Abstract
The aim of this work was to phenomenologically grasp the bodily ways in which rehabilitation from injury, specifically anterior cruciate ligament reconstruction, is expressed and found. We draw upon the first author’s experiences of injury rehabilitation in the form of diary notes, memory recall, and subsequent interviews between the authorship team. The descriptions offered temporally chart how various bodily tensions are announced during rehabilitation and the subsequent attempt(s) at restoring of the body. The findings raise awareness to how body parts that are not functioning become othered, the response to such othering, and how injury reveals itself as a dysfunction. The significance of the work lies in repositioning how the injured individual is always with injury, even if this is etched into their history. Although providing a comprehensive, human experience-orientated reading of injury and rehabilitation, this article shifts the body from being absent and background to appreciate the subtle ways in which the body dis-appears and dys-appears.
Introduction
For some time, there has been a sense that recovery (or rehabilitation) from physical injury is as much a ‘mental’ triumph as it is a ‘physical’ one (Wagman and Khelifa, 1996). It is unsurprising, then, to see a proliferation of research exploring the psychological challenges athletes face (e.g. Trainor et al., 2020), as well as how significant others (e.g. coaches, S&C coaches, physiotherapists) shape their experiences (see King et al., 2023). This has left injury with a prominent place within the sport psychology literature, permeating a range of connected ideas, including psychological factors (Kerr and Minden, 1988), post-traumatic stress disorder from injury (e.g. Padaki et al., 2018), injury prevention (Johnson et al., 2005), and even injury-related growth (Pollak et al., 2022), to name but a few examples. In response, it has become common practice among researchers (e.g. Buckthorpe et al., 2024) and governing bodies (e.g. FIFA) to tag-on ‘psychology’ as a feature of athletes’ return to play protocols. Pauw et al. (2023) exemplified this point when calling for closer psychological monitoring among ACL-R 1 paediatric populations.
However, irrespective of contextual factors or variables that might shape the rehabilitation processes, one fundamental issue that underlies such research is the inherent dualism of splitting the mind and body throughout the restoration process. The consequence of this split leaves the embodied human experience of injury untouched, and perhaps more significantly, assumes a unidirectional link between a range of factors impacting on the body, rather than with the person. For example, King et al.’s (2023) helpful review can be critiqued for reducing rehabilitation to a series of ‘factors’ such as age, gender, sport, competition, injury, and severity. Similarly, injured athletes more generally are described as experiencing a range of stressors, often defined or associated with particular timepoints (Evans et al., 2012), including isolation, a lack of progression, setbacks, hesitations to return to sport, fear of re-injury, and loss of fitness, among other experiences (Bianco et al., 1999). Such readings of being injured, although well-intentioned, are guilty of reducing the athlete to a series of knowable variables.
A further assessment of the sport injury literature reveals the temporality of the rehabilitation process as constant. This is a point reflected in Waldén et al.’s (2023) review of the International Olympic Committee (IOC) consensus statements for recording and reporting injury and illness. Here, Waldén et al. (2023) presented the outcomes of a panel review established by the Fédération Internationale de Football Association Medical Scientific Advisory Board based upon the IOC consensus statements. One particularly notable feature of the review was the overview of key time points in the return to football continuum modified from Ardern and Pruna (2018). The terminology used in this figure was return to match play, followed by return to prior performance. There are two immediate issues present; first, the sense of return is assumed as a point in time that can be measured and achieved, which disregards that returning will not be the same as prior to the injury. This is both in terms of the anatomy of the site of the injury, and the experience of the individual following the injury. Second, but somewhat linked to this point, the idea that ‘prior’ performance was a definitive, accessible, and graspable point that could be identified undermines the fluidity and relationality of such judgements. Indeed, recent arguments have demonstrated that performance must be discovered, constructed, and interpreted by those involved (Corsby, 2024), meaning that identifying ‘prior performance’ as a final step in the rehabilitation process undermines the restoration process. Put another way, ‘pre-injury’ and ‘prior performance’ disrupt the intertwining of past, present, and future, of which Carel (2021) helps us understand that breakdowns such as injury blur a future horizon that was either taken-for-granted or previously assumed as knowable (i.e. the injured athlete can never ‘go back’ to a past definitive or attainable destination).
