By Dr. Kurtis Ashcroft

 

Caoimhe Conlan is County Antrim’s number 6 in camogie – a hard-nosed, tenacious player with a work ethic that most coaches dream about. She’s a leader in every sense, having captained and vice-captained both club and county over the years. On the pitch, she’s not just a defender, she’s a conductor, orchestrating from the back with a sharp mind and sharper tackles.

Unfortunately, early in the 2023/24 county season, Caoimhe sustained a fractured thumb. (Stick with me — this seemingly minor injury plays a key role in the bigger picture). She spent six weeks in a fracture cast, and while she maintained her cardiovascular fitness, most of her conditioning was limited to linear-based running — not exactly a replication of the chaotic, multi-directional demands of elite camogie.

Soon after returning to competitive action, Caoimhe was back doing what she does best. But during a game, while in possession and evading an opponent, she made a sharp cut — the kind of explosive movement camogie demands — and felt that dreaded pop behind her knee. ACL ruptures are rarely subtle, and this was no exception.

From a rehab and sport science standpoint, the dots start to connect. The time spent off-feet during the thumb injury may have contributed to compromised ligament health — especially in tissues like the ACL that rely heavily on regular loading to maintain collagen integrity and tensile strength. Extended periods of underloading can lead to collagen degradation and reduced compliance, creating a perfect storm for injury when the body is thrown back into high-stress, game-like scenarios too soon.

 

The Injury:

Clinical and Imaging Findings:

Caoimhe sustained a non-contact, rotational knee injury during gameplay, resulting in immediate joint effusion, mechanical instability, and audible “pop,” highly suggestive of cruciate ligament injury.

A positive Lachman and anterior drawer test with marked anterior tibial translation and diminished end-point suggested ACL rupture. No clear evidence of injury to the medial/lateral collateral ligaments or posterior cruciate ligament was observed.

MRI Report:
MRI of the right knee confirmed a complete midsubstance rupture of the anterior cruciate ligament, with associated retraction of the ligament fibres. No concurrent meniscal injury, osteochondral defect, or collateral ligamentous involvement was visualised. Articular cartilage appeared preserved, and no evidence of Segond fracture or bone contusion pattern.

 

Impression:
Isolated complete ACL rupture without associated intra-articular or periarticular structural damage.

 

Diagnosis & Management Plan

Following a clinical assessment and MRI confirmation, the diagnosis was clear: a complete anterior cruciate ligament rupture. Given Caoimhe’s age (26), high level of sporting activity, reported instability, and lack of contraindications, surgical reconstruction was the recommended route. The surgical plan? An arthroscopic ACL reconstruction using an ipsilateral hamstring autograft — semitendinosus, with or without gracilis, depending on intraoperative assessment.

 

The Catch: Life Doesn’t Stop for Rehab

Now here’s where real life meets sports medicine.

Every athlete is first and foremost a human being — and humans need headspace. Before committing to surgery, Caoimhe and her partner had already planned a long-anticipated trip around Australia. So, we adapted. Rather than viewing this as a setback, we reframed the pre-op phase as an opportunity: a window to restore full knee extension, normalise gait, enhance neuromuscular control, and build as much quadriceps strength as possible — all while soaking up the Aussie sun. (ACL prehab but make it scenic.)

 

The Operation

Upon returning from her travels, Caoimhe underwent successful ACL reconstruction on 17th February 2025 at Knightsbridge Hospital, Belfast. With surgery complete and the graft in place, it was game on: rehab began in earnest.

 

The Rehabilitation Plan

Taking the “Athlete Focused” approach, from day one post-op, this was a team effort built around Caoimhe.

Dr Kurtis Ashcroft, Director at Athlete Focused Ireland (and the guy writing this blog), led the rehabilitation programming and delivered weekly 1-to-1 rehab sessions. Meanwhile, physiotherapist Síofra O’Mullan took charge of functional restoration, mobility, and clinical progressions. Regular testing checkpoints ensured, we stayed aligned, responsive, and most importantly — evidence-driven.

Together, with Caoimhe at the centre of every decision, we developed a phased, progressive plan rooted in years of rehab coaching experience and the latest research. We’ve blended gold-standard benchmarks with real-world pragmatism, adapting to her responses week-by-week. Below, you’ll find some of our rationale that guided our decisions — the what, the why, and the “how much more can she actually do this week?”  For a glance at Caoimhe’s actual performance data, feel free to reach out to us.

 

Phase 1: 0–2 Weeks Post-Op – Foundation First

The early post-op phase is all about respecting physiology and laying the groundwork. Our focus was simple: control joint effusion, protect the graft, restore full extension, mitigate arthrogenic inhibition and reintroduce quadriceps function. Yes, it’s the basics — but get this wrong, and you’re building a house on sand.

