Latest / The ACL Athlete Podcast / 248 | Stop “Easing Into It”: The Framework to Make Return to Sport Less Scary in ACL Rehab

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248 | Stop “Easing Into It”: The Framework to Make Return to Sport Less Scary 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: Ravi 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: So I was checking in with one of my ACLers, and she's been working on getting herself more exposed to her sport, her sport specifically being roller derby.
• 1:20
  SPEAKER_00: And it's a very physical sport if you guys have not tuned into it.
• 1:24
  SPEAKER_00: We have had many roller derby athletes come through and work with them through different parts of this process.
• 1:31
  SPEAKER_00: And they're super tough humans, by the way, super tough.
• 1:35
  SPEAKER_00: And it's something that is fun to work with these athletes.
• 1:39
  SPEAKER_00: We always enjoy them.
• 1:40
  SPEAKER_00: And it's one of these sports where there's contact, there's falling, and there's a lot of things that these athletes have to react to within doing roller derby itself, right?
• 1:53
  SPEAKER_00: And this includes putting yourself into some positions that can be awkward, not the most ideal feeling after someone tearing their ACL, for example, you know, falling and putting yourself into these like low positions really demands the knee a lot.
• 2:09
  SPEAKER_00: And so it's just a lot after an ACL injury and after going through this process and this surgery, right?
• 2:16
  SPEAKER_00: And so one thing that I wanted to share today, based on the specific check-in with this athlete, she said we had informal practice at a park today.
• 2:27
  SPEAKER_00: So I took the opportunity to try crashing onto the grass.
• 2:30
  SPEAKER_00: And so she sent a video of herself hitting a bunch of different falls into the grass, so from concrete into the grass, like some really padded grass.
• 2:40
  SPEAKER_00: Um, at least I hope it was for you.
• 2:43
  SPEAKER_00: Um but it was a pretty cool thing to be able to see and see the video of her hitting some speed and different positions to fall into it and essentially getting used to it.
• 2:53
  SPEAKER_00: And she said it actually did feel fine though, and it was one of the things that just some note from behind this was one of the things that she felt a lot of hesitation with.
• 3:02
  SPEAKER_00: But she did say it actually felt fine, no knee pain or anything.
• 3:08
  SPEAKER_00: I'm still scared of falling unexpectedly, but maybe a little less scared than before.
• 3:13
  SPEAKER_00: And so this was something that I was like, man, just so simply and beautifully put, a little less scared than before.
• 3:21
  SPEAKER_00: Bingo.
• 3:22
  SPEAKER_00: And so as we navigate the ACL process, it's your rehab team, your physical therapist, your coach's job to help guide this process and make it quote unquote less scary, as she said.
• 3:36
  SPEAKER_00: I like to use the dimmer switch analogy along with this to help visualize it.
• 3:40
  SPEAKER_00: Instead of it feeling like this on and off switch where it's just like, hey, just go do it.
• 3:45
  SPEAKER_00: It's this dimmer switch for us to gradually build up.
• 3:48
  SPEAKER_00: Instead of it being from on and off, it is gradually going from the light being off to slowly brightening it up, right?
• 3:57
  SPEAKER_00: It's a gradual process, and you can kind of adjust up and down.
• 4:01
  SPEAKER_00: You can think about a dial on the radio, being able to adjust the volume, right?
• 4:06
  SPEAKER_00: To to adjust the dial or the intensity or the amount.
• 4:09
  SPEAKER_00: Those are things that can be really helpful in ACL rehab.
• 4:13
  SPEAKER_00: And I think it gets underutilized how much we should actually put this into play.
• 4:17
  SPEAKER_00: And I think one of the things, like I just want to be a little transparent here, is that there are some PTs who just don't get it in some of this.
• 4:27
  SPEAKER_00: And I think they think that it is an easy jump back into things after they've tested, and that's if they've properly tested and did the right testing.
• 4:37
  SPEAKER_00: And this comes back to something I've talked about before, which is clearance versus readiness.
• 4:42
  SPEAKER_00: So in ACL rehab, a lot of times you'll even hear us talk about doing tests.
