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231 | Regression ≠ Failure: Reframing Setbacks in ACL Rehab · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Robbie Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:07
  SPEAKER_00: Today I've got my coffee, it's the morning, and I am super pumped to dive into today's episode.
• 1:15
  SPEAKER_00: And this one is going to be a little bit more of a mindset-focused episode for today.
• 1:22
  SPEAKER_00: And it's about navigating a setback or maybe not being able to progress to the next thing in this process.
• 1:31
  SPEAKER_00: And let's face it, y'all, every ACLer will deal with some type of setback, or at some point, have to deal with not being quote unquote where they were hoping to be for the most part.
• 1:46
  SPEAKER_00: And so this is something that might manifest through the knee flaring up or getting grumpy, or maybe it's testing that didn't go as expected.
• 1:56
  SPEAKER_00: Hopefully, you're getting tested.
• 1:58
  SPEAKER_00: So you didn't hit enough to start running, for example, or maybe it's doing a movement that you're just not ready for.
• 2:06
  SPEAKER_00: Like you tried to do a jump, for example, whatever variation that you have been given.
• 2:11
  SPEAKER_00: And it didn't feel great.
• 2:13
  SPEAKER_00: And yeah, there are times where maybe the body is getting used to it, but a lot of times if it didn't feel great and it doesn't look really good, then it's probably something you're not necessarily ready for just yet.
• 2:25
  SPEAKER_00: There should always be progressions towards building up to especially more complicated movement or things that are a little bit more demanding.
• 2:34
  SPEAKER_00: And so it could be challenging in this ACL rehab process because it could be due to some symptoms flaring up, or it could be because we're just not strong enough, we don't have the range of motion yet.
• 2:47
  SPEAKER_00: The body's qualities or specific attributes, such as those range of motion pieces, strength, being able to be explosive, being able to be very dynamic, you're just not there yet.
• 3:00
  SPEAKER_00: We're still rebuilding this process, and maybe there has been a movement given that you're just not ready for.
• 3:06
  SPEAKER_00: And stuff like this happens more than we like to admit.
• 3:10
  SPEAKER_00: And maybe things aren't just evaluated well enough to be able to make adjustments like we need to.
• 3:17
  SPEAKER_00: But I think what we need to do in this process, especially with dealing with setbacks, or maybe someone not being ready for this next milestone or phase or this movement, it's something that we need to normalize a little bit more versus these linear, non-setback based expectations, right?
• 3:37
  SPEAKER_00: This perfect linear line as time progresses, your progress linearly increases just like each day progresses.
• 3:44
  SPEAKER_00: And life doesn't happen this way.
• 3:46
  SPEAKER_00: And ACL rehab definitely doesn't happen this way.
• 3:50
  SPEAKER_00: As you guys know, it's the crazy zigzag lines where it might go up a little bit, it goes down, it goes backwards, it goes forward, you might have a spike up, spike down.
• 3:59
  SPEAKER_00: Because the thing is, is that this is something that we don't have the full control over.
• 4:04
  SPEAKER_00: It's biological healing.
• 4:07
  SPEAKER_00: There are some weird body changes, like the nervous system also is going under a change because of this.
• 4:15
  SPEAKER_00: The brain is, and then also the body.
• 4:17
  SPEAKER_00: Yeah.
• 4:18
  SPEAKER_00: When you look down, your quads are shot after an ACL injury and then after a surgery.
• 4:22
  SPEAKER_00: And so this is something that's pretty normal.
• 4:26
  SPEAKER_00: And you're also doing this with life, which means it doesn't happen in a vacuum.
• 4:32
  SPEAKER_00: You don't get to control all the variables, and then your life just exists just to do ACL rehab.
• 4:38
  SPEAKER_00: There are other things that are going on, whether you are, you know, in school, whether you are working, whether you're a parent, whether you have other people you're taking care of.
• 4:49
  SPEAKER_00: There are so many other factors that exist that you have to continue with life, which makes this process in and of itself very nonlinear to begin with.
• 5:00
  SPEAKER_00: And the other thing too is that it might be a little bit different than what the Graham shows, Instagram, but it isn't the reality for the majority of ACLers.
• 5:09
  SPEAKER_00: So I want to normalize this a bit to know hey, it's pretty normal for you to not hit that thing yet or to have a setback, and it's not supposed to be this perfect process, or you hit all these things early.
