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270 | The Challenging Dynamic When Friends or Family Help With Your ACL Rehab · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Robbie Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:01
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:07
  SPEAKER_00: Today I want to talk about something that comes up more than you would think.
• 1:13
  SPEAKER_00: And something I don't think gets talked about enough in this space.
• 1:18
  SPEAKER_00: And one thing that is just fun and coincidental about the timing of this recording is that we've got a blower outside, and if you've been with me since OG days, we have had blowers and lawnmowers and construction in the background.
• 1:34
  SPEAKER_00: So this is a bit nostalgic for me, but also a little disruptive.
• 1:38
  SPEAKER_00: But I'm used to it.
• 1:39
  SPEAKER_00: So we carry on.
• 1:41
  SPEAKER_00: So let's talk about this topic because I think it's gonna be super helpful for some of you.
• 1:47
  SPEAKER_00: For some of you, it may not be applicable whatsoever, but I think that many of you in this ACL rehab process who's going through it, you may have a situation where a friend, a family member, a neighbor, a spouse, a parent, someone you already have a relationship with ends up being the person guiding your ACL rehab.
• 2:10
  SPEAKER_00: Maybe they're a physical therapist, maybe they're a trainer or a coach who knows a thing or two about just movement.
• 2:18
  SPEAKER_00: Maybe they just know enough to help, right?
• 2:20
  SPEAKER_00: And on the surface, it makes complete sense why you'd go that route.
• 2:24
  SPEAKER_00: But what actually happens in practice is a different story.
• 2:28
  SPEAKER_00: And that's what this episode is about.
• 2:30
  SPEAKER_00: I'm not here to make anyone feel bad about the decision they made or are currently in.
• 2:36
  SPEAKER_00: I get why people do this.
• 2:38
  SPEAKER_00: I'm here to name what's really going on so that if you're in this situation right now, or you're about to be, you have the full picture.
• 2:47
  SPEAKER_00: And this is after taking so many calls with different ACLs, different situations, whether it's you know, parents involved in the process, they're a trainer, or they're a physical therapist, or it's a neighbor they know who knows a thing about this down the road.
• 3:03
  SPEAKER_00: Maybe it's a family friend who knows about ACL rehab, or maybe it is someone directly in relationship with you, like a spouse, or even like a girlfriend, boyfriend.
• 3:14
  SPEAKER_00: Like, of course, this ranges from you know teenagers typically all the way to people in their 50s, 60s, and even 70s.
• 3:22
  SPEAKER_00: Like it doesn't just pick a certain age or a sport, it uh happens across the realm with so many different ages, populations, and of course, all over the world.
• 3:31
  SPEAKER_00: So you're gonna try and utilize the resources you have available.
• 3:35
  SPEAKER_00: And so this is something that I've been noticing so many different patterns of this, and most importantly, I've been just seeing ACL or struggle, just struggle so hard because our healthcare and insurance system is very challenging.
• 3:51
  SPEAKER_00: And so, yeah, why not work with something that you know personally?
• 3:56
  SPEAKER_00: And it sounds like there's a lot of upsides to this, but this is the thing that I just want to really get into and talk about today.
• 4:04
  SPEAKER_00: And the first thing is just for us to just be honest for a second about why this happens because the reasons are legitimate.
• 4:12
  SPEAKER_00: The most common one is financial.
• 4:14
  SPEAKER_00: That tends to be a really big one.
• 4:16
  SPEAKER_00: ACL rehab can be expensive.
• 4:18
  SPEAKER_00: We just know that things like this, it takes an investment.
• 4:23
  SPEAKER_00: The thing that's also hard is that here, especially in the States, we feel our insurance should be the thing that should get us there.
• 4:32
  SPEAKER_00: And yeah, if you have amazing insurance, then cool.
• 4:35
  SPEAKER_00: But most people don't.
• 4:37
  SPEAKER_00: My family is currently uninsured.
• 4:40
  SPEAKER_00: Like we are using a different strategy for our healthcare this year because it's an absorbent amount of money.
• 4:46
  SPEAKER_00: And I've shared this before on the podcast of how much we spent last year.