• 4:48
  SPEAKER_00: And so tests are helpful proxies to be able to compare to themselves, to the uninvolved side, to normative data, to be able to see what the research shows is valuable for athletes to get back to doing certain sports and activities.
• 5:02
  SPEAKER_00: It reduces the risk of injury.
• 5:04
  SPEAKER_00: It also allows us to know are their bodies ready for it?
• 5:08
  SPEAKER_00: And we use this based on the research and data that shows if you hit these certain thresholds, then you are less likely to tear your ACL again.
• 5:16
  SPEAKER_00: If you do not, then we have a higher chance of re-tearing.
• 5:20
  SPEAKER_00: And we are trying to get you back to high performance while minimizing the risk of re-injury as much as possible.
• 5:26
  SPEAKER_00: I always tell our ACLers make this your last ACL.
• 5:30
  SPEAKER_00: And our job is to make sure that this is your last ACL injury surgery that you have to go through.
• 5:35
  SPEAKER_00: Right.
• 5:35
  SPEAKER_00: And I know anyone listening, you want that just as much as anybody to make sure it's your last and do this right.
• 5:42
  SPEAKER_00: And so with this, I think sometimes with sport, there's this kind of vague unknown, if you will, of like, okay, yeah, you'll return to sport.
• 5:53
  SPEAKER_00: Let's throw in soccer, basketball, football, lacrosse, all the kind of organized sports where we could potentially see ACL is being torn soccer, of course, or football.
• 6:05
  SPEAKER_00: And then there's other sports like skiing, and you've got something like roller derby, and you've got other different activities that people do where the ACL is also at risk, right?
• 6:16
  SPEAKER_00: And so I think that there's almost this perception of it's just easy to just kind of jump back into it once you've cleared these tests.
• 6:25
  SPEAKER_00: But in reality, there's clearance, which these tests do show if you hit the right thresholds, but then there's a different side of this, which I've talked about, which is readiness.
• 6:34
  SPEAKER_00: It's making sure your body is prepared for the demands of the sport and activity that you are trying to get back to do, right?
• 6:41
  SPEAKER_00: And it's not just to do one repetition, it's to make sure that you could do multiple repetitions without the concern of your knee being able to hold up, right?
• 6:49
  SPEAKER_00: And so I think that this is going to be a very important thing in ACL rehab, and especially as we get into these mid and late stages where some of this exposure might start to happen, where you might start to get back on skates, or you might be dribbling with a soccer ball, or you might be dribbling around with a basketball, or running some routes on the field for football or ultimate, or getting on your skis, right?
• 7:13
  SPEAKER_00: And so these are all things that layer into this process.
• 7:17
  SPEAKER_00: And so I think sometimes what can be missed is that it's just like a jump right back into it.
• 7:22
  SPEAKER_00: And it's like, oh, you've cleared it, but we actually need to make this process gradual.
• 7:28
  SPEAKER_00: And I think going through this myself has just kind of highlighted things as well.
• 7:32
  SPEAKER_00: And I resonate so, so much with athletes who are sharing returning a sport and the fear around it, and just the anxiety and the fear of re-injury, and just that feel.
• 7:46
  SPEAKER_00: And I think it's something that is hard to really explain unless you've gone through it.
• 7:53
  SPEAKER_00: And this is not to take away from any of my PT friends or people who are working with ACLers who haven't gone through it, right?
• 8:00
  SPEAKER_00: But I just have a unique perspective having done this twice.
• 8:04
  SPEAKER_00: And so my goal is to always share these things because I do have that unique perspective.
• 8:09
  SPEAKER_00: And with this injury, there is something that is just challenging about especially getting back to sport.
• 8:17
  SPEAKER_00: It's a whole journey, even getting to that point where you're starting to introduce it and getting into the midst of it.
• 8:23
  SPEAKER_00: But then when you're doing it, there's always this kind of like, uh, like feel to it to some degree.
• 8:29
  SPEAKER_00: Like for someone to walk into their sport and just be like, I have no fear, I'm fully there, I'm confident, no worries at all.
