Latest / The ACL Athlete Podcast / 267 | The ACL Decision No One Talks About: Should You Even Return to Your Sport?

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267 | The ACL Decision No One Talks About: Should You Even Return to Your Sport? · 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.
• 1:00
  SPEAKER_00: When most people think about ACL injuries, they think about the highlight reel, right?
• 1:07
  SPEAKER_00: The college quarterback going down, the soccer star grabbing their knee on the soccer field, the NBA player carried off the court, the football player, right?
• 1:18
  SPEAKER_00: And yeah, those injuries are real and they're super devastating, but that is truly a fraction of the ACL population.
• 1:28
  SPEAKER_00: This injury does not really care who you are.
• 1:31
  SPEAKER_00: It doesn't care about your age, it doesn't care about your sport, your level, or the plans that you have.
• 1:37
  SPEAKER_00: It happens to the 14-year-old playing club soccer, the 40-year-old skiing with her family, the weekend basketball player, the dad playing flag football with his buddies in the church league.
• 1:50
  SPEAKER_00: People get hit by cars, their dogs trip them on a walk, they fall off of a step stool when they are doing something in their home or hanging something up.
• 2:02
  SPEAKER_00: Soccer, basketball, football, skiing, snowboarding, lacrosse, volleyball, softball, tennis, hiking, martial arts, pickleball, tricking, and honestly, just living your life.
• 2:15
  SPEAKER_00: This injury does not discriminate.
• 2:17
  SPEAKER_00: And I didn't name all of what we have worked with and all of what people are doing when this injury happens, especially when we're talking about just even general day-to-day activities.
• 2:28
  SPEAKER_00: And here's where the conversation shifts.
• 2:30
  SPEAKER_00: When you tear your ACL in a competitive sport with a clear goal, whether that's making a roster, earning a scholarship, or protecting a contract, the decision to come back is usually straightforward, right?
• 2:45
  SPEAKER_00: You do the surgery, you do the rehab, you get back to it.
• 2:48
  SPEAKER_00: But when this injury happens outside of that world, and it does all the time, and probably for many of you listening, it does apply to you, especially in this case.
• 2:59
  SPEAKER_00: It's not just the high school or the college or the professional.
• 3:04
  SPEAKER_00: It's probably outside of that.
• 3:05
  SPEAKER_00: It's more hobby-based, it's more just something that you love to do from a physical movement competition standpoint, but maybe there's less stakes on the line, but it's something that is really, really meaningful to you, right?
• 3:18
  SPEAKER_00: The recovery conversation changes a bit though, because the question is no longer just when do I get back, which is important.
• 3:26
  SPEAKER_00: It becomes should I go back at all?
• 3:29
  SPEAKER_00: And that is what this episode is about.
• 3:32
  SPEAKER_00: The decision to return to sport or the activity after an ACL injury is not a one size fits all.
• 3:40
  SPEAKER_00: I wish it was, but it really isn't.
• 3:42
  SPEAKER_00: And it never should be.
• 3:43
  SPEAKER_00: There are three things that changes this entire equation.
• 3:47
  SPEAKER_00: So let me break that down for you guys.
• 3:48
  SPEAKER_00: First is the severity of the injury and the surgical history.
• 3:52
  SPEAKER_00: Is this your first ACL tear, your second, your third?
• 3:55
  SPEAKER_00: Did you also tear your meniscus?
• 3:57
  SPEAKER_00: Did you have complications?
• 3:59
  SPEAKER_00: Have you had other major procedures?
• 4:01
  SPEAKER_00: All that matters.
• 4:02
  SPEAKER_00: Each surgery adds weight to the decision.
• 4:04
  SPEAKER_00: Not to mention also your previous injury history is going to layer into this as well.
• 4:10
  SPEAKER_00: Second, your goals.
• 4:11
  SPEAKER_00: Are you trying to compete at a high level?
• 4:13
  SPEAKER_00: Are you recreational or do you just want to live without limitations?
