Torn cruciate ligament can create pressure on the psyche

“I was obnoxious at times,” former German national football team player Kim Kulig told DW in a recent interview. “The worst thing was that I no longer had football, which I loved more than anything. Suddenly, I couldn’t work with the team anymore: I was on my own and had to start all over again.” 

It all started at the 2011 Women’s World Cup, which was hosted by Germany. One of German football’s up-and-coming stars at the time, Kulig twisted her knee in the quarterfinal against Japan. The result: a torn cruciate ligament leading to months of rehab.

But that was just the start; three more knee injuries followed within the next four years. In 2015, Kulig finally threw in the towel and ended her playing career at just 25 years of age. 

Mentally, the monthslong spells of rehab took a great toll, said Kulig, who now works as an assistant coach at VfL Wolfsburg, the serial champions of the Frauen-Bundesliga. One of the biggest challenges, the now 32-year-old said, was learning to be patient. 

“I had been used to a high workload in training,” Kulig said. “It was like an addiction, always pushing yourself to your limit. And then, suddenly, you’re stopped in your tracks and have to learn to appreciate small signs of progress at best.” 

The attacking midfielder didn’t receive psychological support during her rehab, nor did she actively seek it. 

“I dealt with it myself and with my family,” Kulig said. “I didn’t choose to consult a psychologist. When I look back on things, this wasn’t the right decision.” 

A month per player per Bundesliga season 

If you look at the statistics, every football player would be well advised to prepare to deal with injuries.

Each year, the VBG, Germany’s largest statutory accident insurance institution, issues a report on the number and severity of injuries in Germany’s top two men’s leagues in football, handball, basketball and ice hockey. According to the 2021 VBG report, the risk of injury was highest in football: On average, there were 2.5 injuries for every professional player in the Bundesliga and Bundesliga 2 over the course of the season. Four out of five players were affected, on average players were out of action for 31 days and around one in three of the injuries involved the knee. 

Someone like Kulig or current national team player Giulia Gwinn can expect months of work required to recover from torn cruciate ligament to take a mental toll on them. 

“It could well be that long-term injuries also have the biggest psychological effect, leading to insecurities, possibly also spells of depression if the healing process does not go as expected,” said Michael Kellmann, a professor who heads the teaching and research area of sports psychology at the Ruhr University in Bochum.

There is evidence to show that mental support is helpful when recovering from an injury. According to a survey of North American doctors treating patients with cruciate ligament injuries, which was released last October, 95% of respondents found that psychological testing during rehab was as at least “fairly important.” However, just 35% of them regularly conducted such tests, so why is there such a big discrepancy between theory and practice? 

Setbacks are the rule, not the exception.  

“It’s because sports clubs tend to be most likely to cut costs by reducing the use of sports psychologists,” said Miriam Kohlhaas, who works with Germany’s national American football team. 

“In my opinion, there should be a sports psychologist on the coaching staff of any professional team,” Kohlhaas said. “Mental training should be as natural as athletic or strength training. In the best-case scenario, they can also do preventative work with individual athletes.” 

Kohlhaas believes that athletes should start thinking about possible injuries before the season even starts: “What’s the worst that can happen? How should I react to it? Who can I turn to? How can I prevent myself from losing it, and keep calm if and when it happens?”

An even greater psychological burden may be still to come during the long rehab process that follows a serious injury. 

“A prognosis is just that; a prognosis. It’s simply not a promise that a player will be able to play again six months after tearing the cruciate ligament,” Michael Kellmann told DW. “Setbacks are the rule, not the exception.”

Wrong movement out of fear 

During rehab, a “realistic assessment of the situation” is extremely important, Kellmann noted. Otherwise, there is also a danger of not finding the right balance from the athletes’ point of view. Some want too much too quickly and thus overload their damaged bodies. Others develop too much fear of further serious injuries. 

The latter can end badly in contact sports such as American football, Miriam Kohlhaas said. Only if a professional has complete confidence in the parts of his or her body that have been injured will they be able to return to making the tackles they are trained to make cleanly.  

“If, for example, I turn my knee sideways out of fear of a new injury, my shoulder may be in the wrong position. And then the next injury is almost a foregone conclusion.” 

Silver lining 

The coaching staff at Kim Kulig’s VfL Wolfsburg work closely with a sports psychologist. 

“That should really be the case everywhere,” she said, arguing that players need psychological support even when they are not recovering from an injury. “We all know that things aren’t always easy. You also have to learn to deal with setbacks.” 

Her personal injury history helps Kulig in her dealings with injured players today.

“I couldn’t accept my fate for a long time back then,” she said. “Today, I give the players the following advice; accept it quickly, you can’t change it. You have to set yourself small goals, then you’ll be back with the team soon.” 

Even a lengthy rehab process can have a silver lining, she said. 

“You deal with your body every day, work on muscle building, flexibility and coordination. After that, you’re an even better athlete.

“You become more relaxed and get to know yourself as a person much better. My four years of suffering really challenged me, but in retrospect they also made me a lot stronger.”  

This article was adapted from German.

Article source: https://www.dw.com/en/torn-cruciate-ligament-can-create-pressure-on-the-psyche/a-64538363?maca=en-rss-en-sports-1027-xml-atom