‘I wouldn’t wish it on my worst enemy’: inside the recovery of rugby league’s toughest injury: the ACL reconstruction

As the sun glistens through the windows at Wakefield Trinity at their annual media day, you can almost sense the feeling of desperation from some players for the hard work of pre-season to be over. But try telling Tom Johnstone to stop running and training after yet another year from hell for a player who has the world at his feet.

A rupture of the anterior cruciate ligament joint – better known as the ACL – is reportedly one of the toughest injuries for a professional sportsman to recover from. It puts most athletes on the shelf for almost a year, and it can even bring the curtain down on some players’ careers due to the mental and physical exertions required to return to playing.

Suffering it once is bad enough. Twice across a career is devastating. Johnstone has had to rebuild his body from two ACL ruptures in the space of three years. In 2017, at the age of just 21, Johnstone’s world crumbled around him when he was forced to miss almost a year of action. Yet much to his credit, he fought his way back and made his England debut the following year.

Then, on March 12th last year, came the news Johnstone had always dreaded. “I did think that if it happened again, that would be me done,” he explained when asked to recall his emotions after suffering another ACL rupture. The one saving grace? This time, it was Johnstone’s left knee, rather than the right which was damaged in 2017.

The downside? It was much worse this time. “Let me think.. it was the ACL, the meniscus, the MCL (medial collateral ligament) – oh and I fractured the tibia when the knee hyperextended too,” Johnstone reveals without even so much as a wince. So how do sportsmen overcome the mental and physical challenges surrounding such a gruesome injury?

It all begins with arguably the most crucial phase in Johnstone’s eyes: acceptance. “You’ve got to be prepared for what’s coming,” he says. “I was in the middle of Morrisons when I got the call to say what it was, but I remember feeling it in the dressing rooms after I was helped off at Hull. I knew then. The process had already begun before the medical team told me.”

Professional sportsmen live for being on the field. Take that away from them, and they become a different person. Facing up to a long spell away from doing anything normal is one of the biggest mental hurdles to overcome in the early stages – as Johnstone can vividly remember from how basic his early rehab was.

“Outsiders would probably look at what we do in those first few weeks and wonder how the hell we’re getting paid for it,” he smiles. “You have to sit on the floor and pull your heel to your backside as much as you can, over and over again. Or literally something as simple as lifting your leg up straight without bending it, just to get the basic strength into it.

“You can’t help but feel pretty pathetic, but it’s such a serious injury that it sets you back so far and you can’t skip critical phases of the process. You’re sat there looking at everyone sprinting around and I’m lifting my leg up off the floor.. this is embarrassing.”

Prior to that, there is the brutality of an operation which includes adding artificial ligaments to the knee and its surrounding areas to help restore range of movement. “I was bed-bound for the first seven to ten days,” Johnstone recalls. “I couldn’t even get up and down the stairs. Pathetic, isn’t it? But that’s how hard it hits you.”

Even before any operation, the physical pain is brutal. “My knee was actually bigger than my thigh, it was mad,” he laughs. “I had no muscle left in my knee after a couple of weeks because I’d not been using it, so I had to build it back up from nothing. It was messy, mentally exhausting and that was the hardest part.”

The prospect of playing again seems lightyears away while you are doing the most basic of exercises. But to cope with the long-term rehabilitation, Johnstone took a pragmatic approach. “Doing weights on the knee is a big moment, and I remember feeling incredible the day I was told I could hop on my knee! It’s ridiculous when you look back at it.

“If you celebrate each little milestone, it helps you eat with it mentally. It’s a crap process to go through but you’ve got to try and enjoy it – which sounds stupid. If you wish away those nine months, how much of your life have you wasted?”

Arguably the toughest part of the process, though, is being away from the team environment which becomes an every day part of your life. “Sometimes you can go two or three days without seeing the boys,” Johnstone recalls. “You’ve got to be doing different stuff to them so you never really cross paths. It makes you feel like an individual and an outsider.”

An important part of rugby league in today’s world is the support players receive from staff. Gone are the days where players are told to ‘get on with it’ and ‘man up’, and having struggled mentally during his first ACL recovery, Johnstone admits the support chain he had this time was invaluable.

“My partner and parents are at the top of the list obviously, because they’re there 24 hours a day,” he admits. “But the welfare guys at Wakefield, knowing how tough it was last time for me, were great. Even the lads; some days they’d come in and do silly things like hand-eye coordination with you. They make you feel like one of the team.”

Eventually, after all the dark days, comes the moment you feel will never arrive: being told you can run again. “It’s like getting your legs sewn back on,” he laughs. There is still a lengthy process to go at that point; the first contact session, the first proper gym session and, eventually, the first game.

For Johnstone, that moment arrived in pre-season when he was able to step back out onto the field, but he knows the process isn’t over. This is billed as a nine-month lay-off; the harsh reality is that it is much, much longer from start to a complete finish. “It might be April or May before I’m fully back firing,” he explains. “It’ll be well over a year before I’m totally right.

“I can see why people quit. The first one got me pretty bad mentally; I went to see someone about it and spoke to the welfare officer here, but I was only 21. I’d never been injured like that before, so I can completely relate to people who can’t come back from it. I started doubting whether I’d play a game again at one stage. It’s by far the toughest thing you can experience injury-wise. I wouldn’t wish it on my worst enemy.”