• 8:38
  SPEAKER_00: Step onto the field or the core or whatever activity with no anxiety or fear.
• 8:43
  SPEAKER_00: I believe that they're either faking it or they just haven't been educated very well, to be completely honest.
• 8:49
  SPEAKER_00: And so this is something that really does make a difference in making sure that we understand how an ACLer is feeling and that fear is real, especially if the injury is exactly the sport you're trying to get back to, right?
• 9:07
  SPEAKER_00: Meaning if you want to get back to skiing and you tour your ACL skiing, well, getting on skis is going to be a little bit more daunting.
• 9:14
  SPEAKER_00: Versus we have people who might tear their ACL skiing, but they don't really care to ski that much.
• 9:21
  SPEAKER_00: They actually want to go play soccer.
• 9:23
  SPEAKER_00: And so, whilst hooker is actually a higher risk sport in general for ACL tears, skiing, yes, there are a lot of skiers who tear their ACL, is one that you know, usually there's like collision base or like the bindings don't release.
• 9:39
  SPEAKER_00: And so usually there's some sort of specific accident with skiing.
• 9:45
  SPEAKER_00: And so I think that this is something that is really important.
• 9:48
  SPEAKER_00: Did you injure it during the sport itself and you're trying to get back to it?
• 9:51
  SPEAKER_00: Or was it some other activity, but then the other sport is the main goal you're trying to get back to?
• 9:56
  SPEAKER_00: That is a very important caveat in this process and the buildup to getting back to sport.
• 10:02
  SPEAKER_00: And so, as I shared earlier, it can often be viewed as a light switch, especially by surgeons.
• 10:10
  SPEAKER_00: You hit these tests or you hit this certain time point, six months, nine months, whatever it might be, and they're like, Okay, cool, you're cleared.
• 10:18
  SPEAKER_00: And it's always the classic table test, five to ten minutes, maybe if you're lucky.
• 10:23
  SPEAKER_00: And then they're like, All right, cool, ease into it.
• 10:26
  SPEAKER_00: And I'm having conversations with my athletes around here, and their surgeons are like, Cool, just ease into it, or I think you can do this.
• 10:32
  SPEAKER_00: And there wasn't any testing done or any analysis of how the athlete moved, it was in this small little box of a uh medical office, and they did a lockman test, they did a pivot shift, they asked the athlete, hey, how are you doing?
• 10:47
  SPEAKER_00: And it was like five minutes, and then they're like, Cool, you're good to go.
• 10:51
  SPEAKER_00: And it's just crazy to me.
• 10:53
  SPEAKER_00: And so, one thing that I'm just gonna add as a caveat if any advice is given, especially to run, jump, cut, anything like that in ACL rehab, and the provider only saw you for five to ten minutes, I promise you they did not gather enough information to make that decision.
• 11:11
  SPEAKER_00: I promise you.
• 11:12
  SPEAKER_00: It takes at least an hour for us to make sure that we can get enough data to be able to capture your strength, your range of motion, your plyometric ability, your ability to do some capacity testing, all these metrics that we're looking at, you're not going to be able to accomplish this, even if you're the most efficient surgeon in the world in under 15 to 20 minutes.
• 11:35
  SPEAKER_00: I promise you.
• 11:36
  SPEAKER_00: So, this is what's kind of crazy to me sometimes is a tangent, of course, as I'm going on, that decisions are made based on this.
• 11:44
  SPEAKER_00: And so I think that instead of it being this light switch because of, oh, well, you've seen me at nine months, and well, this is all I can do.
• 11:53
  SPEAKER_00: Yeah, you're cleared, good to go.
• 11:55
  SPEAKER_00: Instead, I just wish that there was just like a little bit more communication around, like, yes, you still have this much to do.
• 12:02
  SPEAKER_00: These are the numbers that we still need to hit.
• 12:05
  SPEAKER_00: This is what this process is gonna look like.
• 12:07
  SPEAKER_00: You still need to follow your physical therapist or find someone who specializes in this because this is what's gonna be really important.
• 12:14
  SPEAKER_00: And then a lot of times, you know, surgeons kind of fade into the abyss, and then athletes try to get back to sport.
