Latest / The ACL Athlete Podcast / 277 | The Sympathy Gap: When the Visible Markers of ACL Rehab Disappear

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277 | The Sympathy Gap: When the Visible Markers of ACL Rehab Disappear · 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.
• 0:59
  SPEAKER_00: What is up, team?
• 1:01
  SPEAKER_00: We're gonna get straight into it today, hoping to keep it super short and sweet for you.
• 1:06
  SPEAKER_00: So here's what I want you to imagine.
• 1:09
  SPEAKER_00: You're about eight weeks post-op, the crutches are now gone, the brace is gone.
• 1:15
  SPEAKER_00: That's if you had one.
• 1:17
  SPEAKER_00: You're walking without a noticeable limp, or the the walk has normalized a bit versus it being slower or a little bit of that hitch that I know a lot of you may relate to.
• 1:28
  SPEAKER_00: And to everyone around you, the visible signs of this ACL injury and the surgery have basically disappeared.
• 1:38
  SPEAKER_00: So someone asks you, how's your knee doing?
• 1:42
  SPEAKER_00: And you don't even know where to start, right?
• 1:46
  SPEAKER_00: Maybe you're back at school, maybe you're back at work, maybe you walked into a team environment or a group setting where people haven't been with you through every single day of this, and they see you walking in looking relatively normal.
• 2:01
  SPEAKER_00: And also let's say you have pants on or something covering the knee.
• 2:05
  SPEAKER_00: So someone can't see bandages or a wrap if you have one on there.
• 2:09
  SPEAKER_00: Maybe the scars healed up pretty well and it looks a little bit more hidden, right?
• 2:14
  SPEAKER_00: There's no crutches, no brace, nothing obviously wrong.
• 2:19
  SPEAKER_00: And people can't immediately see that.
• 2:22
  SPEAKER_00: And the math they do in their head is simple.
• 2:24
  SPEAKER_00: You're basically back, right?
• 2:26
  SPEAKER_00: You're back to normal.
• 2:28
  SPEAKER_00: And that's what this episode is about.
• 2:30
  SPEAKER_00: Because if you're in this phase right now, I want you to know something before we go any further.
• 2:36
  SPEAKER_00: What you're feeling is real and you're not alone in it.
• 2:40
  SPEAKER_00: Let me name what's actually happening at this eight-week post-op mark.
• 2:46
  SPEAKER_00: Or let's say it's a range between this maybe even three weeks post-op, five weeks post-op.
• 2:53
  SPEAKER_00: But I'm talking about you're not fresh out of surgery, but you're after that acute stage of surgery.
• 3:00
  SPEAKER_00: So it might be the fourth week, sixth week, it might be eight, 10 weeks out, 12 weeks out, right?
• 3:07
  SPEAKER_00: But let's just kind of take that first window after you are fresh post-op.
• 3:11
  SPEAKER_00: And this is what I'm talking about, this time frame.
• 3:15
  SPEAKER_00: And it's something where the graft is still in that early stage of ligamentization.
• 3:20
  SPEAKER_00: You just had that new graft put in.
• 3:22
  SPEAKER_00: The biology of what's happening inside your knee is still very much in process.
• 3:26
  SPEAKER_00: You're so early in this, you're feeling every little thing.
• 3:30
  SPEAKER_00: The real strength work is really just getting started during this.
• 3:34
  SPEAKER_00: Return to sport is still many, many months away.
• 3:38
  SPEAKER_00: It's not even within sight right now.
• 3:40
  SPEAKER_00: Depending on where you are and what your goals are, you might be somewhere around maybe 10% of the way through this, 15% of the way through this full journey.
• 3:51
  SPEAKER_00: Imagine getting in your car, you have a 10-hour ride in front of you, and you're only one hour into this, right?
• 4:00
  SPEAKER_00: You know, that 10 to 15% of that entire journey has been completed, which doesn't feel like much.
• 4:06
  SPEAKER_00: And yet from the outside, nothing signals any of that.
• 4:09
  SPEAKER_00: People can't see that.
• 4:10
  SPEAKER_00: The visible markers are gone, and when the visible markers disappear, something shifts in the people around you, not because they don't care, right?
• 4:20
  SPEAKER_00: But because humans respond to what they can see.
• 4:23
  SPEAKER_00: The crutches and the brace and the obvious limp gave people more of a cue, right?
• 4:28
  SPEAKER_00: Now that cue is gone, the visible cue.
• 4:30
  SPEAKER_00: And without realizing it, most people around you have quietly filed this away as a resolved issue, right?
• 4:38
  SPEAKER_00: And it's no fault to them again, right?
• 4:40
  SPEAKER_00: They don't see the physical thing.
• 4:41
  SPEAKER_00: So then if they're not truly informed about this process, which is majority of people, most people don't know what an ACL injury is, what it entails for the recovery, until they actually experience it or they have so many people around them who have experienced it or walk someone else through it.
