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182 | 15 Timeless Reminders I Wish I Had During My ACL Rehab Process · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Robbie Patel, a performance physical therapist and coach.
• 0:36
  SPEAKER_00: Both 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.
• 1:01
  SPEAKER_00: What is up, team?
• 1:02
  SPEAKER_00: And welcome back to another episode on the ACL Athlete Podcast.
• 1:06
  SPEAKER_00: So today is episode 182.
• 1:10
  SPEAKER_00: 15 timeless reminders I wish I had during my ACL rehab process.
• 1:17
  SPEAKER_00: So this is something that you know I did some thinking on and was something that was important to me to share.
• 1:23
  SPEAKER_00: And I think it's easy to get wrapped up in the minutia of everything, right?
• 1:32
  SPEAKER_00: You know, it's kind of a phase-by-phase thing, if you will.
• 1:35
  SPEAKER_00: And you're like, man, this is a nine to 12 month process.
• 1:38
  SPEAKER_00: And it just feels like it drags, to be honest.
• 1:41
  SPEAKER_00: And every one of my ASLers knows this.
• 1:43
  SPEAKER_00: Even though you are in it, you're doing the thing, you might be even making progress, and it's amazing.
• 1:48
  SPEAKER_00: But I know it hits everybody where it's, you know, you're just kind of in the throes of it.
• 1:53
  SPEAKER_00: So I wanted to take a step back and just share some things that I wish I had reminders of in my A Sale rehab process.
• 2:01
  SPEAKER_00: So if you are prehab, if you are uh post-operative, maybe you're non-operative route, maybe you're in the the middle phases, the late phases, you know, you could be anywhere along on the continuum.
• 2:14
  SPEAKER_00: And these are going to be really, really valuable reminders that I wish I had to be able to just kind of zoom out for a second and just remember these particular things that I think can be really helpful to anchor us and to maybe shift our perspective a little bit, especially for those of you who might feel like you're in a rut or maybe you feel like you're in a plateau or things are dragging out, um, especially in the not so positive light, right?
• 2:42
  SPEAKER_00: So this is something that I do want to take that step back because I feel like it's very encouraging and is something that I wish I had during those moments whenever I might have been struggling myself.
• 2:52
  SPEAKER_00: So let's get into it.
• 2:53
  SPEAKER_00: Number one, expectations are everything.
• 2:57
  SPEAKER_00: So, you know, if you are working a job and you are expected to get paid$100, right?
• 3:02
  SPEAKER_00: And you only get paid$30, you're gonna be pretty mad.
• 3:06
  SPEAKER_00: So that's a very simplified way of saying, you know, if we think we're gonna get back to a certain point at a certain time point, that's gonna be tough, right?
• 3:16
  SPEAKER_00: And, you know, I'm hoping that, you know, the clinician coach you're working with, your guide, if you will, is helping to shape these expectations, not only from the very start of this, but even as you go through this process, because you know, things can change.
• 3:30
  SPEAKER_00: You could run into road bumps.
• 3:32
  SPEAKER_00: Like we have athletes who just they develop a cyclops lesion and it sucks.
• 3:37
  SPEAKER_00: But the thing is, is that they're gonna have to probably get that removed.
• 3:40
  SPEAKER_00: And when they do, they feel amazing, but it could delay things a little bit, it could pivot the plan.
• 3:46
  SPEAKER_00: So we want to make sure as we're going, we are educating our athletes, but making sure that we're anchoring our expectations and not thinking, oh, well, we're gonna be back running in eight weeks or we're going to be back on the field in six months, right?
• 3:59
  SPEAKER_00: Playing.
• 4:00
  SPEAKER_00: These are things that I think are these kind of false illusions.
• 4:04
  SPEAKER_00: So making sure that our expectations are matching up to reality.
• 4:08
  SPEAKER_00: And when they do mismatch, asking ourselves why.
• 4:11
  SPEAKER_00: Like, why is that mismatching?
• 4:13
  SPEAKER_00: Is it because someone led me astray?
• 4:15
  SPEAKER_00: Is it because I set these expectations for myself that were maybe too high or far-fetched?
