Latest / The ACL Athlete Podcast / 139 | Practical Application of Designing a Gym-Based ACL Rehab Session (Including a Case Study of 3-Month Post-Op ACL - Quad Autograft + Meniscus Repair)

Transcript

139 | Practical Application of Designing a Gym-Based ACL Rehab Session (Including a Case Study of 3-Month Post-Op ACL - Quad Autograft + Meniscus Repair) · The ACL Athlete Podcast

• 0:19
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:23
  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.
• 0:33
  SPEAKER_00: I'm your host, Dr.
• 0:34
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:38
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:46
  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.
• 0:57
  SPEAKER_00: Thanks for joining.
• 0:58
  SPEAKER_00: Now let's dive into today's episode.
• 1:04
  SPEAKER_00: What is up, team, and welcome back to the ACL Athlete Podcast.
• 1:08
  SPEAKER_00: So before we dive in, I have an exciting update for you guys for any of my clinicians, coaches, whether you're an athletic trainer, a physical therapist, a rehab provider of any sort, or you're maybe a strength and conditioning coach who kind of works alongside with ACLers in this process, we're pumped to announce our ACL athlete mentorship that is kickstarting very soon.
• 1:34
  SPEAKER_00: And this ties back to our mission, which is to redefine ACL rehab, to elevate the standard of care and to essentially just serve our ACLers.
• 1:44
  SPEAKER_00: And we know we do that through this podcast, through our remote coaching in person, through our resources.
• 1:51
  SPEAKER_00: Our goal is to serve ACLers, but we also know that there could be a force multiplier by sharing that information with other rehab and coaching professionals who are also working with ACLers.
• 2:02
  SPEAKER_00: So that's our goal is to share just basically this vision that I've had since the start of the company.
• 2:08
  SPEAKER_00: And that's where this mentorship comes in, where we will teach you our processes and systems based on principles using testing, program design, practical application, frameworks, all the things that we're kind of looking for in physical therapy school or through all the different maybe online resources.
• 2:28
  SPEAKER_00: And we've taken all the continuing education, all the things we've learned, all the things we've failed at, and we're packaging this up and we're all going to grow together.
• 2:37
  SPEAKER_00: So if this is something that is of interest to you, please jump on our insider list, which you can find that information in the link in the description below, in order to get early access for this mentorship, which we are keeping at limited spots.
• 2:54
  SPEAKER_00: And we've already gotten so much overwhelming support for this and people on the list, more surprising than expected.
• 3:01
  SPEAKER_00: And so we're super pumped to roll this out and really grow with all of you that do join and put our egos aside and be able to really focus on how we can improve this ACL rehab process for our ACLers for just the landscape as a whole.
• 3:17
  SPEAKER_00: So I promise you, I'm gonna give you my best.
• 3:20
  SPEAKER_00: So if you are a professional working with ACLers, I suggest getting on the list.
• 3:24
  SPEAKER_00: You'll get early access to all the information and be able to sign up.
• 3:28
  SPEAKER_00: And if all the spots are taken, then we will not roll this out to the public.
• 3:33
  SPEAKER_00: So do yourself a favor if you're interested at all, to do that and sign up in the show notes below.
• 3:39
  SPEAKER_00: And if you're an ACL or listening to this, I promise you we've got so much planned for you.
• 3:44
  SPEAKER_00: We're so excited as a company, as a team for all the resources we are going to be rolling out for you here very, very soon.
• 3:52
  SPEAKER_00: So stay tuned.
• 3:54
  SPEAKER_00: Now, to dive into this episode for today, practical application of designing a gym-based ACL rehab session.
• 4:02
  SPEAKER_00: Basically, how are we going to take a framework of a gym session?
• 4:05
  SPEAKER_00: And then how can you really apply this to your own situation, whether you're a clinician coach, ACL, or just kind of trying to structure all this stuff and just being able to have some of those tools.
• 4:17
  SPEAKER_00: So I want to give you some of that today and practically how you can apply that.
• 4:21
  SPEAKER_00: And one of the things that I think is really hard in this space is that there's a lot of variables to juggle.