• 4:17
  SPEAKER_00: Be able to run with your kids, go on a hike, play pickup without thinking about your knee.
• 4:22
  SPEAKER_00: Those are three very different targets.
• 4:25
  SPEAKER_00: And then third, your season of life, your age, your family situation, your career.
• 4:30
  SPEAKER_00: Are you working?
• 4:32
  SPEAKER_00: Are you in school?
• 4:33
  SPEAKER_00: Your financial reality, whether your job is physical or remote, maybe sedentary, how much of your body matters to your livelihood.
• 4:42
  SPEAKER_00: All of these things factor into essentially some of the decisions that you're going to make.
• 4:47
  SPEAKER_00: Now, let me give you some real examples because I've seen these and we see these all the time.
• 4:53
  SPEAKER_00: And these are essentially current athletes we're working with.
• 4:56
  SPEAKER_00: You know, it runs the whole spectrum.
• 4:58
  SPEAKER_00: We have worked with the single-digit youth athlete all the way to people in their 60s.
• 5:05
  SPEAKER_00: We have not worked with an ACLR in their 70s yet, but we have worked with many in their 60s.
• 5:10
  SPEAKER_00: But it ranges the entire spectrum, which is why I'm saying, like, we in that news is highlighted of, you know, high school, college, pro.
• 5:18
  SPEAKER_00: But in reality, this injury spans across so many different people based on the activities they're doing, the sports, you know, and it's not going to pick a certain time.
• 5:29
  SPEAKER_00: It's just, you know, when is that ACL forced to essentially be in a position that's compromised, right?
• 5:34
  SPEAKER_00: And it could be in a number of different ways.
• 5:37
  SPEAKER_00: And so I want to break down just some example situations here.
• 5:40
  SPEAKER_00: I've got a dad, three kids under the age of five.
• 5:44
  SPEAKER_00: He's an anesthesiologist.
• 5:46
  SPEAKER_00: He's on his feet all day in the OR or around the hospital.
• 5:50
  SPEAKER_00: And if he goes down with another injury, his family feels it immediately.
• 5:54
  SPEAKER_00: His income, his presence at home, everything.
• 5:56
  SPEAKER_00: There's a lot of influences there.
• 5:58
  SPEAKER_00: I've got a mom with a six-month-old working remotely.
• 6:02
  SPEAKER_00: Different job demands, different physical requirements, but she's the primary give caregiver for an infant.
• 6:07
  SPEAKER_00: Her kid, a nine-month rehab changes everything about her daily life, especially whenever it's a six-month-old, y'all.
• 6:14
  SPEAKER_00: Like got to carry the infant, got to care for them, got to react to things very quickly.
• 6:19
  SPEAKER_00: And then, you know, a 16-year-old who's already torn his ACL twice, no ambitions for college sports.
• 6:26
  SPEAKER_00: So now you're looking at a teenager who's already been through two major knee surgeries and two long rehab cycles.
• 6:32
  SPEAKER_00: And the thing he was doing it for isn't even on the table.
• 6:37
  SPEAKER_00: A surgeon in his 50s who needs his body to work every day.
• 6:41
  SPEAKER_00: It's very physical.
• 6:42
  SPEAKER_00: It's like carpentry work with the replacements that he's doing.
• 6:45
  SPEAKER_00: But he also loves skiing.
• 6:47
  SPEAKER_00: That's his thing.
• 6:48
  SPEAKER_00: That's what fills his cup.
• 6:49
  SPEAKER_00: So what does he do?
• 6:50
  SPEAKER_00: Does he go back and ski again?
• 6:53
  SPEAKER_00: The same injury, completely different calculus.
• 6:56
  SPEAKER_00: And that's the thing that is so, so important here to make sure that we define in these situations.
• 7:03
  SPEAKER_00: And here's what I tell every single athlete I work with and our team as a whole.
• 7:09
  SPEAKER_00: The goal at the end of your ACL rehab is not necessarily to go back to everything you did before.
