Sports Science and Safety Committee (Gallery) | On the Horizon
» What is a Concussion? An In-Depth Q&A with USL Experts
» Inside NOCSAE: USL Partners with Equipment Standards Leader
» ACL Confessions | 'Life-Altering Injury'
» Brodie Merrill Wants Cleaner, Safer Game (Web Extra)

Don't get the mag? Join US Lacrosse and its 400,000-plus members today to start your subscription.

The Operation

ACL repair is an outpatient surgery. Nadelen and Adams turned to Dr. Les Matthews, a renowned Baltimore orthopedic surgeon who has worked with both the U.S. men's team and the Baltimore Ravens. Matthews was also an All-American goalie at Johns Hopkins and is a National Lacrosse Hall of Famer.

"Being a Terp, it's hard to trust a Blue Jay," joked Adams, a 2001 Maryland graduate. "But I'm going to give it a shot."

ACL patients have three choices: They can use cadaver tendons, taken from organ donors, or tissue taken from either their own patella or hamstring. Cadaver ACLs offer an easier recovery, but the patella creates the strongest post-surgery structure. Adams, Tumolo, Nadelen and Gilroy all opted for patella grafts.

"For my own mental well being, my plan is to prepare myself to come back as a World Cup athlete. My goal is to get back to 100-percent lacrosse mobility," Adams said. "I'm a very hands-on coach and teacher."

The Rehab

If ACL surgery is surprisingly simple, rehabilitation is not.

"The day after I got home, my doctor had this big machine that would bend my knee for me automatically," Gilroy said. "I had to go up five degrees every day, and that was probably the most painful thing I've ever had to do."

During the three weeks between injury and surgery, Gilroy lost 50 percent of the muscle mass in her injured leg. Once she got her knee to the point where it could flex 90 degrees, she started more intense rehab work. "At first, it's gruesome, because you have the machine that goes to 90, and when you get there, they push you past that," she said.

Once mobility returns, the patient moves onto leg raises and squats. Strong quadriceps and hamstrings make re-injury less likely. Gilroy logged a lot of miles walking, and eventually running, backward up a treadmill to build her quad muscles.

Nadelen had two unusual advantages during his recovery: an in-house trainer (his wife) and the blizzard of 2010.

"We set up an athletic training room in our house, with a treatment table, stim (electrical muscle stimulation) and ultrasound," Mary Nadelen said. "Those first three weeks we were icing on and off through the night. Then the big snowstorm hit. We had nothing to do but treat him and wait out the storm."

Nadelen swam in a SwimEx therapy pool, rode a stationary bike, used tension bands and did calf pumps and quad contractions. A major milestone in most ACL recoveries is working up to a two-mile run. The first time Nadelen was cleared to do so, he clocked back-to-back seven-minute miles.

The Aftermath

Nadelen recovered in time for the 2010 world championship in Manchester, England. He played a key role defending Canada's John Grant Jr., helping the U.S. win a gold medal. "I finally took a deep breath," Mary Nadelen said. "He had made it."

For Gilroy, the emotional comeback was as tough as the physical one. She burst onto the collegiate scene with 44 goals and 83 draw controls as a freshman at Florida, but remembering that a routine move could level her was jarring.

"You always have that in the back of your mind. You're nervous. You're hesitant," she said. "But I'm now two years out, and I can now say that I'm 100 percent."

Gilroy had her surgery at Huntington Hospital near her home on Long Island, but rehabbed with Florida's trainers. Tumolo will do the same this fall. She arrived in Gainesville in September.

For Adams, the sport's most celebrated player, her torn ACL at age 33 was the first major physical setback of her career. "I've never really understood injuries," she said. "It's going to make me a better coach."


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