Inside Rachael Saunders' grueling journey through ACL rehab

Dargan Southard
The Des Moines Register

IOWA CITY, Ia. — The image resurfaces every time Rachael Saunders receives a text or call — another reminder of the horrific day that significantly altered the last nine months. It’s not like she’s forgotten the scene. She couldn’t if she tried. But peeking at the past often brings a deeper appreciation for the present.

“Having the picture as my phone screensaver — me on the crutches,” Saunders said, “everything seems better than that.”

West High's Rachael Saunders works on set plays during practice on Wednesday, Jan. 17, 2018.

It’s been a grueling expedition since March 1, 2017, when a simple defensive drop-step transformed into a prolonged nightmare with one severe pop. Torn ACLs certainly aren’t uncommon for female basketball players — and the recovery process is relatively straightforward at this point — but that doesn’t make the bounce-back any less daunting. It’s nine months of rehab, questions and doubt. Nothing prepares you for the darkness.

But that’s in Saunders’ rearview mirror now. The Iowa City West senior guard and Creighton signee returned to action earlier this month, hoping to help guide the No. 3 Trojans (11-4) back to the state tournament where last year’s agony all began.

Saunders is averaging 10.5 points per game so far and will likely see that number increase as the season pushes forward. Her collegiate future remains cemented despite initial concerns of being viewed as damaged goods.   

“Even when she was on the sidelines, she’s always been there with us," teammate Logan Cook said. "She’s always been our No. 1 supporter. But now having her actually back on the court with us, she just contributes so much and is a great asset and a great friend.

“It’s great to see her all healed up.”        

West High's Rachael Saunders, left, and Logan Cook chat during practice on Wednesday, Jan. 17, 2018.

Saunders is the one who brings the noise as West’s emotional leader, always pumping in excitement and encouragement to anyone who needs it. She’s garnered a new perspective too on basketball and life, one that will resonate long after last year’s strenuous journey.

And was it ever a journey.

The snap

March 1, 2017, began with promise as the Trojans began their quest for a state title against Waukee at Wells Fargo Arena. Saunders had just dropped 16 points the week before in the regional final to propel them there. Another quality day appeared likely.

Four minutes in, she heard the snap.

“It freaked me out,” Saunders recalled, “a lot.”

A diagnosis wasn’t immediately known, and she actually checked back in shortly after but quickly collapsed again. Saunders described the second fall as “like my bones almost folded over on each other”, and she instantly hobbled to the training room where her parents rushed in shortly after. It was there that West athletic trainer Sheila Stiles delivered the unfortunate prognosis — torn ACL in Saunders’ left knee.

Her mom wanted to go to the hospital immediately. Saunders refused.

“She was on crutches leading cheers, meeting kids on crutches out of the timeout and different stuff like that,” Trojans coach BJ Mayer said. “So again, the ultimate teammate that you just hope for. I think that says a lot about that kid.”

Rachael Saunders celebrates on crutches with her Iowa City West teammates after a win over Waukee during the Iowa high school girls state basketball tournament on Wednesday, March 1, 2017, at Wells Fargo Arena in Des Moines.

West rallied to knock off Waukee but fell to Valley two days later in the state semifinals. Surgery wasn’t scheduled until March 20, meaning Saunders had to push through her entire spring break in the Virgin Islands on a torn ACL.

At one point, she said, Saunders wasn’t thinking, trying to enjoy the tropical weather as best she could. She tried to throw a ball on the beach — twisted, planted — and crumpled to the sand.

Sounds like a dream vacation.

“I was on the ground for probably 40 minutes, just for all the scar tissue tearing,” Saunders remembered. “It was gut-wrenching.”

The rehab

Physical therapy commenced three days after surgery, and additional discouragement wasn’t far behind. During her first PT session, Saunders, with her right leg flat, was asked to lift her left leg toward the ceiling as an initial test. Seemed simple enough.

She couldn’t do it. Not even close.