• 7:15
  SPEAKER_00: The goal is to know that you could.
• 7:18
  SPEAKER_00: Let me repeat that again because I think this is really, really important.
• 7:22
  SPEAKER_00: Not necessarily discussed very much because a lot of times it's like the ACL tear, let's go back to doing the thing, right?
• 7:28
  SPEAKER_00: And I think context is so, so important when these injuries happen because it's not just a six-week recovery, y'all.
• 7:35
  SPEAKER_00: It's not just like I can carry on with life, but I modify, right?
• 7:38
  SPEAKER_00: Your life could be severely disrupted.
• 7:40
  SPEAKER_00: Let's say you have a meniscus repair that is going to take a six-week non-weight bearing procedure, basically not putting weight on your feet, and it's your driving leg, right?
• 7:49
  SPEAKER_00: Guess what?
• 7:50
  SPEAKER_00: If you have to get your family to A to B, like the thing is, is like you don't really have a choice.
• 7:56
  SPEAKER_00: You can't just, you know, get Ubers all the time.
• 7:59
  SPEAKER_00: And so the thing is, is like everyone's context is so different.
• 8:03
  SPEAKER_00: Like we have people who do manual work for their jobs, and they don't really have these opportunities to just take time off.
• 8:09
  SPEAKER_00: Yeah, people can potentially use FMLA or these different things to help secure pay, but again, it's portions of their pay potentially.
• 8:17
  SPEAKER_00: Did they get hurt on the job?
• 8:19
  SPEAKER_00: Did they get hurt off the job?
• 8:20
  SPEAKER_00: There are a lot of factors that influence this a lot, right?
• 8:24
  SPEAKER_00: And so that's the thing that I want to repeat here.
• 8:26
  SPEAKER_00: The goal at the end of your ACL rehab is not necessarily to go back to everything you did before.
• 8:32
  SPEAKER_00: The goal is to know that you could, that you have the physical capacity, the strength, the power, the ability to move like an athlete, the confidence mentally and physically in your body, the movement quality, that if you decide tomorrow to go play your sport, your body is ready and your mind is ready.
• 8:51
  SPEAKER_00: You are not limited, you're not walking on eggshells, you are scared.
• 8:55
  SPEAKER_00: And then from that position of strength, you make a calculated decision about whether you will.
• 9:02
  SPEAKER_00: The thing that I see a lot is really that people choose not to go back to their sports because they're just not ready.
• 9:10
  SPEAKER_00: Their rehab wasn't good, they're not confident in their knee, they're scared to re-injure again.
• 9:15
  SPEAKER_00: Now you can still be 100% tested out and be scared of re-injury.
• 9:19
  SPEAKER_00: That exists.
• 9:20
  SPEAKER_00: But again, graded exposure and the weight of doing that activity again is going to play into that to build up that confidence, right?
• 9:27
  SPEAKER_00: Again, context of life will play into that.
• 9:30
  SPEAKER_00: But with that said, you want to come from a position of strength.
• 9:34
  SPEAKER_00: You don't want to make that decision out of fear.
• 9:36
  SPEAKER_00: You want to make that decision out of a calculated decision that is weighing the risk versus reward of whether you should get back to doing that thing or not.
• 9:45
  SPEAKER_00: And this is a very critical distinction, and I need you to hear this clearly.
• 9:50
  SPEAKER_00: There is a massive difference between I can't go back because I'm scared and my knee doesn't feel right, and I can go back.
• 9:58
  SPEAKER_00: I'm physically ready, and I'm choosing not to because of where I am in my life right now and my goals.
• 10:04
  SPEAKER_00: One is driven by fear, the other is driven by clarity.
• 10:09
  SPEAKER_00: Fear-based avoidance means the rehab didn't finish its job.
• 10:13
  SPEAKER_00: It means you never got to a place where you trusted your body, and that's a failure of the process, not a failure of you.
• 10:21
  SPEAKER_00: It's a failure of the process.