• 12:20
  SPEAKER_00: And guess what?
• 12:21
  SPEAKER_00: If you re-injure it, a lot of times people don't go back to the same surgeon.
• 12:25
  SPEAKER_00: So then, therefore, that surgeon never knows if you re-injured it or not.
• 12:29
  SPEAKER_00: And so, anyways, I'm going off on such a far tangent, but it's just something that I have been feeling as of recent with just some athletes that I've been seeing recently, where the guidance and the advice that's given is just really off cue of like where they truly are.
• 12:46
  SPEAKER_00: And so then what we have to do at the ASL athlete is re-educate and help get them back on course because then therefore they're like, okay, this all makes sense.
• 12:55
  SPEAKER_00: This is the data, this is what this looks like, this is where I've been, and this is where we're going, this is how this is going to look, right?
• 13:01
  SPEAKER_00: And so that's the main thing here is that we just want this to not necessarily feel like a light switch.
• 15:13
  SPEAKER_00: And so, as this ACLer described it and put it so simply, is it encompasses the way that we essentially approach our return to performance, returning to sport and performance, right?
• 15:25
  SPEAKER_00: Return to performance is making things quote unquote less scary versus that light switch.
• 15:31
  SPEAKER_00: In reality, it's a process, especially if that's the way you injured it, right?
• 15:35
  SPEAKER_00: As I shared, it's a physical, you know, recovery and injury emotionally, but especially high psychological injury too.
• 15:44
  SPEAKER_00: And I think people, you know, see that in hindsight more so that reverses like when they're in it, especially when you're months and months in it, and especially when you've had some setbacks and whatnot, and during this recovery.
• 15:56
  SPEAKER_00: So I think that it's really important to be able to address the mental and psychological side that often goes overlooked because what we see is typically the physical, right?
• 16:06
  SPEAKER_00: But this is where checking in with our athletes, knowing where they're sitting and understanding how they're feeling about you know this next phase or getting back into certain parts of their sport.
• 16:16
  SPEAKER_00: How are they feeling, right?
• 16:17
  SPEAKER_00: And that's really important to us.
• 16:19
  SPEAKER_00: And so one thing I want to share is that yeah, I tore my first ACL non-contact playing football at the end of my sophomore year of high school in the spring.
• 16:28
  SPEAKER_00: So I was nearing the end of the year.
• 16:30
  SPEAKER_00: So I essentially had to miss my entire junior year because there were delays in my surgery and insurance, and then there was just you know delays in my ACL process.
• 16:41
  SPEAKER_00: The guidance was kind of here and there in terms of the way it was.
• 16:45
  SPEAKER_00: And so it was something where when I came back to football my senior year to play my senior season, I was still nervous, even though I had been working out super hard and training, but it's just different.
• 16:59
  SPEAKER_00: Now, I will say I didn't get much guidance as I shared jumping back into football itself.
• 17:04
  SPEAKER_00: There wasn't this like seamless progression necessarily of like, all right, you're this is where you're gonna start for the first two weeks, then progress from here.
• 17:11
  SPEAKER_00: It was just kind of like cold turkey, jump into it, and I was just told you're good.
• 17:15
  SPEAKER_00: So I didn't have someone to help guide me to make it less scary.
• 17:20
  SPEAKER_00: And at times it did feel like too much, but that's where having that good guidance and a plan comes into play.
• 17:26
  SPEAKER_00: It's a gradual process to make it less scary, and eventually you see the scale tip the other way, if you will, from scary to less scary to less scary, to also more confidence and more confidence and more confidence in your body, in your knee, mentally growing more and more through graded exposure.
• 17:49
  SPEAKER_00: And this is where having a framework specific to you is gonna be so so key, y'all.
• 17:55
  SPEAKER_00: People often overlook this thinking it's the end, or they just kind of ease into it.
• 18:01
  SPEAKER_00: That's the biggest thing that we hear.
• 18:03
  SPEAKER_00: They were told to just ease into jumping, running, cutting, and that's maybe the limitations of insurance.
• 18:10
  SPEAKER_00: Maybe it's the limitations or skill set of the surgeon or the PT.
