Latest / The ACL Athlete Podcast / 236 | Running Optional: Redefining Milestones in ACL Rehab

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236 | Running Optional: Redefining Milestones 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?
• 1:02
  SPEAKER_00: Getting straight into it for today.
• 1:05
  SPEAKER_00: So running is a very common milestone for most ACLers in this process, and something we as PTs, as performance coaches, want our athletes to hit.
• 1:19
  SPEAKER_00: Very often we are talking about running and what the criteria are to fit running and when we are looking to aim for that, right?
• 1:29
  SPEAKER_00: Blending not only the time pieces, but then more importantly, the criteria to make sure you are ready.
• 1:35
  SPEAKER_00: You aren't just ready to drive because you're 16, for example, you're ready to drive because you've passed a test, you've done a practical for it, and you have also checked off the box of hitting the appropriate age as well.
• 1:48
  SPEAKER_00: Super, super important here.
• 1:51
  SPEAKER_00: And really running is after the honeymoon period, what I call basically that post-op process where you are getting your range of motion back, the pain and swelling is hopefully going down, you're getting a little bit more strength back, you're getting off your crutches, you're getting back to your normal everyday lives.
• 2:08
  SPEAKER_00: You feel like it doesn't feel like you are pushing your maximum effort to be able to get up and down stairs, get into bed, be able to take a shower without feeling like all is lost in the world.
• 2:22
  SPEAKER_00: And will I ever get back to a normal shower?
• 2:24
  SPEAKER_00: You're beyond this process where you see those day-to-day progressions and usually in the positive direction because of the early part of the ACL rehab, where you know you are kind of constricted to the post op, you can only do so much, and there's just more milestones hitting back to back to back because of how restricted you are post-op.
• 2:47
  SPEAKER_00: So that's our honeymoon process where we see hitting those milestones, life becomes a little bit more normalized, if you will.
• 2:54
  SPEAKER_00: And so after that, let's say it's after the first, you know, four, six, eight weeks that you're starting to, you know, track on with the road ahead.
• 3:04
  SPEAKER_00: And the next milestone we're typically setting our sights on is running.
• 3:09
  SPEAKER_00: And the big thing for us is that I say that running helps us.
• 3:13
  SPEAKER_00: The big thing about it is open up the door to more dynamic type work and athletic things we want to get back to doing in ACL rehab.
• 3:22
  SPEAKER_00: So if we want to start cutting and being able to jump in space, well, guess what?
• 3:26
  SPEAKER_00: We need to be able to start running to do so.
• 3:29
  SPEAKER_00: And when I say jump in space, meaning you're covering ground over a field and you are doing jumping activities as you are running, right?
• 3:37
  SPEAKER_00: So that's more locomotor-based dynamic movements from a technical sense.
• 3:42
  SPEAKER_00: But with that said, the running is going to help open up that door to do more of those things.
• 3:49
  SPEAKER_00: But if we haven't run yet, then therefore it's going to be a little bit harder for us to get to those things because it's kind of like we need to be able to crawl first and then walk and then be able to run before we make too many big jumps.
• 4:02
  SPEAKER_00: So that's going to be super important with this.
• 4:05
  SPEAKER_00: But with that said, we also have some people who are going through this process who injured their ACL, who had surgery, maybe they didn't have surgery.
• 4:14
  SPEAKER_00: But with that said, they are rehabbing to get back to things.
• 4:18
  SPEAKER_00: Who could care less about running?
• 4:21
  SPEAKER_00: It's not a goal for them specifically.
• 4:24
  SPEAKER_00: And while we typically think of the high school athlete, the college athlete, the pro athlete who's on the field or on the court, which yes, this happens to a lot of them.
• 4:34
  SPEAKER_00: That is what typically ACL rehab is printed with through the media, through what we expect and hear about, who has typically running a part of their sports.
• 4:44
  SPEAKER_00: You know, if they're playing football, if they are playing basketball, lacrosse, soccer, all these field and court-based sports are gonna have running as components to them.
• 4:54
  SPEAKER_00: Now we can get nuanced into you know sprinting versus running versus like plopping along, if you will, like a lineman, they're not gonna be running for long distances really.
• 5:04
  SPEAKER_00: And it might be five seconds, it might be 10 seconds, but it's not long, right?
• 5:07
  SPEAKER_00: But running as a prerequisite, as something that is just gonna be natural as a part of their practices and a part of their sport, right?