• 4:27
  SPEAKER_00: You're almost kind of like overwhelmed with also the kind of barriers or the things that you're working up against in the ACL rehab process.
• 4:35
  SPEAKER_00: You know, you've got range of motion issues, you've got pain, swelling, you've got worrying about your knee and the ligament healing, all these different pieces.
• 4:44
  SPEAKER_00: And then now you're trying to work along to get back to running and cutting and all the things that you want to get back to doing.
• 4:51
  SPEAKER_00: And so today I want to focus mainly on a gym-based session.
• 4:56
  SPEAKER_00: So there's organization around it, you have a framework to operate from, and it's something that can be really helpful to organize based on the qualities we're trying to develop.
• 5:07
  SPEAKER_00: And it's more agile, and you can adapt it to the session and to the week and to the phases that you're in.
• 5:15
  SPEAKER_00: But this can help to just apply that in any phase of this process, especially for the gym.
• 5:22
  SPEAKER_00: And I'm going to use today one of our ACLers as a very specific example so we can really ingrain this and see how this can be put into play.
• 5:32
  SPEAKER_00: Now, the one thing I do want to mention is that if you're an ACLer listening and you're like, hey, I'm going to go do this exact session, or this is me, or I'm going to put this in play.
• 5:41
  SPEAKER_00: Now, don't undermine anything that you're given from your own professional.
• 5:46
  SPEAKER_00: Talk with them.
• 5:47
  SPEAKER_00: Just make sure that it's cohesive.
• 5:49
  SPEAKER_00: But if you're just kind of like lost and you're like, well, where can I start with trying to structure something?
• 5:54
  SPEAKER_00: Well, this can potentially help.
• 5:55
  SPEAKER_00: But at the end of the day, there's a lot of moving pieces with what I'm going to share today in order to really utilize this framework.
• 6:03
  SPEAKER_00: So let's dive into this ACLer's case.
• 6:07
  SPEAKER_00: So this guy's name is Jake.
• 6:09
  SPEAKER_00: He's an ACL of mine.
• 6:10
  SPEAKER_00: He's 28 years old, a skier.
• 6:12
  SPEAKER_00: That's how he tore his ACL.
• 6:14
  SPEAKER_00: He tore his ACL plus his medial meniscus.
• 6:17
  SPEAKER_00: He got a quad autographed with a meniscus repair.
• 6:21
  SPEAKER_00: So he was non-weight bearing for four weeks.
• 6:24
  SPEAKER_00: The surgeon also locked him up in a brace into extension, which just sucks.
• 6:29
  SPEAKER_00: But it is what it is.
• 6:31
  SPEAKER_00: And so then we didn't start working together actually until two months post op.
• 6:36
  SPEAKER_00: And so he had a pretty rough start.
• 6:38
  SPEAKER_00: You know, you take the four weeks non-weight bearing, which I get there's limitations, but you combine that with just like the rehab that wasn't really going well.
• 6:47
  SPEAKER_00: It wasn't very prescriptive.
• 6:48
  SPEAKER_00: There wasn't a lot of structure guidance.
• 6:51
  SPEAKER_00: And he was just kind of chilling a lot of the time.
• 6:53
  SPEAKER_00: And there was an opportunity cost with that.
• 6:55
  SPEAKER_00: So we had to just kind of, you know, work with what we have and be able to move forward.
• 7:00
  SPEAKER_00: So with him, we did a performance needs analysis.
• 7:03
  SPEAKER_00: We do this with every single one of our ACLers at the start and throughout the process.
• 7:07
  SPEAKER_00: This is ongoing and adapting.
• 7:09
  SPEAKER_00: But this is where we just dive into the ACLer story to be able to understand the backstory, to understand where they are.
• 7:16
  SPEAKER_00: And some of more the technical nuance pieces that we're not going to dive into today.
• 7:21
  SPEAKER_00: But this is basically where we're getting where they are, where they're going, and what are the next steps and the needs of those next steps and their long-term goals.
