After ACL tear, Huntley's Williams on long road to recovery

Dr. Deborah Mitchell (left) checks the progress on Alyse Williams’ range of motion in her ACL during a therapy session Thursday at Moffett Physical Therapy in Lake in the Hills. Williams, who will be a junior at Huntley, tore her ACL this May during a soccer match against Prairie Ridge. (Lauren M. Anderson – landerson@nwherald.com)

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LAKE IN THE HILLS – Alyse Williams put one foot in front of the other, arms at her sides and hands wrapped around light weights, and lunged forward.

The exercise is simple in nature, and one that Williams, the backbone of the Huntley girls soccer team’s defense, might have done during warm-ups for a match only a few months ago.

But Williams, a junior, is doing the lunges inside Moffett Physical Therapy with added deliberation. She is in the process of rehabilitating her right knee and a torn ACL.

Her three weekly visits to see her physical therapist, Dr. Deborah Mitchell, will ensure that when Williams steps back onto a soccer field in November, she will be prepared for the same high level of soccer that she was before the tear, which happened in May during a match against Prairie Ridge.

But the healing process is long, emotionally and physically. Tearing the ACL was just the beginning.

“It doesn’t [hurt] at all,” Williams says, as she lays against the Total Gym fitness equipment inside Moffett, bending the knee slowly and then straightening it out. “For the most part, I feel fine.”

That’s a common feeling for athletes who tear their ACL and have been rehabbing the injury for a little while, Mitchell says.

But that does not mean the knee is anywhere near ready for competition.

“Even though athletes feel better, it’s important that they put the breaks on,” Mitchell said.

Williams is on a six-month rehabilitation plan, and she is serious about her recovery. Her positive attitude toward exercising and prior knowledge of ACL injuries – Williams’ older sister, Ashley, also tore her ACL and her meniscus while playing for Huntley – have helped her progress, Mitchell said.

“Some people come in and say ‘OK, just fix me,’” Mitchell said. “But Alyse’s rehab has gone beautifully. She has acquired everything much faster.”

Williams walks in Thursday afternoon and gets onto the stationary bicycle. Mitchell instructs her to set the intensity level to eight and to work on a training program designed to simulate cycling uphill for about 10 minutes.

Williams sits down to do the exercise, managing to make it look effortless while finding time to respond to a text message on her cell phone.

Mitchell places a set of five plastic raised circles on the ground for an exercise called stone stepping, aimed at helping Williams regain her balance and coordinate the movement in her knee with her new ACL, which was constructed from pieces of Williams’ hamstring.

There are several different ways to repair ACL tears, but doing so with the hamstring generally yields less pain and smaller incisions.

Using the hamstring, though, sometimes means more time spent rehabbing the injury, since more time is needed for the hamstring to adjust to its new position in the knee.

“It’s frustrating to hold her back when she feels fine,” Alyse Williams’ mother, Gail, said, “but that hamstring doesn’t know yet that it’s an ACL.

Alyse Williams can feel the difference between her left knee and her surgically repaired right one during some of the exercises, she said, including when she tries to balance on top of a Bosu Ball, a dome-shaped oval used to train balance. Williams performs the exercise just after laying down on an exam table while Mitchell massages the right knee, making sure the patella – the bone that protects the knee joint – is not moving out of place.

Mitchell said she had no reason to doubt that Williams would make a full recovery. She is in Phase III of the five-step rehab process outlined for her injury, and as long as Williams continues to do the same exercises at home that she does with Mitchell during physical therapy, Mitchell feels Williams need not worry.

The focus is on the movement in Williams’ knee – she can move it about as well as her left – balancing, strengthening and stretching the repaired ACL and moving forward, backward and laterally.

More intense therapy, like jogging on a treadmill and jumping rope, will begin during Phase IV.

Despite her progress and her dedication to overcoming the injury, Williams worries about her future form often.

“My mom always tells me to think positively,” Williams said, “but it’s always in the back of my mind.”

Williams ties a Thera-Band – a green elastic band that causes resistance – around her ankles and steps sideways across a long foam balance beam sitting on the ground while Mitchell explains that soccer players, more frequently, are coming in to rehab ACL injuries.

Women tend to be more susceptible to ACL tears, Mitchell added, in part because women have a smaller intercondylar notch – the ACL moves within this notch inside the knee joint – than men. It also has been speculated that hormones play a part in the frequency of ACL tears in women.

The summer has been difficult for Williams. She is missing her club soccer season with Crystal Lake Force and wishes she could jog, although with her progress she might be able to do so in a few more weeks. She used crutches for about two weeks after her surgery in mid-May, and had a brace on her knee during that time, but walks without any aid.

The anticipation of getting back on the soccer field is both exhilarating and daunting.
“I knew that it would be painful, and I braced myself for that,” Williams said. “I knew I was going to have to do a lot of work and coming back would not be easy. Right now, I’m not thinking too much about what it will be like to be back out there, or if I will worry [about being injured again], but I bet it will be on my mind.” Phases of recovery

There are five phases of rehabilitation for ACL tears. This is a sample of exercises patients may face during the recovery process:

Phase I: Post-Operative, Week 1

• Basic range of motion exercises, sometimes with brace around the injured knee and sometimes with crutches; quadriceps sets; heel slides; ankle pumps.

Phase II: Maximum Protection, Weeks 2-4

• Balance board; seated heel raises; stationary bike; hamstring curls; bilateral squats progressing to simple leg squats; StairMaster; single leg balance.

Phase III: Late Protection, Weeks 4-8

• Progress hamstring and calf stretching; range of motion activities continue; progress step ups, forward and lateral; progress balance and proprioceptive exercises; Thera-Band exercises; standing hamstring curls with weight; heel raises with weight; progress cardiovascular exercise including stationary biking, use of the StairMaster and elliptical machines.

Phase IV: Functional Rehab, Weeks 8-16

• Discontinue range of motion activities if appropriate; add quad stretching; progress all cardio exercises; make balance exercises more sport specific; start treadmill jogging; start resisted ambulation in all four directions; begin low impact agility drills, like jumping rope and lateral shuffles.

Phase V: Return to activity, Weeks 16-36

• Continue all exercises and progress as necessary; progress running pattern from straight to cutting patterns; progress agility program to be more sport specific.

Source: Crystal Lake Orthopaedic and Sports Medicine and Eclipse Orthopaedic Rehabilitation