Turning specifically to ACL injuries as an example, the dominant concern with the ability to return (or not) to ‘pre-injury levels’ (prior performance) plays out in measuring performance metrics (e.g. Burgess et al., 2021), re-injury rates (e.g. Rambaud et al., 2017), and further psychosocial-oriented analysis associated with recovery (e.g. Walker et al., 2010). Interestingly, Golberg et al. (2024) described in the summary of their project that: Speed, strength, and cardiovascular endurance tests are underrepresented in ACL-R RTS literature. Compared with healthy controls, deficits in athletic performance assessment (APA) results for ACL-R athletes were common; however, many studies reported significant improvements in results for ACL-R athletes over time. There is some evidence that well-trained ACL-R athletes can match the performance of uninjured athletes in high-level sports. (p.1)
The use of the terms by Golberg et al. (2024), such as ‘deficits’, ‘match’, ‘uninjured’, and ‘well-trained’, as well as the label ‘ACL-R athlete’, implicitly express the athlete as having an injury. What is left completely untouched from this literature, however, is the everyday corporeality of the body that is manifest and thrust upon the athlete when experiencing ‘injury’ or breakdown (Carel, 2021).
This article, then, was inspired by phenomenology as a way to rebel against the dominant narrative often found in detached scientific approaches to sport, sport medicine, and sport coaching that have cultural authority to speak about injury and illness. Doing so, the precise aim of this work was to grasp the bodily ways in which rehabilitation (from ACL reconstruction) is expressed and found. Through charting the bodily experiences of being-in-the-world, the intention is to provide a rich account that can illuminate and problematise current conceptualisations of injury and rehabilitation. By providing an illustrative account following a serious injury, the purpose is to describe how rehabilitation and subsequently restoring the body were experienced. Although injury experiences are used as the framing of this article, the focus is not merely on injury and rehabilitation as can be found in much of the literature base (i.e. difficult, emotional, social support) – which might be criticised for isolating features of injury – but to use the body as a way of knowing, or body pedagogic (Shilling, 2017). To encapsulate this point would be to say the injured athlete is always with injury, even if this is etched in their history. In this way, such an endeavour aims to make explicit what is implicitly known about injury.
The work sits against a backdrop of research from medical, sporting, and physical cultural fields, grounded in sociological and phenomenological tenets. For example, the work of Scheper-Hughes and Lock (1987) proposed how a phenomenological viewpoint can enhance medical anthropology by bringing the body back into medical practice; meanwhile, Wilde (2003) accounted for how nurses can help individuals with chronic illness or serious injury understand transformation in their bodies as ‘informant’. The argument here follows Csordas’ (1993) phenomenology of the body, which recognised embodiment as a starting point for human participation in a cultural world. Within the realm of sport and physical cultures, (sociological) phenomenology has helped various authors explore bodily interconnections. Examples include endurance work (McNarry et al., 2021), the pleasure and danger of running in public spaces (Allen-Collinson, 2023), and even the relation to the feeling of temperatures during play (Allen-Collinson et al., 2018). A common sentiment found in this oeuvre is the critique of dualistic (mind-body) notions that separate the body as object and the mind as subject, which can lead to devaluing experience. Indeed, Merleau-Ponty (2012) made the distinction between body-object and body-subject to challenge the philosophical position that accepted a dichotomy between subject and object. Rather than treating the body as an object (body-object), Merleau-Ponty (2012) asserted the need to appreciate the human subject as embodied. In addition, we draw inspiration from Paterson and Hughes’ (1999) phenomenological sociology of impairment, and Sobchack’s (2010) attention to the lived specificities and conundrums of the body, to better sensitise the otherness associated with sporting injury, viewing the body not as an object property, but as the product of social processes, arrangements, and modalities of being in the world. Applying such phenomenological attention to the context of sporting and physical injury, we claim this analysis can reveal how the body-object (the Körper, in phenomenological terms) intertwines with the lived body (body-subject) to challenge the dominant position of objectifying the body. This is a point Csordas (1993) clarified when referring to somatic modes of attention; that is, somatic modes of attention are cultural ways of attending to and with one’s body. It is within this dialectic between attending to and objectifying bodies that becomes a particular point of interest, which, according to Csordas (1993), can reveal the indeterminacy between subject-object, mind-body, and self-other.
The phenomenological spirit of this article might be grounded, not in opposition to the invaluable knowledge produced in the natural (sport) sciences (e.g. physiology, strength and conditioning, physiotherapy, rehabilitation), but as a challenge to the misconceptions and limits of privileging scientific knowledge and rationality (Moran, 2000). Thus, borrowing from Sobchack’s (2010) discussion of a phantom limb, the existing physiological and psychological knowledge concerning rehabilitation can be considered an abstraction in a manner that externalises lived-bodily experience beyond its corporeal embodiment, and while concerned with the causes and structures of the body, it is not equivalent to the immediate bodily perception. Rather than treating the body as a ‘tool’, we might ask: what is it like to be a rehabilitating 2 body? What is it like to live with injury?