• 7:30
  SPEAKER_00: So again, not getting too technical here because we could get into the nuances of breaking down a needs analysis, but we're just going to keep it pretty broad and zoomed out.
• 7:40
  SPEAKER_00: So he is now three months post op.
• 7:42
  SPEAKER_00: So we've been working together for about a month.
• 7:44
  SPEAKER_00: He's still slightly shy of that heel pop and that end range extension, dealing with some residual swelling that'll come here or there.
• 7:53
  SPEAKER_00: End range flexion still does not feel super great, especially with that non-weight bearing and being locked in a brace.
• 8:00
  SPEAKER_00: So it did take him a while to be able to get that flexion back.
• 8:04
  SPEAKER_00: When we tested his quads, they're pretty weak, as you can imagine, with his limitations.
• 8:10
  SPEAKER_00: Plus, he had a quad autograph.
• 8:12
  SPEAKER_00: So he is sitting at 47% symmetry.
• 8:16
  SPEAKER_00: Given the donor site, that also created some issues.
• 8:19
  SPEAKER_00: So where he got that quad tendon taken, there's some sensitivity there.
• 8:23
  SPEAKER_00: And well, ACL rehab in a nutshell just makes your quads shrink down to a hot dog.
• 8:28
  SPEAKER_00: So that didn't work necessarily in his favor, but here we are.
• 8:31
  SPEAKER_00: So we're just working with current capacities and we're going to build those up, right?
• 8:36
  SPEAKER_00: And so the other last piece I wanted to add is that he doesn't really want to drive his knee forward.
• 8:41
  SPEAKER_00: This all makes sense.
• 8:42
  SPEAKER_00: He's got some pain and some swelling that he's dealing with.
• 8:45
  SPEAKER_00: He is not feeling good with end-range knee flexion.
• 8:48
  SPEAKER_00: He's got some quad weakness.
• 8:49
  SPEAKER_00: So his body's going to organize and figure out ways to avoid that movement and to be able to load the knee in general in order to just do the thing.
• 8:58
  SPEAKER_00: So when we're looking at kind of where we're heading, long term, of course, is to get him back to skiing, which he loves.
• 9:04
  SPEAKER_00: But short term, the next thing is to get him back to running.
• 9:08
  SPEAKER_00: Because running is kind of like this big barn door that opens up and allows you to start doing a lot more stuff from a dynamic standpoint, such as, you know, being able to do plyometrics in space, being able to change direction, being able to open up multi-directional speed and things of that nature.
• 9:24
  SPEAKER_00: So that's where the fun begins.
• 9:26
  SPEAKER_00: But first we got to get him there to running in order to open that door.
• 9:31
  SPEAKER_00: So now the goal is to give you insight into what one of these days looks like within his training block.
• 9:38
  SPEAKER_00: But I'm gonna zoom out for a second just so you could see the big picture of how we structured it for him.
• 9:44
  SPEAKER_00: So he has four days that he's training in his week that's dedicated to this specific block based on his schedule.
• 9:51
  SPEAKER_00: So two days are gym focused days.
• 9:54
  SPEAKER_00: One is a quad dominant day, and then the other day has a hamstring dominant compound lift day.
• 10:00
  SPEAKER_00: But there's obviously still a lot of quadricep work built in.
• 10:05
  SPEAKER_00: One other day is a muscle pump and dynamic focus day.
• 10:09
  SPEAKER_00: And then there's a fourth day that is purely just dynamic focus.
• 10:13
  SPEAKER_00: When we say dynamic, it's basically just think about movement in space.
• 10:17
  SPEAKER_00: It's not a lot of strength building necessarily, but it's a lot of movement coordination, getting him ready to be able to prep for running.
• 10:25
  SPEAKER_00: Think of it as just like pre-running movements based on mechanics and just getting into the groove of feeling like he can do that stuff again.
• 12:38
  SPEAKER_00: So that's how we structure things.
• 12:40
  SPEAKER_00: Side note also that this structure itself is highly dependent on where each of our ACLers are within each phase of our 4R system, but then also their athlete schedule, the equipment access, the goals that they have, all these factors are gonna play into it.