• 18:14
  SPEAKER_00: I'm not expecting the surgeon to give you that advice.
• 18:17
  SPEAKER_00: They didn't train for that stuff, they trained how to do the procedure.
• 18:20
  SPEAKER_00: Physical therapists, to be honest, in school, we don't learn anything beyond much of the first 12 weeks of ACL rehab.
• 18:28
  SPEAKER_00: We may be able to give you more exercises, but in reality, our exercise prescription in school was not super great.
• 18:36
  SPEAKER_00: The way that I learned this, I was a strength and conditioning coach before a physical therapist.
• 18:40
  SPEAKER_00: I learned so much during that and worked with athletes, coached athletes, watched movement, group classes, all the things.
• 18:47
  SPEAKER_00: And so that helped me to build a repertoire of understanding movement and then taking my strength and conditioning foundation and then integrating that into physical therapy.
• 18:56
  SPEAKER_00: And that's what's led me to the to the ACL route, especially because there's so much strength and conditioning that is going to be involved in this process to get you back to high performance, right?
• 19:07
  SPEAKER_00: And so that's gonna be so, so important for us and just making sure that uh we're not just easing into this and just being able to actually give structure, create some sort of framework, right?
• 19:22
  SPEAKER_00: And I've touched on this before in a podcast, but I'm going to break it down briefly here to give you guys actual practical advice.
• 19:31
  SPEAKER_00: So I'm gonna share a little bit of our return to performance framework.
• 19:35
  SPEAKER_00: Um, you can catch a previous episode where I share the three-step process, but essentially we're looking at this continuum.
• 19:42
  SPEAKER_00: And so if you think about three different kinds of blocks, if you will, the first one being return to participation, the next one return to sport, and then return to performance.
• 19:52
  SPEAKER_00: So participation is you starting to get involved with the sport now, right?
• 19:57
  SPEAKER_00: It could be solo drills, high control, and then slowly moving towards a process of returning to sport, which might be more of like a modified version of less intensity, less uh volume or minutes based on that.
• 20:13
  SPEAKER_00: And then return to performance is typically unrestricted.
• 20:16
  SPEAKER_00: That is where you're doing the thing, you are full speed ahead.
• 20:20
  SPEAKER_00: Maybe there's a little modification, but we kind of see this as like you're you're kind of unrestricted and you're doing it.
• 20:25
  SPEAKER_00: And so within return to participation, there's three different progressions we actually look at.
• 20:31
  SPEAKER_00: And so this is just something I kind of personally built out, which is when you think about participating in your sport, there's non-contact modification, again, depending on the sport you're playing, contact modification, and then full integration getting back into the thing.
• 20:46
  SPEAKER_00: And then return to sport is modified sport and activity exposure, and then return to performance is unrestricted performance, as I shared.
• 20:53
  SPEAKER_00: Now, there are certain heuristics that we can manipulate, whether it's like intensity from low to high, the volume low to high, minutes from less to more the conditioning aspect of being more general or aerobic typically to more position specific.
• 21:09
  SPEAKER_00: There could be the number of bodies or players, it could be zero to it could be 1v1 to multiple.
• 21:15
  SPEAKER_00: It could be non-contact to contact, it could be controlled type play where it's very predictable and know what you're doing versus very reactive and chaotic, right?
• 21:25
  SPEAKER_00: That's probably more scrimmage-like in a sense.
• 21:28
  SPEAKER_00: And then terrain, right?
• 21:29
  SPEAKER_00: Like let's take something like hiking, skiing, mountain biking, the terrain, the altitude, the degree of difficulty is all gonna layer into how we get people used to things again.
• 21:42
  SPEAKER_00: When you get back on skis, you're not just gonna get back on skis and go down a double black diamond, right?
• 21:47
  SPEAKER_00: Like you could, sure you could, but at the same time, why do it, especially if that's the way you injured it?
• 21:53
  SPEAKER_00: And I promise, for most people, we've worked with a lot of skiers, y'all.
• 21:58
  SPEAKER_00: There's a lot of anxiety getting back on the skis, even though you might have been skiing for 30 years, 40 years, 50 years.