• 5:22
  SPEAKER_00: If you do, then awesome.
• 5:24
  SPEAKER_00: But with the state of ACL rehab and with different graph types and with expectations and with the way that the body just breaks down and needs to build back up, it's easy to get caught up in hitting these things, especially whenever you look at most resources and what's communicated out there based on protocols and time.
• 5:45
  SPEAKER_00: These types of things tend to set us up for feeling like a disappointment or failure because we're not there yet.
• 5:52
  SPEAKER_00: Classic example of this is that at 12 weeks, a lot of protocols will say, start running, right?
• 5:59
  SPEAKER_00: And guess what?
• 6:01
  SPEAKER_00: I would venture to guess that 90% of ACLers are not ready to run at 12 weeks.
• 6:07
  SPEAKER_00: I can pr feel pretty confident in that, given just where this is and working with different graph types and just how long it takes to rebuild, right?
• 6:16
  SPEAKER_00: There are, of course, people who can get there with certain situations, but for the most part, most are not.
• 6:23
  SPEAKER_00: And so that's the thing that is important in this is that I really want to talk about today is that I want to share this quote and really this post that I saw by Altis.
• 6:38
  SPEAKER_00: Altis is a very well-known program for track development and speed development.
• 6:46
  SPEAKER_00: And Dan Paf is someone who is a legend in the space.
• 6:51
  SPEAKER_00: He is the founder of Altus, and he's just an OG coach in the space of strength and conditioning, performance, and especially track and field.
• 7:00
  SPEAKER_00: And this quote is when an athlete isn't ready for a given task, regression isn't a punishment.
• 7:11
  SPEAKER_00: It's progression done right.
• 7:14
  SPEAKER_00: I'm gonna read that again.
• 7:15
  SPEAKER_00: When an athlete isn't ready for a given task, regression isn't punishment, it's progression done right.
• 7:23
  SPEAKER_00: And y'all, this is so freaking good and such a helpful perspective.
• 7:28
  SPEAKER_00: It's flipping the script on when you're just not ready for something yet.
• 7:34
  SPEAKER_00: And I'm saying yet.
• 7:35
  SPEAKER_00: It's not you're just not ready for anything, it's just not yet.
• 7:39
  SPEAKER_00: We still have work to do.
• 7:40
  SPEAKER_00: But instead of viewing it as a failure, which is often what we do in this process, is that we have failed to make this deadline.
• 7:48
  SPEAKER_00: We have failed to meet this particular time or this particular movement, right?
• 7:55
  SPEAKER_00: It's a progression done right whenever there's a regression done.
• 8:00
  SPEAKER_00: And I know that might feel backwards, but when I read this, I was like, man, if this doesn't align so much with ACL rehab.
• 8:08
  SPEAKER_00: And I've taken Altus mentorship programs and learned a lot from Dan Bath and Stu and the others within the Altus program over the years, and they're one of the leaders in track and speed development, but also for performance education, working with some of the most elite of elite athletes and Olympians.
• 8:27
  SPEAKER_00: And Dan is just someone who I'd argue has the ability to look at human movement as one of the best in the world.
• 8:34
  SPEAKER_00: You watch this guy and you watch his videos and see him break things down, the man is brilliant.
• 8:40
  SPEAKER_00: And this quote is so helpful for us, especially as rehab professionals and coaches, and as ACLers, as you're listening to this, navigating the ups and downs of this process for ACLers.
• 8:52
  SPEAKER_00: And so I want to repeat this again because I think it's important to really hit this home.
• 8:57
  SPEAKER_00: When an athlete isn't ready for a given task, regression isn't punishment, it's progression done right.
• 9:05
  SPEAKER_00: It's not taking a step back, but more so a progression because it's exactly what the athlete, or in this case, you as the ACL or as you're listening, maybe that's what you need right now.
• 9:18
  SPEAKER_00: Or an athlete you're working with, if you were a clinician or coach, needs this right now at this moment.
• 9:25
  SPEAKER_00: We encounter this nonstop in ACL rehab.
• 9:27
  SPEAKER_00: You guys know the one step back, two steps forward.
• 9:31
  SPEAKER_00: I'm sure some of you have sometimes felt one step forward and then five steps back, right?
• 9:36
  SPEAKER_00: And so sometimes it is that tug of war.