• 12:59
  SPEAKER_00: So this is how we just structured it out for this specific guy, Jake.
• 13:04
  SPEAKER_00: So for this block, we're gonna focus on addressing a lot of these issues and cleaning things up that he's experiencing in order to attack these, you know, rate limiters, the roadblocks that he's dealing with in order for us to move him forward and get him running.
• 13:19
  SPEAKER_00: So now let's dive into one of these days based on the framework provided.
• 13:24
  SPEAKER_00: And if you guys missed that, that was something that I posted on Instagram that just showed a little bit of that framework of just kind of the big picture.
• 13:33
  SPEAKER_00: But today I kind of want to like dive into a specific use of it and practical application.
• 13:39
  SPEAKER_00: So what I had shared was basically assessing the symptom profile.
• 13:43
  SPEAKER_00: So every session, each athlete, the goal is to be able to assess how they feel before, during, and after, but especially before, because you need to kind of know what that baseline feels like in order for us to make sure that we keep track of that during, after the session, and especially into our next day.
• 14:01
  SPEAKER_00: So this is a part of our feedback loop system that we share with our athletes and coaches.
• 14:05
  SPEAKER_00: And this is just something that's really important because it's gonna help monitor and create a feedback loop for us to adjust the consecutive sessions and training.
• 14:15
  SPEAKER_00: So we're gonna assess the symptom profile.
• 14:17
  SPEAKER_00: So that's gonna be pain, swelling, some soreness, any of those pieces.
• 14:21
  SPEAKER_00: And then we're gonna go into the session.
• 14:23
  SPEAKER_00: So we've got movement prep, we've got technical and movement skill, we've got power, max strength work, accessory strength and hypertrophy work, and then we've got conditioning work.
• 14:35
  SPEAKER_00: So these are all of kind of the buckets or the flow of the session.
• 14:39
  SPEAKER_00: And now I'm just gonna roll through it.
• 14:41
  SPEAKER_00: So we have movement prep, which is basically just getting the body ready for the session.
• 14:45
  SPEAKER_00: We want to get our heart rate up, we want to get the joints moving, we want the body to feel good.
• 14:50
  SPEAKER_00: And if there's anything I've learned as an ACLer two times myself, working with other ACL athletes, there's nothing like going cold into a session and feeling like trash.
• 15:02
  SPEAKER_00: Like you need to warm up.
• 15:03
  SPEAKER_00: And you know, you'll see all this stuff about warm-ups.
• 15:06
  SPEAKER_00: You know, they take away from time in the session.
• 15:08
  SPEAKER_00: If you got 20 minutes, yeah, don't warm up for 15 minutes.
• 15:12
  SPEAKER_00: But look, like the knee is gonna not feel so hot, especially when you're in the early parts of this process.
• 15:18
  SPEAKER_00: And so the last thing you want to do is go and do a max lift without warming up.
• 15:22
  SPEAKER_00: It feels like trash.
• 15:23
  SPEAKER_00: And it's one of those things where, especially with our ACL rehab with our knee, get some good movement prep in, get the fluid going, get things feeling good.
• 15:33
  SPEAKER_00: And then that way you can really build some momentum going into the workout.
• 15:37
  SPEAKER_00: So that's my belief in terms of doing this.
• 15:40
  SPEAKER_00: Now, this doesn't take away from the session, but there is emphasis and importance on doing this and structuring it in a way to essentially add up to work on certain pieces we're trying to improve.
• 15:53
  SPEAKER_00: So, this movement prep, for example, we're gonna get the heart rate up and work on some positions.
• 15:58
  SPEAKER_00: So, for example, we've got reverse treadmill walk to kind of get the quads going, get the heart rate a little bit more elevated.
• 16:04
  SPEAKER_00: Then we go into kind of like this three piece where we're working on mobility.
• 16:08
  SPEAKER_00: So it's gonna be an assisted knee drive forward, holding at end range, lateral hip strength where we're doing a star plank hold.
