Latest / The ACL Athlete Podcast / 058 | When Can You Return to Work after ACLR?

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058 | When Can You Return to Work after ACLR? · 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, ACL athletes?
• 1:06
  SPEAKER_00: I hope you guys are having a good week so far.
• 1:09
  SPEAKER_00: Today we are talking about when can you return to work after ACL rehab?
• 1:16
  SPEAKER_00: And what you can do is actually input any specific, like let's say daily activity or goal.
• 1:23
  SPEAKER_00: So typically it's either school or work.
• 1:26
  SPEAKER_00: What was actually funny is my wife and I were having a conversation and she works with kids with special needs.
• 1:32
  SPEAKER_00: And one just very simple realization we had that she was talking to one of her kids about is that people either go to school or they work.
• 1:41
  SPEAKER_00: There's no really in between.
• 1:43
  SPEAKER_00: I mean, maybe you could try like vacation and travel, but anyways, it's just kind of the realization of life.
• 1:48
  SPEAKER_00: You're either in school or you work.
• 1:50
  SPEAKER_00: And then I guess you retire, but you're working a good part of your life.
• 1:54
  SPEAKER_00: So, anyways, that's what this is talking about mainly is how do we get back to more so work whenever you are post-op ACL.
• 2:03
  SPEAKER_00: This is a question I get often from my own athletes, as well as I've had this come up a lot recently from athletes who are just reaching out.
• 2:11
  SPEAKER_00: So I just wanted to tackle an episode on this so then that way you guys have an idea and you have the principles behind it and you can apply it to your own situation.
• 2:21
  SPEAKER_00: Now, what you will typically hear when the question is asked, or maybe you're asking your surgeon or physical therapist, uh, usually it's coming from the surgeon first because they are basing it off of the surgery they did, timelines, uh, X, Y, and Z.
• 2:37
  SPEAKER_00: So what you'll typically hear is anywhere from four to eight weeks.
• 2:41
  SPEAKER_00: Now, what is really tough is that there cannot be a blanket answer across the board to this question.
• 2:47
  SPEAKER_00: And let me tell you why.
• 2:49
  SPEAKER_00: Everyone's work is different and jobs are different, and then you got to factor in all the things the biological healing of the body, your age, your genetics, the surgery itself, was there a meniscus repair, was there not, any type of restrictions you may have.
• 3:06
  SPEAKER_00: And then obviously, you got to think about the job itself.
• 3:09
  SPEAKER_00: What are the demands of the job?
• 3:11
  SPEAKER_00: And so, in this episode, I want to talk about reverse engineering some of this stuff in order for you to be able to make a better decision in terms of being ready for work and making sure that you have a game plan leading up to it.
• 3:25
  SPEAKER_00: So, first, let's look at some examples of work.
• 3:28
  SPEAKER_00: And obviously, there are so many different occupations and jobs out there.
• 3:32
  SPEAKER_00: So, some to think about in terms of the demand of the job itself is a nurse in the ICU, a middle school teacher, an IT technician, maybe a stay-at-home mom, maybe it's a collegiate athlete, maybe it is a physical therapist.
• 3:49
  SPEAKER_00: You know, all of these jobs are going to have very, very different demands because of just the physical nature of it.
• 3:56
  SPEAKER_00: Maybe one is more sedentary, or maybe the desk job versus one that is going to be very physically demanding, right?
• 4:03
  SPEAKER_00: Let's take someone who's a construction worker versus someone who's does IT, right?
• 4:08
  SPEAKER_00: Like those two things are very, very, very different.
• 4:10
  SPEAKER_00: You're not going to really need to physically use your body as much for an IT job versus someone who is a construction worker, which is obviously very physically taxing.
• 4:20
  SPEAKER_00: So those are some examples.
• 4:22
  SPEAKER_00: And now the thing is I want to break down is some of the factors that you truly do need to consider in order to know when you can return to work.