• 4:21
  SPEAKER_00: And it's okay to set high goals, right?
• 4:23
  SPEAKER_00: And to push towards things, but there's a certain point where you want to make sure that that's a healthy expectation in reality versus that mismatch.
• 4:32
  SPEAKER_00: So if you do feel like you're kind of missing the mark on things, maybe revisit this and make sure that these expectations are anchored to what is it looking like in your timeline and in your process, and especially leaning on your guidance for that.
• 4:46
  SPEAKER_00: You shouldn't be the only one, you know, lining this up.
• 4:49
  SPEAKER_00: It should also be a part of whoever is your expert in your corner.
• 4:54
  SPEAKER_00: Number two, it's long.
• 4:56
  SPEAKER_00: Manage burnout early.
• 4:58
  SPEAKER_00: This process, as I had mentioned, it can range, right?
• 5:01
  SPEAKER_00: It could be nine months, it could be 12 months.
• 5:03
  SPEAKER_00: We've had athletes, it takes 16 months, two years.
• 5:06
  SPEAKER_00: And there's a lot of complexities that are involved with that, whether there are complications, or you know, maybe they kind of fell off the mark for a little bit, or maybe they had bad rehab at the beginning, or they ran into the road bump in the mid-stages.
• 5:20
  SPEAKER_00: You know, there's a lot of things that can kind of happen in this process, but especially early on, you know, you'll get that honeymoon phase, if you will, where you're making the gains day after day after day with range of motion or walking, getting rid of crutches.
• 5:34
  SPEAKER_00: So you want to be careful not to hit the gas too, too hard.
• 5:38
  SPEAKER_00: Um, and you're, you know, going 24-7 every single day because that can lead to burnout.
• 5:43
  SPEAKER_00: And guess what?
• 5:44
  SPEAKER_00: This is a long process.
• 5:45
  SPEAKER_00: So you want to make sure you manage that as early as possible and balance those things.
• 5:51
  SPEAKER_00: Number three, it's okay to take a short break, building off of that previous statement of burnout, right?
• 5:57
  SPEAKER_00: There are times where we might give our athletes, you know, at let's say the three-month mark, we might give them a little bit of a break, if you will.
• 6:06
  SPEAKER_00: Sometimes they've been in the gym for a while, and I will say, hey, for part of this week or this whole week, I'm actually gonna say don't go to the gym.
• 6:14
  SPEAKER_00: And I know this is against all rules, but the thing is, is that sometimes we need that break, especially my athletes who are in it for like six months, maybe it's nine months in, and they're still kind of trucking along, right?
• 6:29
  SPEAKER_00: Gym work, field work, whatever that might be.
• 6:31
  SPEAKER_00: Maybe they're participating in some partial practices and things of that nature.
• 6:35
  SPEAKER_00: So it's a lot, right?
• 6:37
  SPEAKER_00: And so it's a lot on our bodies, but it's also a lot mentally and on our brains.
• 6:41
  SPEAKER_00: So sometimes we just need a break, and that might mean literally not stepping foot into the gym or doing anything where we are having to focus on our knee or ACL.
• 6:51
  SPEAKER_00: It's a constant thought.
• 6:52
  SPEAKER_00: And I think sometimes if we can do this earlier in the process, we try to embed it in.
• 6:57
  SPEAKER_00: Like if an athlete has a vacation coming up, or maybe they've had some testing and they did really well, or we're leading up to the testing.
• 7:05
  SPEAKER_00: Maybe we'll have a little bit of a taper where we just kind of reduce down like what they're doing in the week, volume-wise, or maybe have a day or two instead of like a full-on week, and we'll allow them to take a break.
• 7:16
  SPEAKER_00: And is something that I think is super, super beneficial and underutilized in our rehab process because this is something that can really be like a less is more, which we will also talk about.
• 7:29
  SPEAKER_00: But it might be something where you might actually reduce some stuff and actually gain in that process.
• 7:35
  SPEAKER_00: And I think sometimes having a break can be helpful.
• 7:38
  SPEAKER_00: So if you are considering this, that's okay.