Although the initial inspiration for this article lies in our dissatisfaction with the dominant scientific reading of injury, particularly from an athlete’s perspective, the intention is to redirect an understanding of injury beyond the individual to consider coaches, physiotherapists, strength and conditioning, sports rehabilitation, and a wider range of medical professionals. The purpose is to provide a more comprehensive, human experience-orientated reading of injury, which focuses on the rehabilitating body-subject (Leib, in phenomenology). In this regard, through exploring the socio-relational and temporal features of injury, this article speaks to a wide audience, including the many professions that might benefit from an enhanced sensitivity to the experiences of the injured.
Turning to Phenomenology and the Body
The inquiry for this project is concerned with what Sheets-Johnstone (1999) described as the primacy of movement. Except for a few notable examples (e.g. Allen-Collinson, 2003; Dashper, 2013), the dominant approach to injury-related research has adopted interview-based research designs, questionnaire-oriented research, and intervention-based work (see Christiansson, 2021 for a systematic review as an example). Although beneficial to developing an understanding of injury in the general sense, the phenomenological approach deployed in our project aimed to become attuned to an embodied consciousness of what is felt (e.g. see Fraleigh, 2018). Rather than shedding light on the superficial layers of what was seen or what was said, the primary theoretical and analytic attention in this article was on the embodied, sensory realms of human experiences as ‘a body living with injury’.
The body can be considered a central theme for phenomenology, rooted in the work of Merleau-Ponty. Merleau-Ponty (2012: 146) described the body as ‘our anchorage in the world’, which emphasised the role of the body in perception, action, and giving meaning to our surroundings. However, in Merleau-Ponty’s analysis, the body should not be considered as simply another object in the world; his thinking fundamentally challenges the ontological division between subject and object. Leder (1990) extended this line of inquiry, reminding us that, while our experiences are always embodied, our bodies are seldom the object of analysis. According to Leder (1990), the body is ‘essentially characterised by its absence’ (p.1), meaning the tendency is for the body to remain in the ‘corporeal background’. For Leder, then, the presence of the body can be characterised in many different forms, which he distinguished between body dis-appearance and dys-appearance. The former related to how the sensorimotor experiences of the body, when operating unproblematically, are largely absent from consciousness. In day-to-day practices then, the body occupies a background position, passed over in our concern with the world, meaning the body essentially ‘disappears’ (Leder, 1990). Whereas, when the body experiences pain, discomfort, illness or injury, the background position of the body is thrust to the fore, revealing the ‘dys-appearing’ features of the body. Consciousness is therefore directed to the site of discomfort or pain, which, drawing upon Merleau-Ponty, provides a methodological perspective to examine the appearance of bodily experiences.
Commensurate with Ravn and Christensen (2014), to bring to light these bodily experiences and examine them through a phenomenological lens, we must adopt the phenomenological attitude; that is, a worldview (Weltanschauung) that requires fundamentally challenging taken-for-granted assumptions, characterised by openness and curiosity. In the case of this study, we drew upon the authorship teams’ experiences of injury to phenomenologically question the privileging of objective criteria within rehabilitation (e.g. functionality, visibility, presence) over the lived body’s knowledge (Sobchack, 2010). A similar case was made by Carel (2021), who claimed that pathology, illness, or injury can be a phenomenological tool that forces a radical displacement of the natural attitude, making the invisible visible. Thus, we do not merely claim that we adopted a phenomenological attitude to reflect on injury after the fact, but that the injury itself, to a degree, thrusts us (the first author in particular) into a phenomenological kind of reflection that opens up the project in the first place. The phenomenological grounds for this inquiry, therefore, began with the disruption to meanings and interactions caused by sporting injury. We reiterate, however, Csordas’ (1993) warning that our sensory engagement was not a preoccupation with our body as an isolated phenomenon but also an intersubjective attention to the bodies of others in a way that fuses the author, the research, and the researched. The next section describes the procedures we followed.
The Phenomenological Method, Participant(s), and Writing the Body
Although the phenomenological method adopted in this study is not a traditional technique with a clearly defined set of procedures, there were several commitments made during this study to engage in the phenomenological writing of the extracts. From a first-person perspective, the approach adopted was commensurate with Merleau-Ponty’s (2012) concepts of the ‘lived’ or ‘own’ body, which emphasises the connection between subject and world. The first author initially wrote a series of first-person accounts accrued over a 36-month period that involved the rehabilitation of two ACL injuries. Having suffered an initial ACL injury to his right knee, author one underwent a ‘full-return’ 3 (approximately 14 months), followed by a further ACL tear in the left leg. The injuries occurred while contracted to a semi-professional football club that played in the highest National League. The rehabilitation involved a variety of medical professionals but was principally overseen by a chartered physiotherapist who worked for the football club. Where possible, the rehabilitation was connected to the team training (two to three times per week, plus fixtures) in the latter phases, while the earlier rehabilitation programme frequently involved training five to six times per week alongside frequent check-ups regarding the ability to move, bend, and perform tasks.
