SoccerGirl - Kate Sneddon

What do you think the biggest mistakes athletes are making in their ACL rehab and how do they

stay away from them? Okay. I would say... What's up guys and welcome back to the Soccer Girl Pod. Today we're joined by Kate Sneddon

a physical therapist who specialized in ACL recovery. This is a conversation that especially

hits close to home for me. I tore my ACL and I know firsthand how overwhelming and isolating that

journey can be, especially at a young age. So we talked to Kate about how young players can navigate

such a tough injury, the mental and physical obstacles that come with ACL recovery, and the

best ways to approach her comeback with confidence, with patience that can be very challenging, and

the right support system. So if you're dealing with an ACL injury yourself or you're supporting

a teammate, a friend or family member that is, this episode is for you. So can you just give our

listeners just a brief career background? Yeah. So my name is Kate. I am the founder and head

coach of the Helios ACL Project. I've been a sports physical therapist for six years. I've been an ACL

coach specifically for two of the last years. So now I only work with people who have had ACL

injuries regardless of the sport and it's it's really been an awesome ride so started out in like

a traditional sports clinic seeing like a bunch of athletes an hour and it was it was great

experience got to work with some pros and you know I I loved the in-person work then I kind of

switched my role to like a more classic outpatient setting where you kind of see

moms, pops, grandmas, athletes, all alike, which was awesome. But I was like, I love working with

athletes. And, you know, people that have suffered an ACL injury are just like wildly underserved

So that's kind of how the Helios ACL project was born with a hopes to help athletes actually have

an opportunity and the resources to come back better, which is kind of my little tagline

What do you think is the hardest part of your job and what's the best part

Getting athletes through the period of doubt and uncertainty when they haven't seen the spark of progress yet

And they're so distant from their identity as an athlete. And my job as an ACL coach is to help connect them back to that

so in in part like it's also very rewarding but when someone is in like the lowest point of their

lives and they're like am I ever even going to make it back Kate like I get to say yes and these

are the reasons why you know you're showing up for yourself we have all this you know data to

pull on that you've already started to make progress but that like day one I'm injured like

that's that stinks that stinks no matter who you are and I would say this may be obvious the most

rewarding is seeing them get back and and just the color coming back to them and it's absolutely

addicting and the best part of my job is that I get to help someone be their own hero and get back

to themselves how do you because a lot of parts of coming back are measurable right like you're

when you can go weight bearing and then when you are like cleared to finally jog

And those are big moments that feel like good milestones to hit

But what do you do for the gaps between those milestones where an athlete feels like they're making no progress

and there's no measurable progress to give them? How do you keep them positive

I would argue there's always measurable progress. This guy is really zooming

But I'm a big, big believer in like process goals. So do you guys know what a process goal is

Should I maybe explain it for a second? Explain it, yeah. Just refresh

There's like an outcome goal. Like I can do my first single leg squat

Then there's all the building blocks that are going to get us there. So like what I sit with the athletes and do is like, okay, this is our next milestone

What are we going to do? How are we going to pull this apart so that you are aware of all the steps that lead to success

So like it can literally be as small as I show up three days a week for myself, no matter what

And even on my worst day, I did my five minutes that Kate asked me to do

And we're going to call that a win. And I know if we keep showing up for only five minutes, is that going to get us to the end goal

Probably not. But I think the idea with someone that is in a really dark point in their lives is to show them like

if you just do this little bit, it's going to add to the outcome you want. So I think the idea is

really like zooming in and, you know, throughout those times, like there's going to be times you're

like feeling low. It's just inevitable. So I think another thing that I encourage athletes to do is

like take on a side quest, if you will. Like even it's like, okay, I want to like do my first like

pull up. Like let's work really hard at that right now so that we are creating a more well-rounded

athlete than the athlete that we started with, even if it's not just an eccentric role. And on

the days where you're like, I don't even care about that, go find something fun you enjoy that

has nothing to do with your recovery. And those little like glimpses of light are things that

keep people going, whether it's purely related to their ACR recovery or not

I love that. And I feel like this happens all the time because I coach athletes as well. And

you feel like you're stuck in the mud when you're injured like oh I'm just standing still while

everyone else is still progressing and moving forward but there are literally so many things

that you can be working on that don't involve the use of that leg and I love that you bring that up

because it's hard you have to really sit down and really think about some goals that are outside of

soccer and some that maybe relate to soccer or the sport that you play but there are always things that you can be doing to get better And it like addictive to feel that feeling of getting better at something even if it is not what you want to be doing the most So I love that

