Alex “AJ” Jacoski will go under the knife today for surgery after an ACL injury last month. Jacoski has played for the Breeze since 2014 and also served as the team’s Strength & Conditioning Coach the past two seasons. He granted us an interview to catch up on his pre-surgery care, his rehabilitation plan, and how the injury has put his Ultimate game in perspective.
Briefly, how did your injury happen?
It was during an Ocean City Beach Ultimate (OCBU) league game, I was on defense chasing a deep shot. When my receiver caught it, I ended up directly behind him, too close and going very fast. When I tried to move sideways to avoid a collision, my foot landed sideways and my knee twisted inward. I was also told I stepped on a lump in the turf as they had recently patched a lacrosse goal bare spot with sod. Mostly it’s because I put myself in an unsafe position, and got a little unlucky with turf. I heard the telltale “pop” and knew something was very wrong, but was holding out hope it wasn’t my ACL. I got a final diagnosis a week later from the orthopedic doctor.
ACL tears seem to be incredibly common in ultimate. Why is that? Is the high incidence rate of ACL tears unique to ultimate?
The knee is a hinge joint, along with your elbow and knuckles, meaning it is only meant to move on a single plane, versus a multi directional joint, like the hip or shoulder, which moves through multiple planes and has a lot more range.
Most ACL tears happen during lateral changes of direction when planting hard on one leg, landing after jumping, and deceleration. All of these movements put a ton of force on the knee and if your leg isn’t able to absorb the force, the knee collapses in another direction, and the ACL usually tears. The ACL is meant to keep your femur and tibia (shin bone) from twisting or sliding apart. Since Ultimate is all of these things performed thousands of times, we see a lot of ACL tears. Most people think of cutting as mostly acceleration, but actually deceleration is critical to setting up your cut, and more injuries happen during decelerating than accelerating.
Not surprisingly, a 2013 study showed football had the highest rate of ACL tears (among high school athletes) since it is a contact sport. Other sports include soccer and basketball since they are similar in nature to the movement of Ultimate.
Obviously injury prevention should be any athlete’s top priority. What are some of the exercises and habits you have to prevent injuries?
I read a short piece on Mike Boyle’s strengthcoach.com and he clarified the language we should be using in reference to this training, and that is “ACL reduction” instead of “ACL prevention.” There are just so many variables and uncontrollables (movement of the ball or disc, other players) in sports that injuries cannot be 100% prevented with training. However, you can drastically reduce the chance of injuries by strengthening your muscles and increasing your body awareness and coordination via agility training.
One of the primary goals of Morrill Performance Functional Performance Training (MPFPT) is ACL injury reduction by strengthening the knee stabilizers: glutes, quads, hamstrings, and adductors (groin). Here are a few simple exercises which can be done at home and are a staple in the Breeze MPFPT Warm Up.
Regular body maintenance and recovery via foam rolling or by using the lacrosse ball is essential to keeping your body loose and healthy throughout offseason training and during the Ultimate season.
What are you doing pre-surgery, if anything, to prepare? What are the goals of pre-surgery care?
After my injury, I was immobilized in a straight leg brace and was on crutches for several weeks. This led to a nearly frozen knee joint and rapid muscle atrophy. So before surgery, per the doctor’s orders, I needed to regain full range of motion (ROM) of my very stiff knee, and had to strengthen my leg, specifically the quad. So despite not having an ACL, I need to have a relatively healthy and functional knee before surgery. If I were to go in with inflammation and reduced ROM, and then add the trauma of surgery, my knee would not be able to recover from both at the same time and ultimately wouldn’t achieve full recovery.
I am also a huge advocate of RICE (rest, ice, compression, elevation) and good nutrition, and although they may be inconvenient, doing these small things consistently get you back faster. Any time I’m injured, I switch mindsets from full time training to full time rehab. Instead of rushing back to my game still injured, I get healthy first. “Don’t add strength or power on top of disfunction.”
Has the injury impacted how you think about your next competitive season?
It seems the standard recovery timeline for ACLs is 6-9 months, 6 months being the timeline for return to “running,” (competitive sports a bit longer). My surgery is at the end of December so my 6 month timeline puts me at the end of June, and while I love being optimistic, it is doubtful I will be able to play with the Breeze this upcoming season.
I may try to make a return for club but I’m just going to focus 100% on my knee rehab and see how the next year goes. My doctor told me that healthy young people have a very quick recovery and will want to rush back into things, but while the body may feel good, the ACL itself takes 6 months to fully heal. It is still weak before then. Rushing back to sports before 6 months only increases the chance of re-injury.
I am very inspired by athletes like Adrian Peterson, Alex Morgan, Brandi Chastain, and Rob Gronkowski who have all torn their ACLs and returned to championship level performance in their respective sports. Beau Kittredge is the biggest name in Ultimate to suffer an ACL injury, but in his case it was a sprain (partial tear) and did not require surgery. Still, what he accomplished last year– tearing his ACL, rehabilitating, and playing with the Men’s World’s team in London– was amazing and is a huge inspiration to me. And locally, Sarah Itoh and Adi Malave are badass DC women who have shown me recovery is possible.
Has the injury impacted your mental game?
Mental toughness has been a huge part of my development as a player on the Breeze and my club team Medicine Men these past 3 years, and still intrigues me a lot. After the injury I was very depressed and felt like I let a lot of people down, since I represent FPT and smart training. Over time, I accepted that injuries happen and this is just another obstacle to overcome, and I welcome the challenge. I am also somewhat fortunate that this happened over winter and I’m not missing time with my teams and the glorious summer months full of tournaments, beach ultimate, and Breeze games. The support I’ve received from the OCBU family and from the ultimate community on Facebook has been amazing, and I’m determined to come back. I just had my best year of ultimate of my life and while this is a definite setback, I’m not going to stop.
I am still alive, have both my legs, and have a great support system to help me through this.
The biggest thing in returning to ultimate is confidence. I have a ton of confidence in my surgeon, Dr. Robert Frederik of the Rothman Institute in Philadelphia. He also repaired my shoulder in 2012, before I ever played pro Ultimate, and I trust him to bring me back again. I also have confidence in my mentors in Strength and Conditioning, Tim Morrill, (2016 Breeze teammate) Goose Helton, and Mike Boyle. I’m going to rely on these guys during my rehabilitation and I’m ready to get to work.
You can follow AJ’s journey on Instagram @sagebroj
AJ’s Suggested Books
The Inner Game of Tennis by W Timothy Gallwey
Win the Fields by Lou Burruss