Throughout this period, particularly in the first 14-month period, a reflective journal was kept. Meanwhile, following the second injury rehabilitation, the first author revisited some of the original notes and documented reoccurring or new experiences. The notes included a general sense of the event, individuals involved, interactions, and descriptions of the various settings, all of which were time-stamped throughout the rehabilitation. Following Merleau-Ponty (2012) and Leder (1990), the reflective accounts attended specifically to the lived, embodied experience of the injury, not simply as an isolated subjectivity, but through a shared intersubjective milieu with others (Csordas, 1993). It is these latter notes that became the source of inspiration for this article.
In addition to the original notes, the second, third, and fourth authors were recruited to help with recalling key incidences, revisiting forgotten aspects of the experience, and questioning the relation to the body and senses. While the first author was familiar with adopting a phenomenological attitude towards the data, the second and third authors, who both have a grounding in phenomenology, made a concerted effort to question the description of the injury experiences. The questioning here drew upon Bevan’s (2014) phenomenological interview principles of contextualisation, apprehending the phenomena, and clarification. The authorship team has an extensive history of competing and coaching within high-performance contexts (swimming, cricket, and football, respectively) while also studying and writing phenomenological research. This allowed for a purposeful questioning of taken-for-granted assumptions in the first author’s experiences, while also encouraging a certain naivety akin to bracketing that would support the analysis. In particular, the fourth author, a previous professional footballer, had experience of ACL reconstruction, complementing the existing expertise and bodily experiences among the research team. As the work unfolded, we endeavoured to engage in a more strategic phenomenological interview to develop the analysis from the original (phenomenological) reflective notes. In what follows, then, we try to elucidate an attention to how injury and rehabilitation happened to and with the body within this sporting context.
Findings: Introducing the Body
The Injury
I feel, hear, and immediately understand the POP as the ground rushes towards me, unable to support my body weight. I land crumpled in a state of anger, frustration, and disbelief. All I can hear is the echo of ‘F***king get up’. I crouch on the floor. One hand holding my knee, the other propping my head up. The cold, wet grass presses against my forearm. Its smell fills my nostrils, as I wait for the pain to flow around the knee. Something went; something snapped. Crunch. Twist. I don’t know where my foot landed. My heart and stomach sink as I think to myself, what the fuck was that?
I am aware of someone coming close, ‘Are you ok? What can you feel?’ but I don’t respond. ‘Can I roll you over to take a look?’. I begin to recognise the voice and feel a hand perched on my shoulder. I am now fully aware of the numbness that surrounds my knee. A dull ache that runs down my shin and behind the knee.
‘Ok, I’m going to straighten your leg out’. As soon as the physio begins this action, a sharp pain accompanies the movement. My foot feels like it is free-floating in the air. It feels disconnected. I stare. ‘How does it feel?’, I continue staring at my foot and nowhere at the same time. ‘How does it feel, is it painful?’ the physio repeats. I try to recall the incident, but it has already run from my mind. I am trying to picture the memory, but it evades me.
The throbbing, hot, pulsing ache on the outside of my knee becomes more prominent. I can feel the knee ceasing to work. A brief wiggle of my toes confirms they are there, but the network has been disrupted. A sudden rush of adrenaline hits my stomach; I feel nauseous. In through the nose, out through the mouth. I repeat this for several breath cycles. I settle again and imagine turning; the nausea returns. Something is out of line. Torn. Unsettled. Out-of-sorts.
Day 21 Post-surgery: 4 Feeling Space
Today marks 21 days post-surgery. I’m told 9 months for a return to sport. But why 9 months? Why is that the golden number? That’s 273 days. It is less than a year I tell myself. I look down at my leg and stare at the 10-cm-long scar that now adorns my shin as a permanent reminder of what has happened. Suddenly, the pain, which has been a dull ache, intensifies as my attention is drawn to the knee. I still cannot straighten my leg – ‘You must regain full extension [of the knee] by three weeks’, rings in my head. I’ve not even completed 10 per cent of the ‘golden number,’ and a numbness and disillusionment set in. I reach for the Co-Codamol that lies on the table next to me and twist the packet for two tablets. An action that has become so normal over the last few weeks that I no longer notice its powdery texture on my tongue. I wash the tablets down, hoping that they numb the pain, not just in my knee but also in my backside. I have been in this same position for nearly two hours. My lower back aches, and the left side of my buttocks is numb. I could get up, but I do not. I set myself the task of writing another 100 words before trying to move and bend the leg again. I have to wait for the joint to straighten out. It does not move. Nine months seems a very long way away.
