ACL Injury Recovery – Mental & Emotional Issues
It’s challenging to even know where to start here. There are so many aspects to this. Just dealing with the pain alone, fear of loss of function, the challenges of the initial injury and certainly of initial recovery from surgery… perhaps some of the worst aspects are possibly loss of identity for those of us who deeply associate ourselves with a sport or activity we can’t do for now. Or that we wonder if we can do at the same level one day, or even at all perhaps. All this. And more.
There’s a lot of ways to get sick or hurt. All can be potentially debilitating both physically and emotionally. Knee injuries with ACL and associated damage can be especially challenging. With the possible exception of serious spinal issues, Achilles tendon damage and maybe femur fractures, serious knee damage ranks in the top worst injuries in terms of pain, recovery and long term issues. Besides the physical, such injuries can be deeply challenging from an emotional perspective. First, let’s take a look at who we might be, and how we got here. Then discuss some of the challenges.
Who Are We?
There’s an old expression meant to cover some challenges that says, “We’re all in the same boat.” But this isn’t really true. I heard a better one, which went, “We’re all in the same ocean.” What’s the difference? Well, regardless of the severity, for those of us that have what would be classified as serious knee damage, (whatever the particulars), we’re all in the same “ocean.” We’re all facing a generally similar set of issues in a particular medical sense. But in terms of life situations, we’re in very different boats. A somewhat sedentary 40-something guy will certainly suffer the same pain and rehab issues as any of us, but when done, will just go back to their life with a really bad memory. A Division One athlete may be concerned about her whole future in sport, work like hell to get back, and may – or may not – get there. A single mom or dad? They will have an extremely challenging set of support issues. A 30-something who lives alone and has a job that requires some physicality will face both self-care and career challenges. A 50-something with great health insurance and a supportive family will struggle as well, but perhaps not quite as much as some others. We can list thousands of scenarios. Because we’re all different. Many will have similar themes, but we’re all different and are going to struggle in different ways.
When we look at the various general themes of ACL injury patients, one theme is clear. And that’s sports. Even though most sports-related ACL injuries aren’t actually from contact, (usually more from sudden directional changes, (cutting / pivots), rapid speed changes, awkward landings, etc.), something like 70% – 80% of ACL injuries happen during some kind of sporting event. Other more day-to-day causes include slipping, (maybe on ice), awkward falls, or some other kind of accident. While it’s hard to tell the motivational imperatives of those who’ve just suffered random accidents, for those who’ve been injured from sport, there are some things we can infer. These things won’t be universally true, but we can somewhat assume such folks are generally competitive. They push hard, maybe take some risks, and are driven to perform. This may or may not be a “go all out” type sport person, but usually there will be some sort of high intensity effort. Some play with aggression, high speed and such. Others may be playing at more recreational levels. In any case, chances are good that some of us also have some of our actual identities associated with our sport / activity, and this can be a serious emotional issue.
The bottom line is ACL injuries are more rare for sedentary people. Most suffering from such things are often highly active. And while all may suffer emotionally during recovery, it can arguably be more long-term emotionally challenging, (at least in some ways), for athletes, recreational or otherwise. The day-to-day life challenges for all may be varied, but similar. However, the concern for degradation of long-term capabilities can arguably be more challenging for athletes. And this crosses over from recreational, to competitive to professional. Please… do not interpret this as being dismissive of anyone going through recovery here regardless of their life circumstances. However, there has to be recognition that there’s a difference between those for whom recovery means just getting back to life vs. those for whom a deeply active lifestyle is intrinsically tied up with their identity.
How Do We Start Our Journeys?
Most of us start our painful journey the same way. We feel “the thing” happen as we’re going down or as we’re tumbling or hitting a surface. Down to the grass, the turf, the ice, the snow. Maybe there’s still adrenaline going through an event and we try to get up. But the leg buckles. Or then the pain comes. When we’re sometimes so full of adrenaline, we maybe do pop right up before buckling over. Or maybe we’re the sad pile on the field rolling over back and forth maybe holding our knee. Perhaps we hear a ref flow a whistle. If we’re lucky, maybe a trainer comes out. Otherwise, our friends gather round with the usual, “dude, you ok? where’s it hurt?” Maybe we think, “alright, I’ve been here before, give it a minute and I’ll just walk it off.” And maybe sometimes we can do that. A little. Some may even play through. Others make it back to the bench. And others take a stretcher off the field. Others may have a significant painful wait on a ski slope until an also painful ride off the hill. Whatever the venue, at some point though, we end up with some ice on our knee, seeking where we’re going to find an orthopedist.