• 5:15
  SPEAKER_00: But the thing is that this also happens to a lot of folks who don't need to run or care for it.
• 5:22
  SPEAKER_00: Let's take, for example, the skier, right?
• 5:24
  SPEAKER_00: We have a lot of skiers who are like, I could care less about running.
• 5:28
  SPEAKER_00: I want to get back on my skis.
• 5:29
  SPEAKER_00: And so then, therefore, they don't have running as a goal.
• 5:32
  SPEAKER_00: A hiker, right?
• 5:33
  SPEAKER_00: While you could say, yeah, hiking and running, there could be some relationship there.
• 5:37
  SPEAKER_00: Not really.
• 5:38
  SPEAKER_00: If you just want to go hike and take steps, like you are going to keep a foot on the ground at all times, more than likely.
• 5:44
  SPEAKER_00: And running is actually defined.
• 5:46
  SPEAKER_00: The difference between walking and running is actually there are times where you are actually airborne where there is no foot on the ground.
• 5:52
  SPEAKER_00: Walking, you actually have a foot in contact at all times.
• 5:56
  SPEAKER_00: There is no airborne phase with walking.
• 6:00
  SPEAKER_00: Bet you guys didn't know that.
• 6:01
  SPEAKER_00: That's also how they do the speed walking versus running in the Olympics, and they're always looking out for do they get airborne or not?
• 6:09
  SPEAKER_00: Um, but with that said, we have skiers, yeah, hikers, we have people who do jujitsu, and yeah, maybe they don't care to run.
• 6:17
  SPEAKER_00: It could be a part of their conditioning.
• 6:19
  SPEAKER_00: You also don't necessarily need to run to play the sport.
• 6:22
  SPEAKER_00: Cycling, of course, you're on a bike, and there's plenty of other people who injure their ACL doing other things that may not need running as a part of their life or their sport.
• 6:33
  SPEAKER_00: So, should we care about getting these people back to running if it's not their goal?
• 6:39
  SPEAKER_00: The question here is nuanced, to be completely honest with you.
• 6:43
  SPEAKER_00: So, let me break this down a little bit more in detail.
• 6:45
  SPEAKER_00: In my opinion, I think that this goal, right, with not wanting to run or not caring to run, just allows more flexibility to work on strength longer and not rush into running, which can add an additional layer of complexity to the game plan when we introduce running.
• 7:05
  SPEAKER_00: You know, knees can be pretty sensitive to running, it's impact-related stress, and it just depends on the timing of when that is integrated, the criteria that's met.
• 7:15
  SPEAKER_00: And so running does kind of muddy up the water a little bit with dispersing your time and just the way that the knee is stressed and the way that we're just gonna allocate the structure of it all.
• 7:27
  SPEAKER_00: I'm not saying that we can't do it all.
• 7:29
  SPEAKER_00: Of course, we have most ACLers who are doing this, but I'm also speaking to the people who might not be time sensitive for this, but then also the people who just don't care for this, right?
• 7:39
  SPEAKER_00: And so that's the thing that we want to factor into this as we're thinking about running or maybe not running in this process.
• 7:46
  SPEAKER_00: Now, for us here at the ACL athlete, we want ACLers to have the capacity to run, the ability to run, and it not feel foreign or not sure if they can do it or not.
• 7:58
  SPEAKER_00: We do not want you to leave working with us without knowing that you can physically go and run if you need to or sprint, right?
• 8:05
  SPEAKER_00: It is a general life skill, and we want to make sure you are an athletic weapon when you leave here, whether you care to run or not.
• 8:13
  SPEAKER_00: We are going to give you the preparation and the physical abilities to do that and prep you for this.
• 8:17
  SPEAKER_00: Now, whether you choose to go run after you finish up with us is going to be up to you, but we just want to make sure that you have the ability to do so.
• 8:26
  SPEAKER_00: And I tell these specific athletes who don't care for it is that we're not here to make you into a runner, even for the athletes who are going into different sports.
• 8:35
  SPEAKER_00: Like we're not here to have you go and run three, five miles at a time.
• 8:40
  SPEAKER_00: Like, why would we do that?
• 8:41
  SPEAKER_00: That's not specific to your sport, it's not gonna get you any better at that.
• 8:45
  SPEAKER_00: Um, yes, we want to build up a base of these things if you're gonna have running as a part of your sport, but it's something that isn't specific to it.
