Latest / The ACL Athlete Podcast / 128 | Vetting Your Rehab Professional and Clinic for ACL Rehab - Beyond the Certifications and "Sports Clinic"

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128 | Vetting Your Rehab Professional and Clinic for ACL Rehab - Beyond the Certifications and "Sports Clinic" · 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.
• 1:04
  SPEAKER_00: What's up, team?
• 1:05
  SPEAKER_00: Welcome back.
• 1:06
  SPEAKER_00: Today I have some coffee.
• 1:08
  SPEAKER_00: It is the morning.
• 1:09
  SPEAKER_00: My brain is firing on all cylinders, and I am excited to dive into today's topic vetting your rehab professional and clinic for ACL rehab beyond the certifications and quote unquote sports clinic.
• 1:23
  SPEAKER_00: So in the past, I've talked a lot about the rehab professional you're working with, even vetting the clinic.
• 1:28
  SPEAKER_00: But today I want to do a little bit of a deeper dive based on a question I got from an ACLer, and I want to share my response and go a little bit deeper into all these details.
• 1:39
  SPEAKER_00: So you have like a very good litmus test, if you will, when you leave this episode of the professional you're working with and the clinic that you're at, because these people and this clinic can make or break how your ACL rehab process goes.
• 1:54
  SPEAKER_00: I cannot stress this enough.
• 1:56
  SPEAKER_00: They are the guide and they are the GPS on this long, long journey that is going to be hard.
• 2:02
  SPEAKER_00: There's going to be a lot of detours.
• 2:03
  SPEAKER_00: And you need to make sure the person who is that GPS and that clinic that is facilitating that environment and the way to get there is going to be the person that you trust and that has a plan and is able to take you through all the turns and detours and whatnot.
• 2:20
  SPEAKER_00: So let's get to the question.
• 2:22
  SPEAKER_00: Hello, I am seven weeks post-op with a hamstring graft ACL.
• 2:26
  SPEAKER_00: I had to move and not feeling it with the new PT in the facility I'm at.
• 2:31
  SPEAKER_00: What certifications, specialties, initials next to someone's name should I focus on in choosing a new PT and/or a clinic?
• 2:40
  SPEAKER_00: I want to be in a facility that sees a lot of these and deals with athletes trying to get back on the field, or for me personally, that's jujitsu.
• 2:49
  SPEAKER_00: So this is someone who is trying to get back to a sport that is going to require a lot of demand on their body, on their knee, and a lot of high performance.
• 2:58
  SPEAKER_00: And before you tell me that you're not an athlete as you're listening to this, it doesn't need to be some professional athlete or college athlete.
• 3:06
  SPEAKER_00: Look, you've got a body, you're trying to do something that is going to challenge you and that you love to do.
• 3:11
  SPEAKER_00: And usually it involves moving, it involves using your body more than just your daily activities.
• 3:16
  SPEAKER_00: So you are an athlete and it's relative to you and the things that are potentially difficult, but also just fun for you.
• 3:23
  SPEAKER_00: So this is something where you need to be treated like an athlete.
• 3:27
  SPEAKER_00: And in that term, it doesn't mean you need to be sprinting and lifting the heaviest weights possible, although that should be involved in your ACL rehab process to some degree for sure, especially the heavy lifting.
• 3:38
  SPEAKER_00: But this is all going to come back to you and your goals, but you should be working hard and it should look like a strength and conditioning program over time.
• 3:47
  SPEAKER_00: And so this is something that I want to stress and make sure is that is this physical therapist, is this physio, is it athletic trainer, whoever the rehab professional is, this person is able to get you back to that thing, and there is an environment to support that.
• 4:02
  SPEAKER_00: Whether maybe you're doing stuff on your own in the gym because you feel pretty independent, you just need the guidance and the day-to-day structure and the movements and the prescription, or maybe it's actually being a little bit more handheld in person to watch how you're moving and to be coached a little bit more.
• 4:18
  SPEAKER_00: But that environment needs to facilitate what it is that you need to get back to over time.
• 4:24
  SPEAKER_00: And first off, with this, some good reference episodes from the past I've done, episodes 32 and 33, choosing the right PT for ACL rehab, parts one and two, along with choosing the right environment, which is episode 45.
• 4:38
  SPEAKER_00: These touch on asking your PT specific questions to see if they understand ACLs, have the experience with ACL, and if the clinic is setting you up for success or failure.
• 4:49
  SPEAKER_00: Today we are diving into how you can make these judgments yourself based on the research and potentially the initial few sessions and experiences that you have with your physio, rehab professional, and the clinic that you're going to be in.
• 5:03
  SPEAKER_00: But before we get straight into it, I want to share some initial thoughts about the reality of physical therapy, physio, and just ACL rehab, the rehab process in general.
• 5:14
  SPEAKER_00: And I think it's important to be very transparent about this, about basically what we go into training for with physical therapy school.