Totally. Most people, I think, think that ACL tears come from contact, but with soccer specifically

with female soccer players, what's the reality? Like, is that the most common or like, when do

you see tears happen the most with them? Female athletes have a, and this stat hurts a little bit

A two to nine times increased risk of sustaining an ACL injury in their respective sport compared to males

So I think definition wise, we should know what we're talking about

So there's non-contact injuries and contact injuries. Contact injury is like if you're running, someone dirty slide tackles you, takes your knee out, like an impact happens to your knee

There's nothing we could really do to prevent that besides make sure we have some great refereeing

Um, aside from a non-contact injury, these are the ones that we hope to prevent

So a non-contact injury, the two most common mechanisms are when someone is running and

decelerating into a cut, having just the wrong position. And essentially your femur rotates one way, your leg is planted

The result is an ACL tear or landing in a way that is like just, you know, let's say

you go up for a header, you're in contact with another player, you come down, your knee's not

quite in the position that you thought it would or would be the most adaptive to land to keep your

ligament safe. So like those are the two most common ones we see. And these are the ones that

are really turned up for our female athletes compared to the males. Totally. Yeah. If you

could teach one movement skill to female athletes to help reduce risk, what would it be

if I could teach athletes one skill, it would be how to land under different conditions

Well, I just read a video on that. It hurt my knees to watch

You're very athletic, by the way. I would watch it. I was like, look at her. When I tell you it is just from demonstrating for athletes, like I don't even practice these

things on my own anymore. It's just demonstration. But I really love that you just brought that up

Continue to elaborate on it. So in the PT biz, in the medical field, multifactorial, all that means is there's multiple factors that can either turn up your injury risk or turn down your injury risk

So I don't even really use the term ACL prevention or ACL injury prevention because the best we could do is ACL risk reduction, which is like, okay, maybe semantics

But to me, it's important to know that we can't just put up a shield and block all ACL injuries from happening

so multifactorial for female athletes means that we need to consider how strong you are we need to

consider your play volume we need to consider like where you are in the season we need to consider

like are you like resting enough are you playing a year round like soccer year round all of these

things can add up and when the stars align in a bad way that's when an acl injury can happen so

it's not just like one thing that's going to create a non-contact tear. It's usually a plethora

of things kind of adding up and turning up that injury risk. I love that. And super important to

reiterate, like you said, that some of those factors are in our control and some of them are

literally out of our control. So what would you say the most controllable risk factors are

In-season, if I was an in-season soccer player right now, the most controllable factor is probably

monitoring my fatigue. So that's making sure I'm getting enough sleep. That's making sure that I'm

not playing back-to-back-to-back tournaments where my legs have no time to recover. If you're a coach

not running your girls into the ground. So those are, I would say, the most I can control is today

What are the biggest myths or truths that you hear about female soccer players tearing it

Is it, we talked about the shape and everything, or is it hormones or genetics? Is there anything

that you think is like people make up or something that's like no this is like factual about female

athletes i have combed through the research probably more than any any person you may speak

to about this so like i am a big believer in controlling the controllables but we do have to

like acknowledge what may be different now typically females have a larger q angle we kind

of get like the period gets blamed a lot can you explain the q angle so the q angle is the angle of

your hip to your knee and the larger that angle is as is typical with like a developed female form

that puts your knee in relative valgus, which is like kind of the like position that gets

press about ACL tears. Now, like what I will say is currently there is not conclusive evidence

that that is causative. So like you look at, I'm going to use Michael Jordan as an example

because this picture is like burning my mind. There's a picture of him with less like severe

valgus and he's like driving to the net and he has not had an acl tear so like valgus by itself

is not dangerous it's when you have the inability to control it that's when it's a problem so like

if females if let's say like okay yes we're in relatively more valgus we should really be

strength training to make sure that we can control it type thing so I acknowledge that structure plays

a role and like some younger athletes maybe maybe developing hit their growth spurt and suddenly

they all like gangly and can control themselves like yeah we can control that but I think on the broader scope like pro athletes like we we are strong and we are like you you playing at that level because you like developed

peak athleticism right so I think there are some things to be said about structure

but I don't think it is really worth any athlete's time worrying about the angle of their hips when

there's so many things we can control. So you mentioned the importance of strength training