• 4:32
  SPEAKER_00: And this is also something I want students and people in school to be able to utilize as well.
• 4:37
  SPEAKER_00: So you just insert that same thing.
• 4:40
  SPEAKER_00: So depending on your specific context, maybe you're in high school and you're needing to go back to school itself and move around in the halls and in classrooms, and maybe you want to get back to uh being a part with your team at practices.
• 4:53
  SPEAKER_00: So navigating that and understanding what you need there.
• 4:57
  SPEAKER_00: And then if you're in college, I remember there was a lot to navigate, whether it was buses or stairs or just the huge crowds of people, whenever people are shifting classes.
• 5:08
  SPEAKER_00: So these are all things you have to figure out.
• 5:10
  SPEAKER_00: And one is to make sure that you are safe and don't risk something just because you're trying to get back to it so quick.
• 5:18
  SPEAKER_00: So, regardless if we're talking about high school, college, or more specifically in this episode work, it all kind of applies across the spectrum.
• 5:26
  SPEAKER_00: Now let's look at the factors that we need to consider to know are we ready to take that on?
• 5:32
  SPEAKER_00: And the lens that I want you to look at this is through the same thing as we're getting back to any other activities.
• 5:39
  SPEAKER_00: So if you think about the general progression post-op or post-injury, is to be able to start walking normally again, to be able to do your daily tasks and to be able to drive and to be able to just generally move around.
• 5:52
  SPEAKER_00: And then we move to the next level.
• 5:54
  SPEAKER_00: What is the next level of demand, which is typically work or maybe just kind of being outside and moving around a little bit?
• 6:01
  SPEAKER_00: And then it's moving more towards what most people want to get back to, which is their sports, right?
• 6:06
  SPEAKER_00: So that is all going to vary, and that's usually towards the end of the ASO rehab spectrum where we're trying to put a lot of stress on the body, get ready for the sport that you are trying to do or the activity.
• 6:18
  SPEAKER_00: So obviously, we're able to handle a lot at the end, hopefully, right?
• 6:24
  SPEAKER_00: So if we look at work, we're gonna look at it the same way.
• 6:28
  SPEAKER_00: Well, what are the needs of work in order to make sure our bodies can meet the demands of it?
• 6:33
  SPEAKER_00: Because if we have a very low capacity, which is the amount of work that we can handle or do, so in this instance, maybe it is walking, then it's going to kind of blow our knee up a little bit because that threshold is so low.
• 6:47
  SPEAKER_00: So we need to make sure that threshold is much above whatever we're trying to do, and then that way it's still facilitating our recovery and our rehab, and we don't set ourselves back.
• 6:57
  SPEAKER_00: So let's dive into some of these factors that need to be considered in order to know are you ready to go back to work or not?
• 7:05
  SPEAKER_00: And the first factor is going to be your job.
• 7:08
  SPEAKER_00: So you need to analyze your job.
• 7:10
  SPEAKER_00: So, what we do and what I do for all my athletes is a performance needs analysis.
• 7:16
  SPEAKER_00: And this is done in any good strength and conditioning program where we're trying to figure out okay, here's the athlete's sport, and here's where they're at, and here is what we need to do in order to program and build them up towards those end goals.
• 7:30
  SPEAKER_00: And so we are breaking it down by different components of psychology and physical and tactical and technical.
• 7:37
  SPEAKER_00: There's a lot of different things that go into it.
• 7:39
  SPEAKER_00: But for you, when you're looking at your job and you're evaluating it, you need to figure out okay, one, you would know if it's physical or not, how physically demanding is it, and then figuring out what types of way are you physically exerting yourself, right?
• 7:55
  SPEAKER_00: So a construction worker is going to need to take a lot of steps, lift heavy weight, a nurse in the ICU is going to have to take a lot of steps, and that might be something where they have to transfer patience.