• 5:23
  SPEAKER_00: So my background, I did an exercise and sports science degree in undergrad for four years.
• 5:28
  SPEAKER_00: And then I went to physical therapy school and got my doctorate for three years.
• 5:31
  SPEAKER_00: And so we had clinicals, you know, we had all the cadaver labs, we had biomechanics, we learned all the things.
• 5:38
  SPEAKER_00: And in physical therapy school, we don't spend a ton of time on ACLs.
• 5:43
  SPEAKER_00: We learn about it, we learn about the high risk of it.
• 5:46
  SPEAKER_00: Sure, we go through some of the rehab process itself.
• 5:49
  SPEAKER_00: But in all transparency, unless you have some specialized program in physical therapy school, or maybe you have a good professor who is teaching the lectures, we spend time on the knee, but we cover so much.
• 6:02
  SPEAKER_00: You think about the entire human body, we have to cover from neurological diseases to cardiopulmonary to obviously musculoskeletal injuries, and you think about everything that we have to deal with and the nuances and differential diagnosis, that there is not a ton of time spent on ACL rehab in all transparency.
• 6:22
  SPEAKER_00: And so if you are going into this space, you get a generalist degree of being able to treat all these different conditions.
• 6:30
  SPEAKER_00: Sure, we covered the ACL process, but since there is so much to cover, you do graduate as a generalist.
• 6:37
  SPEAKER_00: This means that most physical therapists don't leave school with this amazing understanding of how ACL rehab is and how to go from start to finish.
• 6:45
  SPEAKER_00: Sure, you might talk about it in some of the lectures, but at the end of the day, we are not equipped to come out of this process, especially with the experience that is needed and the repetitions with ACLs because there is so much variety in the cases that we get, the types of procedures, the types of clientele, all these different pieces play into how this is going to be rehabbed.
• 7:09
  SPEAKER_00: And you combine that with a lack of strength conditioning and exercise prescription performance principles that are not covered.
• 7:17
  SPEAKER_00: And you have someone who doesn't know a lot about how to truly help someone beyond the very basic stuff.
• 7:22
  SPEAKER_00: And I'm not sharing this to just, you know, crap on my profession, but it's a true transparency and problem that we have in this space.
• 7:30
  SPEAKER_00: And so when people are like, well, why are re-injury rates so high?
• 7:33
  SPEAKER_00: Why are we not clearing people to return to sport?
• 7:36
  SPEAKER_00: Or why do people, you know, have these mental health issues?
• 7:39
  SPEAKER_00: I think a big problem is honestly that a lot of people coming out of our profession is not equipped to handle this injury.
• 7:46
  SPEAKER_00: And I'm not sitting here on a pedestal saying like I am and no one else is.
• 7:50
  SPEAKER_00: There are amazing people out there who are well equipped and there are people who are gaining experience and people have to start somewhere for sure.
• 7:57
  SPEAKER_00: But I can strongly say that with the amount of orthopedic offices and outpatient physical therapy clinics that exist in the US and around the world, most physical therapists don't come out and are not specializing in ACL rehab.
• 8:11
  SPEAKER_00: So, therefore, if you're looking for someone to be specialized, you have to pursue that.
• 8:17
  SPEAKER_00: You can't just walk into a general clinic and be like, hey, like, do you know ACL rehab really well and ask all these questions?
• 8:23
  SPEAKER_00: There is a very strong chance that they will not be able to answer every question from those previous episodes or the things that I talk about today with full transparency, unless they are just so specialized in this space.
• 8:36
  SPEAKER_00: So this means for physical therapists that unless you really go out of your way to truly learn ACL rehab, most clinicians aren't equipped to handle this injury, especially the mid to late stages, because we just don't learn it in physical therapy school, unless you have a strength and conditioning background or there's a lecture or a elective you can take.
• 8:56
  SPEAKER_00: But you know, this is still something that is a bit archaic, and school is still trying to catch up, and people getting into this space are starting to realize oh, I don't really know as much as I thought I did or as equipped just because I have my doctorate.
• 9:11
  SPEAKER_00: And so that's something that is important.
• 9:14
  SPEAKER_00: And I think with the physical therapy process and with physio, the initial four to 12 weeks are not necessarily easy, but they are limited by the surgery and the injury itself.
• 9:26
  SPEAKER_00: You're just constrained to that injury or the surgery.
• 9:29
  SPEAKER_00: So it's easier to not notice the problems with the physio as much.
• 9:33
  SPEAKER_00: There's always going to be protocols and there's always gonna be kind of exercises that they can kind of implement, right?
• 9:40
  SPEAKER_00: So you won't be able to notice those problems as much early on because of the constraints of the injury or the surgery.
• 9:45
  SPEAKER_00: Where PTs can be okay in this four to potentially 12-week process, and you might not notice as much differences in the skill set because of the constraints of the injury or surgery.