What muscles do you think are most important for female athletes to be training? I think every

question you ask me, I'm going to say, but wait, I have to zoom out. There are important muscle

groups. I'm going to say, you know, we want strong quads and hammies. Your hamstrings are going to be

really important. We want strong glutes, particularly like the hip abductors, right

controlling that dynamic valgus. The whole system works together. So you want to make sure that

you know, if we look at a perfect strength training program, it's going to include like

jumping and landing. It's going to include like broad strokes, like can you squat in a functional

pattern? Can you hinge in a functional pattern? Can you load those movements? And if you're someone

that like has no experience strength training and want to reduce your ACL injury risk like either

get a strength coach don't just like go to the gym and try to be a bodybuilder because there are

specific things athletes should be doing I think but something is always better than nothing so like

if you do nothing train a squat train a hinge pick up some weight put it down you're going to be

better than you were before for doing that. So like I am not a perfectionist in any way

shape or form around this. I just want athletes building a good foundation

And you can leave the fancy stuff for Instagram. If you could give players one actual tip that they could use starting tomorrow to protect

their ACLs, what would it be? Recover just as hard as you train. That's what I would say

Nice. Love that. All right. We're going into post-injury recovery now. What do you think the biggest mistakes athletes are making in their ACL rehab and how do they stay away from them

Timeline based narrative of ACL recovery is not really factual. Oftentimes does not pan out and contributes to athletes not getting the correct care

So I think that let's take a step away from like at nine months, I will be back to sport

At 12 months, I will be back to sport because I have worked with athletes personally that have, you know, been ready at six months

Not that I would advocate for that. But and then athletes that are ready at like two years

And there's so much that goes into like why people's journeys are different

And every single person's journey is different. So that's like a very big thing that I need athletes who are injured to know is that like it's okay if you're not where you're supposed to be in your mind

because that piece of paper, that protocol they give you is like the best things can go

best case scenario, and it often doesn't match up with reality. I think the other thing I would like athletes to know is like

please find someone that works with a lot of ACL cases. This is an incredibly specific type of rehab and recovery

So like getting matched up with good care from day one is just going to like minimize your risk of setbacks

And like our end rule is that you get back to sports. So we want to make sure we have someone that understands your sport and like why it's important to you, not just that like wanting to get back to sports

This makes me laugh because when I tore my ACL, I went to, I lived in New York City

So I went and stayed with my parents for a while because it was just easier not to climb stairs and go on subways

And my first PT was also doing my 90 year old grandpa's PT

So my mom or my neighbor would drive us together. So my grandma would go in and do this

we'd have the same physical therapist. And I'm like, this doesn't seem right. And then when I moved back to New York City

I had someone who was like very invested in ACL and athletes. And I was like, yeah, there's a big difference

Like I was peeing out, like watching ESPN, my grandpa. And then I'm in the city with this physical therapist

who's like making me sweat. Like it was hard. So I feel like that's definitely like a really good point

is like find someone who knows what they're doing with ACLs, especially

Not that it wasn't, it was fun, but. you did mention I think earlier about like confidence with recovery how can players

rebuild trust with their bodies and movements because it can feel so scary to do things for

the first time after like I remember certain movements I was like so nervous to do like

how do you help build their confidence trust is a tricky thing because our beliefs influence

how we move through our recovery um and I think my strategy has been always including the athlete

in on like kind of what our plan is so like how we're gonna know they're ready

from a physical standpoint because I do typically see that like the if your physical body is ready

typically the confidence comes with it and there'll always be that moment of like

oh I'm gonna do it and then you do it and you're like I'm fine but the important part before that

is like building our trust in the plan first they have to do all of these criteria to prove

they're ready and then it's like okay well I've already proved to myself I'm ready because I can

do xyz now I'm gonna take the leap of faith because I believe in the plan and I believe in my

I trust my care team. What would your suggestion be to an athlete who says

like I can't stop playing with hesitancy? Like they're scared to go into tackles

and they're scared for physical contact on the field. Do you suggest that they do more work off the field