• 8:06
  SPEAKER_00: A middle school teacher might need to take a lot of steps and maybe react to something where there's a fight in school, or maybe there is something where they need to react quick because someone got hurt, or maybe there's a lot of times where you're not really doing anything besides just having to take on a lot of steps and deal with a lot of punks.
• 8:26
  SPEAKER_00: And so this is something that is going to be very different compared to the IT technician or someone who has a desk job where they could just prop their leg up, chill, not have to really take too many steps, and a lot of their job is more so just stationary in front of them, right?
• 8:42
  SPEAKER_00: That's going to be so, so different from a physically demanding standpoint.
• 8:47
  SPEAKER_00: So, one of the things I recommend is figuring out how many steps you're going to take in the day.
• 8:52
  SPEAKER_00: I think this is so important and something that can get missed that is very simple, that you can record.
• 8:59
  SPEAKER_00: And so I will give you an example.
• 9:01
  SPEAKER_00: I have some teachers I'm working with post-ACL, and one of the things that they had mentioned is that they need to get up to roughly around 10,000 to 15,000 steps in a given day.
• 9:12
  SPEAKER_00: And that's a lot of steps, but you gotta think about how much they're shifting and transitioning and things of that nature and trying to keep up.
• 9:19
  SPEAKER_00: So if you have a teacher who's wanting to go back to work, then that is something where we need to make sure that the phases initially are built up to get them back to that.
• 9:29
  SPEAKER_00: And that is going to dictate the timing as well.
• 9:32
  SPEAKER_00: So if you are three weeks post-op and let's say you had a meniscus repair, you're not even putting that foot down.
• 9:38
  SPEAKER_00: So then now you have to decide, okay, well, how much time do I have off?
• 9:43
  SPEAKER_00: Let's say you have up until eight weeks off in order to go back to work.
• 9:47
  SPEAKER_00: Well, you have eight weeks to try and build up to a volume you think you can tolerate.
• 9:52
  SPEAKER_00: So that's getting off the crutches, being able to walk appropriately.
• 9:56
  SPEAKER_00: And then if you're thinking about achieving 10,000 to 15,000 steps, that's a lot.
• 10:02
  SPEAKER_00: So we need to make sure that we are tackling this and knowing how many steps you're going to average in a day and whatever the job demand is.
• 10:11
  SPEAKER_00: And if you have to take those steps, we need to make sure that we are building a plan to build you up towards that step count.
• 10:18
  SPEAKER_00: It's no different than someone training for a marathon, if you will, or a half marathon, or even a 5K.
• 10:24
  SPEAKER_00: We need a week by week progression of step count in order to make sure that we are acclimated to that.
• 10:30
  SPEAKER_00: Otherwise, what I will see is that when the step count skyrockets, that people's knees will get grumpy, they will get painful, and they will swell.
• 10:39
  SPEAKER_00: It'll happen because the capacity of the knee is not used to those steps and it's a lot of stress to it, and it's freaking out.
• 10:47
  SPEAKER_00: So don't let it freak out, and that's where the plan in place is so important.
• 10:51
  SPEAKER_00: But the plan itself has to be based on something objective to help you get there.
• 10:56
  SPEAKER_00: So four to eight weeks is so arbitrary for anybody.
• 11:00
  SPEAKER_00: I understand that time is a very good uh anchor point for all of us because we use it so much, but because every person varies so much that we need to be able to have something else that we anchor to that's a bit more uh objective in day-to-day that can help bridge back to something that they're trying to do.
• 11:21
  SPEAKER_00: So let's say take the 10,000 uh step example.
• 11:25
  SPEAKER_00: If we try to even get halfway to that, that's 5,000, right?
• 11:28
  SPEAKER_00: So we need to get, let's say, someone's trying to get 10,000 steps at eight weeks.
• 11:34
  SPEAKER_00: Ideally, if we can get somewhere towards you know 5,000 at week four or five, that's good.
• 11:39
  SPEAKER_00: We're halfway there.