• 8:52
  SPEAKER_00: So we don't need you out there becoming, you know, a 5K runner, a 10k runner, unless it is your goals to get back to doing so.
• 9:00
  SPEAKER_00: And we have people who want to run 5Ks, 10K's, half marathons, full marathons, ultras.
• 9:05
  SPEAKER_00: So then, yes, we are going to be catering and individualizing the plan to those people, right?
• 9:11
  SPEAKER_00: But we want to make sure you could be prepared for this and especially prepared for life.
• 9:15
  SPEAKER_00: And I think that is really important from a training and health standpoint, is that you're prepared for what life demands of you, and that could be in different seasons.
• 9:23
  SPEAKER_00: And if you need to run to get out of the rain, you can do it.
• 9:27
  SPEAKER_00: You need to chase someone who has stolen your purse, for example, you can do it.
• 9:32
  SPEAKER_00: Run after your kid before they run into a street.
• 9:35
  SPEAKER_00: Trust me, I get it.
• 9:36
  SPEAKER_00: You need to react and be able to run really quick, or maybe it is legit running from your life, right?
• 9:42
  SPEAKER_00: Or running for your life.
• 9:43
  SPEAKER_00: That's how that should be said.
• 9:45
  SPEAKER_00: You could be running from your life too.
• 9:47
  SPEAKER_00: That tends to happen to people, but you are running for your life, right?
• 9:51
  SPEAKER_00: We don't know the circumstances that we will have in our lives, right?
• 9:55
  SPEAKER_00: You just never know.
• 9:56
  SPEAKER_00: And we want to make sure you're prepared to do so when that time comes.
• 10:00
  SPEAKER_00: In these types of situations, what we do for our A-sailers, we just build up a base.
• 10:05
  SPEAKER_00: We want a capacity to run, and that's it.
• 10:07
  SPEAKER_00: Again, not making you into some big runner, but just making sure you have enough of the ability to run more than five seconds, for example.
• 10:16
  SPEAKER_00: But being able to do that without the knee responding poorly, being able to have it stress without it responding poorly.
• 10:22
  SPEAKER_00: And then what that is going to do is just make sure that the knee is tolerating the impact and knowing that you can check that box and do it, but then also opens up that door, as I mentioned earlier, to more dynamic things like sprinting, jumping in space, those locomotive-based jumping movements and then cutting, right?
• 10:41
  SPEAKER_00: Like to cut, yes, you can kind of make a step and cut, but in reality, when people are cutting, they're going to be running in space when they cut, right?
• 10:49
  SPEAKER_00: And so then, therefore, we want to make sure that you can do the running, but then also open up the door to more of these more jumpy, athletic type dynamic things, as we call it.
• 11:00
  SPEAKER_00: And what I find in this ACL rehab process is that physical therapists and surgeons often feel inclined, or maybe they just kind of get giddy and excited, and they often feel inclined to get their ACLers to start running, especially at a set time point.
• 11:16
  SPEAKER_00: And this is the biggest no-no in this process is we don't run just solely on time.
• 11:20
  SPEAKER_00: We don't make decisions at all based on time with the ACL athlete, and you should never make decisions solely based on time at all in ACL rehab.
• 11:28
  SPEAKER_00: That is a very confident rule of thumb for us, and it should be for you.
• 11:34
  SPEAKER_00: Time alone is not going to dictate anything.
• 11:36
  SPEAKER_00: But we use time plus criteria.
• 11:39
  SPEAKER_00: So, what's the range of motion?
• 11:40
  SPEAKER_00: What's the strength?
• 11:41
  SPEAKER_00: What's the jumping abilities?
• 11:42
  SPEAKER_00: Psychologically, where are you testing out at?
• 11:45
  SPEAKER_00: Like where are all these different buckets we're looking at in order to make sure we are prioritizing the right buckets and filling the right ones up, especially to be prepared to run or do said task or activity, right?
• 11:56
  SPEAKER_00: We need to make sure those prerequisites are checked.
• 11:59
  SPEAKER_00: And so then, therefore, the thing that we see is that when I ask some of these people their goals, they say they hate running.
• 12:07
  SPEAKER_00: And so I'm like, why were they forced to start running, especially at an arbitrary time point like three months, which is so common to hear?
• 12:15
  SPEAKER_00: And I often think that this is more of a surgeon or a PT having that milestone in their head.