Caoimhe’s background as a physiotherapist was a massive advantage here. She knew the importance of early movement quality, and her discipline showed. With her kind of consistency, we achieved full passive extension and active quadriceps activation within the first two weeks — ticking off the biggest early-stage boxes. No racing back to action — just deliberate, high-quality movement from a highly engaged athlete.

 

Phase 2: 2–8 Weeks – Build Without Breaking

The aim here was progressive loading without overreaching. We layered in isometric strength work (particularly quadriceps and hamstring), proprioceptive training, neuromuscular drills (posture, positioning and patterning), and low-impact conditioning via bike and pool. We incorporated as much hypertrophy training of the lower body as possible through closed chain exercises, progressing to PWB open chain exercises from week 4 and onwards. Establish segmental coordination and patterning i.e.- lumbo-pelvic control and hip dominant movement strategies.

Caoimhe’s technical awareness and training background meant she wasn’t just doing the work — she understood why each component mattered. That buy-in? It’s a coach’s dream.

 

Week 4 – The Setback:
Here’s where we hit a bump in the road.

While working pitchside at a game, Caoimhe sprinted onto the field when a player went down — instinct kicking in, as any good physio would. Unfortunately, her hamstring (which was also her graft donor site) didn’t take too kindly to the sudden burst. A flare-up followed, forcing us to temporarily reduce the volume of her hamstring work to let things settle.

We adjusted on the fly — scaling back volume, modifying iso angles, and prioritising recovery. Within 10 days, she was back on track. The lesson? Rehab isn’t a straight line, and even with perfect planning, life happens.

 

Phase 3: Weeks 8–12 – Load, Strengthen, Stabilise

With hamstring symptoms fully resolved and clearance from Siofra, we initiated eccentric hamstring loading — slightly later than initially planned. The focus during this phase shifted toward progressive hypertrophy, increased training volume, and the introduction of strength key performance indicators (KPIs). While avoiding excessive detail, one benchmark was the front squat, targeting 1–1.5x body weight.

Proprioceptive work continued with increasing complexity, complemented by aerobic capacity development via structured bike intervals under load.

We also began comprehensive force testing — capturing asymmetries, rate of force development, and readiness markers to guide progression. Caoimhe’s numbers were consistently strong and steadily improving.

Her adherence? Still over 95%. By this point, she was likely correcting me mid-session.

Once lower limb strength asymmetries fell below 20%, we introduced open-chain concentric quadriceps work. Pain and swelling were well controlled, and full range of motion (ROM) was achieved. Movement progressed from straight-plane to diagonal and rotational exercises.

 

Phase 4: Weeks 12–16 – Reintroducing Dynamic Movement

With a solid strength foundation in place, we began reintroducing dynamic, sport-specific movement. This phase transitioned from extensive partial-weight-bearing plyometrics to intensive full-weight-bearing bilateral efforts, and then into unilateral variations as tolerated — increasing both intensity and contact volume (“touches per session”) as we advanced.

Key training components included:

• Jogging reintroduction via progressive dribble bleeds
• Jump mechanics and deceleration drills
• Single-leg strength development and landing strategy
• Multi-directional movement integration
• Eccentric overload training
• Force plate assessments – CMJ, SL CMJ etc.,

Collaboration between athlete, S&C coach, and physiotherapist remained seamless. Each phase had defined entry and exit criteria based on objective data, athlete response, and context — no guesswork, no unnecessary acceleration.

Caoimhe adapted exceptionally to the rising demands. Her movement quality remained elite — a reflection of both her dedication and her deep understanding of the process.

 

Phase 5: 16+ Weeks – The Athlete Returns

At this stage we are 15 weeks into the rehab process, Caoimhe has her eyes firmly on the return-to-play horizon. We will move into integrated metabolic conditioning on pitch, blending technical movement with energy systems demand and layering in cognitive challenges (reaction-based drills, decision-making, and fatigue exposure). We are not just focusing on numbers at this stage – we are identifying through the coaching eye that Caoimhe can absorb and express force during running, decel, cut and change direction efficiently.

 

Key areas of focus:

• High-speed running reintroduction
• Controlled cutting and curvilinear sprinting
• Plyometric sequencing (depth jumps, bounding, reactive hops through multiple planes)
• Game-specific energy system development
• Continued lower/upper strength progressions

We were no longer just rehabbing, we are rebuilding an athlete.

 

Final Thoughts

Rehab is rarely linear, and Caoimhe’s journey has been a perfect case study in how science and coaching (The AF way) come together to deliver results. Her background as a physio gives her an edge, but it is her mindset — relentless, curious, and committed — that really makes the difference.

Over 95% adherence thus far, meticulous attention to detail, and a genuine team approach — that’s how you return from ACL surgery, not just healed, but better than before.

 

We haven’t included Caoimhe’s testing data in this blog, but if you would like access, feel free to reach out to us at kurtis.ashcroft@athletefocused.com