• 16:16
  SPEAKER_00: And then we've got another mobility movement that's gonna be basically an isometric combo where you're doing a split squat with a target forward, and then there's gonna be a rock back to load that back leg with that quad while it's being on stretch.
• 16:31
  SPEAKER_00: Guess what?
• 16:32
  SPEAKER_00: We're gonna be targeting that donor site as you know it.
• 16:35
  SPEAKER_00: Once we move through this movement prep, we're gonna go into our technical and movement skill block.
• 16:40
  SPEAKER_00: So this is gonna be something focused on something that we're trying to be fresh for and feel good about.
• 16:46
  SPEAKER_00: And we want to just improve that skill feeling and maybe some positions.
• 16:51
  SPEAKER_00: So for this, we're gonna do a Bosch step up, which is gonna work on triple extension and an opposite hip hike.
• 16:59
  SPEAKER_00: So that's gonna help us to be able to really iron in some good acceleration and sprinting positions later in the road, but especially focusing on that triple extension since that heel pop is feeling not so hot just yet.
• 17:12
  SPEAKER_00: And then we're gonna move into our power blocks.
• 17:15
  SPEAKER_00: So with this, we're gonna be focusing mostly on plyometric base work.
• 17:19
  SPEAKER_00: So we're gonna do some extensive playos, which are gonna be band assisted pogos for double e.
• 17:25
  SPEAKER_00: And then we're gonna work into some eccentric focus plyometrics where we're building the brakes as we call it.
• 17:31
  SPEAKER_00: So these are altitude drops into some trap bar or dumbbell deceleration drops.
• 17:37
  SPEAKER_00: So we're focusing on the eccentric component or the braking or the landing component of a plyometric because that's an important piece here as we're trying to build the athlete back up.
• 17:48
  SPEAKER_00: Before you try to take off on running, jumping, all that stuff, we need to know how to break the system.
• 17:54
  SPEAKER_00: And focusing on the eccentric pieces will help so much, especially in getting us back to return to running and a lot of the pieces down the road.
• 18:03
  SPEAKER_00: And this is the thing, in my opinion, eccentric strength, especially of the quads, is probably one of the biggest missing factors that are worked on within this ACL rehab process.
• 18:14
  SPEAKER_00: This is something where the quad is working at lengthening to be able to slow the body down, to be able to resist the force.
• 18:24
  SPEAKER_00: And this is something that we don't necessarily work on because strength is specific.
• 18:28
  SPEAKER_00: So we do want to make sure we work on it from an eccentric standpoint, especially in the early phases, to be able to absorb and mostly accept and attenuate force.
• 18:38
  SPEAKER_00: So that's where this power block comes in.
• 18:41
  SPEAKER_00: And this is where we're gonna work on a Smith machine split squat with a front heel elevated to allow that knee to go forward to be able to load and not worry too much about balance or anything going on.
• 18:53
  SPEAKER_00: We're just trying to put a high amount of force into the ground and load the quad in a single leg type movement.
• 19:00
  SPEAKER_00: Then we're gonna work into our accessory strength and hypertrophy work.
• 19:04
  SPEAKER_00: So we're gonna have our barbell hip thrust that's gonna be working on a good glute pump, but then also some strength pieces to be able to build up the posterior chain and the hamstrings.
• 19:13
  SPEAKER_00: And then we're gonna go into our single leg seated knee extension with a two up, one down.
• 19:19
  SPEAKER_00: Again, an eccentric focus that we like to work on early in the ACL rehab process before we're running.
• 19:25
  SPEAKER_00: So then that way we can accept those forces that I had talked about earlier.
• 19:30
  SPEAKER_00: And then we're gonna work on some seated hamstring curls.
• 19:33
  SPEAKER_00: So just good old isolated work that's gonna help work on the quads, work on the hamstrings.
• 19:39
  SPEAKER_00: And then finally, we're gonna finish with some energy system development, some conditioning, which is going to be focused on bike sprints for anywhere from five to 10 rounds for 10 seconds on for hard and 50 seconds off or just an easy RPM.