• 12:22
  SPEAKER_00: And again, don't get me wrong, with most ACLers, we are going to get them back to running and doing this thing.
• 12:28
  SPEAKER_00: And maybe there is more time sensitivity to it.
• 12:31
  SPEAKER_00: But with that said, it's also kind of this very gray area.
• 12:36
  SPEAKER_00: And oftentimes it's just this kind of automatically programmed time point in their head, and they're pushing it on the ACLer to start running at three months, versus it being more ACLer driven, which this process should be, right?
• 12:50
  SPEAKER_00: Like we're here to guide you, but your goals and what you want is what is going to drive the way that we design things and build this thing out and structure it.
• 12:59
  SPEAKER_00: That is how this should be driven is from the ACLer at the center versus you coming in and you know, we're like, all right, you have to hit it at this point, right?
• 13:09
  SPEAKER_00: We give you, of course, the criteria for it and what we can expect from a timing just roughly, and we update that as we go range-wise, like from a time range.
• 13:18
  SPEAKER_00: But with that said, like we want to build it to you versus us make you fit it to our standards or mostly our timeline, if you will, because that's gonna be really important.
• 13:32
  SPEAKER_00: Because again, assuming your goal is not to run, then that has no relevance to any other goals as well, right?
• 13:39
  SPEAKER_00: So that's the thing that is really important here is that I think almost PTs and surgeons, they just have these timelines already set up.
• 13:47
  SPEAKER_00: So then therefore they're just like, all right, we're gonna hit this running, and you're usually gonna do what they say, right?
• 13:52
  SPEAKER_00: Like in most situations, you're not like, whoa, whoa, like I don't want to run, I don't need to run, right?
• 13:57
  SPEAKER_00: In some situations, maybe you might speak up, but you're letting them lead the charge here.
• 14:02
  SPEAKER_00: And so they're like, all right, it's three months in and we're gonna start running, or even four or five months, right?
• 14:08
  SPEAKER_00: Like the thing is, is like we need to make sure that lines up with what you want as well, right?
• 14:13
  SPEAKER_00: So that's gonna be something that's really important.
• 14:15
  SPEAKER_00: And so the other point I do want to mention is that there's really no time sensitivity to this.
• 14:21
  SPEAKER_00: While yes, it might not be a part of your goals.
• 14:23
  SPEAKER_00: Maybe running is just the next step into doing those dynamic things, but you could care less.
• 14:29
  SPEAKER_00: But there's no time sensitivity to it.
• 14:31
  SPEAKER_00: Now, do we just ignore it and just say, like, all right, well, we'll run in like nine months, right?
• 14:37
  SPEAKER_00: No, but like someone could care less if they run in three months, especially if there's no time sensitivity.
• 14:42
  SPEAKER_00: And they could care less at five months or seven months if that's not something specific to them.
• 14:48
  SPEAKER_00: Um, but I always say, why rush?
• 14:51
  SPEAKER_00: That is the biggest thing here is why rush trying to get into running, especially when we know it's gonna be a nine to 12 month process.
• 14:59
  SPEAKER_00: I get it.
• 14:59
  SPEAKER_00: If it's something that you really want to get back to doing, then yeah, we're gonna prioritize it.
• 15:04
  SPEAKER_00: And I'm not here to just say the three months is bad.
• 15:08
  SPEAKER_00: It's just more so of most people are not ready at three months, and you could put a lot more into the tank and get a lot more out in the long term by waiting a little bit longer, even four to five months, um, to get stronger.
• 15:22
  SPEAKER_00: But we've had people who have been able to do it earlier, for example, and they're crushing it.
• 15:27
  SPEAKER_00: So that's why we use criteria plus time to be able to make these decisions.
• 15:32
  SPEAKER_00: But the biggest thing is why rush this process outside of people who are super time sensitive where they need to get back to a set time to be ready for something, then yeah, we might start integrating this earlier.
• 15:44
  SPEAKER_00: And for our ACLers, we're still integrating a lot of dynamic tasks that will ingrain the pattern of running.
• 15:52
  SPEAKER_00: Like we start working on these mechanics like A marches, wall acceleration drills, like some uh three position heal cycles.
• 16:02
  SPEAKER_00: Like we work this stuff in super early.
• 16:03
  SPEAKER_00: We're talking about like weeks post op.