• 7:41
  SPEAKER_00: But I would also reflect and be like, are you taking a break because you're just like wanting a break in terms of you know, you haven't been really doing stuff and you just kind of like give up and take a break, you know, that's questionable.
• 7:52
  SPEAKER_00: But if you're trying to take a break because you've been working at it really hard, then I think that there are times where that is very much warranted, which is what I am getting at with this point.
• 8:02
  SPEAKER_00: Number four, master the basics very, very, very well.
• 8:06
  SPEAKER_00: The basics, they stand the test of time, right?
• 8:10
  SPEAKER_00: There's a reason why squatting and deadlifting and you know, lunging, things of that nature, like just different movements, they continue to stick within programs.
• 8:21
  SPEAKER_00: Now, there's lots of variations, lots of ways to coach this.
• 8:24
  SPEAKER_00: There's lots of ways to go from isolated strength to integrated strength of those compound movements.
• 8:30
  SPEAKER_00: We still obviously want to focus on the basics of all this.
• 8:35
  SPEAKER_00: So we don't need to get fancy.
• 8:37
  SPEAKER_00: There's a lot of exercises on Instagram.
• 8:40
  SPEAKER_00: You know, we've got an athlete who, you know, we had a consultation with, and the guy was taking two hours every single day to complete his list of exercises, literally two hours just for you know some basic post op stuff.
• 8:53
  SPEAKER_00: And we're like, whoa, like what is this?
• 8:56
  SPEAKER_00: And he was like, Well, I've got like 30 or 40 exercises that my PT gave me.
• 8:59
  SPEAKER_00: And I'm like, this is insane.
• 9:02
  SPEAKER_00: How is that even possible to be doing that much in a day?
• 9:05
  SPEAKER_00: You're gonna burn out.
• 9:06
  SPEAKER_00: And two, like, if you're doing that many exercises, one, your PT is just throwing things at the wall and seeing what sticks.
• 9:13
  SPEAKER_00: And two, is that you're being less effective with all of those movements?
• 9:17
  SPEAKER_00: Why don't we condense this down into something that's like five to 10 movements?
• 9:22
  SPEAKER_00: And there's certain categories or buckets that you can work on, but that's gonna be really important in terms of doing that, just to make sure that we can focus on the right exercises and put as much intent behind those versus spreading them out across 30 to 40 movements.
• 9:40
  SPEAKER_00: To me, that is just wild, y'all.
• 9:42
  SPEAKER_00: And that seems so overwhelming.
• 9:44
  SPEAKER_00: And I think what this ends up coming back to is how can we master the basics instead of all the flashy stuff, instead of creating this like laundry list of stuff, how can we prioritize focusing on these particular goals and outcomes, and how can we allocate certain movements that we know are consistently going to reap benefits?
• 10:03
  SPEAKER_00: And I think that's one of the keys with program design and with physical therapy and performance that we're hoping we can get from the professional that you're working with, right?
• 10:14
  SPEAKER_00: Is that they can kind of help you to master these basics.
• 10:17
  SPEAKER_00: But this is something that we do see is that it's easy to just get caught up in the fancy stuff, the flashy lights, the new equipment, the technology, but the basics are the thing that stand the test of time and it's something that we anchor to as a team, and it just reaps the benefits over anything else.
• 10:36
  SPEAKER_00: Number five, strength is the foundation for athletic development.
• 10:41
  SPEAKER_00: When we look at this pyramid or this hierarchy, if you will, we want to make sure that strength is such a foundational component of this, especially with ACL rehab.
• 10:50
  SPEAKER_00: It's the thing that we lose the most.
• 10:52
  SPEAKER_00: It's the thing that is the base of building up our athleticism and the qualities that we want to develop.
• 11:00
  SPEAKER_00: So while we need the range of motion, that's really important for sure.
• 11:03
  SPEAKER_00: Alongside that, we need to make sure we have strength.
• 11:05
  SPEAKER_00: And what we mean by that is can our muscles exert force through that range of motion?
• 11:11
  SPEAKER_00: We're talking about the quadriceps and hamstrings to be very specific.
• 11:15
  SPEAKER_00: And so, with that said, we want to make sure can that thing be strong?