• 4:58
  SPEAKER_00: Not a lot of people understand the ins and outs of this process, which makes this recovery so hard.
• 5:03
  SPEAKER_00: Because it's not like it's a spinal cord injury where, you know, that's pretty extreme, right?
• 5:08
  SPEAKER_00: And there's permanent loss with that.
• 5:10
  SPEAKER_00: With something like this, it really does break you down.
• 5:13
  SPEAKER_00: But the thing is, is like, yes, you're trying to build back up, but people don't realize how much this ligament and this knee injury really does impact someone's life.
• 5:23
  SPEAKER_00: And so a lot of times people see not these things, right?
• 5:27
  SPEAKER_00: They don't see the visible markers, and then so they can kind of file it away as being resolved.
• 5:32
  SPEAKER_00: And so I call this that sympathy gap.
• 5:35
  SPEAKER_00: And it shows up right around this phase where almost every ACL athlete I've ever worked with, they experience this.
• 5:44
  SPEAKER_00: And I experienced this.
• 5:46
  SPEAKER_00: And here's what that sympathy gap actually looks like in real life.
• 5:51
  SPEAKER_00: It's the friend who stopped asking how you're doing because they figured it was old news.
• 5:56
  SPEAKER_00: It's the person at school or at the gym who sees you walking normally and assumes the story wrapped up, you know, maybe a few weeks ago.
• 6:04
  SPEAKER_00: You're good to go now.
• 6:05
  SPEAKER_00: It's those acquaintances, maybe people you see at the gym or the PT clinic who say something like, Oh, you're all good now, right?
• 6:12
  SPEAKER_00: With total confidence, like completely oblivious to what this process is, but they're just saying it like it's obvious.
• 6:20
  SPEAKER_00: And here's what that does to you.
• 6:22
  SPEAKER_00: You're already in the harder, less rewarding part of this process.
• 6:25
  SPEAKER_00: You're in that post-honeymoon recovery, if you will, where the gains aren't so clearly every single day and every single week.
• 6:33
  SPEAKER_00: And those early weeks had that certain momentum to them.
• 6:36
  SPEAKER_00: There was that clarity, and you were a little bit more feeling that momentum.
• 6:41
  SPEAKER_00: And this was something where you know people were checking in because you just had a major surgery.
• 6:48
  SPEAKER_00: The gains were more consistent.
• 6:50
  SPEAKER_00: Now the progress is a bit slower, it's less obvious.
• 6:54
  SPEAKER_00: The work is more demanding, and the external support that helped carry you through the beginning has faded a little bit more quietly, right?
• 7:04
  SPEAKER_00: You're more isolated and at the exactly wrong time of this process, which is so hard.
• 7:10
  SPEAKER_00: And I remember feeling this from both of my ACL rehabs, and they were in completely different contexts, but the experience was very much the same.
• 7:21
  SPEAKER_00: The first time I tore my ACL in high school, and I remember getting back to football practice, not actually participating, but actually joining my team for us preparing for the fall.
• 7:33
  SPEAKER_00: So this surgery was in July, and then I remember hitting into August, September, and it was roughly around that eight-week mark, it might have been six weeks.
• 7:44
  SPEAKER_00: I can't remember the exact timing of it.
• 7:45
  SPEAKER_00: It was earlier in that process, but I was off crutches, I was still early, still figuring out how my knee felt day to day, still navigating everything that comes with that phase.
• 7:56
  SPEAKER_00: And my teammates, they didn't really understand where I was.
• 8:00
  SPEAKER_00: They assumed I was a lot further along than I was.
• 8:03
  SPEAKER_00: And I remember how defeating that felt because inside I knew exactly how hard it all still was.
• 8:10
  SPEAKER_00: I knew what I couldn't do yet.
• 8:12
  SPEAKER_00: I knew how much fear was still there, just even just navigating every day, trying to walk down a stair.
• 8:18
  SPEAKER_00: People don't understand how underestimated this is to just be able to navigate stairs, even early in this process.
• 8:24
  SPEAKER_00: Yes, you have your range of motion back and you have some ability to walk, but there's still just kind of like that eggshell walking fear that kind of exists in these early phases.
• 8:36
  SPEAKER_00: But none of that was visible to them.
• 8:38
  SPEAKER_00: They saw me walking around at practice, and the assumption was basically, ah, he's he's good.
• 8:43
  SPEAKER_00: Like he's doing really well.
• 8:45
  SPEAKER_00: And I was standing there knowing how far from good I actually was.
• 8:50
  SPEAKER_00: That was the first time.
• 8:51
  SPEAKER_00: The second time, I tore my ACL again in college.
• 8:54
  SPEAKER_00: And that time I had to get back to work quickly because that was how I was essentially paying rent along with the student loans.