• 9:39
  SPEAKER_00: Yes, one step back, one forward, two back, one forward through this process.
• 9:44
  SPEAKER_00: And you know, it just depends on where you are, the type of injury, the surgery, life circumstances, and how the body is responding.
• 9:53
  SPEAKER_00: And then also the rehab process itself, right?
• 9:56
  SPEAKER_00: So there are a lot of factors into this, and it's the never-ending roller coaster and adapting the plan given how volatile some ACL rehabs may be.
• 10:06
  SPEAKER_00: But this is where shifting this mindset is so important for us as ACLers and this rehab professionals.
• 10:13
  SPEAKER_00: We sometimes feel pressured for the sake of time, and I know I have felt this before as not only an ACLer, but as a professional working with ACLers.
• 10:25
  SPEAKER_00: When I have a young athlete who is seven months post-op and she's still not running yet, right?
• 10:32
  SPEAKER_00: And she came from somewhere else, and she had a very terrible extension, she had a cyclops lesion, she didn't have but 50% quadricep strength symmetry.
• 10:43
  SPEAKER_00: And so, yes, they are further along in the process, but that doesn't mean anything in terms of their readiness.
• 10:50
  SPEAKER_00: This person is not ready to run, they're not ready to do dynamic things.
• 10:53
  SPEAKER_00: So we sometimes feel that pressure because they've been long enough in this, because of the sake of time, and maybe for psychological well-being and other factors, or maybe there's other stakeholders like parents or coaches or other people on their care team, surgeons, other performance people or PTs who are also contributing or making also these types of recommendations to make decisions and moving this ACL or forward.
• 11:21
  SPEAKER_00: And it can be challenging.
• 11:23
  SPEAKER_00: But when we look at it through this lens, it helps us to stay anchored to what's important while still accounting for all of these variables, right?
• 11:33
  SPEAKER_00: And we're not just gonna progress somebody just for the sake of time, and that's what gets us into trouble in this ACL rehab process, is that we're progressing people based on time because it feels right or they're good enough.
• 11:45
  SPEAKER_00: And we just can't do that.
• 11:47
  SPEAKER_00: Good enough is why we are leading to re-injury rates that are so high right now.
• 11:53
  SPEAKER_00: So we need to make sure that we are testing appropriately, we are progressing and programming appropriately, that we are also regressing appropriately when needed.
• 12:03
  SPEAKER_00: And every athlete at some point will need a regression where they have to take a step back, or maybe the movement is too challenging, maybe their need just kind of bugged out with a certain movement, right?
• 12:13
  SPEAKER_00: So we got to regress it, right?
• 12:14
  SPEAKER_00: That is not failure, right?
• 12:16
  SPEAKER_00: That is progression done right.
• 12:20
  SPEAKER_00: And the other thing too here is that as a good coach and as a good physical therapist, knowing that we can really be adaptive with programming to be able to regress a movement, progress it when we need to, and what we call lateralize, which is also changing the movement itself.
• 12:38
  SPEAKER_00: Maybe it's the same stimulus, but we are changing the movement to get a similar stimulus.
• 12:45
  SPEAKER_00: And any good professional can do that.
• 12:48
  SPEAKER_00: And so that's something that we want to make sure we can do, and also with any movement, there's always a safe starting point and an entry point for us to utilize to be able to get this stimulus to some degree.
• 13:02
  SPEAKER_00: And yeah, sometimes there is a no-go with certain things.
• 13:05
  SPEAKER_00: Like if you're early in the process, jumping is probably a no-go.
• 13:08
  SPEAKER_00: But with that said, there are going to be build-up progressions block by block, face by phase, to make sure that you feel ready and you look ready, right?
• 13:17
  SPEAKER_00: And we're gonna test those things out.
• 13:19
  SPEAKER_00: And so that's where it's gonna be really important.
• 13:22
  SPEAKER_00: So if you are someone who is dealing with just a challenging ACL rehab, which is probably most of you, and you also feel like you're just stuck, right?
• 13:32
  SPEAKER_00: Like you feel like you're doing the same exercises, maybe there's no answer.
• 13:37
  SPEAKER_00: And you know, the classic thing that I will hear from ACLers that their rehab professionals will say, or maybe the surgeon, is that it'll get better with time.
• 13:46
  SPEAKER_00: And that answer honestly makes me so mad because that is not an appropriate answer.
