to, nordic hamstring curls, lunges, heel-calf raises, 
hip bridges, and jump/hop and hold (focusing on 
landing stabilization). 2,6 Coaches are encouraged to 
utilize the links provided at the end of this article to 
incorporate ACL prevention exercises. 
It is important to note that if an athlete is injured, 
they should seek specialized medical attention. These 
injuries are often non-emergent, and going to the 
Emergency department can cost families thousands 
of dollars, and put financial strain on the health care 
system. Instead, it is recommended that families and 
athletes suffering from non-emergent sports injuries 
seek care by a sports medicine physician or surgeon 
directly as they are most trained to handle these 
injuries effectively in a costly and timely manner. 
Resources are provided below as a resource for 
coaches and families if care is needed.
Initial Psychological Impact Of ACL Injury
Many high school coaches have witnessed serious 
injuries and the emotions that follow. As a high 
school coach it is important to understand the imme-
diate and long term psychological aspects of injury, 
to best support athletes during recovery. 
The moment an athlete suffers an ACL injury marks 
an abrupt and profound psychological shift, often 
triggering a cascade of intense emotions and fears. 
The initial phase is characterized by a jarring transi-
tion from a physically active, team-oriented identity 
to one of isolation and uncertainty. Immediately 
following an ACL injury, athletes commonly experi-
ence a grief-like response, cycling through denial, 
anger, depression, and eventual acceptance (Figure 
2).  
The Shift From Team Member To Sideline 
Spectator 
A cornerstone of athletic identity is being an active 
and contributing member of a team. For many, this is 
a primary source of social connection, purpose, and 
self-worth. An ACL tear instantly strips this away. 
The injured athlete is no longer a player but a sideline 
spectator, feeling a sense of detachment and offload-
ing. They're physically present but unable to partici-
pate, leading to feelings of loneliness, loss of 
purpose, and sometimes, a sense of guilt for not 
being able to contribute. This can be especially 
difficult for athletes who define themselves heavily 
by their sport.
Catastrophic Thoughts And Fear 
Immediately following an ACL tear, an athlete’s 
mind often spirals into catastrophic thinking. Athletes 
may fixate on worst-case scenarios, such as "I'll 
never play again," "My career is over," or "I'll never 
be as good as I was." These thoughts are rooted in a 
deep-seated fear of losing their athletic ability and 
identity. The unknown nature of the recovery 
process—the long timeline, the painful rehabilitation, 
and the potential for setbacks—fuels this anxiety. 
The athlete may also be concerned about the loss of 
scholarships or contracts and the financial implica-
tions of being unable to play.
Common Psychological Concerns 
Beyond the immediate fears, several other psycho-
logical issues are common in the initial post-injury 
period:
• Emotional Dysregulation: Athletes may experi-
ence a range of emotions from shock, disbelief, and 
denial to anger, frustration, and sadness. This emo-
tional rollercoaster is a normal part of processing the 
injury and the sudden change in life circumstances.
• Loss of Identity: Sport often serves as a core 
component of an athlete's identity. The injury can 
create an identity crisis, as they no longer have their 
primary role to define them. This can lead to feelings 
of being lost or purposeless.
• Social Isolation: While teammates may initially 
offer support, the injured athlete's experience quickly 
diverges from the team's. Practices, travel, and games 
continue without them, leading to a sense of being 
Figure 2.
24

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