• 16:06
  SPEAKER_00: Like we are working some of this stuff in and getting you there and progressing it based on how you are doing and responding.
• 16:12
  SPEAKER_00: And so then, therefore, when people do get to running, they're almost kind of itching to run whenever we do clear them to start running and hit the criteria because they've already been working on this stuff.
• 16:22
  SPEAKER_00: So it's almost like a second nature to them when they do start doing actual running and working on this.
• 16:28
  SPEAKER_00: But the thing is, is like we're not pushing this off, we're like actually working on the prerequisites a lot leading up to it.
• 16:34
  SPEAKER_00: But if there's no time sensitivity or it's not their goals, then why rush it, right?
• 16:38
  SPEAKER_00: Let's keep the main thing the main thing, which is likely quad strength.
• 16:42
  SPEAKER_00: Just kidding.
• 16:43
  SPEAKER_00: But in all seriousness, it's probably quad strength.
• 16:46
  SPEAKER_00: It's always going to be your top priority in ACL rehab, like forever.
• 16:51
  SPEAKER_00: Okay, maybe not forever, but for a long time.
• 16:53
  SPEAKER_00: And yes, we can have running in the mix, but why rush it early, especially in this situation?
• 17:00
  SPEAKER_00: And most importantly, I think the thing here to make sure to take home is let's cater the game plan to you, to the athlete, the ACL are in front of us, versus following the protocol from 2004 that says let's run at 12 weeks.
• 17:15
  SPEAKER_00: This is meeting our ACLers where they're at, fitting everything to their specific goals and plan versus the PT trying to fit them to a standard protocol that they expect everyone to go through at the same rate.
• 17:28
  SPEAKER_00: And it just doesn't happen in ACL rehab.
• 17:31
  SPEAKER_00: And so I do want to make sure that this is clear that if your goal isn't to run or it is not a part of your goals, or maybe there's not really much time sensitivity, then I would almost push back on these time frames that are typically given.
• 17:49
  SPEAKER_00: And this is working with different ACLers through this process because also graph type is going to weigh in a lot on this.
• 17:56
  SPEAKER_00: If you have a hamstring versus a quad, patellar, allograft, you guys are all gonna be cruising in your own different lanes.
• 18:02
  SPEAKER_00: You also maybe have other procedures that were done.
• 18:05
  SPEAKER_00: Maybe you were non-weight bearing for four weeks, and so therefore, you know, your timeline is gonna be a little different, right?
• 18:13
  SPEAKER_00: You were slower to begin with some of these things, right?
• 18:15
  SPEAKER_00: So I think that these are just important factors to consider.
• 18:18
  SPEAKER_00: So we can't just blindly say 12 weeks or even maybe 16 weeks that you're gonna start running when we don't even know where you're at at week three because you're in week two, right?
• 18:29
  SPEAKER_00: Yes, we can have targets, and that's what we provide for our ACLers to give you guys an idea.
• 18:35
  SPEAKER_00: Yeah, we try to aim for four to five months to be able to start running post op, but we continue to update our ACLers every step of the way so they know what these milestones look like.
• 18:45
  SPEAKER_00: The criteria stays clear for them.
• 18:48
  SPEAKER_00: And then also we are adjusting things based on if it's within their goals, what they want.
• 18:53
  SPEAKER_00: Um, is there time sensitivity?
• 18:55
  SPEAKER_00: Is there not?
• 18:56
  SPEAKER_00: So all these things factor into making sure this is as dialed in as possible.
• 19:00
  SPEAKER_00: So I hope this helps y'all.
• 19:02
  SPEAKER_00: I feel like I notice a lot of people are just like, yeah, I'm just jumping into it.
• 19:05
  SPEAKER_00: That's what my PT said.
• 19:06
  SPEAKER_00: And they're like, I don't really care to run, I don't ever want to run ever, you know, and people feel strongly about running a lot of the times.
• 19:14
  SPEAKER_00: And so then therefore, it's like, why push it if it's not a goal?
• 19:18
  SPEAKER_00: And why don't we just kind of focus on some other areas that might actually move the needle and make your knee feel better earlier, and then integrate that stuff and make sure you can do it and then keep the thing moving, right?
• 19:29
  SPEAKER_00: So I hope this helps y'all.
• 19:30
  SPEAKER_00: If you have any questions, you know where to find us.
• 19:33
  SPEAKER_00: Until next time, this is your host, Robbie Patel, signing off.