Inside the Mind of an ACL-Injured Athlete

A Conversation with Professional Soccer Player - Andrew Nabbout

Mick: I'm grateful, I'm blown away, I'm excited – all the things you should be feeling when you get to actually get inside the mind of an ACL-injured professional athlete. And tonight I've got the joy of presenting and talking to Andrew... Nabbout, is that correct? I got a heads-up on the pronunciation!

Andrew: (Laughs) Yeah, Nabbout, with a 'T' – like 'in a boot'.

Mick: Perfect! Andrew, I appreciate you coming along, mate. Thanks very much.

Andrew: My pleasure.

Mick: For those of you guys who are maybe a bit unfamiliar – because we do have some listeners from all over the world and some students – Andrew has played in the Australian A-League since 2013-2014. Melbourne Victory was his first club, with a couple of stints there, time at Newcastle Jets, and overseas in Malaysia and Japan. He's now currently at Melbourne City and has 10 caps for Australia. So he's highly credentialed and not a bad footballer too!

Andrew: Yeah, that's what I keep telling myself! But yeah, it's been a pretty rewarding career so far. So, yeah, pretty grateful.

Mick: Well, Andrew, tonight is largely ACL focused. While athletes often don't want to dwell on injuries, we're grateful for your willingness to share a player's perspective. Can you take us back to round three of this season when the injury happened? You'd just scored the winner against Western United about 10 minutes prior. What a rollercoaster of emotions - the highs of scoring a goal, and then the lows of the injury.

Andrew: Yeah. Obviously, it was pretty violent the way it happened. I'd literally scored a goal a minute earlier, which, as a professional athlete, especially a footballer, when you score a goal, you more often than not get a sudden burst of energy and excitement and adrenaline. And then when the injury happened, I did an action that I've done thousands of times: went to press the fullback, he changed direction, and I was running at full pace, planted my foot to change direction, studs got caught in the turf, and my knee kept going, unfortunately. It just felt like my knee ripped in half.

Initially, I thought I'd dislocated my knee – I'd never felt an ACL go before. Everything popped. Physios came on, and my leg just went sort of limp. I couldn't lift it, couldn't move it. Everything just deactivated. My quads wouldn't turn on. Eventually, I got feeling back, got up, and hobbled off. I knew straight away I'd done my ACL because of everything you hear – the sound, the feeling, the mechanism. The doctors checked me on the pitch and were like, "Yeah, it's not good." It's crazy because I was riding a high, scored two games in a row, coming off a lot of rehab in the last few years, felt like I was getting back to my best. And then it all came crashing down.

Mick: And this is your first ACL? No family history of it?

Andrew: I'm the first one, unfortunately. Yeah. Knock on wood, I never really had knee problems before. I've had a split in my quad tendon where it attaches to the patella for a few years, but it never really gave me trouble for long. But never really had any knee mechanics injuries. This is the first one.

Mick: It's certainly different from soft tissue niggles. I understand you had significant Achilles problems the year before too. Was that a rupture or tendonitis?

Andrew: I had Haglund's deformity in both sides, right on the insertion, digging into my tendon. For a couple of years, I was playing through the pain. It ended up splitting and shearing off about 60-70% of the tendon. It was pretty bad. I saw the surgeon, he shaved the bone and stitched up my tendon. Gave me a six to nine-month rehab timeline, and I got back in four. Then my left one flared up from compensation, and I had the identical surgery on that side.

Mick: So, a fairly disrupted previous year. We're getting a better understanding of ACL injuries now, and why they happen. You've pressed defenders thousands of times. Why now, right? Inconsistent training, like we saw post-COVID, can be a factor. That sudden re-load after time away from regular training.

Andrew: Yeah. So, obviously I waited a couple of days for the swelling to go down before the scan. It was more to see what other damage I'd done; I was getting bad pain in my MCL. After the scan, a physio I used to work with, now at the Demons in the AFL, told me, "Go see Julian Feller." Honestly, best thing I ever did. He was amazing. The way he speaks to you, how comforting he is, like speaking to one of our own doctors. He was super calming, really good to work with. He gave me another week for my knee to settle, as he didn't want to operate while it was still swollen. And yeah, we did surgery, and here we are.

Mick: Julian's one of the world's best. It's so important to have that communication. Was non-operative management ever discussed, and trying to return quickly like the famous case of the EPL player did a few years ago?