• 11:20
  SPEAKER_00: Can it test out to where it needs to be?
• 11:22
  SPEAKER_00: But can we build up that strength over time and build that foundation?
• 11:26
  SPEAKER_00: And then therefore, we can be powerful from that.
• 11:29
  SPEAKER_00: But guess what?
• 11:30
  SPEAKER_00: If we don't have strength, we can't be powerful.
• 11:33
  SPEAKER_00: But if we want to be able to be elastic or being able to be reactive in a sense, we can't do that unless we're powerful and we need to have strength to have power, right?
• 11:45
  SPEAKER_00: So these things kind of build on top of each other.
• 11:48
  SPEAKER_00: So they can't just skip just because time is progressing.
• 11:51
  SPEAKER_00: And that's why we stress so much about strength being the foundation.
• 11:55
  SPEAKER_00: And when there's a clinic that only has weights that go up to 30 pounds, or they're not loading you up very heavy over the period of time through your ACL rehab, that's a problem because it doesn't really develop strength.
• 12:07
  SPEAKER_00: Just because you're doing exercises or it's quote unquote challenging, doesn't necessarily mean that it is building the quality of strength.
• 12:15
  SPEAKER_00: So over time, this goes from maybe those higher repetitions, endurance-based, into more strength-based work.
• 12:23
  SPEAKER_00: And so what this means is that we are looking to get the muscle group stronger from compound lifts, being maybe leg press to squats, lunges, deadlifts, any type of multi-joint movements.
• 12:36
  SPEAKER_00: And then we're also gonna be focusing also on single joint movements.
• 12:40
  SPEAKER_00: So isolated strength for the quadriceps, the hamstrings, the glutes, the calves.
• 12:47
  SPEAKER_00: So those are muscle groups that we're gonna want to make sure we're developing.
• 12:51
  SPEAKER_00: And so this is gonna be really, really key, especially as we get further into the process, that we are potentially decreasing the amount of volume, or maybe it's not, you know, three sets of 10 and it's now becoming three sets of five, but then the intensity is increasing where we only have two reps left in the tank, or maybe one rep left in the tank.
• 13:10
  SPEAKER_00: So we're talking about RPE eight to 10.
• 13:13
  SPEAKER_00: If you don't know what these are, then this is something to look up.
• 13:16
  SPEAKER_00: And then this is also something that I hope we can uh be able to implement.
• 13:20
  SPEAKER_00: And this is what we do with all of our athletes.
• 13:22
  SPEAKER_00: They understand what reps in reserve are, and they understand what RPE or rate of perceived exertion is, because these are going to correlate to intensity.
• 13:31
  SPEAKER_00: So then that way on any given day and training block that we are working with them, they're able to know, all right, well, is my strength increasing?
• 13:39
  SPEAKER_00: This is how I anchored this process and my strength to where it is.
• 13:43
  SPEAKER_00: And this gives us such a good proxy of where they are and where we need to be headed.
• 13:48
  SPEAKER_00: So, all this to say, strength is the foundation for athletic development.
• 13:52
  SPEAKER_00: It literally is going to open the door to so much.
• 13:55
  SPEAKER_00: But if you don't have it there, you're not gonna be able to run, you're not gonna be able to jump, you're not gonna be able to cut, you're not gonna be able to do the things athletically you want to do because strength is such a big, big prerequisite to doing those things because those require power and elasticity and reactivity, like all these things that we want to have, but strength is gonna be such a big component of that.
• 14:18
  SPEAKER_00: Number six, less is more.
• 14:20
  SPEAKER_00: Going back to that example of the laundry list of exercises, or maybe going to the gym every single day for two hours, right?
• 14:28
  SPEAKER_00: Less is more.
• 14:30
  SPEAKER_00: We find that if we can create intention behind every single exercise and reduce down the actual number of things you're doing, and even being in the gym less, then that could be super valuable.
• 14:44
  SPEAKER_00: And what I mean by being in the gym less, this means that maybe you aren't going six, seven days a week.
• 14:50
  SPEAKER_00: Maybe you're only going three to four days a week, and you're being so intentional about that 45 minute to hour-long window you have, even if it's 30 minutes.
