Latest / The ACL Athlete Podcast / 075 | Do You Need to Apply the Gas, Brakes, or Coast in Your ACL Rehab?

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075 | Do You Need to Apply the Gas, Brakes, or Coast in Your ACL Rehab? · 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.
• 1:03
  SPEAKER_00: What's up, team?
• 1:05
  SPEAKER_00: Today is episode number 75.
• 1:08
  SPEAKER_00: Do you need to apply the gas, brakes, or coast in your ACL rehab?
• 1:15
  SPEAKER_00: So this is a recent concept that I have been talking with my athletes about because, as we know, this process is not super linear, and sometimes we need to have a good frame of reference of where we're at and what the goal or the theme should kind of be.
• 1:33
  SPEAKER_00: And this is going to be important because it can help you from a mindset standpoint, especially.
• 1:39
  SPEAKER_00: What our mindset is typically is hit the gas, move forward as quickly as we can in ACL rehab.
• 1:47
  SPEAKER_00: We want to make progress, we want to get back to all the things that we want to be doing, our goals, as well as not feel so limited and not feeling like ourselves.
• 1:56
  SPEAKER_00: So obviously, exercising and doing everything we can to move forward is going to be key.
• 2:02
  SPEAKER_00: But sometimes I'm going to argue that hitting the brakes or even coasting, maybe even taking a different route or lane, is going to be so, so key in this process.
• 2:15
  SPEAKER_00: So let's break these three components down gas, brakes, coast.
• 2:20
  SPEAKER_00: Anyone listening to this is very familiar.
• 2:22
  SPEAKER_00: These are your modes of driving in a car, right?
• 2:25
  SPEAKER_00: So the gas is accelerating and moving forward.
• 2:28
  SPEAKER_00: The brakes are slowing down or stopping, right?
• 2:32
  SPEAKER_00: And then you have coast, which is kind of staying at the same speed.
• 2:36
  SPEAKER_00: And oftentimes in this process, we need to know which mode is most important based on your current circumstance, situation, and context.
• 2:47
  SPEAKER_00: And as I mentioned earlier, we'll want to often hit the gas, especially early on.
• 2:53
  SPEAKER_00: We're coming in hot, we're fresh, post-op or post-injury, and we often think more is better.
• 3:00
  SPEAKER_00: It'll help speed up the process.
• 3:02
  SPEAKER_00: And then this is something that we'll slowly realize is that there's a sweet spot with everything that Goldilocks, not too hot, not too cold, but just right.
• 3:13
  SPEAKER_00: And that's something that a lot of times we have to learn the hard way because we typically push too much.
• 3:19
  SPEAKER_00: And it ends up being a grumpy knee or burning out or something along those lines that makes us have to slow down something like potentially a setback, right?
• 3:30
  SPEAKER_00: And so we want to try and avoid these as much as possible and making sure that we know when we need to apply the gas, the brakes, or just kind of coast along, right?
• 3:40
  SPEAKER_00: And going back to the idea of if we do more, then it'll help speed up the process, right?
• 3:46
  SPEAKER_00: Let me just tell you guys this now.
• 3:48
  SPEAKER_00: There's nothing that quote unquote accelerates the rehab process.
• 3:52
  SPEAKER_00: You could follow protocols, a surgeon may tell you that you'll be cleared at six months.
• 3:56
  SPEAKER_00: Guess what?
• 3:57
  SPEAKER_00: There that's not the case.
• 4:00
  SPEAKER_00: Unless you're in a very unique situation, maybe non-operative, a different type of surgery.
• 4:06
  SPEAKER_00: But anyone who's going through a reconstructive surgery, you guys gotta make sure you anchor yourself to at least nine months, if not longer.
• 4:14
  SPEAKER_00: And that'll help you from an expectation standpoint.
• 4:17
  SPEAKER_00: But there's nothing that will accelerate this process.