• 9:56
  SPEAKER_00: The surgery is that main limiter, so you're going to be doing basic stuff anyways.
• 10:01
  SPEAKER_00: The other part that's tough is that you're gonna also notice a lot more progress in those first four to eight weeks.
• 10:08
  SPEAKER_00: Range of motion changes, which are probably the biggest thing that people chase in the first early acute phases.
• 10:14
  SPEAKER_00: So, you know, for our restore phase, we were working on the quiet knee, making sure that deconditioning doesn't happen with the other limbs and the body.
• 10:22
  SPEAKER_00: And so those are gonna be big pieces with our restore phase.
• 10:26
  SPEAKER_00: And so people notice big changes immediately post op because when your knee is straight and you're working on trying to get it bent and getting it straighter, getting the quad active, you're going from not being able to walk to being able to walk, you're not gonna notice those changes nearly as much because those are gonna be the straightforward things you're working on.
• 10:45
  SPEAKER_00: You're basically going from two polar opposites of fully immobilized, post-surgery and limited, to moving and walking.
• 10:52
  SPEAKER_00: Those are kind of night and day differences in how you feel, your daily function, especially, and you'll have those noticeable differences compared to mid to late stages where those are not as available and you're pushing more into higher end physical training, less noticeable changes day to day.
• 11:10
  SPEAKER_00: So this is where it's also hard to kind of vet this process initially because you're just like, all right, it's immediately post-op, you know, I'm gonna start working on range of motion, you know, I've got my exercises, I'm going to PT.
• 11:22
  SPEAKER_00: You know, this is how it always looks across the board, no matter where I go.
• 11:25
  SPEAKER_00: Side note, it does not.
• 11:27
  SPEAKER_00: But with that said, you're just it's hard to notice early on.
• 11:31
  SPEAKER_00: So that's one of the things that I do want to share.
• 11:34
  SPEAKER_00: And the other piece is that I understand that most clinics you walk into aren't naturally going to be equipped with ACL experts.
• 11:41
  SPEAKER_00: And I want to stress that because I'm not sitting here being like, well, just find the clinic that has the ACL expert in it, but you need to make sure you vet the person who you're working with and the clinic to make sure they at least are equipped for where you are currently and knowing that there might be an end point with when that finishes its course based on their expertise, not because your insurance runs out or because that's covered.
• 12:04
  SPEAKER_00: And that's another thing that's going to be key here is that don't let that be the thing that kind of sucks you in because at the end of the day, this process is hard.
• 12:13
  SPEAKER_00: You need to make sure that you have the person with the skill set equipping you the entire way, and that might be certain pieces or people through this process that takes certain phases of it.
• 12:24
  SPEAKER_00: And that's the other part to stress here.
• 12:27
  SPEAKER_00: And it's more so of these clinics, and when you step into them, even if they don't have the ACL experts, it's how the education is designed, as I mentioned, plus how rehab in general and most of the healthcare systems are built.
• 12:43
  SPEAKER_00: And so I wouldn't expect to walk in with someone who's an expert and has seen hundreds of good quality outcomes with ACLs.
• 12:50
  SPEAKER_00: It's just not the reality unless you're in a specialized sports clinic, someone who literally gets referred constantly all the time, and you see those outcomes and you see it in the clinic.
• 13:00
  SPEAKER_00: But I would expect enough to exist to get the bare minimum with things like strength testing, not kicking into the hand, but actually strength testing with a dynamometer or isokinetic machine, not using time or protocols and using criteria and educating on this process.
• 13:17
  SPEAKER_00: This is even harder in countries where care might not be the best or rural areas where resources and options are limited and are a lot less.
• 13:25
  SPEAKER_00: Beauty now is that technology and remote access has the ability to cut through that.
• 13:30
  SPEAKER_00: So that is something that you don't have to be confined just to your geographic location, and there are so many remote resources available that you don't have to be stuck to just where you are physically.
• 13:43
  SPEAKER_00: Now, let's get back to this response to this guy.
• 13:46
  SPEAKER_00: We're tackling how to actually vet your rehab professional and clinic for ACL rehab.
• 13:51
  SPEAKER_00: And as I had mentioned, why do you think I'm stressing this so much to create a podcast episode just based on it?
• 13:58
  SPEAKER_00: Because this person is your GPS and guiding you on the journey that can honestly make or break this process, whether you get back to what you love, or honestly a potential re-injury.
• 14:08
  SPEAKER_00: And that is something that is real, and that's my goal with this podcast is to be real with you guys and just show the transparency of what I see, the calls that I have, the hundreds of ACLers we as a team have worked with.
• 14:20
  SPEAKER_00: So this is the world of ACL rehab.
• 14:23
  SPEAKER_00: So now we have to adapt to it and you have to take control.
• 14:26
  SPEAKER_00: First of all, do your research people.