• 22:04
  SPEAKER_00: You want to get back on them, but you also want to build that up progressively, right?
• 22:08
  SPEAKER_00: So we have like practical progressions that we utilize from some different levels of maybe non-contact drills, one-on-one, small group, doing some small-sided games, manipulating some contact within there if it's involved, scrimmaging, and then returning to sport, returning performance.
• 22:28
  SPEAKER_00: Four key principles I've talked about before: physically prepared, psychological readiness.
• 22:35
  SPEAKER_00: We want that dialed in.
• 22:37
  SPEAKER_00: We want graded exposure to the sport and activity, and we want to make sure that the load is being managed.
• 22:43
  SPEAKER_00: We want to make sure it's not an acute spike.
• 22:45
  SPEAKER_00: You're not going from, oh, I practice five, 10 minutes in this practice to a full 60, 75 minute practice.
• 22:54
  SPEAKER_00: You're not going from a game where you did five, 10 minutes of play to 60 minutes of play, right?
• 23:00
  SPEAKER_00: There needs to be a gradual progression into that to make sure that you're feeling fully ready.
• 23:06
  SPEAKER_00: So we use that.
• 23:07
  SPEAKER_00: We use the control chaos continuum of going from high moderate control to moderate to high chaos.
• 23:14
  SPEAKER_00: And it's the continuum that we utilize.
• 23:17
  SPEAKER_00: And so these are things that are super important in this process that we break down for our mentees and our mentorship, for our ACL athletes, we walk them through this and help them understand this is where you are, and this is how we're gonna build this out.
• 23:31
  SPEAKER_00: So we are trying to make it super practical.
• 23:34
  SPEAKER_00: And one of the things that I love to just do is ask my athletes to brain dump all the things possible they may do uh solo, right?
• 23:43
  SPEAKER_00: And then maybe when they do with team based drills or 1v1 or 2v2, and then contacts, small groups, scrimmages, etc., for us to just get a good idea of this, and then we will have them rank from easier to harder.
• 23:57
  SPEAKER_00: And then this helps us to build out a progression to be like, okay, well, at least we got something to work with versus being.
• 24:04
  SPEAKER_00: Like, yeah, go jump into practice.
• 24:06
  SPEAKER_00: And this is always the messiest stuff is that the coach isn't always going to know.
• 24:10
  SPEAKER_00: The parent isn't going to always know if there's a parent involved.
• 24:13
  SPEAKER_00: The physical therapist, I mean, if you're familiar with the sport, then maybe, but there are sports that you may not know the ins and outs of the drilling of the coach or what they do within it.
• 24:25
  SPEAKER_00: Like I wouldn't say like I am incredibly versed in roller derby and every single in and outs of it, but this is where teaming up with your athlete, looking at other resources to make sure you create a structure framework and understanding okay, this is low demand to high demand, right?
• 24:43
  SPEAKER_00: And so that's for us to make sure we can create the safest entry point.
• 24:47
  SPEAKER_00: And I promise you guys, with any sport, there's a safe entry point.
• 24:51
  SPEAKER_00: Basketball, you can literally be doing standing drills, see seated drills, lacrosse, you could throw a ball against the wall.
• 24:59
  SPEAKER_00: Um, there's so many different things that we can do.
• 25:02
  SPEAKER_00: Volleyball, like you can volley with your coach, teammate, you do be seated, standing, you can kind of move forward and back, side to side.
• 25:09
  SPEAKER_00: There are so many different ways for us to be able to integrate it and have a safe entry point.
• 25:14
  SPEAKER_00: And then also know what's the next small step after that.
• 25:17
  SPEAKER_00: And let's say something feels a little too daunting, let's take a step back, let's regress it back, right?
• 25:23
  SPEAKER_00: So then this is gonna help us, especially for sports and activities that might be a little less obvious and and maybe straightforward, right?
• 25:33
  SPEAKER_00: Because that could be challenging.
• 25:34
  SPEAKER_00: And I think sometimes physical therapists feel like they need to know every sport, the ins and outs of every sport, and be able to recite, you know, the energy man demands and the needs analysis of every single sport.
