UVA study hopes to heal confidence along with torn ligaments

September 26, 2025
Chris Kuenze monitors Candence Layne as she walks on a treadmill during ACL surgery recovery.

Recovery from ACL surgery is sometimes easier physically than mentally. A new research program at the University of Virginia School of Education and Human Development’s kinesiology department may help. Cadence Layne, a research assistant, walks the treadmill under the watchful eye of kinesiology professor Chris Kuenze. Both have had ACL surgery. (Photo by Matt Riley, University Communications)

When Chris Kuenze was 16, he injured his knee in a backyard accident, keeping him from playing sports during his junior and senior years of high school. Decades later, his injury is still top of mind.

“I am not sure that I ever had a feeling of being recovered,” he said. “There was always a sense that the injury could happen again. I was reminded of that when I would wake up with a stiff knee or experience a little pain while playing pickup basketball that I knew my friends weren’t experiencing.”

Being nervous about returning to play after a knee injury is a common experience. Evidence suggests even when young people are given a green light after physically recovering from an injury, many still struggle to fully trust they are ready. 

Chris Kuenze stands for a photo at the University of Virginia School of Education and Human Development’s kinesiology department

Kuenze understands patients who recover physically from ACL surgery but still struggle with anxiety about returning to play because he has those same emotions. (Photo by Matt Riley, University Communications)

Now an associate professor of kinesiology at the University of Virginia School of Education and Human Development, Kuenze is focused on helping young people who experience a knee injury mentally and physically recover so they can return to activity.

“Most ACL – anterior cruciate ligament – injuries happen to young people who are really active and participate in jumping, cutting and decelerating sports, like basketball or soccer,” Kuenze said. “These are young people we hope will return to their sport of choice after recovery. But we have found that patients really struggle to be physically active a year or two after surgery.”

Kuenze said when patients recover physically, they are often still struggling with fear, anxiety and a general feeling of distrust that they are ready to return to sports. 

With funding from the Jefferson Trust and the Digital Technology Core Seed Grant Program, plus support from the Headspace mindfulness app and the Oura Ring, Kuenze and his colleague, Shelby Baez at the University of North Carolina, Chapel Hill, are launching a pilot study to help individuals to increase activity, both physically and mentally.

To measure current activity levels and estimate how much more movement researchers hope to see, the study uses the Oura Ring fitness tracker. Researchers hope magic happens when they pair the tracking technology with mindfulness exercises in the Headspace app.

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Cadence Layne knows how challenging it can be to recover both physically and mentally. She tore her ACL during a high school soccer game, then suffered a minor knee injury just weeks after being cleared to return to play. Now a fourth-year cognitive psychology major, she has a keen awareness of the mental struggles she experienced during recovery.

“I remember a lot of coaches telling me it would be as much of a mental battle as a physical battle,” Layne, who works as a research assistant with Kuenze, said. “After reinjuring my knee in my fourth game back and completing that recovery, my doctor advised me to take it easy in my next game. But that really stuck with me. From that game and beyond, I began playing very fearfully.”

Kuenze said most patients feel physically ready, but struggle with fear and anxiety. He said patients who drop sports or activities after recovery are less likely to replace them with new activities.

“Do they ever fully recover? Do they feel like they’re recovered? And what can we do to support that recovery in a way that makes them feel like it was an experience that led to healthy behaviors in the long term?” Kuenze said. 

a smartphone on a desk with a digital wellness app on the screen. On the phone is placed a ring device that measures the wearer's vitals.

Integral to the research program’s results is a smartphone app, created by Digital Technology Core, that provides a series of prompts and questionnaires to measure anxiety and mental well-being, as well as pain and symptoms. (Photo by Matt Riley, University Communications)

That’s what the pilot program’s researchers hope to discover. Through specific rehabilitation-focused modules from Headspace, researchers will tee up 10- to 15-minute mindfulness meditation sessions to diminish participants’ sense of anxiety about their knee and the risk of reinjury.

Mark Rucker of Digital Technology Core and his team have developed a series of prompts and questionnaires to measure anxiety and mental well-being, as well as pain and symptoms.

“The Digital Technology Core is thrilled that we can support Chris’ research,” Rucker said. “It’s our mission to make the latest consumer smart devices accessible to all faculty, and this project is a perfect example of what’s possible.”

For Kuenze, the research is personal. He is now three surgeries into his own knee injury recovery.

“My experience has only made it clearer to me that patients need whole-person care starting before their surgery so that they can have realistic expectations, a consistent support network and collaborative strategies to overcome the most common mental and physical challenges in their recovery,” he said.

Media Contacts

Audrey Breen

Senior Associate Director of Communications School of Education and Human Development

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