• 10:23
  SPEAKER_00: And informed choice means you did the work, you got yourself to a place where you are fully capable.
• 10:30
  SPEAKER_00: And from that place, you're assessing risk versus reward, like any smart, calculated human being would.
• 10:38
  SPEAKER_00: That's the standard, and that's what your rehab should get you to.
• 10:42
  SPEAKER_00: Not I'm thinking I'm probably fine, not my PT said I was good to go at six months based on a timeline, not I'm cleared because it's been long enough.
• 10:52
  SPEAKER_00: You should be objectively ready, tested based on what the research shows is evidence to this date, objectively testing your quads, hitting as close as you can to your peak torque to body weight, 100%, if not better, per quad on both sides.
• 11:07
  SPEAKER_00: Your hamstrings to be at a good symmetry and making sure that we are testing things from a dynamic standpoint, jumping, running, cutting, all the things that you can compensate with, and usually where the ACL is going to be more tested at in terms of whether it's going to do its job, but also where the body and the different athletic abilities are going to be really tested.
• 11:32
  SPEAKER_00: And if not, there is going to be compensation, and then worst case scenario is going to be you're putting your knee at risk, right?
• 11:38
  SPEAKER_00: You should be objectively ready, tested through the research-based criteria, not on a timeline only, confident, and then you decide.
• 13:52
  SPEAKER_00: And I'll give you my own example because I live this.
• 13:56
  SPEAKER_00: I live this every day, and I have evaluated this over years and years and years.
• 14:00
  SPEAKER_00: I've torn my ACL twice, right?
• 14:03
  SPEAKER_00: And this happened when I was in high school and then in college.
• 14:07
  SPEAKER_00: I went to PT school and we had different recreational sports that we did as a team.
• 14:13
  SPEAKER_00: We played softball, we did soccer, we did volleyball, we did all kinds of things, but we were an active group of just PT students.
• 14:21
  SPEAKER_00: And the thing is, is that I would take part in all those things.
• 14:25
  SPEAKER_00: I knew the risk reward of that, but I loved playing sports at the time.
• 14:28
  SPEAKER_00: All my friends, athletic, you know, we wanted to compete against different people.
• 14:33
  SPEAKER_00: So that was something that I decided to do, right?
• 14:36
  SPEAKER_00: And I understood the risk of that, knowing I've torn my ACL twice, but the joy of hanging out with my friends and being able to do this, the camaraderie of it was worth it.
• 14:45
  SPEAKER_00: Right.
• 14:46
  SPEAKER_00: Now you fast forward and it's been quite a while, 10 plus years.
• 14:51
  SPEAKER_00: And the thing is, is that I've had my ACL procedures, of course.
• 14:55
  SPEAKER_00: I've had other injuries that are a little bit more minor, if you will.
• 14:59
  SPEAKER_00: But the other major thing is my hip procedure, which I had last year.
• 15:03
  SPEAKER_00: And so I've had laboral tears in both hips.
• 15:05
  SPEAKER_00: You know, I've dislocated my shoulder three times, broken ankles on one ankle multiple times.
• 15:11
  SPEAKER_00: The list goes on of my injury history, right?
• 15:14
  SPEAKER_00: I am no stranger to what it takes to come back from like a major injury and even minor injuries as well, right?
• 15:20
  SPEAKER_00: And right now, I could go play, you know, flag football tomorrow.
• 15:25
  SPEAKER_00: I have the strength, I have the movement, I have the confidence in my body to do it, but I don't.
• 15:31
  SPEAKER_00: And now hear me out.
• 15:32
  SPEAKER_00: And it's not because I'm afraid, it's because I've done the math.
• 15:37
  SPEAKER_00: I have two young boys.
• 15:39
  SPEAKER_00: I use my body every single day to demonstrate exercises and movements for athletes that I work with.
• 15:44
  SPEAKER_00: My body is literally my tool for my business, along with obviously the remote side of things.