• 4:50
  SPEAKER_00: It's crazy.
• 4:51
  SPEAKER_00: And the thing is, is that we feel that insurance should help us out and cover these things.
• 4:57
  SPEAKER_00: And people are like, well, does insurance cover this?
• 5:00
  SPEAKER_00: And it's hard because you might have limited visits, you might not be a network, you know.
• 5:06
  SPEAKER_00: And the the hard part is finding someone who like specializes and understands this.
• 5:11
  SPEAKER_00: So we get that ACL rehab can be expensive.
• 5:13
  SPEAKER_00: It's it's an investment for your health and it's a long process.
• 5:17
  SPEAKER_00: And the thing that I always tell people is not if your insurance runs out, it's more of when.
• 5:24
  SPEAKER_00: So you need to have an option.
• 5:26
  SPEAKER_00: And it also matters if you're getting the quality rehab because you could use insurance and it could take maybe a year and a half to two years to get you there, or you may use some insurance and go out of network or out of pocket, and it gets you there in a more reasonable time because you're working with someone who's more specialized in this, right?
• 5:45
  SPEAKER_00: And so this is the challenges of the system.
• 5:47
  SPEAKER_00: So, with the the nature of it having some financial side of it, insurance visits run out pretty fast based on this process.
• 5:56
  SPEAKER_00: The out-of-pocket cost adds up.
• 5:58
  SPEAKER_00: So when you have a friend who's a PT or a parent who's a clinician or a neighbor who's a coach, the math looks really attractive.
• 6:05
  SPEAKER_00: It's free access in a sense.
• 6:07
  SPEAKER_00: Unlimited sessions, someone you already trust.
• 6:10
  SPEAKER_00: That's a real upside.
• 6:11
  SPEAKER_00: And I'm not gonna dismiss that whatsoever.
• 6:14
  SPEAKER_00: The second reason is access.
• 6:16
  SPEAKER_00: Not everyone has a great ACL specialist in their area.
• 6:19
  SPEAKER_00: And I would say for 90 to 95% of people, they don't necessarily have that, especially easily accessible.
• 6:26
  SPEAKER_00: There's not just a lot of ACL specialists out there.
• 6:28
  SPEAKER_00: Remotely, yes, you can get on the internet, you can search, you can look at Instagram and all the places.
• 6:34
  SPEAKER_00: And these days, everyone's a ne-in ACL specialist.
• 6:37
  SPEAKER_00: Um, it's really grown rampant in the more AI remote world.
• 6:41
  SPEAKER_00: Um, it's just a thing that's happening.
• 6:43
  SPEAKER_00: And so you have to just be careful, vet people, do all the things that I tell you on this podcast and make sure you're trusting with the right people based on that.
• 6:51
  SPEAKER_00: But the thing is, it's hard to find that, especially geographically in the area.
• 6:56
  SPEAKER_00: And a lot of the times, the ACL specialists I know in metro cities, different areas, majority of them are at a network.
• 7:05
  SPEAKER_00: They do not take insurance.
• 7:07
  SPEAKER_00: All the ones that I typically recommend, who I'm like, they can get you there.
• 7:11
  SPEAKER_00: You want in person, they can get you there.
• 7:13
  SPEAKER_00: It's gonna come at a cost because they don't take insurance.
• 7:16
  SPEAKER_00: Now, that's not always the case, but I would say majority of the network that I know, they're gonna be at a network and they're gonna be a more of a fee for service.
• 7:25
  SPEAKER_00: And it's because insurance challenges the way that we can get reimbursed and we can't deliver the care as well.
• 7:32
  SPEAKER_00: And so that's the thing that's hard.
• 7:34
  SPEAKER_00: Now, with that said, there are plenty of places I do know that do the insurance game and they do it well.
• 7:40
  SPEAKER_00: And it might be better state regulations where their reimbursements are better.
• 7:44
  SPEAKER_00: But it's a challenge with ACL rehab because we can't necessarily just see two to three people or four people an hour and expect for this person to get the best care in the world and more individualized to specialize, especially outside of those sessions, right?
• 7:59
  SPEAKER_00: And so the access is challenging in the area, and a lot of athletes are working with general practitioners who are doing their best.