• 11:41
  SPEAKER_00: And it's always not going to be this clean and easy because it depends on when someone gets off their crutches.
• 11:46
  SPEAKER_00: Do they have any restrictions and a weight bearing standpoint?
• 11:49
  SPEAKER_00: So those are things that need to be considered whenever you're building back up.
• 11:53
  SPEAKER_00: So going back to the job, is it physical?
• 11:56
  SPEAKER_00: Are you taking a lot of steps in the day?
• 11:59
  SPEAKER_00: Are you lifting a lot of things?
• 12:01
  SPEAKER_00: Maybe you're moving side to side, transferring patients a lot, uh, or is it more stationary or a desk job style?
• 12:08
  SPEAKER_00: That is going to be a very big factor in this.
• 14:15
  SPEAKER_00: Then you have to factor in the injury itself.
• 14:18
  SPEAKER_00: What was the injury?
• 14:20
  SPEAKER_00: Was there bone bruising or fracture?
• 14:23
  SPEAKER_00: Were there other ligament damage?
• 14:25
  SPEAKER_00: Uh, was there any meniscus issues?
• 14:28
  SPEAKER_00: What was done in the surgery?
• 14:30
  SPEAKER_00: This is a very, very big one because if you have a meniscus repair versus menasectomy, your knee is going to respond very differently.
• 14:37
  SPEAKER_00: And your restrictions are probably going to be if you had a repair, is a lot of surgeons will put you at non-weight bearing at least pretty early for two weeks to four weeks and even up to six to eight weeks.
• 14:49
  SPEAKER_00: So that's going to be important to know from your surgery well, what is your weight bearing status?
• 14:55
  SPEAKER_00: And that will actually impact a lot of you being able to get back to a job where you might have a lot of steps.
• 15:01
  SPEAKER_00: Otherwise, you're going to be crutching along a lot, and that can be really tough too, right?
• 15:06
  SPEAKER_00: Especially from a recovery and stress standpoint.
• 15:09
  SPEAKER_00: One other additional piece I want to highlight here is that when people are offloaded and non-weight bearing for let's say four weeks, when they go to do partial weight bearing or toe touch or weight bearing as tolerated, so essentially you go from not putting any weight on the foot to gradually loading the leg and starting to get back your normal walking gait, the knee can swell up.
• 15:32
  SPEAKER_00: And it's because it has not been loaded from an impact standpoint or a compression standpoint, and that's essentially what we do whenever we put our limbs on the ground.
• 15:42
  SPEAKER_00: Whenever we go through the gait cycle, we are compressing that knee joint up and through, and that's what happens whenever you go from non-weight bearing to weight bearing.
• 15:51
  SPEAKER_00: And so that could be a different stress to the joint, and depending on the knee and the healing and how things are going, it can react by swelling a little bit.
• 16:01
  SPEAKER_00: This is not uncommon, and I actually see this a very, very good bit with athletes, and they get surprised because things are going well, all of a sudden their weight bearing is tolerated, they start putting some load on the knee, and it kind of swells up a little bit.
• 16:14
  SPEAKER_00: So that is something to be on the lookout for if you are someone who is non-weight bearing for a bit and then has a go-to weight bearing.
• 16:22
  SPEAKER_00: The other piece to this is was there a lot of swelling to begin with?
• 16:26
  SPEAKER_00: And this is a big factor in my opinion.
• 16:29
  SPEAKER_00: And I think that swelling can really be the bane of existence for anyone who's dealing with a knee issue, ACL.
• 16:37
  SPEAKER_00: Um, I've dealt with it so much, and I've had a lot of athletes who have dealt with it, and it's one of those things where there's only so much you can do.
• 16:44
  SPEAKER_00: And it's usually the things that we don't want to do, which is just offload the knee, decrease the amount that you are putting stress on the knee.
• 16:53
  SPEAKER_00: So it's this vicious cycle.