• 15:49
  SPEAKER_00: If I go down with another major injury, that impacts my ability to provide for my family, show up for my kids, and serve the athletes who trust me with their recovery.
• 15:58
  SPEAKER_00: The joy I get from playing flag football, yeah, sure is there, but I miss competing, I miss that feeling, but it doesn't outweigh what's on the other side of the equation.
• 16:09
  SPEAKER_00: And it's something that, you know, for me, what fills my cup is being able to move, being able to continue to get myself healthy, and importantly, being able to challenge myself without really putting myself nearly at risk.
• 16:23
  SPEAKER_00: And this is just something that's important to me currently, and being able to make sure that I can stay healthy for my boys and my family.
• 16:30
  SPEAKER_00: That's super important to me right now, and that's big, big priority.
• 16:34
  SPEAKER_00: Could I go play?
• 16:36
  SPEAKER_00: Yes.
• 16:36
  SPEAKER_00: Should I?
• 16:37
  SPEAKER_00: That is a different question.
• 16:39
  SPEAKER_00: And the answer for me right now is no, not out of fear.
• 16:43
  SPEAKER_00: It's just out of wisdom, out of clarity of where I am in life, in my season of life.
• 16:47
  SPEAKER_00: And I want to be honest about something else.
• 16:49
  SPEAKER_00: People don't always think about the full toll of another major injury.
• 16:53
  SPEAKER_00: It's not just the physical recovery.
• 16:55
  SPEAKER_00: You know, a lot of times we're like, oh, I could do the rehab again.
• 16:58
  SPEAKER_00: And it's like, yeah.
• 16:59
  SPEAKER_00: But it's also the financial cost, the surgery, the time off work, the months of rehab.
• 17:05
  SPEAKER_00: It's the mental and emotional weight, especially if you've already been through it once or twice.
• 17:10
  SPEAKER_00: You know what's coming, you know how long the road is.
• 17:13
  SPEAKER_00: That makes it even heavier, not lighter.
• 17:16
  SPEAKER_00: It makes it harder whenever you tear your ACL again.
• 17:19
  SPEAKER_00: People think, oh, you've been through it, I'll get through it again.
• 17:22
  SPEAKER_00: But it's like, ah, you know, you start to question things a little bit more because then you're like, I have another long road ahead.
• 17:28
  SPEAKER_00: What if I do this again?
• 17:29
  SPEAKER_00: And I always tell people, after your second ACL injury, you will rethink the things that you do.
• 17:36
  SPEAKER_00: And I know you don't want to hear this.
• 17:38
  SPEAKER_00: And the thing is, usually, yes, after your first ACL, you are like, okay, that was the one time thing.
• 17:43
  SPEAKER_00: And then when the second one happens, usually a lot of times people will be like, okay, this is my last chance at going at this, right?
• 17:52
  SPEAKER_00: And that's where you start to dial in some calculated risks.
• 17:56
  SPEAKER_00: But then when you do it a third time, there is a different narrative that enters your head.
• 18:03
  SPEAKER_00: And a lot of people don't entertain that.
• 18:05
  SPEAKER_00: But the thing is that you have to entertain it because you have to understand all the risk of this injury and this recovery.
• 18:12
  SPEAKER_00: And the thing is that I wish that you there was 100% injury prevention, but it just doesn't exist.
• 18:18
  SPEAKER_00: There is nothing more prevalent to another ACL injury than someone who has already torn their ACL.
• 18:24
  SPEAKER_00: And I know this is not the sunshine and rainbows that you guys are probably hoping for here, but I'm trying to make sure that I get a point across here that is very important, that is just honestly not really discussed.
• 18:35
  SPEAKER_00: And I know a lot of you who are listening to this are like focused on rehab, wanting to take it to the next phase of things.
• 18:42
  SPEAKER_00: And that's important, but I want to always zoom out and make sure that people understand there are decisions that have to be made and other factors to consider in this.
• 18:51
  SPEAKER_00: And so the thing that's super important is the time.
• 18:56
  SPEAKER_00: Nine to 12 plus months of your life.
