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Why Goodes was so good
10:37:20 AM Wed 26 May, 2004
Paul Visentini
Sportal/exclusive to afl.com.au
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Adam Goodes made a remarkable recovery from a posterior cruciate ligament (PCL) injury to not miss a week and play against the Hawks on Sunday in Sydney?s one-point victory. The injury occurred the previous week in the opening ruck duel against Fremantle, once again inflaming debate about the controversial ruck rules. Goodes took little further part in the game and was limping significantly on the day.
How does Adam Goodes not miss a game, whilst Michael Gardiner and Beau McDonald have required surgery and will miss at least a season due to a PCL injury?
The PCL is one of the ligaments in the middle of the knee, which along with the anterior cruciate ligament (ACL), connect the major bones of the leg, the femur above and the tibia below. Like ropes they cross (from the latin ?cruciarius?), the ACL attaching at the front (anterior) of the tibia, the PCL at the back (posterior).
The ACL is extremely important to knee function. Without it, the knee is unable to sustain twisting movements, and would give way. This is called ?instability?. The PCL is not so important. The knee can function without it, as it does not become grossly unstable even if the PCL is very loose. Also the PCL can be injured to varying degrees, like an ankle. The ligament can be torn just a small amount or completely. The ACL more usually completely ruptures.
In the case of Goodes, he had an MRI to confirm a tear, and a return time of two to six weeks was reported. Even at that early stage there was talk of not missing the Hawthorn game. This would likely indicate that the PCL tear was not severe, as swelling and pain in the knee must have settled quickly in the first 2 days. Also, the MRI must have shown a lesser injury, with no complicating injuries to bone, cartilage or surrounding tissue.
Given that the PCL injury does not limit function, pain and swelling are great guides as to whether an individual will play. Another guide is ?feel?, or what the physios call proprioception. This is the ability of the knee to feel changes in position or balance. The physios would spend the week controlling swelling and pain, gently progressing strength work and proprioception. Towards the end of the week running drills are instigated to improve ?feel?. If the player feels good, it is all systems go.
Goodes was said to have had little pain but a ?weird looseness?, and was seen at times to struggle with some actions. His placement at centre half back was an advantage, as a backline position is seen as easier, as well as allowing running in a straight line more than twisting. He played well.
Of course most PCL injuries are more severe, with an average of between five and six games missed per PCL injury over 1997-2002 AFL seasons.
In the cases of Gardiner and McDonald, it is likely recurrent failure of the usual rehabilitation left no other choice than to try and tighten the loose PCL.
As we know PCL injuries result in a knee that will never be normal, behaving like a loose wheel nut. The car can still drive, but significant wear and tear occurs. This of course will limit careers of footballers at all levels over time, but in the case of Gardiner and McDonald, that time was now. The knees were unable to function well at the highest level without irritating areas other than the PCL. The last resort was surgery.
Interestingly, former Richmond player and coach Barry Richardson began his career as a half forward flanker before becoming a full-back as a result of two ACL and one PCL injured knees. He learnt to jump off his other leg and could only turn one way. Great athletes have a capacity to adapt their bodies to deal with injury, as well as the way they play the game. We look forward to Adam Goodes becoming one of the great centre half-backs!
Paul Visentini is a Sports and Musculoskeletal Physiotherapist and a director of Physiosports Brighton and Alphington Sports Medicine Clinic. He is Chairman of Sports Physiotherapy Australia and Physiotherapist to the Melbourne Tigers. He is part of the ?Licking Wounds? show on SEN 1116 10pm Thursdays.
10:37:20 AM Wed 26 May, 2004
Paul Visentini
Sportal/exclusive to afl.com.au
Related Content:
Adam Goodes made a remarkable recovery from a posterior cruciate ligament (PCL) injury to not miss a week and play against the Hawks on Sunday in Sydney?s one-point victory. The injury occurred the previous week in the opening ruck duel against Fremantle, once again inflaming debate about the controversial ruck rules. Goodes took little further part in the game and was limping significantly on the day.
How does Adam Goodes not miss a game, whilst Michael Gardiner and Beau McDonald have required surgery and will miss at least a season due to a PCL injury?
The PCL is one of the ligaments in the middle of the knee, which along with the anterior cruciate ligament (ACL), connect the major bones of the leg, the femur above and the tibia below. Like ropes they cross (from the latin ?cruciarius?), the ACL attaching at the front (anterior) of the tibia, the PCL at the back (posterior).
The ACL is extremely important to knee function. Without it, the knee is unable to sustain twisting movements, and would give way. This is called ?instability?. The PCL is not so important. The knee can function without it, as it does not become grossly unstable even if the PCL is very loose. Also the PCL can be injured to varying degrees, like an ankle. The ligament can be torn just a small amount or completely. The ACL more usually completely ruptures.
In the case of Goodes, he had an MRI to confirm a tear, and a return time of two to six weeks was reported. Even at that early stage there was talk of not missing the Hawthorn game. This would likely indicate that the PCL tear was not severe, as swelling and pain in the knee must have settled quickly in the first 2 days. Also, the MRI must have shown a lesser injury, with no complicating injuries to bone, cartilage or surrounding tissue.
Given that the PCL injury does not limit function, pain and swelling are great guides as to whether an individual will play. Another guide is ?feel?, or what the physios call proprioception. This is the ability of the knee to feel changes in position or balance. The physios would spend the week controlling swelling and pain, gently progressing strength work and proprioception. Towards the end of the week running drills are instigated to improve ?feel?. If the player feels good, it is all systems go.
Goodes was said to have had little pain but a ?weird looseness?, and was seen at times to struggle with some actions. His placement at centre half back was an advantage, as a backline position is seen as easier, as well as allowing running in a straight line more than twisting. He played well.
Of course most PCL injuries are more severe, with an average of between five and six games missed per PCL injury over 1997-2002 AFL seasons.
In the cases of Gardiner and McDonald, it is likely recurrent failure of the usual rehabilitation left no other choice than to try and tighten the loose PCL.
As we know PCL injuries result in a knee that will never be normal, behaving like a loose wheel nut. The car can still drive, but significant wear and tear occurs. This of course will limit careers of footballers at all levels over time, but in the case of Gardiner and McDonald, that time was now. The knees were unable to function well at the highest level without irritating areas other than the PCL. The last resort was surgery.
Interestingly, former Richmond player and coach Barry Richardson began his career as a half forward flanker before becoming a full-back as a result of two ACL and one PCL injured knees. He learnt to jump off his other leg and could only turn one way. Great athletes have a capacity to adapt their bodies to deal with injury, as well as the way they play the game. We look forward to Adam Goodes becoming one of the great centre half-backs!
Paul Visentini is a Sports and Musculoskeletal Physiotherapist and a director of Physiosports Brighton and Alphington Sports Medicine Clinic. He is Chairman of Sports Physiotherapy Australia and Physiotherapist to the Melbourne Tigers. He is part of the ?Licking Wounds? show on SEN 1116 10pm Thursdays.