• 14:30
  SPEAKER_00: Don't always rely on what's up the road or what your surgeon recommends.
• 14:34
  SPEAKER_00: If you're getting something like an iPhone or a laptop or going to a certain school or getting a certain job, you'll research and find what's best.
• 14:43
  SPEAKER_00: But for some reason, we'll often just settle for just whatever physical therapy is available down the road, fits the schedule, assuming it's all the same for especially ASL rehab.
• 14:54
  SPEAKER_00: Guess what?
• 14:55
  SPEAKER_00: It is not, as I mentioned before.
• 14:57
  SPEAKER_00: If you lined up 10 different PTs within a five mile radius of me, and I promise you they will approach it differently to some degree based on their background, education, experience, beliefs, etc.
• 15:11
  SPEAKER_00: Like a teacher or any other profession for that matter, where yeah, there are a lot of roads that lead to Rome.
• 15:18
  SPEAKER_00: You can do it very many different ways, but the principles and the core science and the way that we build things and the way our human body moves stays the same.
• 15:28
  SPEAKER_00: There can be a hundred different exercises for knee extension.
• 15:31
  SPEAKER_00: But if you are only getting to zero and that's the belief of them, you are going to be in trouble.
• 15:36
  SPEAKER_00: So that's the thing that I want to stress here is that sure there's many roads that lead to Rome, but if you're trying to get to Rome, but most of those roads only get you there 30% of the time, or maybe it's a completely different destination.
• 15:49
  SPEAKER_00: Welcome to the world of ACL rehab.
• 15:51
  SPEAKER_00: I'm not sitting here trying to be super negative, guys.
• 15:53
  SPEAKER_00: I never want to be that way, but it's just it's really pressed on me with a lot of these conversations and a lot of the things that I see is to share just the blind spots in this space.
• 16:03
  SPEAKER_00: Many people enter this space not understanding, and I get that I was like that twice through my own two ACL rehabs and having immigrant parents.
• 16:12
  SPEAKER_00: And these are just things where you're just like you kind of get funneled along the system and you just kind of do what they say, but then that could lead to a potential reinjury.
• 16:21
  SPEAKER_00: So my goal is to share with you what is the true landscape of this space, and as of July of 2023, we're still here and we've got a lot of work to do.
• 16:31
  SPEAKER_00: And so, not researching and vetting who you'll be working with might be single-handedly the biggest problem that I see.
• 16:38
  SPEAKER_00: And for many people, they don't go see their physical therapist or physio until after they have the procedure or post op.
• 16:46
  SPEAKER_00: And that's the way the system is doing things, and that's okay.
• 16:50
  SPEAKER_00: Get in there if you can, at least one visit prehab, maybe two for pre-op at the most, or at the least, sorry.
• 16:59
  SPEAKER_00: And if you're post-op, follow the same process.
• 17:02
  SPEAKER_00: Get in there, really see and vet this person.
• 17:05
  SPEAKER_00: And one of the things I actually want to share, I love from one of my athletes, Shannon, who absolutely crushed this process and got back to skiing.
• 17:12
  SPEAKER_00: She said, asking your surgeon to write a prescription for prehab is not only a good litmus test for the PT clinic, but also for the surgeon.
• 17:21
  SPEAKER_00: I inquired about prehab before my surgery, and surgeon said I didn't need it, even though I had a bent knee, non-weight bearing, non-functional, rapidly deflating quad, and surgery was in a week.
• 17:33
  SPEAKER_00: Man, it could be an absolute game changer just to get in there one visit before your ACL rehab.
• 17:39
  SPEAKER_00: And yeah, it's true.
• 17:40
  SPEAKER_00: It's a good way to vet like what does your surgeon believe, and also go into the PT clinic, check it out, check out the PT you might be working with, get acclimated to the process.
• 17:50
  SPEAKER_00: You can go back to the last episode to dive in more about this detail of this episode.
• 17:55
  SPEAKER_00: So thanks, Shannon.
• 17:56
  SPEAKER_00: As I could not agree more, and another solid way to do this, the litmus test as she references.
• 18:02
  SPEAKER_00: So continuing on on vetting your clinic and professional to make sure they're the right person for you.
• 18:08
  SPEAKER_00: So I said before, do your research.
• 18:10
  SPEAKER_00: And all this is about doing the research, find the clinics that are available.
• 18:14
  SPEAKER_00: If you're needing insurance, take the insurance route.
• 18:17
  SPEAKER_00: If you do out of pocket, cool.
• 18:19
  SPEAKER_00: Also think about this whole long-term process.
• 18:21
  SPEAKER_00: If you are post-injury or post-surgery, then you need to think, all right, for the next nine to 12 months, what is this process going to look like?
• 18:28
  SPEAKER_00: Is my insurance gonna help me?