• 16:54
  SPEAKER_00: There's swelling, you go back to work, let's say it's a physical job, there's pain and swelling, but you got to keep going back to work.
• 17:02
  SPEAKER_00: So it's this ongoing cycle, and the only true way to fix this naturally is to truly offload it, to balance that stress initially in order to make sure that we're navigating it the right way.
• 17:15
  SPEAKER_00: And then what we need to think about is how is the knee recovering in the early phases?
• 17:20
  SPEAKER_00: Are you getting that quiet knee?
• 17:22
  SPEAKER_00: Are you getting that full knee extension?
• 17:24
  SPEAKER_00: Are you getting your range for flexion coming along pretty well?
• 17:28
  SPEAKER_00: Is the swelling coming down?
• 17:29
  SPEAKER_00: Is the pain coming down?
• 17:31
  SPEAKER_00: Are you normalizing your gait pattern?
• 17:33
  SPEAKER_00: Those initial phases where you're kind of protecting the knee, but getting that foundation built is going to dictate a lot of how you can return back to work as well.
• 17:42
  SPEAKER_00: So these are all things that I want you to think about.
• 17:45
  SPEAKER_00: And now we're gonna dive into some more practical strategies and things that you can incorporate in order to know, okay, am I going to be ready or not?
• 17:54
  SPEAKER_00: And so what I want to do is reverse engineer the demands of your work requirements, and then that way you know, okay, here's the things that I need to look for, and then how can I create a plan to get there?
• 18:06
  SPEAKER_00: And maybe this is something that you talk more so with your physical therapist in order to game plan this out to make sure this doesn't create a big bump in your recovery, because I can see this oftentimes where people will return back to work and then rehab takes a back seat and then it ends up aggravating the knee, and then it becomes an issue.
• 18:26
  SPEAKER_00: So we want to make sure we have a plan in place to attack it.
• 18:29
  SPEAKER_00: So, as I had mentioned before, treat work the same thing as any activity or sport you're trying to build back to.
• 18:35
  SPEAKER_00: And especially if it's something that is more physical, then we need to account for that.
• 18:40
  SPEAKER_00: Do you need to be able to walk?
• 18:42
  SPEAKER_00: How many steps are being taken?
• 18:45
  SPEAKER_00: Are you lifting things?
• 18:47
  SPEAKER_00: Do you need to potentially react really quick?
• 18:49
  SPEAKER_00: Maybe you work in a nursery or kids are super young and you need to keep them from killing themselves.
• 18:56
  SPEAKER_00: Who knows?
• 18:56
  SPEAKER_00: Like, you know, with babies, we're trying to make sure that they're alive.
• 19:00
  SPEAKER_00: And I know in nurseries you're trying to make sure they not fall or run into anything.
• 19:04
  SPEAKER_00: So maybe you need to react.
• 19:06
  SPEAKER_00: I've worked with a mom who literally tore her ACL because her daughter was about to fall off a ledge, and she had a choice of either making this weird kind of movement to catch her daughter, or her daughter fell off, and who knows what would have happened.
• 19:19
  SPEAKER_00: And she risked her ACL, which was worth it, right?
• 19:23
  SPEAKER_00: I think, right?
• 19:24
  SPEAKER_00: Um, but it's one of those things where you have to know, like, okay, what is worst case scenario?
• 19:30
  SPEAKER_00: Maybe you need to be lifting people out of a bed and you work in a hospital and you're doing transfers.
• 19:36
  SPEAKER_00: Is there pivoting or twisting related to your work that you need to account for?
• 19:41
  SPEAKER_00: So some general buckets that I want you to think about are the amount of steps you need to take in a given day, the strength that is actually needed for the job.
• 19:51
  SPEAKER_00: Are you doing lifting?
• 19:53
  SPEAKER_00: In what type of directions?
• 19:55
  SPEAKER_00: Is there reactivity involved?
