On a muddy field in Antalya, Turkey, BIIK Kazygurt practiced for the most decisive match of the season. They were to face Bayern Munich the next morning in the round of 16 of the 2022 UEFA Women's Champions League, one of the most celebrated competitions in European soccer.

In a dead sprint recovery, Shannon McCarthy attempted to block a cross. Her heels dug into the unstable ground with force. She froze after hearing the telltale popping sound. The pain seared.

"In that moment, I knew something was tragically wrong," said McCarthy, who was in her fourth year of professional soccer. "There was instant swelling. I was actually shaking."

The native of Pinckney, Mich., tore two ligaments in her knee, both her ACL and MCL, along with 10% of her meniscus. She couldn't think about what it meant for her soccer career – though she knew prospects were bleak. First, McCarthy needed immediate care.

"I was not in the country of my work visa, and my team was leaving the country the next day for competition, so I was going to be in Turkey with a wrecked knee," she said. "I eventually flew to Kazakhstan to have an MRI. I basically needed complete reconstruction in my knee."

Eventually, McCarthy made her way to University of Michigan Health's Department of Orthopaedic Surgery, around 20 miles from her hometown. The reconstruction lasted approximately two hours but went to plan. The long road of rehab lay ahead.

"At the 36-hour mark after my surgery where the morphine wears off, it was like someone took a blowtorch to my leg," McCarthy said.

Rehab journey

In the first six weeks following her surgery, Shannon's rehabilitation was limited. Her knee was swollen and locked in a brace. Her rehab team focused on gaining some quad strength and movement in the knee, laying out goals for recovery in the short and long term.

"I was pretty sure I wasn't going to play again, certainly not overseas," McCarthy said. "But I also coach a youth club, and I wanted to get back to a point where I could participate with athletes and do everything the players do to be the best possible coach I could be."

The typical length of rehabilitation for an ACL reconstruction surgery is around nine to 12 months to return to sport. Shannon's return was slightly complicated by the additional injuries.

Immediately, her team provided building blocks to get back to high-level athletics. Once strength improved, they would move to jumping, then hopping and cutting.

"The moment I met Shannon, I could tell she had a fierce determination to excel in rehab," said Corey Block, P.T., D.P.T., S.C.S., physical therapist at MedSport, U-M Health's multidisciplinary sports medicine team led by orthopaedic surgeons.

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"It's hard to stay engaged with therapy when it's kind of simple stuff when you're used to high-level athletic activity. So, I involved the soccer ball as soon as I could."

Mentality

Even for professional athletes, rehabilitation doesn't come without challenges. Shannon had to get over the hump of gaining full extension in her leg, as is often the case with MCL repair, as well as keeping a steady knee when doing more active workouts.

She describes it as grueling.

"Being an athlete, I'm used to instant results, almost like instant satisfaction from the work I'm doing," McCarthy said. "So, doing some of the slower work, like sitting there with a duffel bag on my knee to let gravity pull it to full extension, that just feels so counterintuitive for athletes."

However, Block says, Shannon's fierce will power shone through at the onset of her time in therapy.

"Recovery from injury is just as much mental and emotional as it is physical; there is a fear of reinjury that can be overwhelming," she said.

"There's trusting the leg the first time you squat or walk without your brace, or when you run and jump. We practice in the clinic in a very safe environment to ensure the patient is comfortable and building confidence – not just pushing ahead. Shannon had the ability to commit to the program no matter how hard it was. So, I knew that she would stick with it and stay focused on her short- and long-term goals. Based on her determination, I knew she could get where she wanted to be."

The return

Eventually, McCarthy began training at her old gym, incorporating more field sessions. She put her cleats back on and began changing direction at a high tempo with higher intensity.

She was having fun again.

"At around six months, I started thinking, 'I might really be able to play again,'" McCarthy said. "I played with some pros who came back to Michigan during their offseason, and they couldn't believe what I was able to do. By 10 months [after the operation], I started playing with more reckless abandon – that moment of zero hesitation where I'm sliding, jumping over people and blocking things. Just so much fun."

On May 12, one year and 11 days after having surgery for what her father playfully called a "mush knee," Shannon McCarthy checked into a match for Detroit City FC, a team in the USL W League.

"I was cautiously optimistic, trying to ease into the speed and physicality of the game," she said. "But there was a moment where it clicked. I was sliding in front of someone to block a pass, and I did it with my surgically repaired leg. That's when I knew it was going to be great. I was playing in front of my family for the first time in five years. It was a blast."

McCarthy plans to continue playing in USL W while advocating for it to become professional. She's determined to see that the young girls she's coaching can play for money in Michigan, not having to travel overseas just to make a living doing what they love.

Seeing that resolve translate from the rehab room back to the field – that's the ultimate gift for Block as a physical therapist. 

"I'm super proud of Shannon," she said. "I know she put a lot of work to get where she's at. It wasn't always easy mentally or physically, and I'm happy to see her back to doing what she loves. It all makes me really thankful for the opportunity to work with patients like her."

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