• 18:30
  SPEAKER_00: Is that gonna be viable with the physical therapist I'm working with?
• 18:34
  SPEAKER_00: Is there a personal trainer or strength conditioning coach who is very familiar with performance and ACLs that can maybe take you a little bit of the way there after you finish your initial physical therapy?
• 18:45
  SPEAKER_00: That's essentially our team in a nutshell.
• 18:47
  SPEAKER_00: We are physical therapists, athletic trainers, strength conditioning coaches, but we can do both ends of the spectrum.
• 18:53
  SPEAKER_00: We know the rehab side and the complicated cases, all the way from pre-injury, sorry, post-injury to post-ACL reconstruction, to all the different procedures to getting them back to fully return to sport.
• 19:08
  SPEAKER_00: We've taken taken hundreds of people through it.
• 19:10
  SPEAKER_00: This is our process, and this is our bread and butter.
• 19:13
  SPEAKER_00: Not everyone is going to be equipped with this, and most likely your clinic is not going to have that, but you need to make sure that the person you're working with through this process can take you through that continuum, even if it's a small phase of it, and then you move on to the next person.
• 19:28
  SPEAKER_00: Now, there are going to be a lot of variables to consider, so y'all stick with me.
• 19:32
  SPEAKER_00: First, the clinic and the environment itself.
• 19:36
  SPEAKER_00: Is the clinic set up with weightlifting equipment, racks, machines that can get heavy?
• 19:42
  SPEAKER_00: Not where it's just the little colorful weights on a little wooden tree where they can stack up pretty.
• 19:48
  SPEAKER_00: We're talking about dumbbells ranging from five pounds all the way to 80 pounds, maybe even heavier.
• 19:54
  SPEAKER_00: What about the barbell rack or trap bar to get strong?
• 19:58
  SPEAKER_00: We need to overload with weights.
• 20:00
  SPEAKER_00: Same with machines.
• 20:01
  SPEAKER_00: Do they have a leg press, leg curl, leg extension?
• 20:04
  SPEAKER_00: Guess what?
• 20:04
  SPEAKER_00: My clinic that I work at and see ACLers out of, we don't have a leg press, leg curl, leg extension.
• 20:09
  SPEAKER_00: But guess what?
• 20:10
  SPEAKER_00: We still are able to create a lot of those stimulus through BFR, through overloading, through manual work, through being able to overload the muscles through external weights to still get those same effects on the quads, hamstrings, and the lower body in general.
• 20:27
  SPEAKER_00: Those are all to help isolate, but then also to strengthen as a compound movement like leg press.
• 20:32
  SPEAKER_00: And there's so many different varieties of ways to do that.
• 20:35
  SPEAKER_00: But it's great to have those machines at your disposal.
• 20:38
  SPEAKER_00: And anytime athletes are not with me, they're going to the gym and they're doing work on those machines and free weights and all the other different pieces they might need to work with.
• 20:48
  SPEAKER_00: So is that clinic environment itself set up for you?
• 20:51
  SPEAKER_00: What about the space to do jumping, running, cutting?
• 20:55
  SPEAKER_00: You gotta think about those, especially in the mid to late stages, or is it super tiny and limiting?
• 21:00
  SPEAKER_00: Again, not a deal breaker, but will impact your results and process without having a solid gym type equipment and space to do it.
• 21:08
  SPEAKER_00: Your environment needs to facilitate it.
• 21:11
  SPEAKER_00: If you're trying to fix your car but you don't have any tools available, guess what?
• 21:15
  SPEAKER_00: You're out of luck.
• 21:16
  SPEAKER_00: So the same thing here, you need to make sure that you have the tools available at the least and someone to help you use those tools to make sure you're working towards the goals in this ACL rehab process.
• 21:26
  SPEAKER_00: That's where your environment will impact so so much of how this process can go.
• 21:32
  SPEAKER_00: Next, what about the population that you see there?
• 21:35
  SPEAKER_00: What type of patients do you see in the clinic versus what they market they see or are?
• 21:41
  SPEAKER_00: The sports clinic or the sports medicine clinic is the thing that makes me laugh the most because guess what?
• 21:48
  SPEAKER_00: It is a marketing scheme more than anything.
• 21:51
  SPEAKER_00: Sure, it is in reality, a lot of places do have that, and they are truly a sports clinic.
• 21:56
  SPEAKER_00: Any clinic owner wants to see athletes, so it helps to.
• 22:00
  SPEAKER_00: A wider net too, whenever you essentially say, Hey, we're a sports medicine clinic, we treat all kinds of athletes, we see athletes, but then you get in there, are they actually seeing athletes in there similar to you and getting back to higher level performance?
• 22:13
  SPEAKER_00: Or is it just post-op older folks?
• 22:16
  SPEAKER_00: A lot of outpatient physical therapy clinics are working with people who are, you know, back pain and you know, post-op total knees and shoulders, and there is nothing wrong with that, and especially if you have limited resources where you live, they might have to see all the things, and that's totally fine.