• 18:58
  SPEAKER_00: It's needing that help, losing some independence, especially early on, not being able to potentially pick up your kids or be able to navigate classes normally, not being able to drive for weeks, possibly, relying on your spouse or your parents, your family, your support system in ways that you just didn't plan for.
• 19:17
  SPEAKER_00: And it's okay in the first time and even the second time, right?
• 19:20
  SPEAKER_00: It's it's one of those things that you just kind of process and you're like, okay.
• 19:23
  SPEAKER_00: But then, like, you know, if you put that back on the table, it is important to just consider just the weight of it all.
• 19:28
  SPEAKER_00: And for someone on their second or third, every single one of these do hit a little bit harder.
• 19:34
  SPEAKER_00: And we have so many athletes where all of this directly influences their decision, which is really important.
• 19:40
  SPEAKER_00: And now I am not coming on here to say as soon as you tear your ACL twice, you're not gonna do anything that you love ever again.
• 19:46
  SPEAKER_00: That's not true.
• 19:47
  SPEAKER_00: We have many people who go on to do so much of incredible things back to higher level sports, soccer, all the things that put them at risk.
• 19:56
  SPEAKER_00: But they have weighed their risk or reward, right?
• 19:59
  SPEAKER_00: They we have talked through what that is.
• 20:01
  SPEAKER_00: You know, we're not going to sugarcoat any of these conversations, right?
• 20:05
  SPEAKER_00: We need to make sure you're aware of what these are.
• 20:07
  SPEAKER_00: And any provider you're working with should talk to you about these.
• 20:10
  SPEAKER_00: It shouldn't be like, yeah, let's get back to it.
• 20:13
  SPEAKER_00: You're not, you're not gonna get injured again.
• 20:15
  SPEAKER_00: Like you're bulletproof.
• 20:16
  SPEAKER_00: It just doesn't exist in the world of the human body.
• 20:18
  SPEAKER_00: And when we are putting ourselves into places of traffic where we could potentially risk this injury again.
• 20:25
  SPEAKER_00: It's about making sure that you develop yourself based on the research, all the objective criteria, based on the demands of your sport or activities to make sure your body is prepared for those things and putting you at the most reduced risk of re-injuring again, right?
• 20:40
  SPEAKER_00: And the thing is that season of life will influence so, so much of this.
• 20:45
  SPEAKER_00: And I think that that's very important here in terms of this episode, because we have many athletes who do come to us that are like, yeah, I I did this.
• 20:57
  SPEAKER_00: Now I want to get back to playing basketball, but I just don't know if it's worth it anymore.
• 21:03
  SPEAKER_00: You know, they grew up a basketball athlete and they're like, it it they love it.
• 21:07
  SPEAKER_00: But the thing is, is like they've already torn it twice playing basketball and they're on their third recovery, right?
• 21:13
  SPEAKER_00: So the thing is, is like the context of their life is going to potentially drive do they go and play basketball again.
• 21:20
  SPEAKER_00: But the thing that I always tell people at the end of this is that when you finish your ACL rehab, you should have the confidence to say, I can go and do this.
• 21:30
  SPEAKER_00: I could do this.
• 21:32
  SPEAKER_00: I'm choosing not to because of this calculated decision of weighing the risk versus reward of it.
• 21:39
  SPEAKER_00: So here's the bottom line.
• 21:41
  SPEAKER_00: You should finish your ACL rehab ready, physically capable, confident in your body, not limited by fear.
• 21:48
  SPEAKER_00: You should be able to say, I can do this and mean it.
• 21:51
  SPEAKER_00: But whether you step back on that field, the court, the slope, you know, whatever it is, the mat, that's your call.
• 21:58
  SPEAKER_00: And it should be based on a clear-eyed, honest assessment of your life, your risk, and your reward, right?
• 22:05
  SPEAKER_00: For some people, even after the two or three, it is absolutely worth it.
• 22:10
  SPEAKER_00: Lindsay Vaughn is an incredible example.