And we’re wondering, “Just how bad is this? Is this one of those ACL things? I’ve heard they’re bad. I hope this isn’t surgical. Maybe it’s just a bad sprain. Even though… this pain is different than other injuries I’ve had. Damn.”
How do we tear up ACLs? It could be a freak accident. But for a great deal of us, it’s sports. For many of us that had this happen through sport… Most of us – or a lot anyway – are somewhat hardcore in terms of activity level and participation. Being slammed into being bed-ridden is bad for anyone. But for some of us? I think worse. Is that a selfish value judgement? Maybe. But, there you go.
Welcome to the Health Care System We Hope You Enjoy Your Stay
At this point, we have another big, giant schism among the types of boats we’re in. Some of us may be in places like the U.S., that has potentially amazing care capabilities for such things. IF we have good insurance. If not, that’s a different kind of problem. Others may be in countries with poor care. And others may be in countries with decent care, social insurance for all, but long wait times. In the U.S., with insurance, you can potentially get to a good orthopedist within a day, have an MRI within a week, and a follow up shortly after. Then, whatever happens next happens next. Regardless of country, we might also be in hugely different places. Someone getting hurt in Vail, CO on the ski slopes has some high end orthopedists nearby. (Gee, wonder why?) Of course, a patient might not actually live there. (Though some may actually fly in for surgery.) Anyway, others of us may live in large or medium size cities with plenty of high quality options. And others? Maybe be far out in the suburbs or rural, where quality care and rehab may be prohibitively far in terms of travel. (Or at least disruptively challenging.)
In any case, we all need basic diagnosis. At some point, likely imaging of some sort; probably starting with X-Rays and then we get to put some of our body into the MRI tube for awhile as we wonder, “Maybe it’s not so bad. But then again, I’m in here. So maybe not so great either.” Most of us have a sense that if it’s bad enough that we’re at the MRI stage, chances are good this is going to be surgical. Yes, treatment will vary and maybe isn’t surgical. Choices depend on damage diagnosis, age, activity goals, and knee stability. And there’s a cohort of folks that take a non-surgical route. But… mostly, we’re headed down the rabbit hole. MRI alone might not seal the deal in terms of decision-making. There’s other tests. And often there’s a “watch-and-rehab” approach to see if surgery an be avoided. But a large number will end up opting for surgery later.
Joining the Club
There’s actually two clubs… Club Coper and Club Surgery.
Either way, we all have concerns about the future. We’re all trying to optimize outcomes in an imperfect world with imperfect information based on rough probabilities and pure hope.
The ACL Coper Club
Some of us end up in what might be called the “Club Coper.” This is for those who opt out of the surgical route and instead rely on rehabilitation, muscle strengthening, and movement retraining to stabilize the knee. This path can be viable for many, depending on the nature of the injury, lifestyle, and personal goals. Typically, orthopedists and physical therapists help determine whether you might be a good candidate: Is your knee relatively stable despite the ACL tear? Are your meniscus and other ligaments intact? Do you have the strength, balance, and discipline to maintain a demanding rehab program? And perhaps most importantly, what are your long-term activity goals?
For someone who wants to return to high-intensity pivoting sports like soccer, basketball, or hockey, coping alone may not be enough. But for those whose daily lives don’t require sudden directional changes, hikers, cyclists, swimmers, or those with more moderate activity levels, non-surgical management can work remarkably well. The pros include avoiding surgery and its risks, shorter recovery time, and often a quicker return to basic function. It can also build tremendous body awareness and confidence through active control. The cons include the ongoing uncertainty of instability, the possibility of future knee buckling events, and a higher risk of meniscus or cartilage damage if the knee gives way again.
For many in this group, success comes down to a mental shift: accepting that “recovery” might not mean returning to everything exactly as before, but rather adapting intelligently, learning new limits, strengthening what’s left, and redefining what being “back” really means.
The ACL Surgery Club
I didn’t put this article in the first version of this site. Why? I didn’t think to. Why? Because I’m tough. I don’t have such issues. I play sports well into middle age. I’ve been successful and I do tough manly things a lot. I build furniture. I volunteer with a fire department.