• 13:54
  SPEAKER_00: Yes, there are things that we may not have full answers about.
• 13:58
  SPEAKER_00: Like, yes, we could say it'll get better with time, but let's be detectives and figure out what's going on.
• 14:03
  SPEAKER_00: I literally just talked to somebody, she's gone to multiple physical therapists and surgeons, and she's been having this extension-based issue, and it's kind of crazy.
• 14:12
  SPEAKER_00: We talked on the phone.
• 14:14
  SPEAKER_00: All we did was talk on the phone about her case, and we were able to just nail down what it was.
• 14:19
  SPEAKER_00: And it's just because she was doing the same stuff, no one was really looking into what was going on, and I didn't even evaluate her, whether it was remotely or in person.
• 14:30
  SPEAKER_00: We talked on the phone and we're like, this is it.
• 14:34
  SPEAKER_00: And we were able to get to it because it was just carving out the details of her case, listening to her story, listening to what works and what doesn't work, and it's just something that we need to make sure that our ACLers are heard, that we are able to make a specific plan for them and to be able to make changes, not just it gets better with time.
• 14:58
  SPEAKER_00: So just know regression isn't a step back, it's progression and it allows us to build momentum for what's ahead.
• 15:09
  SPEAKER_00: So if you're having an ACL or dealing with this or you're an ACL or listening, feeling like you always have to take a step back.
• 15:17
  SPEAKER_00: Know that is progression done right.
• 15:19
  SPEAKER_00: Now, let me also be clear here.
• 15:21
  SPEAKER_00: If you're constantly always taking a step back, then maybe the programming and the guidance isn't getting you where you need to go.
• 15:27
  SPEAKER_00: But just know that there are times where you have to take that step back because maybe you pushed a little bit too hard.
• 15:33
  SPEAKER_00: Maybe the knee is just still a little sensitive, maybe it was just a movement that wasn't something that you were ready for.
• 15:39
  SPEAKER_00: But just know that that step back is okay and it's progression done right.
• 15:43
  SPEAKER_00: And the other thing I want to share in addition to this is that it's normal to have the knee be a little sensitive when you're pushing its boundaries.
• 15:52
  SPEAKER_00: I think sometimes we almost want to stay in the safe zone.
• 15:55
  SPEAKER_00: And of course, with a more sensitive knee, we do want to be a little bit more, as we say, undercook it versus overcook it.
• 16:02
  SPEAKER_00: But with that said, we also want to push the boundaries a little bit.
• 16:07
  SPEAKER_00: And when you're trying to stress your body and push the boundaries, it's normal for the knee to respond to that and feel a little sore, right?
• 16:16
  SPEAKER_00: But we want to also make sure we have certain feedback loops and certain guiding parameters in place to make sure that this is done right and that it's not too many steps back repeatedly over time.
• 16:30
  SPEAKER_00: And that's what a good coach is going to do.
• 16:31
  SPEAKER_00: They're gonna make those adjustments and adapt versus trying to force it or progressing because it's been long enough.
• 16:39
  SPEAKER_00: It's for the sake of time.
• 16:41
  SPEAKER_00: They're at this certain point and they should be doing this by now.
• 16:44
  SPEAKER_00: But you got to earn the right to do that.
• 16:46
  SPEAKER_00: I don't care what time frame you are out of surgery, you have to earn the right to progress.
• 16:51
  SPEAKER_00: And so that's where testing is gonna be really helpful.
• 16:53
  SPEAKER_00: That's where having a very adaptable program is gonna be helpful and having expert guidance.
• 16:59
  SPEAKER_00: So if you need any help, guys, please reach out to us.
• 17:02
  SPEAKER_00: We work with people all over.
• 17:04
  SPEAKER_00: And if you have any questions, we are here to help.
• 17:08
  SPEAKER_00: Otherwise, I hope that this is helpful for you to just kind of reframe things, whether it's the ACLer you're working with or ACLer listening.
• 17:17
  SPEAKER_00: Regression isn't a punishment, just know it's progression done right.
• 17:21
  SPEAKER_00: So that's something to help flip that script, change the mindset, and know that's still momentum in the right direction, and you'll get back to doing the thing as long as you are following these particular principles.
• 17:32
  SPEAKER_00: Until next time, team, this is your host, Robbie Patel, signing off.