• 9:02
  SPEAKER_00: And so I had multiple jobs at that point.
• 9:05
  SPEAKER_00: One of them was working as a physical therapy tech at a PT clinic.
• 9:10
  SPEAKER_00: I was trying to get hours, I was trying to get experience, but that was also somewhere where I was lucky enough to have some PT that they helped me out with.
• 9:18
  SPEAKER_00: So I went back to work pretty soon after post op.
• 9:23
  SPEAKER_00: And I remember the patients there who I knew, who I'd seen kind of regularly through the weeks prior to, asking me, Oh, are you are you back to normal now?
• 9:34
  SPEAKER_00: A few weeks after my surgery.
• 9:36
  SPEAKER_00: And I remember my PT who I would work with there, who was treating me at that same clinic, catching those comments with me.
• 9:44
  SPEAKER_00: And we'd kind of look at each other after someone said something like that.
• 9:48
  SPEAKER_00: And there was this kind of shared understanding between us where we just kind of looked and she understood how I felt, and she kind of understood also like how just the perception of that was really challenging because these were people inside a physical therapy clinic surrounded by rehab every single day, and they still had no concept of what this process actually looked like.
• 10:11
  SPEAKER_00: That's how deep this gap goes.
• 10:13
  SPEAKER_00: And I'm sure many of you in your physical therapy clinics, if you're going, you have all kinds of people around you rehabbing different things, and they see you maybe even doing some jumping, maybe even some running, and they're like, Oh, you're back to it.
• 10:25
  SPEAKER_00: And you're like, No, I'm still not 50% there, right?
• 10:29
  SPEAKER_00: And it's so hard for people to conceptualize this because unless they're in it, they have been explained it or they have truly experienced it.
• 10:38
  SPEAKER_00: It's just really challenging for people to really see that unless they see the physical limitations of it, the true like restrictions of using a crutch or a brace or something that is more visually easier to connect to, right?
• 10:52
  SPEAKER_00: And here's the thing about the question everyone keeps asking you how's it going?
• 11:00
  SPEAKER_00: It sounds simple, but at eight weeks post op, it is one of the harder questions you'll face on any given day because your options are not great.
• 11:09
  SPEAKER_00: If you tell the truth, you sound like you're complaining about something people have already mentally resolved.
• 11:15
  SPEAKER_00: If you say you're good, you're performing a version of recovery you're not actually in.
• 11:20
  SPEAKER_00: And if you try to explain it, you watch their eyes glaze over within about 30 seconds.
• 11:25
  SPEAKER_00: So most ACLers just say, good, and carry the rest alone.
• 11:30
  SPEAKER_00: And that's exhausting, y'all.
• 11:32
  SPEAKER_00: And it compounds over time in a way that's quiet and it's really hard to name.
• 13:41
  SPEAKER_00: So let's talk about what you can actually do with this because I don't want to leave you here.
• 13:46
  SPEAKER_00: As you guys know, I really care about being practical.
• 13:48
  SPEAKER_00: I just also want to maybe put a name to it and be able to also understand what you guys are going through.
• 13:56
  SPEAKER_00: And it might not even be surgery, it might be non-operative, right?
• 13:59
  SPEAKER_00: But this all aligns the same with what people feel in this process.
• 14:04
  SPEAKER_00: And it might not even be at the eight-week or 10-week mark or early post-op.
• 14:09
  SPEAKER_00: This still exists in the mid and late stages, too, especially when people are dealing with complications and maybe the quads aren't getting there or they're dealing with limitations.
• 14:19
  SPEAKER_00: People just kind of forget about it.
• 14:21
  SPEAKER_00: The sympathy slowly dies down.
• 14:23
  SPEAKER_00: And while we're not wanting people to constantly ask us, how are we doing or checking in, we also do want people to be aware of it to some degree, right?
• 14:33
  SPEAKER_00: I think it's important, especially from our support system.
• 14:36
  SPEAKER_00: But it's just kind of hard to answer these questions when they get them repeatedly and not really knowing exactly how to truly answer it, especially for someone who is maybe not as informed or not as close to you, right?
• 14:49
  SPEAKER_00: So let's talk about the practical pieces here.
• 14:51
  SPEAKER_00: So, first, number one, name this phase for yourself.
• 14:57
  SPEAKER_00: Not for anyone else, just internally.
• 15:00
  SPEAKER_00: You are in the part of ACL rehab where the outside no longer reflects the inside, right?
• 15:06
  SPEAKER_00: The external perception versus the internal reality.
• 15:10
  SPEAKER_00: Giving it a name is a form of orientation.
• 15:13
  SPEAKER_00: It helps you stop feeling like something is wrong with you for how hard this still is.
• 15:18
  SPEAKER_00: When nothing around you looks hard anymore.