• 8:06
  SPEAKER_00: I don't fault them.
• 8:08
  SPEAKER_00: But ACL rehab just isn't that person's lane.
• 8:11
  SPEAKER_00: We don't go to PT school to be ACL rehab specialist.
• 8:14
  SPEAKER_00: We go to PT school to make sure that we can treat everything as neurological conditions, cardiopulmonary conditions, obviously uh orthopedic conditions.
• 8:24
  SPEAKER_00: But the thing is, is that like we're not amazing at any of those things.
• 8:28
  SPEAKER_00: We're barely equipped to to do anything more than just a primary care, if you will.
• 8:35
  SPEAKER_00: And so that's the thing that I always compare things to is are you getting primary care or are you going down like, you know, you have a very specific neurological issue?
• 8:43
  SPEAKER_00: Do you have a heart-related issue?
• 8:45
  SPEAKER_00: You go to a specialist.
• 8:47
  SPEAKER_00: If you have a skin-related issue, most of the time you're gonna go to a dermatologist.
• 8:50
  SPEAKER_00: You're not just gonna go to your primary care, especially if it needs further detail or it's a more of a complicated process.
• 8:56
  SPEAKER_00: ACL is complex, there's no simplicity to this.
• 9:00
  SPEAKER_00: I promise you, and whoever says that is just not seeing enough ACLs, to be honest.
• 9:05
  SPEAKER_00: And so that's the thing that is challenging with this.
• 9:08
  SPEAKER_00: So if someone in your life has clinical knowledge, it feels like a step up from what you're currently getting.
• 9:15
  SPEAKER_00: And the third reason I want to bring up here is trust.
• 9:18
  SPEAKER_00: You know this person, you don't have to vet them, you don't have to wonder if they're legit, you don't have to build a relationship from scratch.
• 9:28
  SPEAKER_00: There's already a foundation there that feels safe, especially when you're dealing with something as emotionally loaded as an ACL injury.
• 9:36
  SPEAKER_00: So, yes, there are real reasons people make this choice.
• 9:40
  SPEAKER_00: And in certain situations, if the person is genuinely an ACL specialist and the dynamic works, it can be fine.
• 9:48
  SPEAKER_00: But it's very, very rare, and that's not what we typically see, especially when athletes are breaking this down to us.
• 9:55
  SPEAKER_00: Here's where it does get complicated.
• 9:58
  SPEAKER_00: The first issue is specialization.
• 10:00
  SPEAKER_00: Most of the people in this role are not ACL specialists, as I shared.
• 10:03
  SPEAKER_00: They're general practitioners, general coaches, or trainers with broad knowledge.
• 10:08
  SPEAKER_00: They care about you, they want to help you, but ACL rehab is a specific lane.
• 10:12
  SPEAKER_00: And being outside that lane, even with good intentions, means the programming, the progressions, the return support criteria, the benchmarks, they're often not where they need to be.
• 10:22
  SPEAKER_00: I see this a lot with coaches, like trainers, who are like, yeah, I do ACL and I'm no knees.
• 10:29
  SPEAKER_00: And yes, they know strength and conditioning and they know things about the process, but there comes a point where there might need to be a little bit more specialty understanding, especially if someone's dealing with pain, swelling, any type of like restrictions within the knee that's mechanical in nature.
• 10:49
  SPEAKER_00: You know, there are a lot of layers to this that you know sometimes I think the scope can sometimes get too blurred, and it can make it challenging because you're doing things, but you're not necessarily moving the needle on the things that you need to.
• 11:04
  SPEAKER_00: The second issue is how seriously you get taken.
• 11:07
  SPEAKER_00: This is a big one.
• 11:08
  SPEAKER_00: And this one's hard to hear, but it's true.
• 11:11
  SPEAKER_00: When your rehab happens inside a personal relationship, the urgency changes.
• 11:15
  SPEAKER_00: It becomes a favor, it gets fit around other things.
• 11:19
  SPEAKER_00: The informal setup leads to informal execution.
• 11:23
  SPEAKER_00: You might be getting 70, 80% of what you need, which sounds pretty good.