• 19:57
  SPEAKER_00: And that's gonna be the main thing that we're going to do for this session.
• 20:01
  SPEAKER_00: Now, the goal here is driving intent.
• 20:05
  SPEAKER_00: We're not trying to like list 20 or 30 different exercises.
• 20:09
  SPEAKER_00: We have very intentional exercises that we are going to focus on here.
• 20:13
  SPEAKER_00: And there's an intent for this day, this quad dominant day, to be able to improve a lot of these deficits that we're dealing with and the qualities we're trying to build up in order to get to the next step and milestone.
• 20:25
  SPEAKER_00: Now, this is just gym day one of the two days that we have planned in the block.
• 20:31
  SPEAKER_00: And this is something that is also not including the muscle pump portion of his dynamic day.
• 20:37
  SPEAKER_00: So we're trying to hit a certain amount of volume in order to promote hypertrophy and frequency, but then we're also trying to balance that recovery since the knee can get a little bit grumpy.
• 20:47
  SPEAKER_00: So this is where making sure we structure these things appropriately and balance the recovery is going to be so key.
• 20:53
  SPEAKER_00: So he's got two focused gym days, one that's like a half and a half day of a little bit of a muscle pump and dynamic day, and then another day that's a dynamic day.
• 21:03
  SPEAKER_00: Now, there's so many ways to flip all this, but this is what works for his schedule and what we optimize best for this particular block and responding well to.
• 21:12
  SPEAKER_00: And to give you guys an example, day one looks different from day two.
• 21:16
  SPEAKER_00: We're working on different qualities.
• 21:17
  SPEAKER_00: It has a little bit more of a hamstring emphasis day for at least the compound movement.
• 21:22
  SPEAKER_00: We're exploring some other different movement options, but it all follows a very similar framework of similar qualities we're trying to develop, but it's going to look a little different in terms of the exercises, some of the rep schemes, some of the tempos, and the movements overall, but we're still targeting the same outcomes.
• 21:41
  SPEAKER_00: And so, what I want to come back to here are really those deficits and outcomes that we are trying to tackle.
• 21:47
  SPEAKER_00: So let's go back to those.
• 21:49
  SPEAKER_00: So we had mentioned that he was slightly shy of a heel pop.
• 21:52
  SPEAKER_00: Well, there are things that are embedded in his week to work on this, but specifically in this day, he had the Bosch step up that we were working on.
• 21:59
  SPEAKER_00: There's some other positions for him to be able to finish into an extended position with his knee in order to work on that heel pop, but mostly just an active extension piece.
• 22:11
  SPEAKER_00: Swelling is focused on basically balancing the load management of his entire week and his current block.
• 22:18
  SPEAKER_00: End range flexion, the mobility work in end ranges with the movement prep, was able to tackle this.
• 22:24
  SPEAKER_00: Plus, if we get the swelling down, that's going to help improve the flexion over time.
• 22:28
  SPEAKER_00: The 47% quad symmetry and the weakness given the donor site and that sensitivity.
• 22:36
  SPEAKER_00: Well, that is done through that quad strength that we're working on with the eccentric emphasis, along with that lean back with the isometric to help load that quad tendon to get the rectus femoris at a lengthened position.
• 22:49
  SPEAKER_00: So we can get some solid quad work for that tendon and that donor site.
• 22:54
  SPEAKER_00: For us to get back to running, we have to introduce some lower level biometrics and being able to accept load.
• 23:01
  SPEAKER_00: That's going to be really important in order to make sure that we are going to get back to running because we're going to have to deal with that because running is essentially small little jumps over and over and over and over, sure at a lower level, but we are repeatedly doing that.
• 23:16
  SPEAKER_00: So we got to make sure that we prep the system before we actually start running.
• 23:20
  SPEAKER_00: So we're building that in.
• 23:21
  SPEAKER_00: And then the other last piece was doesn't want to drive the knee forward.
• 23:25
  SPEAKER_00: Well, we're biasing forward knee movements with that isometric in the movement prep.