• 4:20
  SPEAKER_00: Yes, you may be able to get to running a little earlier, but sometimes that'll depend again on the surgery, the type of injury you had, maybe your background, which plays a big role into this, your status as a physical conditioning, that'll all play into this, right?
• 4:38
  SPEAKER_00: But I've seen plenty of athletes with insane physical athleticism and capacity, and they're still limited because at the end of the day, they can't always control the injury, the surgery, or even how the knee and body is responding to the healing process.
• 4:54
  SPEAKER_00: So back to that point of speeding up the process, we can't accelerate it.
• 4:57
  SPEAKER_00: And one of the things I want to ask you about is if you think about a paper cut, everyone's familiar with a paper cut.
• 5:04
  SPEAKER_00: Is there a way to speed up the healing of a paper cut?
• 5:07
  SPEAKER_00: Or any wound for that matter?
• 5:10
  SPEAKER_00: No.
• 5:11
  SPEAKER_00: But there is a way to help make sure we can keep moving forward and tend to the cut by doing everything we can control and providing the best environment.
• 5:20
  SPEAKER_00: You could always put some neosporin on it, you could put a band-aid on it, you can make sure that you provide the best environment and best options to have the best recovery and healing.
• 5:31
  SPEAKER_00: And this allows us to apply the gas progressively to keep moving forward in your ACL rehab, right?
• 5:38
  SPEAKER_00: So if we're providing the right environment, we're taking the right steps, let's say pain is great, range of motion is great, and then you're kind of progressing along.
• 5:47
  SPEAKER_00: A lot of times this is coming back to a very, very specific and individualized program for you, the athlete, designed by your physical therapist and coach, and they are the ones who are guiding you in this process.
• 6:02
  SPEAKER_00: But this is something that needs to be agile.
• 6:04
  SPEAKER_00: So with any of my in-person remote athletes, we have to pivot so many times because things can come up, whether it's life or the knee.
• 6:14
  SPEAKER_00: But at times we'll be like, okay, like now's the time to hit the gas, you're doing really well, the knee feels good, you're progressing in strength, you're passing all the testing and objective measures that we want you to.
• 6:26
  SPEAKER_00: So that's where we can hit the gas a little bit, and I'll let them know.
• 6:30
  SPEAKER_00: But sometimes in this process, we need to hit the brakes, and that might mean slowing down or even potentially stopping for a very, very short period of time, and that can look so different for so many people.
• 6:44
  SPEAKER_00: Maybe you slipped, maybe the knee swelled up, maybe a new pain has come up and it's impacting your ability to move your knee like you want to.
• 6:53
  SPEAKER_00: Maybe there's something in the joint that needs to get checked out.
• 6:56
  SPEAKER_00: It's okay to hit the brakes sometimes in this process.
• 7:00
  SPEAKER_00: And there's this weird perception that we need to keep moving forward and progressing each day in a perfect linear fashion.
• 7:09
  SPEAKER_00: And life doesn't operate like that, and many things that you have to work really hard for at the end of the day don't typically follow this type of pattern.
• 7:18
  SPEAKER_00: Also, speaking from experience with someone who has had two ACL injuries, surgeries, rehabs themselves, and working with hundreds of others, there are times when we might need to hit the brakes and stay exactly where we are.
• 7:35
  SPEAKER_00: My favorite ways to think about this is one step back to go two steps forward.
• 7:41
  SPEAKER_00: It's hard at first, but it can make a huge difference, especially when the knee is not responding the way that you want to.
• 7:50
  SPEAKER_00: And so I've had athletes who, no matter what we try and do, that they have a very, very irritable, sensitive knee that doesn't necessarily want them to move forward.
• 8:03
  SPEAKER_00: And it depends on the phase they're in.
• 8:06
  SPEAKER_00: Maybe they did something outside of training and it just aggravated the knee.
• 8:11
  SPEAKER_00: And so we had to pivot and we had to make sure that we hit the brakes a little bit to allow the knee to calm down, to make sure we course correct with the game plan in order to keep moving forward.