• 22:34
  SPEAKER_00: But what I'm saying is that it'll tell you a lot if they say they see athletes or quote themselves as a sports medicine clinic, but they're not really showing that based on the population that's walking in the door.
• 22:45
  SPEAKER_00: It's likely the professionals there don't get a ton of reps with these type of athletes trying to get back to higher level performance.
• 22:53
  SPEAKER_00: Doesn't mean that they can't, but again, it will tell you a lot and will also show maybe do they have those repetitions that you're looking for to get back to especially something like a cutting, jumping, and pivoting sport?
• 23:05
  SPEAKER_00: Or is it something where they're like, yeah, the insurance will cover the post op.
• 23:09
  SPEAKER_00: And that's where they might just typically see people and can do their thing.
• 23:14
  SPEAKER_00: And then after that, it's like, okay, is this the place that I want to be?
• 23:18
  SPEAKER_00: Next is for the rehab professional, physical therapist, physiotherapist, athletic trainer, athletic therapist, Cairo, anyone in the rehab space who can potentially treat people who are ACLers.
• 23:31
  SPEAKER_00: This is more important than anything else, in my personal opinion.
• 23:36
  SPEAKER_00: The person, the guide.
• 23:38
  SPEAKER_00: You can find the specific questions regarding their ACL experiences, such as number of ACLs they've done, worked with, graph types, complex injuries, their return to sport testing, including strength testing, milestones, protocols, length of care, overall game plan, criteria, you name it.
• 23:57
  SPEAKER_00: Here's the other thing that I am going to say that can be of incredible value to know you might be with a really good physical therapist.
• 24:05
  SPEAKER_00: Do they have a strength and conditioning and performance background?
• 24:08
  SPEAKER_00: Do they understand how to teach people to lift heavier weights?
• 24:12
  SPEAKER_00: Things like running mechanics, plyometrics, agility.
• 24:17
  SPEAKER_00: Most will say that they can, but again, they need to specifically have a skill set in this.
• 24:22
  SPEAKER_00: And this can be something that is a little tough because you know you can walk into any clinic and there can be people who are just jumping on a box or maybe just doing a cutting drill of some sort.
• 24:32
  SPEAKER_00: So, how are you able to delineate whether that's good value or not?
• 24:36
  SPEAKER_00: And a lot of this comes back to the way that they're coaching and what they're educating about, the queuing, and also are they really lifting heavy weights and doing things like jumping, running, and cutting that looks more athletic and performance focused?
• 24:50
  SPEAKER_00: That's the big thing here in terms of being able to try and initially vet from that strength and conditioning and performance background.
• 24:58
  SPEAKER_00: In terms of letters, you'll usually see PTs with certifications like sports or orthopedic certified specialists, SCS or OCS.
• 25:08
  SPEAKER_00: Honestly, OCS doesn't mean a lot in my personal opinion.
• 25:12
  SPEAKER_00: I remember my first clinical instructor having this and doing an orthopedic residency herself.
• 25:17
  SPEAKER_00: I thought it was so cool when she told me all this.
• 25:20
  SPEAKER_00: She legit gave everyone the exact same thing while she did her notes and there was no individualization.
• 25:27
  SPEAKER_00: Um, there wasn't really a lot of rationale behind it.
• 25:30
  SPEAKER_00: So I don't think that there's as much merit to the OCS in terms of guaranteeing they're a good ACL rehab expert.
• 25:37
  SPEAKER_00: SES has more value, in my opinion, where they have actually had to accumulate hours with field coverage.
• 25:43
  SPEAKER_00: Again, still doesn't mean you are an ACL expert, but if you're working within the sports realm a little bit more, there's a likelihood that you've worked with more ACLs, have gone through more training based on that, and have some experience, but most of all, they have all just basically passed tests.
• 26:00
  SPEAKER_00: Yeah, there's practical components to it, but especially a written component.
• 26:04
  SPEAKER_00: And so again, passing a test.
• 26:07
  SPEAKER_00: We know that passing a test like the SAT doesn't necessarily mean a ton outside of you can pass the test.
• 28:17
  SPEAKER_00: Along with these same lines, the CSCS, certified strength and conditioning specialist.
• 28:22
  SPEAKER_00: This is a baseline knowledge of strength and conditioning.
• 28:25
  SPEAKER_00: I have it personally, our team has it, but it honestly didn't teach me much about the true strength and conditioning and coaching side of things.
• 28:34
  SPEAKER_00: This is the one that can fool people most because it's something where it sounds legit, but at the end of the day, it was a computer test that I took and is still what people do to this day to get the certification.
• 28:45
  SPEAKER_00: It means that you get a baseline information, you studied it, and you were able to take the test and being able to pass it.