And I’m… kind of an idiot sometimes. Because maybe I’m not so tough after all.
The thing is, I’ve been hurt before. Kind of badly. And been though the physical therapy thing. Depending on how you count, this is the 4th time I have to learn to walk again. But here’s the thing, the truth… this one was scary. And hurt. A lot. Worse than the others. Worse than when the same leg got broken, or my ribs, and some other things. And beyond the physical pain, so many things were being ripped away. Sure, there’s the things you immediately can’t do. (Like drive.) And there’s the sports, and various activities. And the reality that some things are going to be very long term. (Though in my 50s, much less long term than a young person suffering through this particular injury.)
And then, there’s some other things. Just how bad might this be?
Lack of independence.
We’re all special, right? There’s an old joke about this. “YOU are Unique! You’re Special! (Just like everyone else)” One of the things we all generally suffer from besides the pain is loss. And it’s not just loss of doing some of our favorite things, it’s also that some of those things are also tied up into our identities. “I’m a hockey player.” “I’m an athlete.” But all of a sudden, how, when and even whether we’ll be those things again is challenging. The teams belong to, the friends we hang out with, all of it changed in an instant. What will come next? Again, it will be different for all of us.
And you’ve probably faced the following as well. No one else gets it. This is one of those, “if you haven’t been through it” things. Maybe that’s like any community. But this injury is just so messed up in terms of what you need to get through, it’s nuts. The funny part is how you connect with others. My injury happened in my late 50s. All of a sudden I have more in common with a 20-something kid or a single mom or… whomever… who’s going through this. Sort of. We’re all going to have our own journeys as they say. (I certainly don’t have the same issues as someone who’s maybe going to lose an athletic scholarship, or a woman who’s navigating pregnancy and this injury at the same time.)
Some don’t have health insurance. Some may be in countries where it’s hard to get care. Or, it’s free to get care, but it might take months or longer to get an MRI or surgery. Some may have health insurance, but just got to school three weeks ago and now are headed home to recover. Others are early career living in some recently new city they just moved to living in a 2nd floor walkup with practically no friends or family nearby to help. (And most of us need some serious help. There are those that do their recovery alone. But that… well… more power to them.)
The Fears for Future?
Same ocean again. But the boat? Me? Fine. I’m done with ice hockey. That’s three bad injuries in 10 years, (broken ribs, legs, etc.), but I’ll be able to ski with family again. (I think probably.) But… some young person, maybe a Division 1 athlete? Will they make it back to the same level?
Check out the Reddit stories about how people injured their ACL.
Deeper Emotional Challenges
There are some folks who may be more deeply challenged than others due to this injury. This might be because they are just inherently more susceptible to emotional trauma, or they may be facing major real-world life implications due to the injury, from loss of a job to more complicated child-care issues and so on.
Regardless of the reason, if things become overwhelming, more help is going to be needed than a random story or two on someone’s web page. The best place to start is usually with your orthopedic team or physical therapist, who can connect you with sports psychologists or rehabilitation counselors experienced in injury-related anxiety and identity loss. Many hospitals and larger orthopedic practices have mental-health professionals on staff who specialize in working with post-surgical or long-term rehab patients.
If those resources aren’t available, you can also look for licensed clinical social workers (LCSWs), psychologists, or counselors familiar with sports injuries and chronic pain. Platforms like Psychology Today, BetterHelp, or Talkspace allow you to search by specialization and insurance. Local or online ACL recovery groups, including subreddits, Discord communities, or Facebook groups, can also help you connect with people who understand the emotional rollercoaster you’re on.
And if you ever find yourself sinking into prolonged depression, hopelessness, or thoughts of self-harm, don’t wait. Reach out immediately to a mental-health hotline such as 988 in the U.S. (Suicide and Crisis Lifeline), or the equivalent in your country. This injury can be brutally hard, but you’re not supposed to face it alone. Help is out there and getting it is a sign of strength, not weakness. Remember also that if you’re on any type of medication, adverse effects are possible and this can also be mental and imitational effects. Whatever the reason, you may need immediate help to get through bad moments or longer term counseling.
📰 Web Articles
The Psychological Impact of Chronic Knee Pain
🎥 Videos
The TRUTH about the MENTAL side of ACL rehab
How I survived the mental side of my ACL recovery journey (and became stronger from it)