• 22:12
  SPEAKER_00: She's gone through a lot, but she's also an Olympian and has pretty much dedicated her life to what she does, right?
• 22:18
  SPEAKER_00: It makes sense.
• 22:19
  SPEAKER_00: Does it make sense for the 16-year-old who's had three ACL tears?
• 22:24
  SPEAKER_00: And before you tell me that doesn't happen, I've seen it, y'all, and it breaks my heart.
• 22:29
  SPEAKER_00: I did plenty of podcast episodes where I refer to these athletes who have two ACL tears and they're not even 17 yet.
• 22:38
  SPEAKER_00: I've done this with someone who's 14 years old, and it's crazy.
• 22:42
  SPEAKER_00: Like it happens, y'all, and it's the reality of this, especially in female athlete sports, soccer being a big one of these, which I know has a big target on it.
• 22:51
  SPEAKER_00: It is just the reality of this.
• 22:53
  SPEAKER_00: And there's a lot of layers to it, especially with just the early sports specialization, and especially for kids who are just not taking breaks, they're not strength training.
• 23:02
  SPEAKER_00: It is so needed, but it is hard with the culture that is created, especially for club sports.
• 23:08
  SPEAKER_00: Now I'm gonna digress from that, but it is something super important, especially if it's a youth athlete, that there needs to be some smart decisions made.
• 23:16
  SPEAKER_00: I had a call yesterday with an athlete, she's 16, two ACL tears.
• 23:20
  SPEAKER_00: First ACL tear was two years ago, second ACL tear happened earlier this year.
• 23:25
  SPEAKER_00: And it breaks my heart.
• 23:27
  SPEAKER_00: Two ACL tears before you're 16 or 17 years old.
• 23:31
  SPEAKER_00: You have to make some decisions that are important.
• 23:33
  SPEAKER_00: And the thing is, is that when you're that young, you're kind of making decisions in the short term of like, you know, I got to get back on the field.
• 23:39
  SPEAKER_00: This is my life, my identity.
• 23:41
  SPEAKER_00: But the thing is, is that it's so important for PTs, stakeholders, parents, especially, to have these conversations with ACLers to make sure like, is this worth it?
• 23:52
  SPEAKER_00: Like, what is the long term goal here?
• 23:54
  SPEAKER_00: And the thing that I always want to also showcase is that you're likely wanting to move for the rest of your life, and especially for people who are younger.
• 24:04
  SPEAKER_00: They're potentially wanting to get married.
• 24:06
  SPEAKER_00: They're probably wanting to have families.
• 24:08
  SPEAKER_00: They're probably wanting to stay fit, be in the gym, run, be active, ski, whatever it is, other activities that give them life and movement that is going to be good for them metabolically from a health standpoint, but then also just give them what they're hoping for to be able to push their bodies and stay healthy, right?
• 24:25
  SPEAKER_00: And be able to do things that may not be as competitive, but something that is meaningful still to them.
• 24:32
  SPEAKER_00: And so you have to consider the short and long-term consequences of this.
• 24:36
  SPEAKER_00: And so that might be a bit more apparent for people who are in their, you know, 20s, 30s, 40s, 50s, but for the younger athletes, it is easier to look shorter term.
• 24:48
  SPEAKER_00: I get it.
• 24:49
  SPEAKER_00: I was there.
• 24:50
  SPEAKER_00: Um we work with tons of youth athletes and they're just focused on getting on the field.
• 24:54
  SPEAKER_00: They don't care about the rehab.
• 24:55
  SPEAKER_00: They're like, oh, it was a fluke, right?
• 24:58
  SPEAKER_00: Or even if it's a second one, it's like, no way it's gonna happen three times.
• 25:01
  SPEAKER_00: And it's like, okay, we need to have these conversations with the parents and making sure that everyone understands all the risks and what's going on.
• 25:10
  SPEAKER_00: And so as I'm kind of coming back to this, for some of these people, two or three tears, it's absolutely worth it.
