– Interview by Enda King, Qatar

You have more experience than most with ACL injuries during your career, could you give us some insights into your knee injuries?

My first ACL was when I turned around 17 years old at the national team camp for youth, in 2010. I was operated on two days after injury, so I was lucky. I had no idea and had never heard about ACL before, because I was young and didn’t know about it, but it was tough. But then got back to playing and in 2013 it happened again in the same knee with the same situation. I just passed the ball and then I got tackled from behind, then when I landed on my leg, my knee just went out and clicked. Then I got back to playing and it was almost like two to three year cycle. In 2015 I injured myself again but this time it was my left knee. Then also got back from that and played for many years. I played a lot of years without any problems but then I landed on my knee and then gradually it was then my ACL, but it was fine, but I decided a year ago, 2022, to have the surgery done.

Obviously, that is more injuries than any team would want rather than an individual player, did you find that the rehabilitation and recovery were easier or more challenging as you gained those experiences?

I would say the second one was definitely easier than the first one because I had no idea what I was expecting. The long journey, the pain, and the hard work. Also, I could learn from my first mistakes because maybe it wasn’t so cardio-focused at first time, so I took a bit longer time so I could add more of that stuff. The third one was maybe the hardest one mentally because I just got my first call-up for the women’s national team and had been doing well already. It’s like knowing exactly the journey again, but it was also okay because it was easier in one way, because I also knew what was expected and I was learning from my previous two ACLs experiences, “I need to do this better and this better”. And you know, you learn then you grow. Last time has been pretty hard because there are some cartilage issues and stuff and with the swelling, so maybe mentally that’s also been one of the hardest ones.

What have your major learnings been about ACL rehabilitation throughout that time?

Well definitely to set, of course, the vision has to be back out there playing games and be fully fit and healthy, but to also have smaller goals directly after the surgery. Get full flexion, get full extension and the next step is like walking without crutches, biking, jumping, running and it’s important, or at least was for me, to have those small steps to be able to celebrate the big thing or not the big but the small celebration on the way to the big goal.

How have rehabilitation approaches changed over that time?

I have a lot of learnings, just to take it more day by day. It was also that it goes up and down. It’s like a roller coaster, that I feel it’s like a journey, you have good days, you have bad days, but also now to accept like “okay maybe today was a bad day, what can I do to have the best day today?”. Well, to prepare yourself in the best way for the next day, be calmer in the whole journey. Not being so stressed, just do everything I can, but still accept that maybe it’ll take longer time. It’s important not to compare too much to other people with the same injury, because I’ve been doing it. I was telling myself not daily but very often, but it’s so easy, just look at other players and you’re like “oh, they’re playing again” or like “They’re running, why am I not running? It’s been one month more!”. So, I don’t know, maybe mostly the mental aspects of it.

When you are speaking to a colleague or teammate who has suffered ACL injury, what advice do you give them and what are the most important factors for them to consider while going through the process?

As I said, be prepared that there will be ups and downs. Do not to skip any steps or rush ahead, really take it slow, because if you do it and you do it correctly, it will also go better in the end. Do not rush it and then have a setback from that, then it takes even longer time or that you cheat with some things or exercises because the only person you’re cheating on is yourself.

For those involved in rehabilitation (physios, S&C, coaches) what advice would you give them from a player's perspective to optimise their approach to ACL rehabilitation?

Well, I thought about this a lot yesterday, but then I still landed on a kind of mental aspect also by going through the same journey with fellow teammates and stuff. Don’t forget the mental aspect of it all, because usually if you’re playing a team sport and you get kind of separated from the team, it’s pretty hard to be alone and it’s pretty easy also to get kind of outside the team and the circle. So just have that in mind. Don’t forget the human behind the athlete during this journey because it’s a long journey and it’s tough. But to still have in mind, how the human is doing or if you need massive support or it could also just have to make it fun. That is what’s kind of helped me during my journey to make it fun. You can make jokes and find like good things during the process.

In spite of these challenges, you have had a wonderful career and played for some of the best teams in the world - what are your career highlights to date?

There are so many but would say the World Cup bronze medal in 2019 in France is definitely a highlight. It was the second tournament with the National Team, but it was just amazing. A big tournament and a big achievement for me as an individual but also for a team. It was also great to play the Olympics in Tokyo 2021, it was a bit different because it was like all other sports too. So, it was really cool to see all the athletes and we were so close. I’m proud of the silver medal, but I will never get over everything, to win that final.

You are now playing in the USA - what are the main difference in terms of football and training compared to European football?

I would definitely say the athletic part of it, I feel that a lot of American football players are so strong and so fast that I’m really impressed with the athletic systems that they have. It’s also reflected a bit in the game. It’s more transitional going back and forth. It’s very fast and not as much tactical maybe as we have in Europe.

What about in terms of rehabilitation - what differences have you noticed either side of the Atlantic?

Not too much, but it’s been a lot more running this time, so I have been the fittest during my whole rehab in the US. So, it’s a lot of training, a lot of hours.

Enda King P.T., Ph.D.

Head of Elite Performance and Development

Aspetar Orthopedic and Sports Medicine Hospital

Doha,Qatar

Contact: enda.king@aspetar.com