• 8:23
  SPEAKER_00: What I will often see is that people will continue to kind of follow the plan that was initially planned out, and the issue becomes is that they try to keep moving forward, but then the knee starts to get grumpy, swelling, pain, aches, and issues.
• 8:39
  SPEAKER_00: And then what we need to do is probably slow down and hit the brakes a little bit.
• 8:44
  SPEAKER_00: And this doesn't necessarily mean you have to stop or you have to take a big step back.
• 8:49
  SPEAKER_00: It means that you could just kind of slow down in terms of the way you're moving forward.
• 8:54
  SPEAKER_00: And I know a lot of this is more abstract in terms of talking about ACL rehab, but I want you to be able to translate this over to your own rehab as well as think about the context you're in.
• 9:05
  SPEAKER_00: Maybe it's been hard for you to make progress because you're having a knee that is swelling up and painful because you've been running a lot, but you're just like, maybe more running is better.
• 9:16
  SPEAKER_00: Quick answer here, probably not.
• 9:18
  SPEAKER_00: And something else needs to be done, but it might be something where, hey, maybe you kind of take a step back and give yourself a little bit more time to build up some strength and some capacity with different movements, and then plug running back in instead of forcing it.
• 9:34
  SPEAKER_00: And you look three, six months later down the road, and your knee's still kind of swelling, and you can't tolerate running well.
• 9:40
  SPEAKER_00: Instead, what we'll have to do is maybe slow down and introduce some other components of it, and then slowly put it back together, and there's a good chance that the knee will be more compliant in a better place and tolerates the demands of running better.
• 9:57
  SPEAKER_00: And that's us hitting the brakes, and it's going to be tough.
• 10:02
  SPEAKER_00: And sometimes it's us trying to hit the brake and even find a different route.
• 10:06
  SPEAKER_00: It might not be the same route, but we need to be able to take that 30,000-step view instead of looking at the leaves and being able to decide: okay, is this something where we need to pivot, or maybe we just need to slow down because it's moving too fast?
• 10:21
  SPEAKER_00: Maybe we're hitting the the gas too hard, and that's the problem.
• 10:25
  SPEAKER_00: And then sometimes we just need to coast.
• 10:29
  SPEAKER_00: We just need to put the windows down, we need to put the top up, and we just need to be coasting while we're while we're driving, enjoying the sights, the scenes, all the things, and not feeling like we need to slow down and not feeling like we need to speed up a ton.
• 10:46
  SPEAKER_00: So we're still moving, but it's steady, it's probably slower than it is fast, and no one likes to just kind of coast a little bit, but you're still inching forward, you're still making those 1% gains, and in reality, that's what this process is.
• 11:03
  SPEAKER_00: But this could be where we're in a weird funk, maybe it's physically, emotionally, mentally, or some sort of issues arise with the knee, maybe it's swelling or pain.
• 11:14
  SPEAKER_00: And it's not to a point where you got to hit the brakes, but we're still able to coast along and we're still working on the controllables, the things that you can control within your own ACL rehab, but it just might not be moving as fast as you want it to, and that's okay.
• 11:34
  SPEAKER_00: And I'll give you a good example.
• 11:36
  SPEAKER_00: One of my athletes has been dealing with a lot of knee swelling and pain, and we have been trying to make sure that we optimize her program, some of her daily life and her work and things like that can limit her a bit.
• 11:52
  SPEAKER_00: And so that's the thing that we're kind of playing against, is even though that might demand her moving around more, being on her feet, but then her knee wants to respond with pain and swelling.
• 12:03
  SPEAKER_00: So then that inhibits her ability to walk well and to take the stairs.
• 12:07
  SPEAKER_00: And so this has been this kind of tug of war, if you will.
• 12:10
  SPEAKER_00: And so one of the things we've had to make sure that we talk about is the game plan, making sure that we course correct, as well as we are going to have to coast a little bit, and that's been coasting with some of the movements that she's been doing and giving her good guidance in terms of okay, these are the things you can go with, these are the things that might not be beneficial, but we're gonna still keep working the inch forward and coast along instead of speed up.