Andrew: Absolutely not. Funny enough, one of our women's players has had three ACLs and now plays without one, going really well for her. But for me, it was never an option, purely the type of player I am – too explosive, too risky. I just accepted it's a 9 to 12-month injury and to crack on with rehab. Luckily, I'm old enough now that my mind's in a pretty good place. Even though it's tough and you go into holes, being older and having had a few injuries, I sort of embrace the challenges. I don't see it as a failure as much as a challenge. But ACL rehab is different; you can't fast-track it without risking re-injury. It humbles you.

Mick: Unlike soft tissues where you can shave off some time, the ACL is a hard stop - 9-12 months return to sport for most people. What are some of the things you miss most, or can you describe some of the "holes" you mentioned?

Andrew: At the moment, because I'm normally an aggressive rehabber and often get back quickly, I feel further ahead than I am. I'm on the field running, sprinting, doing ball work. I look at the team and think I can do that, but realistically, I'm miles off it, you know? And when that reality sets in, it puts you in a bit of a hole. Everything in rehab is controlled; in a game, you can't control that. That's where I get humbled. Just because no matter how close you feel, you're still so far. So that's sort of the holes that I go in a little bit and get out of them just by reminding myself that, you know, you're still probably further ahead of where you should be, but your, you know, your graft hasn't matured and, you know, you still got time, and don't risk it because you don't want to do it again.

Mick: Have you had any rocky moments or setbacks in these five months?

Andrew: A couple. Because I had a quad graft and a LEAT (lateral extra-articular tenodesis), it was slower and stiffer initially. Then in the gym doing plyometrics, I hyperextended my knee. That was scary; thought I'd done something else again. My knee stiffened up. Took a couple of days to settle. I've also got this distal medial hamstring tendon pain that hasn't gone away since surgery. Haven't been able to load hammy curls or Nordics until recently, and even now it's restricted – assisted Nordics, blood flow restricted curls. But on the other hand, my quad strength is almost better than before the ACL.

Mick: What are some silver linings you've found?

Andrew: Mainly, accepting I'd miss this season but be ready for day one of next preseason. Round one next season is 11 months post-op. So that timing means I'm not missing games by waiting. My quad strength is back, almost 240kg three-rep max on a single leg press, nearly matching my other side. Hamstrings still have a deficit because I couldn't load them for a long time, but it's getting there. That's what's holding back high-speed running right now.

Mick: What are some qualities in your medical team that make them good, that make you feel comfortable and supported?

Andrew: They're very good with communication and empathy. They'll sit down at the start of the week, explain my sessions, why I'm doing things. And because I've done this for so long, I can ask, "Can we do something different today?" instead of the same conditioning. They're flexible and let me have a say, while ensuring no corners are cut. It makes it enjoyable, as much as rehab can be.

Mick: That's a great point for physios: listen, understand what the athlete enjoys, and vary things while still achieving the stimulus. For example, If you want eccentric loading, there are many ways to do it other than Nordics.

Andrew: Exactly. I don't enjoy 1k repeats, which is a big thing at Melbourne City. I'm more fast-twitch. They know I hate them. So they'll give me lots of 40s, 60s, 200s, MAS runs – which, as tough as they are, I prefer over 1k's. We found a happy medium. Also, physios sometimes aren't able to just say, "I'm not sure." For me, "I don't know" are powerful words. Admitting that gains so much more trust than giving an answer for the sake of it.

Mick: That's wonderful insight. It's so important for physios to be humble and admit when they don't know, and then find out. It builds trust.

Andrew: Yeah, and I've been lucky. Most physios I've had have been extremely good. I still keep in contact with many for advice. It's good to get different perspectives; some have expertise in different areas. A good physio understands when you seek other opinions.

Mick: So, at month five, what does your week look like? Are you up at 5 am with cold water and nose tape?

Andrew: (Laughs) Not quite that heavy! Up at 6 am, 45-min drive to training. Mondays: field session (running mechanics, change of direction, speed, some football, conditioning) plus a hybrid strength-power lower body gym session. Tuesdays: full lower body strength (squats, hang cleans). Wednesdays: normally off. Thursdays: skill session, change of direction, speed exposure (no conditioning), then a gym session. Fridays: core and hip conditioning gym session, off feet. Saturdays: my big day – everything: big volume, big skills. On off-field days, I now do off-feet conditioning like assault bike, MetCon, or swimming.

Mick: Is that big Saturday priming you for a game day return, usually a Saturday?

Andrew: Yeah. And we normally have Sunday off, so they sort of give me a big hit that day, on and off pitch, along with a strength-based gym session.

Mick: And the golf game suffers the next day?

Andrew: Absolutely. Hitting balls left and right. But it's good active recovery!

Mick: Last one: what are the expectations or criteria moving forward for your return to play? Any specific tests or measures you've been told about?