I start slowly, gingerly moving my foot, but it is not long until ‘the knee’ stops dead in its tracks, as though someone has placed a ball between my foot and my bum. There is space, but I cannot fill it. I give my hamstring another gentle pull to see if I can encourage another few millimetres of movement, but nothing changes. It is stuck. The more I try to pull, the more pressure builds up in the front of my knee. This causes ‘the scar’ to jump into my attention as pressure builds. The stitches are being pulled apart. Suddenly, I am aware of my hands on the knee. I do not remember putting them there, but they help to control and stabilise things. I need my hands, as the muscle on the outside of my leg has wasted considerably. I barely recognise my leg. I can pinch the skin and pull it up with ease, like the loose skin around a cat’s neck. Years of gain, lost in a matter of weeks. The thickness, the definition, and the strength have all gone. I try to fire my quad. The outside twitches like two electric pads have sent shocks through the muscle, but nothing happens in terms of movement.
Day 25: Watching, Seeing, and Feeling
I decide tonight is the night to go watch the team play for the first time. As I stand on the side of the pitch, the game is unfolding in front of me. I slump against the yellow barrier that separates the pitch from the spectators. I am acutely aware of the two very different physical barriers; the cold metal one that I can touch and that presses into my chest, and the limiting internal one that pulls and presses at my knee. I begin to try and stretch the induced 5 leg back by pushing my heel to the floor, but instantly the back of my knee gives off the telltale signs that this is not going to be appreciated for long. A tightness flares up, and despite my best efforts to push the stretch on a little further, there is no way it is going to move. The stretch feels soothing and fulfilling, but the lack of mobility and comparison to what was previously possible is debilitating.
Two players crash into each other in front of me, snapping my focus to the match. As I watch them, pain shoots through the front of my knee. What on earth was that? I then feel my quad relax. I must have subconsciously tensed it in response to what was unfolding in front of me. A protective mechanism I did not know existed. I know that I could not cope with the movement on the pitch that the players had exhibited. One player continues to roll around on the floor. What if it is serious? I begin to see myself in and through another body and wonder how he will respond if it is serious. The nausea and feelings from that day return. I can smell the grass once again.
Day 33: Prescribed Exercise
240 days to go until ‘full recovery’. One step at a time up the stairs to the gym. As I do so, a younger man brushes past my shoulder, effortlessly taking two steps with each bounding stride. ‘Good leg first to heaven; bad leg first to hell,’ 6 I repeat to myself. As I trudge on, I begin to question the accessibility to the gym. Why is it located upstairs, and where is the lift that surely should be available to all? This is the first time I have ever asked this question. I notice a tight sensation surrounding my left knee, the good knee. It has been working overtime this last month. The right knee is induced with sickness, bolts, screws, and an artificial tendon that I am told will turn into a ligament, meaning the other must compensate for now. With the additional pressure, the cogs have already tightened.
I begin to work through the prescribed exercises as printed in the booklet. The same booklet that I imagine is given to every ACL reconstruction patient, although are two injuries/people ever completely the same? Having done these exercises a few times, the movements feel attainable, even if they are uncomfortable. The outer range of each exercise is still accompanied by pain. I have come to terms with this and appreciate that this is a likely occurrence as I try to push each rep, set, and gym session. I return to the question, ‘How on earth will I be able to play football again if I can’t even straighten my leg?’. I am yet to make the 0 degrees of extension (i.e. a straight knee) as demanded by the physio.
In between sets, my focus drifts off to the last game I played. The warm feeling of doing something ‘good’ fills my body; a good pass, a good tackle, a good block. One particular tackle replays continuously in my head. The ball lands and I spring into action, sliding from the side of a player to secure the ball before popping up to play a pass with the outside of my right foot. I can feel the suddenness of the movement and the ball caressing the side of the foot. My right leg involuntarily wiggles, connecting mind to body, but this sends a sharp pain through the knee that brings me crashing back to reality. The less I move, the more I move.