• 23:30
  SPEAKER_00: We've got the max strength work where the heel is elevated to drive the knee forward and emphasize the quad.
• 23:37
  SPEAKER_00: And not to mention that the other days that balanced to work on a lot of these other pieces to move the needle and to get Jake ultimately back to running and in the final stages back to skiing, right?
• 23:50
  SPEAKER_00: And this framework allows us to tackle these deficits based on our needs analysis of Jake and also make sure we're addressing all the appropriate qualities.
• 24:00
  SPEAKER_00: And that's what's helpful about this is that it allows.
• 24:04
  SPEAKER_00: Us to be agile in case something comes up with Jake or any ACL that we work with, but we don't get lost in the exercises.
• 24:12
  SPEAKER_00: We allow the principles that are building these frameworks or even this session, for example, to guide us.
• 24:19
  SPEAKER_00: And this is just basically good training.
• 24:22
  SPEAKER_00: If you were to look at any good strength and conditioning session, we're just making this a little bit more nuanced to the ACL rehab process.
• 24:30
  SPEAKER_00: Is it perfect?
• 24:31
  SPEAKER_00: Definitely not.
• 24:32
  SPEAKER_00: But it could be very adaptable given any situation.
• 24:36
  SPEAKER_00: And I can honestly show you 10 different ways we can organize this based on the ACL are in front of us, but it's all based on principles.
• 24:44
  SPEAKER_00: We need an operating framework that this is derived from first in order to make sure we can do that.
• 24:51
  SPEAKER_00: And it helps us to just make sure to keep a zoomed out process, but also a zoomed in process.
• 24:57
  SPEAKER_00: So the micro and then the macro, and being able to make sure that we're helping our ACLer move in this process, move forward.
• 25:06
  SPEAKER_00: And it's not just this list of exercises, which I know a lot of ACLers get.
• 25:12
  SPEAKER_00: They come in and they're like, hey, like I've got these 20 exercises.
• 25:16
  SPEAKER_00: And then they might be unorganized.
• 25:19
  SPEAKER_00: And then also there's no intensity or kind of rep scheme behind them.
• 25:23
  SPEAKER_00: It's just like, hey, here are the exercises.
• 25:25
  SPEAKER_00: But most importantly, the intensity is the thing that's going to drive the outcome that we're going to get from it.
• 25:33
  SPEAKER_00: So we're trying to rebuild athleticism.
• 25:35
  SPEAKER_00: We're trying to address these gaps, tackle these deficits that we're seeing in the ACL rehab process with any ACL are in front of us.
• 25:43
  SPEAKER_00: And I think being able to come at it from having a system, having an approach that is rooted in the principles, in the research, in the science is going to help us a ton to make sure we don't leave any of these gaps.
• 25:57
  SPEAKER_00: And also just not feeling super overwhelmed and unorganized when we are trying to build these sessions and being able to make sure that we're tackling everything that we need to over this long, long journey.
• 26:10
  SPEAKER_00: So I hope that this was helpful, team.
• 26:12
  SPEAKER_00: I wanted to give you guys a practical application of this framework that I provided on Instagram and also just in this podcast episode specifically, just to be able to see what it looks like with an ACL or a specific case, a real life example.
• 26:30
  SPEAKER_00: And I think it's easy to talk general, but you know, I want to always make sure that there's a practical example that you could take away from this and put in play immediately.
• 26:40
  SPEAKER_00: So check out the post if you want.
• 26:42
  SPEAKER_00: It's helpful to kind of see the visual of it.
• 26:45
  SPEAKER_00: I've got it on my Instagram, so you can go there.
• 26:48
  SPEAKER_00: Most importantly, I suggest if you are a clinician, coach, any provider working with an ACL or sign up for our mentorship.
• 26:57
  SPEAKER_00: That is going to be in the show notes below.
• 27:00
  SPEAKER_00: And I promise it will be worth it.
• 27:03
  SPEAKER_00: Get on the insider list, and we cannot wait to see you guys there.
• 27:07
  SPEAKER_00: Until next time, team, this is your host, Robbie Patel, signing off.