• 15:21
  SPEAKER_00: You're not behind, you're not failing.
• 15:23
  SPEAKER_00: You're in a specific phase that almost every ACL athlete goes through, and most people around you just don't have the context to see it, right?
• 15:32
  SPEAKER_00: So name this phase, right?
• 15:35
  SPEAKER_00: Second, you don't owe everyone the full explanation.
• 15:40
  SPEAKER_00: You get to choose who you go deep with and who gets the short answer.
• 15:45
  SPEAKER_00: Still in it, long road, but I'm doing the work is a complete and honest answer.
• 15:51
  SPEAKER_00: You don't have to walk everyone through the full ACL recovery timeline every time someone asks.
• 16:23
  SPEAKER_00: And I've had people call me all the different things.
• 16:25
  SPEAKER_00: I've had Randai, Rabbi, Rob, Robbie, you know, all the different things that could be mistaken for Ravi and even more than that, which is bizarre, some of the things that I've been called.
• 16:37
  SPEAKER_00: But there are a lot of situations where I'm like, I'm not gonna really correct you in this moment, or someone writes my name on a cup.
• 16:44
  SPEAKER_00: It's not worth it, right?
• 16:46
  SPEAKER_00: But if it's something, maybe a longer-term relationship or something like that, or you're starting out a relationship and you want them to know your name properly, you might correct it, right?
• 16:55
  SPEAKER_00: So you're gonna try and figure out who is the people that you're gonna really actually tell this to and who you're not necessarily gonna address and just kind of keep it rolling, right?
• 17:06
  SPEAKER_00: The third part of this is finding at least one person who does get it.
• 17:10
  SPEAKER_00: This might be your coach, it might be your PT, it might be a person in your life who has been through something like this, a teammate, um, it might be a community member, someone online, but you need somewhere that your reality and the outside perception can actually match, even occasionally, even one person.
• 17:28
  SPEAKER_00: That matters more than it sounds like it should.
• 17:31
  SPEAKER_00: And I think that's important here in a situation like this is to have someone you can talk to about this.
• 17:36
  SPEAKER_00: And it could be, yeah, even a parent, it could be a sibling, although siblings don't necessarily have a ton of uh sympathy, I would say.
• 17:44
  SPEAKER_00: But with that said, like find that person, especially that you can relate to.
• 17:48
  SPEAKER_00: And I find that finding that community or person is really important.
• 17:52
  SPEAKER_00: Number four is understand what this phase is actually building.
• 17:57
  SPEAKER_00: And I think this is the most important part.
• 18:00
  SPEAKER_00: The strength you're putting in right now doesn't show yet, and that's really hard.
• 18:05
  SPEAKER_00: The trust you're developing in your knee doesn't show yet.
• 18:08
  SPEAKER_00: The mental work you're doing in the background, the consistency, the patience, the showing up when it feels pointless or you don't really want to, none of that stuff is really visible right now, but it is the work that determines how this will go.
• 18:23
  SPEAKER_00: This invisible phase is where the foundation gets laid, as I have shared with you guys, so important.
• 18:29
  SPEAKER_00: And when you look back at this later, this is the part that you will point to.
• 18:34
  SPEAKER_00: I remember both of these phases clearly the high school version and the college version.
• 18:40
  SPEAKER_00: And I'll tell you, the invisibility of the struggle was its own specific kind of heart.
• 18:46
  SPEAKER_00: Not necessarily harder than the surgery or the early weeks, but just kind of felt a little more isolating, a little lonelier, right?
• 18:55
  SPEAKER_00: Because the outside had moved on and the inside hadn't.
• 18:58
  SPEAKER_00: And there's a particular weight to carrying something that the people around you can't see anymore.
• 19:07
  SPEAKER_00: If you're in this right now, I want you to hear this directly.
• 19:11
  SPEAKER_00: The work you're doing in this phase is real.
• 19:14
  SPEAKER_00: The fact that no one around you can see it does not mean it makes it less real.
• 19:21
  SPEAKER_00: You know what you're navigating, you know your body knows what it's doing.
• 19:27
  SPEAKER_00: Keep going.
• 19:28
  SPEAKER_00: And that's the main thing here is just keep going.
• 19:31
  SPEAKER_00: Have a process to this.
• 19:33
  SPEAKER_00: And if you're in this phase without a real plan or someone genuinely in your corner, that's exactly what we're here for at the ACL Athlete.
• 19:41
  SPEAKER_00: You should not have to navigate this alone, and you don't have to.
• 19:45
  SPEAKER_00: Thank you guys so much for listening.
• 19:47
  SPEAKER_00: I hope that this is helpful.
• 19:48
  SPEAKER_00: I will talk to you in the next one.
• 19:50
  SPEAKER_00: This is your host, Robbie Patel, signing off.