• 11:28
  SPEAKER_00: But for something as complicated and high stakes as ACL, that gap really matters, y'all.
• 11:34
  SPEAKER_00: The third issue is that you can't advocate for yourself.
• 11:37
  SPEAKER_00: Think about what it takes to push back on your rehab, to say this isn't working.
• 11:41
  SPEAKER_00: I'm not progressing, I need something different.
• 11:43
  SPEAKER_00: That's hard enough with a stranger.
• 11:45
  SPEAKER_00: Now imagine you're saying that to your friend, your parent, your spouse.
• 11:49
  SPEAKER_00: The relationship, that stake changes everything.
• 11:53
  SPEAKER_00: So instead of speaking up, you may stay quiet or you might say something a little bit more passively.
• 11:59
  SPEAKER_00: You go along with it, and the rehab suffers, and the time suffers on how long you're dealing with it.
• 12:05
  SPEAKER_00: The fourth issue is what happens if you want to leave, because eventually a lot of people reach that point and it is genuinely painful.
• 12:13
  SPEAKER_00: You feel guilty, you don't want to hurt someone who is trying to help you out, so you stay longer than you should, or you try to quietly fade out.
• 12:22
  SPEAKER_00: And either way, it creates awkwardness in the relationship that had nothing to do with the ACL rehab before any of this started.
• 12:29
  SPEAKER_00: And the fifth thing, and this is the one I think gets overlooked, is the identity conflict.
• 12:35
  SPEAKER_00: The moment someone steps into the role of your clinician or your coach, a new dynamic gets introduced into that relationship.
• 12:42
  SPEAKER_00: They're not just your mom or your friend or your spouse anymore.
• 12:47
  SPEAKER_00: They're also your PT.
• 12:49
  SPEAKER_00: And those two roles don't always coexist cleanly.
• 12:52
  SPEAKER_00: It creates friction, it creates tension, and both sides feel it.
• 12:57
  SPEAKER_00: I want to share a couple of real situations because this isn't theoretical.
• 13:01
  SPEAKER_00: We see it all the time.
• 13:02
  SPEAKER_00: I literally had a conversation last week, the week before that, and there have been so many conversations with ACLers regarding situations like this.
• 13:11
  SPEAKER_00: So one athlete mentioned up front that he had been doing PT with some friends who were physical therapists.
• 13:18
  SPEAKER_00: He said it was a little challenging.
• 13:20
  SPEAKER_00: And when I described the dynamics to him, the not being taken seriously, the difficulty speaking up, the awkwardness, he said it felt spot on.
• 13:28
  SPEAKER_00: He had actually tried to have a direct conversation with them about it.
• 13:32
  SPEAKER_00: They took it seriously for a moment, but then things reverted.
• 13:36
  SPEAKER_00: He eventually came to work with us, not because we pushed him to, but because he needed something different.
• 13:42
  SPEAKER_00: Something that was fully structured around him and his rehab, not around an existing friendship.
• 13:48
  SPEAKER_00: And this one was hard because we were just like, we want to support you.
• 13:52
  SPEAKER_00: And you know, if you feel like this rights the ship, then go for it as long as it gets you back to doing the thing.
• 13:58
  SPEAKER_00: That is all that I care about here.
• 13:59
  SPEAKER_00: I am never a pressure-based person.
• 14:01
  SPEAKER_00: We would love to work with people, we would love to support them.
• 14:04
  SPEAKER_00: But at the same time, if they feel like what they have access to locally is better, then that's awesome.
• 14:09
  SPEAKER_00: We're in full support as long as they get back to doing the thing and they do it right with good rehab.
• 14:13
  SPEAKER_00: And so this was challenging because, you know, it ends up being one of those things that in conversation, yes, maybe it improved a little bit, but then it regresses back.
• 14:23
  SPEAKER_00: And usually the signs of how it goes during the whole process or let those feelings, those gut feelings you get, tend to persist.
• 14:31
  SPEAKER_00: They tend to not clean up in most cases because it's a system issue, it's a relationship issue.
• 14:36
  SPEAKER_00: There are a lot of layers to it.