• 25:48
  SPEAKER_00: Y'all, there are so many sports out there that I've been exposed to with working with athletes all over the world.
• 25:53
  SPEAKER_00: There's handball.
• 25:55
  SPEAKER_00: There are so many other different sports that I'm like, I didn't really know that this existed or how it worked.
• 26:01
  SPEAKER_00: And then athletes are like, well, I want to get back to this, and this is how I tore it.
• 26:04
  SPEAKER_00: And so then that's where you go, do your own research, watch the sport, read up on it, but then also ask the athlete to join you in the process to be able to create a framework together and be able to understand how we can make this less scary.
• 26:20
  SPEAKER_00: And that's what I want the theme to be today, not a light switch, a dimmer switch.
• 26:24
  SPEAKER_00: How can we make return to performance less scary over time?
• 26:29
  SPEAKER_00: And slowly nudging that towards more and more confidence because every ACLer is going to feel some slight bit of fear, especially if that's the way they injured it, if they're getting back to it.
• 26:41
  SPEAKER_00: And so we would just want to make sure we understand can we build out a process specific to them to make sure it's less scary over time and that they can ultimately get back to it through, especially that graded exposure and being able to nudge their system, themselves, their confidence in the right direction.
• 27:01
  SPEAKER_00: And you'll slowly start to see that scale tip from feeling that fear to slowly starting to feel that confidence really build.
• 27:11
  SPEAKER_00: And that's where gradually exposing them to this and having a process is so, so valuable.
• 27:18
  SPEAKER_00: So I hope that this was helpful, y'all.
• 27:20
  SPEAKER_00: I thought that this was just a good thing that this ACLer had shared with me, and it just kind of really sparked this idea to share with you guys because I get the question a lot.
• 27:32
  SPEAKER_00: I've been having a lot of these conversations with a lot of my ACLers and with younger ACLers and their parents when they're, you know, nearing this process.
• 27:41
  SPEAKER_00: And we're trying to line this up to make sure we understand okay, what are we looking at?
• 27:47
  SPEAKER_00: And I think this is even more important for maybe the ACLers who are longer in the process, right?
• 27:52
  SPEAKER_00: Like I have some who, you know, they had some hiccups through this, they had some scar tissue cleanouts, they came from other places.
• 27:59
  SPEAKER_00: And so it's not the typical nine to 12 month process.
• 28:02
  SPEAKER_00: It's also a quad tenant in some of these.
• 28:05
  SPEAKER_00: So they're even being delayed longer.
• 28:07
  SPEAKER_00: So then, therefore, the timeline is so uh blurry for them that they're getting later in it and they're like, Well, I want to get back to this, right?
• 28:16
  SPEAKER_00: So we have to make sure we understand what that looks like because as soon as you get out of that, you know, six month, nine month time frame, and it's not been the cleanest process overall, then it starts to be like, well, what does this look like?
• 28:31
  SPEAKER_00: And if we don't have a process or a framework to come back to to educate them, then they're just gonna keep feeling lost.
• 28:37
  SPEAKER_00: So we want to make sure that you feel equipped and know this is where you are, this is what we're working towards, this is the end goal, and this is how we're gonna get there.
• 28:46
  SPEAKER_00: The GPS, that is what we're trying to be here, and we're trying to make it so specific to each of our ACLers.
• 28:52
  SPEAKER_00: So if you guys are ever searching for help or you're feeling lost in this process, we are here to help here at the ACL Athlete.
• 29:00
  SPEAKER_00: If you want to reach out to us, our information is in the show notes.
• 29:04
  SPEAKER_00: Find someone local.
• 29:06
  SPEAKER_00: All I ask is that you just find someone who knows this process.
• 29:10
  SPEAKER_00: And when you ask questions, that they have answers, that you feel clarity around this, and that they can guide you because it will be the most important decision you make in ACL rehab.
• 29:23
  SPEAKER_00: Point blank.
• 29:24
  SPEAKER_00: Until next time, team, this is your host, Robbie Patel, signing off.