• 19:57
  SPEAKER_00: Do you need to be able to pivot on a spot in order to, you know, maybe something happens like the kid at the nursery?
• 20:04
  SPEAKER_00: You need to know if these types of things are necessary.
• 20:07
  SPEAKER_00: And then what we need to do is make sure we build up to each of these and that this is not just a straight shock to the system.
• 20:14
  SPEAKER_00: So, as we talked about before, steps, right?
• 20:17
  SPEAKER_00: If we require work at 10,000 steps and you've only been hitting 2,000, that is going to be a huge wake-up call to you and to the knee.
• 20:27
  SPEAKER_00: So we need to build this up and only after the knee calms down some.
• 20:32
  SPEAKER_00: So unfortunately, you can't force this.
• 20:34
  SPEAKER_00: If your knee is swelled up and you're trying to increase your step rate, that's not necessarily going to be the best way to tackle this because you need to make sure your knee is calm and we need to slowly build it up, just like the whole running sequence.
• 20:48
  SPEAKER_00: So if you're trying to run a 5K or a 10K, you need to think about this as kind of like a plan in order to build up to that volume.
• 20:57
  SPEAKER_00: So, same thing with uh the step count.
• 20:59
  SPEAKER_00: So, if you're trying to acquire 10,000 steps on average to make sure your knee is comfortable with it and responds well, well, maybe that starts acclimating early in this process and it goes from 2,000 in a few days, knee tolerates that well, then maybe we bump it up to 3,000, then we bump it up to 4,000, and it's an intentional plan to build up.
• 21:21
  SPEAKER_00: The thing is, you just don't want to spike that from 2,000 to 5,000 or 5,000 to 10,000.
• 21:27
  SPEAKER_00: And then it's going to really be important to make sure you have the recovery the day after to know, okay, did my knee tolerate that or not?
• 21:36
  SPEAKER_00: And that's going to be very important.
• 21:38
  SPEAKER_00: The other big piece here is going to be strength.
• 21:41
  SPEAKER_00: If you need to lift someone out of a bed and transfer them, and you can barely do an air squat without hesitation, then there is a gap here, right?
• 21:50
  SPEAKER_00: So we need to make sure that the requisites are met in order to transfer over to whatever it is that we need to do with our work.
• 21:57
  SPEAKER_00: So, some things I want you guys to look out for.
• 22:00
  SPEAKER_00: Rehab sometimes takes a back seat once work starts up, especially if it's a physically demanding job.
• 22:06
  SPEAKER_00: It takes time away and is physically exhausting.
• 22:09
  SPEAKER_00: So the last thing you want to do is go to the gym or do your rehab.
• 22:12
  SPEAKER_00: And then what that can lead into is a grumpy knee, and there's more swelling and pain, and then it's this vicious cycle of I need to work and I need to function, but my knee is also pissed.
• 22:24
  SPEAKER_00: And so that is something that could be that cycle that you want to make sure you break, and that's where doing this stuff early and building a plan on it is so important.
• 22:34
  SPEAKER_00: Prioritize offloading.
• 22:37
  SPEAKER_00: So in the early phases, we get too quick to starting to want to walk.
• 22:42
  SPEAKER_00: Use your crutches appropriately.
• 22:44
  SPEAKER_00: And I want you guys to think about instead of it being an on and off switch, think about it as a dimmer switch.
• 22:50
  SPEAKER_00: And you're slowly turning the light on.
• 22:53
  SPEAKER_00: That's the same thing in this process.
• 22:55
  SPEAKER_00: You're slowly ramping these things up very, very gradually, as opposed to an on and off switch of hitting eight weeks or something.
• 23:03
  SPEAKER_00: And I think that's one of the things that probably gets missed the most in ACL rehab is that you just don't automatically cross over this magical threshold.
• 23:11
  SPEAKER_00: It's a completely gradual process.
• 23:14
  SPEAKER_00: And that way you know you get feedback from your body and able to know is it handling it or not.