• 28:53
  SPEAKER_00: Plenty of people I've seen work and have a CSCS that has no business coaching in all transparency, but this is just something that I see.
• 29:03
  SPEAKER_00: And again, when people are like, hey, what certifications are good to know if this coach is awesome or this physical therapist?
• 29:10
  SPEAKER_00: And it's like these are entry points.
• 29:12
  SPEAKER_00: And that's the thing I want to share here before you think I'm destroying all these certifications and achievements.
• 29:18
  SPEAKER_00: They have merit to them and they have their place.
• 29:20
  SPEAKER_00: But again, it's just an entry point in baseline education, in my opinion.
• 29:26
  SPEAKER_00: I would recommend seeing what their actual experience is in strength and conditioning and performance.
• 29:32
  SPEAKER_00: All of my foundational knowledge came from spending an entire year as a strength coach with the University of Georgia for their athletic teams.
• 29:39
  SPEAKER_00: From basketball to soccer to swimming, equestrian Olympians to track and field.
• 29:44
  SPEAKER_00: I was mentored by some of the best in the field.
• 29:46
  SPEAKER_00: And we had weekly meetings and assignments we had to do.
• 29:50
  SPEAKER_00: It was really, really hard.
• 29:51
  SPEAKER_00: It made me so nervous, but I learned so much.
• 29:54
  SPEAKER_00: Not only the science and the concepts, but programming for different athletes, sports to practicals on the floor and coaching.
• 30:03
  SPEAKER_00: We would get analyzed.
• 30:04
  SPEAKER_00: We would be analyzed by the cues we give, the amount of cues we give, the way that we conduct the coaching with individuals versus a group.
• 30:13
  SPEAKER_00: We got ripped apart.
• 30:15
  SPEAKER_00: And I remember for one of my practicals, I had to present a program for soccer for a certain offseason, and I had to build like a six-week program, and I got ripped to shreds because there were a few things that I just plugged in there that I just didn't have a reason for.
• 30:31
  SPEAKER_00: I just saw it on something else, and one of my coaches did it, and so I just plugged it in.
• 30:35
  SPEAKER_00: They ripped me apart.
• 30:37
  SPEAKER_00: And since then, I have always stood with why am I doing this?
• 30:41
  SPEAKER_00: If I give my ACL or something, why are they doing this?
• 30:44
  SPEAKER_00: What is the principle?
• 30:45
  SPEAKER_00: What is the stimulus?
• 30:46
  SPEAKER_00: What is the intent behind the reason why we are giving them this?
• 30:50
  SPEAKER_00: Otherwise, if you cannot answer that, then that needs to be tossed out, or you need to find out why and make sure it's serving the goal and the purpose.
• 30:58
  SPEAKER_00: The actual experience is what really created this for me, not the test taking or the concepts.
• 31:05
  SPEAKER_00: Now, does your rehab professional need all of this?
• 31:09
  SPEAKER_00: No, this isn't a must whatsoever.
• 31:12
  SPEAKER_00: But you must know that they're not going to be able to get you all the way there if they're not experienced in this rehab to full performance.
• 31:19
  SPEAKER_00: It's likely, anyways, just because we have to deal with insurance, but you should know that if their background is pretty limited in terms of strength and conditioning, performance, and especially ACL rehab.
• 31:30
  SPEAKER_00: Wish that was easier, but it's the way that certifications go.
• 31:34
  SPEAKER_00: Experience and background is the most pivotal decision makers in ACL rehab and picking the right person and clinic.
• 31:41
  SPEAKER_00: The other thing that I'm gonna suggest to you guys that I've shared before is the gut test.
• 31:46
  SPEAKER_00: My suggestion is if your gut is telling you it's not a good fit to find another option, whether that's local or if remote, lots of options exist now.
• 31:56
  SPEAKER_00: But with that said, if your gut's like, hey, like this isn't seeming right, what ends up happening is that you'll have the insurance available, or it's just easier to just do the thing, to just allow them to continue.
• 32:09
  SPEAKER_00: You know, it's good enough, if you will, but then there comes a certain point where you get stuck.
• 32:14
  SPEAKER_00: And sometimes it's because of not being able to address what that gut was telling you.
• 32:19
  SPEAKER_00: So this is where I say, you know, get in before, vet the professional, vet the clinic, even post op, being able to just see, all right, how's this looking?
• 32:29
  SPEAKER_00: And then eventually, if you need a plan B and plan C, that's great.
• 32:33
  SPEAKER_00: Follow your gut and know that majority of physical therapy as it currently stands is not always going to get you all the way there.
• 32:40
  SPEAKER_00: And that's probably the last thing that I want to stress here is that your PT can be good for certain phases of this process.
• 32:48
  SPEAKER_00: Maybe they absolutely crush the initial post op.
• 32:52
  SPEAKER_00: They have incredible results, get people to a quiet knee, get them to a certain baseline of foundational strength.