Day 144: Hop, Jump, Land
I stand on top of the box. 12 inches separates me from the floor, but it feels like 12 feet. My palms are sweaty, breathing rate elevated, heart pounding in my throat, and all I am preparing for is to drop off the box, land, and jump again. I am filled with an impending sense of dread and uncertainty. I hang my foot over the side but instantly draw it back. What’s the matter with me? I have done this countless times before. I begin to talk to the leg, trying to send it a message. ‘You can do it. You’ll be fine’, I whisper. It is such a simple movement, but I just cannot picture the movement. After a short pause, I once again urge the foot to move and this time I fall from the box – down, up, and down again. The movement feels clunky; parts are moving that were unnecessary. I notice a young woman next to me springing elegantly up onto a higher box. The smoothness of her movement impresses me as she dips down, pushes the ground away from her, spends time in the air and lands softly. I watch her repeat the movement another couple of times and think to myself, she must be an athlete. I no longer feel like an athlete.
Despite the clunkiness of the movement, no pain arrives. I have three to do. After each jump, I wait for the pain. The ground feels soft and squidgy below my feet, sucking all the energy from my legs and the drop. I can barely get off the floor. I can feel my ankles, calves, quads, and glutes all searching for power; searching for height that is not there. I am surprised to still be pain-free.
Day 198: Normality
Walking through the park is my favourite activity to do in the summer. The early morning alarm, straight out of bed, no snoozing, pull on some clothes and out the door on an empty stomach. It is 6:45, I’m 30 minutes into the walk, and until now I haven’t considered my knee once. Hugo, my lively four-legged companion, is investigating some bushes up ahead. Every so often, he sprints back towards me to collect a treat. I’m amazed every time at his deceleration control. He can go from top-speed to stopping on a dime with virtual ease. I am moving towards an acceleration and deceleration phase of the rehabilitation. I read last week that the body must control peak forces over six times body mass during a deceleration. SIX TIMES! I always mistook speed for acceleration, but slowing down is where the magic happens. Getting going is not the issue anymore, but the thought of slowing down causes problems. I look at my knee; the scar is a blueish-purple colour now; fully sealed but prominent. The remnant of stitches still present. I often get a tickling sensation under the scar. I return to my previous train of thought; last week I squatted twice my body weight for five, slow, not-particularly deep repetitions. At the time, it felt like a huge achievement, but how on earth does squatting twice my body weight equate to six times my body mass? When the bar is fixed on my back, it feels crushing, pushing every vertebra and lower limb joint closer together, squeezing me down into the floor. Every rep is a battle. I would be crushed by triple the weight on the bar! I wonder how being fixed on two feet during a squat equates to controlling a force six times body weight that is moving. The match-up perplexes me. One is fixed and the other is free – how can they help each other? They feel ontologically different. I suddenly realise I’ve walked the length of the park transfixed.
Day 233: Feeling Like a Footballer
The ball hits my foot and dies in front of me, which brings about a chorus of ‘nice touch’, from some teammates. The feeling is familiar, natural. Wow, I forgot I can do that. I step back, slide the ball to the next player and run forward to join the back of the queue once again. This is the first time I’ve moved like a footballer in seven months. The ball surprises me every time it comes towards me, but the surprise turns into shock as the ball reappears in my gaze where I intended for it to go. I just move here and there as the activity requires. It is predictable in pattern but also unpredictable in how the ball might arrive and what I will need to do to control it.
Just then, the next ball arrives, and it is veering off to the right. I spring to the side with an outstretched leg. The wayward pass reconnects with the pattern as I bounce back to follow the ball. ‘Great tidy-up’, one of the players shouts. I then progress the ball forward and continue to the next part of the line. Moments later, the whistle calls the practice to an end. I immediately go to my knees, ‘Is there pain?’ Alarmingly, and amazingly, no pain. The spring to the right and back was more aggressive than anything I have done in the gym up to now as part of my rehab. Was that too much? I wonder, but still no pain arrives. I begin to get ready for the next practice, while always waiting to see if the pain will appear.
***
The next day I wake up to the left knee feeling tight and restricted, while the right knee feels puffy around the kneecap. I try to extend the knee, but pain instantly envelopes the kneecap. Ouch! The pain I was expecting last night has arrived. Did I do too much? Have I re-torn the ACL? F**k! As the initial shock subsides, I understand the pain is in the front of the knee as opposed to the back. This gives me some solace. I continue my examination, pressing my thumb and forefinger into the pads on either side of the knee. Wow, that was a bad idea. I don’t want to leave the bed. I wonder if leaving the bed is even possible. Hugo just stares up at me, head cocked to one side like dogs do when they are interested or curious. He is ready to go, but I’m not ready to stand up just yet.
Discussion
Throughout the data, we have described a series of (embodied and sensory) experiences pertaining to injury rehabilitation and the ways in which injury is expressed through the body. A central point has been to present how a large part of rehabilitation for long-term injury is not a definitive start and end point – one that moves from being injured to being rehabilitated – but involves the fluctuations of being with injury. Consequently, the discussion is dedicated to understanding two interrelated issues: first, the experience of the embodied subject throughout rehabilitation; and second, understanding how time is worked through and with the body. We conclude with some practical recommendations.