• 12:37
  SPEAKER_00: It's still forward, and that's what's most important.
• 12:40
  SPEAKER_00: And typically, this isn't for a very, very long time, it's usually just for a short stent in order for you to get into a good place with the knee and maybe with life and training.
• 12:51
  SPEAKER_00: It could be a very big like mental thing that you're trying to work through, like a roadblock.
• 12:56
  SPEAKER_00: So that's where we just make sure we maintain and then coast, and hopefully, that's allowing us to provide the ability to use the gas pretty soon by coasting for a bit.
• 13:09
  SPEAKER_00: And that's the exciting part is that you're putting in the work and you're still being patient, and then eventually that gas pedal can get hit and we can keep moving forward.
• 13:18
  SPEAKER_00: And the last piece that I want to add to this sticking with this whole analogy of the car, gas, brakes, and coasting in your ACL rehab, is that you are trying to get to a certain destination.
• 13:31
  SPEAKER_00: That's your end goal.
• 13:33
  SPEAKER_00: And you're on this road, you're taking all these different routes, all these detours potentially.
• 13:40
  SPEAKER_00: But the thing is, is that if we do not have a GPS to get us there, it is going to be really tough.
• 13:46
  SPEAKER_00: It might take a longer route, it might take twice or three times the amount of time.
• 13:52
  SPEAKER_00: You may never get there if you do not have the GPS or the roadmap that you need.
• 13:57
  SPEAKER_00: And that's where a PT slash coach who is specialized in this is going to be so so key.
• 14:04
  SPEAKER_00: You can have the best car in tune, but if you're trying to get to a goal and you don't know how to get there, it's going to be kind of useless.
• 14:13
  SPEAKER_00: So that's where a protocol is not going to be the golden ticket.
• 14:17
  SPEAKER_00: A good PT or coach is going to be the thing that is going to get you there, but that alone won't.
• 14:23
  SPEAKER_00: It needs to be a plan in place specific to you, your own route, as well as your own guidance, your PT or your coach who is specialized in this, who serves as the GPS to get you there.
• 14:37
  SPEAKER_00: You're in the driver's seat, as I always tell any of my athletes, I'm just the one who is helping you as the GPS to get there.
• 14:45
  SPEAKER_00: And that's what's going to be so key with this is that a lot of the times you don't have to decide this.
• 14:50
  SPEAKER_00: It needs to be a team effort, and it's something that should be communicated to you whether we are hitting the gas, brakes, or coasting.
• 14:58
  SPEAKER_00: And that's what I do with all my athletes and letting them know with our program and our coaching that that's what's happening.
• 15:05
  SPEAKER_00: We tell our athletes which turn they need to take.
• 15:08
  SPEAKER_00: If there's traffic ahead, do we need to take an alternate route?
• 15:12
  SPEAKER_00: Or maybe you're right on time for the destination.
• 15:15
  SPEAKER_00: Google factors all these things in based on the algorithm, and so should your guide in this process.
• 15:21
  SPEAKER_00: So if you are feeling lost, if you feel like you need a GPS or a game plan, we have a team of coaches who are dedicated to ACL athletes remotely as well as in person.
• 15:34
  SPEAKER_00: So please don't hesitate to reach out, even if you just need some sort of, hey, what is the next step?
• 15:40
  SPEAKER_00: I'm feeling pretty lost.
• 15:41
  SPEAKER_00: We always want to help any of our ACL athletes out.
• 15:45
  SPEAKER_00: That's gonna do it for today, guys.
• 15:47
  SPEAKER_00: Thank you all so much for hanging out.
• 15:50
  SPEAKER_00: Any of you newcomers who are listening today, thank you for tuning in.
• 15:55
  SPEAKER_00: We've got a lot of fun things down the pipeline for the company and for our athletes and our community.
• 16:01
  SPEAKER_00: So stay tuned.
• 16:02
  SPEAKER_00: Until next time, this is your host, Robbie Patel, signing off.