• 14:59
  SPEAKER_00: We've had athletes make progress with literally two days a week with only dedicating 30 minutes.
• 15:06
  SPEAKER_00: And now that is very minimum viable as possible, but it's doable as long as the intent is there.
• 15:13
  SPEAKER_00: And we're talking about the the busy, you know, CEO type people who don't really have a lot of time, the moms who, you know, their their schedules are chaotic.
• 15:23
  SPEAKER_00: Um, and so there's not a lot of flexibility within their windows because they're trying to find gaps to work out with managing multiple kids.
• 15:32
  SPEAKER_00: So there are a lot of things in play.
• 15:34
  SPEAKER_00: So, you know, being able to assign this lessons more is such a key principle and heuristic to use because you can just put so much more into every single thing.
• 15:45
  SPEAKER_00: And it's this kind of concept of addition by subtraction.
• 15:48
  SPEAKER_00: So you're actually getting rid of stuff, but you're adding to because you're putting so much value and emphasis into each movement.
• 15:55
  SPEAKER_00: So this is something that you know a lot of times people have to learn the hard way.
• 15:59
  SPEAKER_00: And I think this always comes back to good guidance and program design and your coach deciding, all right, cool.
• 16:05
  SPEAKER_00: This is kind of what you need right now based on the volume and what our goals are, and being able to cut that stuff down as needed just to make sure that you are putting as much intent behind every single movement you're doing.
• 18:22
  SPEAKER_00: Number seven, your quad is the most important muscle.
• 18:25
  SPEAKER_00: Period.
• 18:26
  SPEAKER_00: You guys know this.
• 18:27
  SPEAKER_00: If you've been listening to this podcast, if you are on your first episode, you're probably like, man, this guy's really hitting it hard.
• 18:33
  SPEAKER_00: But the quad is the most important muscle that exists for ACL rehab.
• 18:39
  SPEAKER_00: My number mind will not change for quite a long time because of the number of ACRs I've seen, the ACL process myself, and then just seeing it all the research and what it alludes to, if a quad is weak, you're gonna have problems.
• 18:55
  SPEAKER_00: And the thing is that the quad is the main thing that shuts down.
• 18:58
  SPEAKER_00: We know this through artogenic muscle inhibition and just what exists in this space.
• 19:03
  SPEAKER_00: So if you have to target and literally pick one muscle, you know, even for those quad dominant athletes, you are still needing to target your quads, even though you might be a quad dominant athlete, whoever you know decides on that, maybe.
• 19:18
  SPEAKER_00: But um, with that said, even our most quad dominant athletes that people would say that they are, they still prioritize the quad more than anything because guess what?
• 19:27
  SPEAKER_00: That's the thing that got shot in their ACL rehab, in the in the injury itself, in the surgery.
• 19:34
  SPEAKER_00: So we are prioritizing that thing for the top number one muscle group.
• 19:39
  SPEAKER_00: And also, if you're like, I need to hang one particular muscle group on your mirror that I'm like, that's my number one priority for these next nine to 12 months.
• 19:47
  SPEAKER_00: It is your quad.
• 19:48
  SPEAKER_00: I promise you that if you get your quad really, really, really, really, really, really strong, you will have a very successful outcome for the most part with your ACL rehab.
• 19:58
  SPEAKER_00: Now, hamstrings fall right behind that.
• 20:01
  SPEAKER_00: But with that said, quad is king, as Eric Meter likes to say.
• 20:06
  SPEAKER_00: So, number eight, eat lots of protein and fuel yourself.
• 20:10
  SPEAKER_00: Instead of feeling like you need to be in this caloric deficit, maybe you're moving less, right?
• 20:14
  SPEAKER_00: This is something that we want to make sure you fuel yourself.
• 20:18
  SPEAKER_00: Look at food as fuel, not as calories and you know, good and bad stuff.
• 20:24
  SPEAKER_00: Of course, the stuff's important, but look at it as fuel, right?
• 20:27
  SPEAKER_00: You want to fuel yourself to recover.
• 20:29
  SPEAKER_00: Protein is so key, especially with you know, surgery and recovery, and you're rebuilding muscle back.