In 1995, Crossley provided a helpful distinction between work that contributes to a sociology of the body and carnal sociology. The former, Crossley (1995) explained, relates to understanding ‘what is done to the body’, while the latter addresses the role of ‘what the body does’ in social life. Crossley’s (1995) distinction represents a noteworthy point of critique raised throughout this article that intersects physiology, strength and conditioning, rehabilitation, physiotherapy, coaching, physical cultures, and any other related field impacted by injury. This is not to decry such disciplinary perspectives but follows Merleau-Ponty’s (2012) critique in recognising how externalising the body can reify unhelpful dualisms. For example, in many places, the data can be read as ‘othering’ the injured knee (i.e. referring to the ‘induced’ leg, day 25) or descriptions of bodily aspects in a normative sense (e.g. not recognising the tone of the leg on day 21). In this way, Charlie’s knee was often described in a detached, objective sense. The Cartesian dualism we critiqued from the outset was represented in talking of the injured body as ‘not part of our own’, which was ultimately reflected in the timeline prescribed for completion of rehabilitation, just like any other object in the world. This apparent contradiction served as a valuable example of the ambiguous nature of a lived-bodily engagement in sport, as the injury thrusts forth what Aggerholm (2025, p. 7, emphasis in original) described as ‘a circular tension between the physical body that we have and the lived body that we are’. The double concept used in this way by Aggerholm acknowledges that physicality matters in sport, without reducing the body to an essence.
Returning to Leder’s (1990) notions of dis-appearance (i.e. relegated to the margins of our awareness) and dys-appearance (i.e. any abnormality with that body that becomes central to our perceptual awareness), the sensorimotor experiences prior to injury were unproblematic, and largely absent from consciousness, while injury thrust the sites of the body to the fore (e.g. body failure, breakdown). Thus, the dys-appearance of the knee was continually re-appearing throughout the different guises of the rehabilitation. Some examples included watching football, climbing stairs, jumping, landing, and ultimately returning to sport-specific activity. Yet, what becomes interesting was that the body revealed through the ‘dysfunction’ was frequently made sense of through scientific object knowledge (i.e. of how rehabilitation should work to ‘fix’ the injury; a straight leg by week three), and therefore, the subjectivity was that of a consciousness inhabiting the dysfunctional body-object (i.e. what the knee feels is possible and what I feel is possible of the knee). A crucial point, then, is how such knowledge becomes detached by being overly concerned with ‘how’ the body rehabilitates; that is, the causes and structures of the body.
The resultant concern with how body-object can be ‘fixed’ and measured leaves no regard for the body-subject as unfolding, that is at once situated and transcendent (Merleau-Ponty, 2012). Whereas, from the extracts, the experiences of the body were not just a singular site of pain (i.e. the knee/ACL itself) but referred to the on-going changes that dys-appeared (Leder, 1990). In this way, the findings expressed dominant categories in how the injury was made-sense-of, where, on one hand, the rehabilitation process was underpinned by scientific rationality (e.g. straighten your leg by this timepoint; begin running by this timepoint; move to jumping at this timepoint), yet on the other hand, was only accessible through the body-as-it-is-lived. This is not to disregard such physiological rationality, but as Sobchack (2010) helps us understand, we can appreciate both the subjective phenomenal body and an objective material body. We can then approach each lived body as a union of the two to understand the lessons we receive from both the self and the relation to others.
This argument is not merely to advocate for richer writing of injury, and other body-related activities (e.g. Bluhm and Ravn, 2022), but concerns the mind-body-world nexus. Rather than treating injury as a stress, adversity, or even trauma that an injured individual might have to contend with, the phenomenological perspective allows us to pay attention to how the body is the subject of experience (Leib) and not merely the object of experience (Körper). Crossley (1995), drawing upon Merleau-Ponty, described how the coordination of the body-in-the-world requires a practical embodied know-how. Yet, as demonstrated throughout the data, injury created disruption with such know-how, resulting in a distinct bodily sense of unfamiliarity and unease (e.g. butterflies on day one following injury). In this regard, we might turn to the idea of ‘horizons’ to locate the subjectivity of injury and rehabilitation, for as Heidegger (1962) tells us, the world itself is not what generates meaning, but it is the individual’s being in the world. What Heidegger (1962) helps us understand is that the being in the world can be recognised not as some idealised entity, a mere ‘present’ of the kind that might be captured in a photograph, but as an unfolding movement, as a temporal intertwining of past, present, and future. The combination, therefore, involves having-been (i.e. situated by history), being-in (i.e. present circumstances, and physical capacities), while simultaneously being-towards future possibilities (i.e. possibilities that are perceptible based on such history and circumstance).