• 14:38
  SPEAKER_00: The second situation involves a current athlete of ours.
• 14:41
  SPEAKER_00: She reached out by email.
• 14:42
  SPEAKER_00: She was nine weeks out of a complicated ACL reconstruction, limited on insurance visits, getting PT every other week, and also meeting with a PT friend on the side to help fill the gaps.
• 14:53
  SPEAKER_00: She said she was struggling with accountability and didn't feel like she was getting an individualized program.
• 14:59
  SPEAKER_00: Here is what I shared with her, and I'm gonna read this because I think it captures exactly what I'm trying to say today.
• 15:06
  SPEAKER_00: It definitely makes sense to get some additional eyes on your programming, and it sounds like your PT friend could be a great resource.
• 15:12
  SPEAKER_00: The only thing I gently flag from seeing this many ACLers' journeys is that working with friends or family can sometimes blur the lines a bit.
• 15:21
  SPEAKER_00: Not always, but often the dynamic leads to less structure, less objectivity, or less intentional progression than what you'd get with someone whose sole role is to coach you, to be your PT.
• 15:32
  SPEAKER_00: You deserve someone who can be fully honest, fully present, and fully invested in guiding you forward rather than something that's more of a side project or a favor you're helping someone out.
• 15:42
  SPEAKER_00: You may have a different setup with your friend, and if it works, that's great.
• 15:46
  SPEAKER_00: And we're in full support of that.
• 15:47
  SPEAKER_00: I want to share that perspective because we've seen it with a lot of athletes that get stuck in this in-between zone without the clarity or progression they really need.
• 15:56
  SPEAKER_00: That in-between zone, that's the phrase I want you to hold on to because that's exactly where a lot of athletes end up.
• 16:03
  SPEAKER_00: Not getting bad rehab, not getting great rehab, just floating somewhere in the middle.
• 16:08
  SPEAKER_00: And for an ACL, the middle is not where you want to be.
• 16:11
  SPEAKER_00: Okay, and I want to also be transparent about where I personally stand on this because I think it matters.
• 16:16
  SPEAKER_00: I don't treat friends or family, that's just a full stop for me.
• 16:20
  SPEAKER_00: If my brother tore his ACL tomorrow, I would not be the one guiding his rehab.
• 16:24
  SPEAKER_00: If my wife tore hers, same answer.
• 16:25
  SPEAKER_00: My best friend, same answer.
• 16:27
  SPEAKER_00: Can they ask me a question?
• 16:28
  SPEAKER_00: Absolutely.
• 16:29
  SPEAKER_00: Will I point them in the direction and help them find the right person?
• 16:33
  SPEAKER_00: 100%.
• 16:34
  SPEAKER_00: Always.
• 16:35
  SPEAKER_00: But I will not be the one running their program, helping them with the decisions, making clinical decisions, those types of things.
• 16:43
  SPEAKER_00: I learned this a hard way early in my career and I used to do it.
• 16:46
  SPEAKER_00: And what I found over and over was that people don't take it the same way.
• 16:51
  SPEAKER_00: They follow maybe 60, 70, 80% of the direction, and then they go their own route on the rest.
• 16:57
  SPEAKER_00: They don't speak up when something isn't working.
• 16:59
  SPEAKER_00: I may not necessarily treat them as seriously as someone who is just a true athlete of mine.
• 17:04
  SPEAKER_00: And so the dynamic is just different.
• 17:06
  SPEAKER_00: And for something as complicated and as consequential as ACL rehab, different isn't good enough.
• 17:12
  SPEAKER_00: I hold that line today because I've seen what it costs when the line gets blurred.
• 17:17
  SPEAKER_00: And I don't want that for anyone I care about.
• 17:20
  SPEAKER_00: But here's the flip side to all of this, and I think it's important.
• 17:24
  SPEAKER_00: When you work with someone who has no prior relationship with you, you gain something that's hard to put a number on objectivity.
• 17:32
  SPEAKER_00: They can tell you the truth, they can push you, they can challenge you, and they can do all of that without worrying about how it affects dinner on Sunday or the friendship you've had for 10 years.