• 25:16
  SPEAKER_00: And it makes sense.
• 25:17
  SPEAKER_00: Their sport is their identity, like I said, their joy, their community, and the reward for them outweighs the risk.
• 25:24
  SPEAKER_00: That's a valid answer.
• 25:25
  SPEAKER_00: And the most important thing is that they have evaluated that from all angles.
• 25:29
  SPEAKER_00: For others, it's not.
• 25:31
  SPEAKER_00: They've done the math and they're at peace with it.
• 25:33
  SPEAKER_00: That's a valid answer, too.
• 25:35
  SPEAKER_00: Neither is wrong.
• 25:37
  SPEAKER_00: The only wrong answer is not being ready to make the choice at all.
• 25:40
  SPEAKER_00: Because if fear is making the decision for you, the rehab didn't do its job.
• 25:45
  SPEAKER_00: So get yourself to a place where you can and then decide if you will.
• 25:50
  SPEAKER_00: So important in this process, and for many ACLers, if you're an athlete of ours working with us, you have heard me say this more than likely.
• 26:00
  SPEAKER_00: The thing is, is that it's going to be an important risk reward evaluation for yourself.
• 26:05
  SPEAKER_00: And this can change.
• 26:07
  SPEAKER_00: You may have a certain goal that you get to, you know, in six to nine months through this process, and you might reevaluate it based on life circumstances that change.
• 26:17
  SPEAKER_00: People get pregnant, people get married, people get different jobs, people decide that the college sports wasn't worth it and they're burned out from it.
• 26:26
  SPEAKER_00: There are so many layers of this that can influence the choices.
• 26:30
  SPEAKER_00: Working with an athlete right now, and his team is kind of struggling a little bit and he's trying to come back.
• 26:36
  SPEAKER_00: The thing is, is that we had a conversation yesterday actually about the risk reward of making sure you don't force yourself out there based on feeling like you need to save the team.
• 26:46
  SPEAKER_00: We need to make sure you get out there because you're objectively ready, you feel confident in your body and your knee, and not rushing this process, right?
• 26:54
  SPEAKER_00: Don't try to go out there and save the team or feel like you are the one who's gonna bring this team back.
• 26:59
  SPEAKER_00: You need to make this decision for yourself and for no one else.
• 27:02
  SPEAKER_00: And it's so important because this athlete is on ACL tear number two.
• 27:07
  SPEAKER_00: So, therefore, we had these conversations and we have talked through all this on multiple occasions.
• 27:13
  SPEAKER_00: He's on board, he is incredibly dialed in, he is a college athlete, and the thing is that he is assessing this risk reward, and we're having ongoing conversations about this.
• 27:24
  SPEAKER_00: But the thing here is just so important is just making sure you get yourself to a place where you can and then decide if you will.
• 27:32
  SPEAKER_00: This does not mean throwing in the flag, and that's one thing I want to make clear.
• 27:36
  SPEAKER_00: It means that you're making a calculated decision based on where you are in your life and what makes sense for the short and long term.
• 27:44
  SPEAKER_00: And they're both wins.
• 27:46
  SPEAKER_00: Just because you just don't go back to the thing that you know you tore your ACL twice to, or maybe it's too high of a risk.
• 27:52
  SPEAKER_00: That's okay.
• 27:54
  SPEAKER_00: There are often a lot of things that people can fill up their cup outside of that.
• 27:58
  SPEAKER_00: And that's where I would encourage you to lean into if you're struggling with that and realize that the risk is pretty high for you based on where you are in your life.
• 28:06
  SPEAKER_00: So I hope that this helps.
• 28:07
  SPEAKER_00: I hope that this maybe creates a little bit of peace for some of you guys who are trying to decide.
• 28:12
  SPEAKER_00: But you need to make sure you're ready and making this decision, not off of fear, but based off of clarity.
• 28:18
  SPEAKER_00: Until next time, team, this is your host, Ravi Patel, signing off.