Olympian D’Agostino shares 3 lessons after ACL injury

ACL injury“The crux of Olympic competition is to do everything you can to be the first one to cross the finish line,” says Abbey D’Agostino. But that’s not what Abbey did during the 5,000-meter qualifying heats in the 2016 summer games.

Abbey had trained for her Olympic moment for years, adhering to the rigid 24/7 lifestyle of an elite athlete since graduating from Dartmouth College and signing to run professionally with New Balance.

Abbey’s Olympic moment came unexpectedly when she and New Zealand runner Nikki Hamblin collided and tumbled to the ground.

What happened at the Olympics is an example we should be talking about in youth sports. It’s not just about achievement. It’s about sportsmanship.

Abbey ignored her training, her coach’s advice, her dreams.

She stopped and extended her hand to Nikki, and the pair hobbled through the final mile of the event side by side.

“What happened at the Olympics is an example we should be talking about in youth sports. It’s not just about achievement. It’s about sportsmanship,” says Dr. Mininder Kocher, associate director of Boston Children’s Hospital Sports Medicine.

There were a few things Abbey didn’t know during that fateful mile. She would be diagnosed with a devastating injury: a complete tear of anterior cruciate ligament (ACL), a meniscus tear and a strained medial collateral ligament. She and Nikki would be awarded the Pierre de Coubertin medal for Olympic spirit. And her team would expand.

Physical therapist Carl Gustafson would join Team Abbey, along with her coach Mark Coogan and Kocher, a world-renowned knee surgeon.

Abbey’s decision to stop running during the race of a lifetime and lift her rival has provided invaluable lessons on sportsmanship.

“It’s a really humbling process of relearning where my identity lies,” says Abbey.

Research shows the psychological impact of an ACL tear on an adolescent athlete can be similar to a cancer diagnosis. “It’s a big deal. In many adolescent athletes, their identity and their peer group are tied to being an athlete, and when they lose that, they can lose their bearings,” says Kocher. “The athlete’s risk of depression increases.”

“Abbey she is very strong mentally and very calm. That’s helping her,” says Kocher.

What has the Olympian learned since the race?

ACL injuryEmbrace the opportunity

“This is a really unique time in training. Rehabilitation is my No. 1 priority, but I have flexibility in terms of other events and speaking engagements,” says Abbey. Those other events run the gamut from meeting President Barack Obama to visiting patients at Boston Children’s.

Abbey’s ACL surgery

Abbey is a rare runner not only because of her gifts but also because ACL injuries are uncommon in her sport.

She tore her ACL and meniscus and sprained her MCL, the ligament on the inside of the knee. “To get all three is bad luck, but not uncommon — maybe 10-20 percent of patients,” says Kocher.

Kocher treated Abbey’s sprained MCL with crutches and a hinged knee brace, allowing it to heal on its own. Then the pair discussed her ACL surgery.

ACL reconstruction requires a tendon graft. Most patients are treated with an autograft, a harvested hamstring or patellar tendon. However, that can result in quadriceps or hamstring weakness. An allograft (donor tendon); however, carries a slightly higher re-tear risk.

“In an athlete like Abbey, who is performing at the highest level, any sort of deficiency, even if it’s small, can be the difference between world-class and not,” explains Kocher.

Because running isn’t a high-risk activity Abbey and Kocher decided to use an allograft.

During Abbey’s surgery, Kocher repaired her meniscus, which reduces her risk for arthritis in the future. “Sometimes the surgeon has to remove the meniscus, which acts as a shock absorber in the knee.”

Kocher continues to work with Abbey’s coach and physical therapist to guide her back to elite performance.

Running is no longer just a platform to reach others in terms of a great performance or record-breaking time, Abbey says. Her new opportunities allow her to share her vision of youth sportsmanship. Abbey and Kocher agree that staying involved with teammates can help healing.

Pour your energy into your teammates, says Abbey. “Attend meets. Create notecards. Be a positive force. This maintains the connection with sport and creates a lasting appreciation for friendship.”

Kocher adds, “Talk about your feelings. [If emotions become overwhelming] a sports psychologist can help athletes build coping strategies.”

Create a relaxed mindset

For years, Abbey has embraced the elite-athlete mindset. Everything is calculated and finely tuned to achieve a specific goal.

“That’s not the nature of my life right now. I have to be in tune with my body’s natural signals,” says Abbey.

She’s taking time to read, nurture relationships and reflect on her future. “It’s easy to idolize running. Through this experience, I’ve learned I’m complete without running. When I do return to sport, I know I’ll approach it with gratitude for the gift rather than as a way of proving my self-worth.”

Still, Abbey misses her training schedule, which included up to 80 miles of running every week, producing endorphins that can have a positive impact on mental health.

Focusing on rehabilitation has helped, says Abbey. She’s cycled on a stationary bike since the injury and started aqua jogging four weeks after surgery.

Kocher encourages patients to channel their athleticism into rehabilitation. It not only rebuilds strength, range of motion and balance to prepare the athlete to return to sport, but also provides an important emotional boost in a safe environment that doesn’t stress the ACL graft.

Keep your eyes on the prize

Abbey’s dreams have shifted but not disappeared.

“One of the first things Dr. Kocher told me is that I would be able to return to elite running without a problem.”

Abbey has set her sights on qualifying for the world championships in August 2017. The goal requires speed, yet her approach is relaxed.

Abbey and Kocher, together with her physical therapist and coach, have devised a carefully calculated training plan that will progress from aqua jogging to running on an anti-gravity treadmill to walking and then jogging and finally running again.

How fast and where Abbey will go is unclear. A few things, though, are clear. Her reconstructed ACL is strong enough to take her there, and her place in Olympic history is sealed.


Make an appointment with a Boston Children’s sports medicine specialist.

Learn more about ACL injury and recovery.