Do you suggest that they don jump into full practices Is it more of a mental thing they have to overcome Yeah So assuming that an athlete has truly passed the criteria to play

what I've done in the past is like had a conversation like, okay, like let's get to

the bottom of this. Are you feeling something in your knee that's telling you you're not ready for

this? Because the thing I don't want is an athlete moving with hesitancy. That's where

re-injury lives. So I think for the typical athlete, if they're truly ready to play and it's

just fear, then we're going to do visualization. We're going to get a friend who you trust and like

and doesn't want to hurt you. And you're going to practice certain elements. You're not going to pick the person that's buying for your spot, right? You're going to pick someone that is going to be

down to help you. And practice some of those skills. If an athlete, it's a mental barrier

then we have to just practice that skill. Now, if the true thing is that they're actually not ready

then we got to make sure that we're taking steps back and you're not ready for field play yet

Because moving with fear means you're going to move weird. It means you're going to move in

positions that you probably shouldn't be in. And then even if you're not re-tearing your ACL

like you could hurt something else or just not even be at anywhere near your performance level

And that's going to affect your mental health negatively. You mentioned how teammates can help

What about parents and coaches or other ways teammates can too? What's the best way they can support an athlete during the recovery

I love this question. This is a sweet question. So you may, if your teammate is hurt, you may not understand fully what they're going through

And if you haven't been through this, if you have been exposed to ACL injury, to some degree you probably won't

so I think being there for them to do fun things with is important because a big part of ACL injury

is like being isolated from your teammates so like even if it's like going to get ice cream

with them right like making them feel like they are just as much a part of that team even though

they're not on the field is like really key if you're a parent or coach trying to well okay if

your coach trying to include them in what they can do, right? Even if it's literally like, hey

like what, what did you see in that drill that we need to do different? Or like, you know what I mean

Because their brain still knows how to play. So like including them in that, I think can be

extraordinary helpful for their mental health. And if you're a parent, I think just like having

space for your kids to be like a little bit cranky and a little bit um and it doesn't mean that you

stop being in parenting mode by any means but like this is really hard this is really hard for a

full-grown adult with a fully formed frontal lobe for someone that is a minor and like lives and

breathes for soccer like that's their whole identity so like just having space for them to like

not be themselves and not pushing. You have to think positively because a lot of times

it can be a false positive. So like space to be grumpy, but then encouragement to take action

Yeah. No one wants to be told, just think more positively when you're really down in the dumps

about being injured. That's like the last thing you want to hear. What's the biggest myth you wish

would die forever about ACL injuries. That coming back faster means you came back better

That is a good one. And I feel like that's really important. I mean, I know we talked about a little

earlier, but it's really important for athletes to hear that. Well, Kate, thank you so much. I

really appreciate it. I know our listeners, whether they have had a knee injury or going through one

or want to prevent one, I feel like this was really helpful. So thanks so much for coming on

Thank you so much for having me. And if anyone wants to follow me, Helios ACL project is the best place to reach me if you are looking to up your ACL recovery game

I really enjoyed this episode a lot. Shannon, I remember when you tore your ACL. That was a journey. Like, what were you? Where was your headspace during that

dude i wish i had something like this back then like this information um i feel like it

like we said earlier it can feel like very isolating it's a hard thing to go through

um like it's like little things like the stairs we worked in the city going up the subway stairs

like you don't realize how much like of a challenge it is to not have you had a cane

it's pretty flossy i had a sick cane it was a floral pink retractable i would just whip it

out of my backpack and I felt like Willy Wonka. That was a highlight of the ACL. Oh, it came

But it came. It came for sure. And doing PT with my like 90 year old grandpa at the time was pretty

fun. But yeah, it is a tough. It's a tough thing. It's scary. I remember when I did it, I knew right

away. I feel like a lot of people do. It's a challenge and it's it stinks. But it is helpful

that people like Kate are giving us information now that can help that process

and help you get through it a little bit easier, which is nice. That interview was so great

I feel like if you were going through this experience, she just saved you a lot of time

on having to search through articles online and watching other videos and stuff

And I just think that was really wonderful, useful information for anyone

going through the rehab experience. Of course, if you're going through it

shoot us a DM, send us an email. Tell us about your journey. Tag us in your journey and your comeback

Everyone loves to watch a good comeback. Follow us on all the things

IG, subscribe to the pod. Tell your mom to follow us on Facebook

You know, all the things. And we'll see you next time