In the injured athlete, then, we might begin to see fractures in this temporal structure, with one’s perceived horizons now in conflict with their situation. For example, on day 33, the sentiment ‘the less I move the more I move’ is an expression of an abundant horizon of possibilities; of a mind that now appears to exceed the limits of the body, sensing possibilities that are no longer attainable. As a consequence of still being that same body that has lived and has known possibility, the injured body continues to recognise a horizon that no longer feels within its grasp. Past and present, which before worked in concert, now thrust into view horizons that contradict one another. A further example can be found on day 233, which allowed past and present to collide when returning to the pitch and finding the surprise of what the body can do again, yet the pain arising the following day reconnected the same body as not being back. And so, the temporal intertwining that Heidegger (1962) introduced as the basis of our understanding of ourselves and the world appears to have torn with the ligament. Here, perhaps, lies the source of that tendency towards ‘othering’ the injured limb, towards the appearance of a dualism that philosophically we have already rejected. On this reading, this is not a mind in conflict with the body that contains it, but an embodied mind in conflict with its own history, grappling with the annihilation of its possibilities through no fault or agency of its own.
As we have already shown, however, in the context of sport and particularly football, exposure to linear ‘return to play’ protocols for ACL reconstruction (e.g. Waldén et al., 2023) assumes both a prior unproblematic bodily function and capability while also presenting a temporality (or future horizon as discussed earlier) that is unconcerned with change (see day 233). In this way, a key point perpetuated throughout the findings reflects Paterson and Hughes’s (1999) nuanced discussion on the way in which ‘impaired carnality dys-appears in the context of intercorporeal and intersubjective relations because it has been prevented from making its mark on the design of social space and time’ (p. 609). This is not to contradict the many forms of bodily dys-appearance that are produced by race, class, gender, and disability, or even the hyper-awareness of the body that might be found in high-level athletes, but demonstrates the social production of self-objectivation experienced through injury. Thus, what becomes crucial is the ways in which the promise of bodily futurity is unevenly distributed and experientially constitutive through the intercorporeal associations of the social world. This is a point raised by Allen-Collinson (2003) when referring to the experience of inner-time and the disruption caused to athletes’ experiences of movement. Despite Allen-Collinson’s (2003) recognition of a corporeal understanding of time while rehabilitating, such analysis has not yet made its way into rehabilitation, physiotherapy, and other body-as-object-orientated disciplines.
From a phenomenological perspective, we have demonstrated how movement (or potential movement) cannot be detached from the sensations, visual, tactile, and somatic experiences of the body. A point to draw from the data involves understanding the tensions between watching, feeling, and observing the activity that led to injury in the first instance while also acknowledging how rehabilitation requires coordinating a complex series of actions. In this case, moving from fixed exercises to more dynamic movements, and then variations of the sport itself meant constantly shifting and challenging what Schütz (1967) referred to as an inner perception. In this way, the ideal plan and structure for the rehabilitation – often measured through sessions, metrics of performance, time from surgery, etc. – cannot be detached from the embodied feeling movement.
Concluding Points
The findings and discussion provide a radical carnal critique of existing literature on rehabilitation by making a place for a complementary appreciation of the embodiment of injury (Csordas, 1993), as opposed to treating the body solely as the object of analysis. This critique, therefore, extends to the day-to-day practices associated with athletic performance (e.g. coaching, physiotherapy, sports medicine, sports rehabilitation) that either ignore the body as subject, or express the natural attitude of rehabilitation beginning and ending. We contribute a novel perspective to this discussion concerning what rehabilitation entails. Our descriptions contextualise how injured individuals experience their body and act accordingly throughout their prescribed rehabilitation. While connecting to wider areas of study, such as disability studies or feminist works, the value lies in presenting the experiential oddities of being injured and pursuing rehabilitation. The novel contribution here is that we have described the experience of being injured or being with injury in the hope of helping others; perhaps others who have similar injury experiences, others who support individuals with injuries, or even those who remain blissfully unaware of injury experiences altogether. Our desire is that the next time we encounter someone who is with injury or has been severely injured, we are sensitive, more watchful over the words used, and open to discussing the ways their body relates to the world. Our ambition extends to speak to a wide(r) audience, including physiotherapy, strength and conditioning, and other medical professions, through enhancing a level of awareness and sensitivity to the body as a subject living with injury. This is not to decry the well-versed mechanisms found in textbooks but to recognise the human and bodily components that can be lost when the athlete experiences such complications.