“When you can’t lift up your own leg, being able to play is the furthest thing from your mind — incredible mental doubt that I didn’t even know was possible in my own head,” Saunders said. “I thought I was a lot stronger than that, but when something like that happens, it’s almost hard to avoid thinking that.”

Gradually, though, the rehab began to serve its purpose as Saunders attended PT workouts every Monday, Wednesday and Friday, as well as on the weekends when she could. Her AAU season with the Iowa Barnstormers was zapped as extra sessions overlapped with out-of-town road trips, but Saunders eventually fought through the disappointment and realized how beneficial the additional training was.

Benchmarks started to emerge a couple months in, always generating extensive smiles and excitement no matter how trivial the task previously appeared.

Walking normally was an accomplishment, as was the first bend of the knee. Three-and-half to four months in, Saunders was cleared to run on land after doing so exclusively in a pool after surgery. Planting, cutting and jumping were mixed in over time, and Saunders initially hoped she’d be cleared closer to six months rather than the typical nine.

“She was trying to tell anybody who’d listen that she was ready to go,” Mayer said. “Ultimately, that’s not quite my call, nor was it hers probably."   

One final hurdle loomed.

It’s referred to as an isokinetic knee test, and Saunders pegged the machine as “something I most hate in this world.” She had been working to pass since four months after surgery, needing to show a minimum of a 10-percent deficit in her repaired knee compared to her healthy one.

“They have you strapped in — and your leg is strapped in — and you have to kick up and pull back against resistance. And. Saunders explained. “That was my final test. Incredible time commitment and frustration went into that machine. Passing it was incredible.”

The test show only a two-percent deficit, and Saunders was cleared for 5-on-5 practice right before Christmas.

Never had she received a better gift.

The reassurance

Omaha is only about a two-hour drive from Des Moines, so Jim Flanery — like many college coaches do — ventured over the state tournament last March to watch his 2018 commit. Saunders knew the Creighton women’s basketball coach would be in attendance for the Waukee game and wanted to put on a show.

Then, snap.

Saunders committed in October 2016 and hadn’t signed yet. As her mind took off sprinting in the Wells Fargo Arena training room, one thought prevailed above the rest.

Why would Creighton still want me?

Saunders said she called Flanery a day or two after the injury and broke the news. She braced for the worst.


“He said, ‘I just want to let you know that nobody on our part has lost faith in your ability to play here,’” Saunders said. “And I just had this wave of relief come over me.”

Creighton women's basketball Jim Flanery had zero hesitation about sticking with Rachael Saunders after her ACL tear.

Flanery’s reasoning was simple.

“When you commit to a kid and they commit to you, there’s no guarantee that they’re going to be injury-free,” he said. “But just knowing her mentality and her work ethic, I knew she’d tackle rehab in a way that would get her back on the floor as quickly as she could — while not risking coming back so soon that she would have bigger issues or lasting issues.

“It’s never a good thing, but the bottom line is ACL tears are part of women’s sports. Unfortunately, they’re a lot more common for women than men. That’s just part of the deal.”

Flanery and his assistants received updates throughout the rehab from both Saunders and her dad. She visited Creighton for its summer camp, her official visit and a handful of games, allowing the coaching staff to get in-person checkups as well. Flanery said he didn’t micro-manage Saunders’ progress, instilling trust in her family and doctors that everything would turn out satisfactory.  

“If your sitting in our chair,” he said, “you’re pretty confident that Iowa City is going to enough good options from an orthopedic standpoint.”

Saunders signed this fall and ecstatic for the collegiate scene — but there’s still unfinished business in Iowa City. She yearns for a title in her final prep campaign. But if it doesn’t happen, so be it.

Life goes on.

A glance at her phone shows just how worse it could be.     

Dargan Southard covers preps, recruiting, Iowa and UNI athletics for the Iowa City Press-Citizen, The Des Moines Register and HawkCentral.com. Email him at msouthard@gannett.com or follow him on Twitter at @Dargan_Southard.