• 32:58
  SPEAKER_00: Amazing.
• 32:58
  SPEAKER_00: But then when they're like, all right, I don't really know how to progress things from the strength conditioning side, that's okay.
• 33:04
  SPEAKER_00: And I think that that's something where we have to kind of swallow our pride and our ego and making sure we know where we are comfortable with and making sure that we just don't lead people on just because they're there, their visits, their volume.
• 33:18
  SPEAKER_00: We got to make sure we're serving the person in front of us.
• 33:21
  SPEAKER_00: And when that is exhausted, that needs to be referred to someone else to continue that path.
• 33:26
  SPEAKER_00: So this might be another rehab professional with this skill set, or it's a really good strength and conditioning coach who understands performance in this population.
• 33:35
  SPEAKER_00: If you get both, that is the unicorn that is going to really help you because they will understand any problems that will come along in this process and then also be able to address the more performance-oriented side of things.
• 33:48
  SPEAKER_00: And I promise this person who guides you through the ACL rehab process truly can make or break it, how the journey goes, but ultimately getting back to what you love.
• 33:57
  SPEAKER_00: Can't stress that enough.
• 33:59
  SPEAKER_00: And the last thing I want to end this episode with because I feel like it can probably come off as like, hey, don't do this.
• 34:05
  SPEAKER_00: This is the expert ACL, don't use these people.
• 34:08
  SPEAKER_00: Most PT is bad.
• 34:10
  SPEAKER_00: And I think that I just want to be fully transparent here is that I never intend for these episodes to be negative or throw hate or shade on any profession, any background, any certification.
• 34:22
  SPEAKER_00: I love my profession.
• 34:23
  SPEAKER_00: I love what I do.
• 34:25
  SPEAKER_00: I'm so passionate about it.
• 34:26
  SPEAKER_00: And I have so many colleagues and friends who are doing such good work in this space.
• 34:31
  SPEAKER_00: But because of the way that this system has been built, it puts people at a disadvantage, especially for ACL rehab.
• 34:38
  SPEAKER_00: I was that person, and I have seen hundreds of people go through this.
• 34:42
  SPEAKER_00: I've had thousands of conversations with ACLers on the phone, being in this exact same scenario because of the person that they worked with, or because of the healthcare system, because of insurance, because they weren't educated on the process.
• 34:55
  SPEAKER_00: And then guess what?
• 34:57
  SPEAKER_00: That leads to mental health declines, not getting back to what you love, knee problems, you name it.
• 35:03
  SPEAKER_00: And it really comes with this territory, and it's tough.
• 35:06
  SPEAKER_00: It's just hard.
• 35:08
  SPEAKER_00: And so that is the point of this podcast is to help you, to inform you, whether you're an ACLer, a mom, dad, a loved one supporting, a rehab professional trying to figure it out if you fall into these buckets or not.
• 35:23
  SPEAKER_00: It's really just to help you guys and feel educated.
• 35:26
  SPEAKER_00: It's the reality of where we are with the current quote unquote standard of care for rehab and for specifically ACL.
• 35:33
  SPEAKER_00: We have a massive problem with not enough people qualified to treat this problem and a system not built for it.
• 35:39
  SPEAKER_00: It's growing and it's getting better, but it is not there yet, and we have a lot of work to do.
• 35:44
  SPEAKER_00: Until re-injury rates decrease, we still have to do so much.
• 35:48
  SPEAKER_00: And I don't think this system is something we can fall back onto just yet.
• 35:53
  SPEAKER_00: I have optimism and I have hope, and I hope that people who are really pushing this space is going to be able to make a massive difference.
• 36:00
  SPEAKER_00: And I do think that.
• 36:47
  SPEAKER_00: So I'm going to hop off here before I go on any more tangents.
• 36:51
  SPEAKER_00: I can't say how much I appreciate all of you for taking the time to listen, to share reviews, to share the podcast, to send messages, share on IG.
• 37:02
  SPEAKER_00: Please continue doing that.
• 37:04
  SPEAKER_00: It continues to fuel the fire and we are going to continue to keep going.
• 37:08
  SPEAKER_00: We're going to keep going just for you guys.
• 37:10
  SPEAKER_00: If you're ending this episode and you're fired up just like me, leave us a five-star review, whether it's on Spotify, on Apple Podcasts, whatever platform that might be.
• 37:19
  SPEAKER_00: This does a world of difference for reaching other ACLers so they can grab this information.
• 37:26
  SPEAKER_00: So they're not the ones who are stuck in this like limbo period or like, oh, I can make a difference in my ACL rehab process and don't have to rely on external people or systems to get them back to what they love.
• 37:38
  SPEAKER_00: So that is going to be it for today, guys.
• 37:41
  SPEAKER_00: Thank you all so much for hanging out.
• 37:43
  SPEAKER_00: Until next time.