• 17:43
  SPEAKER_00: You also gain a real structure, not a favor, not something fit around someone else's schedule, an actual clinical process built specifically around your ACL, your timeline, your criteria, your goals specific to you.
• 17:57
  SPEAKER_00: And maybe the most underrated benefit, the person who was in that role before gets to go back to just being that person.
• 18:05
  SPEAKER_00: Your friend goes back to being your friend.
• 18:07
  SPEAKER_00: Your parent gets to go back to being your parent.
• 18:10
  SPEAKER_00: Your spouse gets to go back to being your spouse.
• 18:14
  SPEAKER_00: The friction that was building in that relationship, it goes away because they don't have to carry that weight anymore, and neither do you.
• 18:20
  SPEAKER_00: And the original relationship gets preserved and you build a new one, a PT to athlete relationship.
• 18:27
  SPEAKER_00: That is specifically designed for this process.
• 18:30
  SPEAKER_00: No history, no relational stakes, just someone fully in your corner whose only job is to get you through this the right way.
• 18:40
  SPEAKER_00: So if you're in this situation right now, if a friend or a family member is currently helping you with your rehab, I'm not here to tell you that you made the wrong decision.
• 18:49
  SPEAKER_00: I understand why you made it, but I want to ask you to ask yourself honestly Am I being taken seriously?
• 18:58
  SPEAKER_00: Am I getting a real program?
• 18:59
  SPEAKER_00: Can I speak up when something isn't working?
• 19:02
  SPEAKER_00: Am I actually progressing?
• 19:04
  SPEAKER_00: Do I know where I am and do I know where I'm going?
• 19:07
  SPEAKER_00: Is this objectively being tested?
• 19:11
  SPEAKER_00: If the answers are all yes, great, keep going, you've got an awesome person and you're in the small minority.
• 19:18
  SPEAKER_00: If the answer is no, or if you're not sure, that's worth paying attention to because your ACL rehab is not the place to settle for the in-between zone.
• 19:27
  SPEAKER_00: The stakes are too high in this process, y'all.
• 19:29
  SPEAKER_00: The window matters, and you deserve someone who is fully locked in on you.
• 19:35
  SPEAKER_00: I have seen people who have doubled the timeline of this process because of something like this.
• 19:40
  SPEAKER_00: They could have been out of this in, you know, nine months and they're still in it two years later.
• 19:45
  SPEAKER_00: And I hate it.
• 19:47
  SPEAKER_00: I absolutely hate it.
• 19:48
  SPEAKER_00: And that's the thing that is so challenging.
• 19:50
  SPEAKER_00: I see this also with a quote unquote nice PT who is a kind person.
• 19:55
  SPEAKER_00: You know, most of us are not in this field to make a ton of money.
• 19:58
  SPEAKER_00: It's because we love working with people and we like helping them move, getting back to things.
• 20:02
  SPEAKER_00: But the thing is, is that the nice PT, you're just gonna naturally get that in 90% of cases in physical therapy.
• 20:10
  SPEAKER_00: It's just the general persona of what you're gonna get.
• 20:13
  SPEAKER_00: But this is the same thing that we typically hear in this is that people don't want to move or change because they're nice and the relationship, they value it, right?
• 20:24
  SPEAKER_00: But there's a difference between that and also making sure you're getting what you need in the quality and rehab.
• 20:30
  SPEAKER_00: And it could also be the difference in getting back to the things that you want to do and what you care about, and that's so, so important in this process.
• 20:37
  SPEAKER_00: So that's gonna be it for today, y'all.
• 20:40
  SPEAKER_00: If this resonated, please share it with someone who needs to hear it.
• 20:43
  SPEAKER_00: And if you're navigating this right now and want to talk through where you're at, you can always reach out.
• 20:48
  SPEAKER_00: You can go to the show notes.
• 20:50
  SPEAKER_00: We have our info there.
• 20:51
  SPEAKER_00: You can go to theacelathhlete.com, and we are here to help in any way possible.
• 20:57
  SPEAKER_00: I'll see you in the next episode.
• 20:58
  SPEAKER_00: This is your host, Robbie Patel, signing off.