• 23:20
  SPEAKER_00: Can you create flexibility at work?
• 23:23
  SPEAKER_00: Can you talk to coworkers or maybe your boss or whoever it is and work something out where you're not on your feet as much?
• 23:30
  SPEAKER_00: And just make sure that you stress is important to the recovery and just be transparent about how you're handling it and dealing with it.
• 23:38
  SPEAKER_00: And just know that if you make these steps appropriately in the beginning and take care of this, then down the road it's going to take care of itself.
• 23:47
  SPEAKER_00: And you won't have to take a step back or deal with it as much if the early phases are tackled appropriately.
• 23:54
  SPEAKER_00: So make sure you communicate and see if you have flexibility with work and whatever that is.
• 23:59
  SPEAKER_00: And so I understand that everyone has different financial and work situations.
• 24:04
  SPEAKER_00: So that's what can really dictate whether someone needs to return or not.
• 24:08
  SPEAKER_00: I've had some people who are desk workers, they returned the day after or three days after the weekend, right?
• 24:15
  SPEAKER_00: And that's something that's very doable, but it's always going to be so dependent.
• 24:20
  SPEAKER_00: I have some people who are in some financial binds, and that means they had to get to work faster and they have a physically demanding job.
• 24:27
  SPEAKER_00: And I understand that.
• 24:28
  SPEAKER_00: Here's going to be my advice to you as a healthcare professional and a coach and someone who's gone through this process is to take care of your knee early and do it really, really well.
• 24:39
  SPEAKER_00: Don't rush it, don't force things.
• 24:41
  SPEAKER_00: Listen to your physical therapist or coach you're working with.
• 24:45
  SPEAKER_00: Make sure that you do it well and you have progressions and you don't make big jumps because that is going to make a huge impact in laying that foundation and as you move forward in the process, especially returning back to work.
• 24:59
  SPEAKER_00: A general rule less physically demanding job is, the quicker you can return back to work.
• 25:05
  SPEAKER_00: As I mentioned, one of my athletes is a desk worker, so they were back to work pretty quick.
• 25:09
  SPEAKER_00: But I have some who are the teachers or they work as a nurse and they had to wait because they have to lift, they have to take a lot of steps.
• 25:17
  SPEAKER_00: And so that is something that they had to delay returning to work because that's not also something they could just do in front of a computer.
• 25:24
  SPEAKER_00: And so the more physically demanding your job is, the longer you probably need to wait before you start again.
• 25:31
  SPEAKER_00: So my advice to you is don't rush back to work at the cost of not allowing your knee to heal and normalize in the first phase of ACL rehab.
• 25:41
  SPEAKER_00: These people typically can have lots of problems throughout the early parts of ACL rehab because the knee never got quiet and never settled down, and it has ongoing pain and swelling because they rushed back to work, usually because they're probably having to take a lot of steps at work and they're on their feet a lot.
• 26:01
  SPEAKER_00: So this limits them, and then there's swelling and pain, and then it starts that vicious cycle.
• 26:07
  SPEAKER_00: So take care of your knee early.
• 26:10
  SPEAKER_00: Make sure that you are reverse engineering the demands of your work and building up towards that, and there's a game plan towards that, not just for sport, but each phase of this process, there needs to be a buildup.
• 26:23
  SPEAKER_00: So take these different objectives and see if you can figure out okay, here's where I'm at, here's where I need to return, and here's what I need to build up to in order to tolerate that.
• 26:32
  SPEAKER_00: And bring that to your physical therapist and see if you guys can build a plan in order to get there.
• 26:38
  SPEAKER_00: And make sure you do not get caught in this vicious cycle, and so that way you can have a very seamless ACL recovery.
• 26:46
  SPEAKER_00: All right, team, that's going to do it for today.
• 26:49
  SPEAKER_00: Thank you guys all so much for listening.
• 26:51
  SPEAKER_00: This is your host, Robbie Patel, signing off.