• 20:35
  SPEAKER_00: If you don't have enough protein in your body, that is going to be something that it's gonna be pulling from muscle and it's gonna be pulling from other areas to make sure that that calorie that is needed is going to be pulled from the appropriate places, right?
• 20:49
  SPEAKER_00: And so that's gonna also play into you know that recovery process and also your energy and also what you can bring to your workouts.
• 20:56
  SPEAKER_00: So these are all things that are gonna be really important, especially to make sure you dial in your protein along with your other macronutrients.
• 21:03
  SPEAKER_00: Number nine, the timeline is different for every ACLer.
• 21:07
  SPEAKER_00: It is every single ACLer, no one has the exact same timeline.
• 21:12
  SPEAKER_00: And while I tell you it's gonna be at least a nine-month process, you know, we try to give our athletes a good healthy perspective of nine to 12 months.
• 21:20
  SPEAKER_00: There are some people who might be able to get to things earlier, and there might be people who get beyond that, and it takes them, like I said, 16 months, two years.
• 21:31
  SPEAKER_00: It just kind of depends on your own journey, right?
• 21:34
  SPEAKER_00: But just know that even the athlete who had your same procedure, let's even back this up.
• 21:40
  SPEAKER_00: They had the same injury, they had the same exact procedure.
• 21:44
  SPEAKER_00: Let's even just go out on a limb.
• 21:46
  SPEAKER_00: They had a quad autograph, they had a medial meniscus repair, and they had an LET.
• 21:54
  SPEAKER_00: Let's just say they had all those.
• 21:56
  SPEAKER_00: Every single one of you who have had this, you're all gonna have a different process and journey.
• 22:00
  SPEAKER_00: I don't care if the same surgeon even did it.
• 22:03
  SPEAKER_00: So, this is something that I do want you to take this internally, so then that way you don't compare yourself to other people because that is so tough, especially whenever we have, you know, these certain athletes and they see other athletes in the same process.
• 22:19
  SPEAKER_00: You know, it's cool to talk to them and see where they're at.
• 22:22
  SPEAKER_00: But the thing is, you just gotta know you are in your own lane, uh, doing your own thing.
• 22:28
  SPEAKER_00: So your timeline is going to be different compared to other people.
• 22:32
  SPEAKER_00: Number 10, have a clear, structured, and adaptable plan.
• 22:37
  SPEAKER_00: I cannot, cannot stress this enough.
• 22:40
  SPEAKER_00: I'd probably say the number one thing that people reach out to us to work with us remotely is that they feel lost.
• 22:46
  SPEAKER_00: There is no clarity in next steps, they have no structure, they're doing 30 or 40 exercises, or maybe they're just doing, you know, exercises at rehab and then they're coming home and not doing anything.
• 22:57
  SPEAKER_00: And so there's just opportunity costs all around it.
• 23:00
  SPEAKER_00: The other thing is the adaptable plan.
• 23:02
  SPEAKER_00: It's like whenever there is a setback, you know, it doesn't seem like it's adapted, or maybe like live throws some curveballs at you, you get busy, work, school, some sort of emergency comes up, maybe you have to travel for vacation.
• 23:17
  SPEAKER_00: It can be very disruptive.
• 23:19
  SPEAKER_00: And so you need an adaptable plan that's still focused on the goals, and that's where it's really, really important to dial that stuff in.
• 23:26
  SPEAKER_00: I can't stress to you how much structure and having intention behind every single session you do at the clinic or whether you're not at the clinic, outside of the clinic, there needs to be intention behind that.
• 23:37
  SPEAKER_00: And there needs to be structure, there needs to be a rhyme and a reason.
• 23:40
  SPEAKER_00: Our team does not give an exercise out unless there is intention behind it and it's towards a very particular goal.
• 23:47
  SPEAKER_00: We have to have a why behind everything and the way that we structure and build things out for our athletes, whether you're the 14 year old all the way up to the 68 year old, you know, and you're getting back to soccer or you're getting back to jujitsu or skiing, right?
• 24:03
  SPEAKER_00: Like these are All going to have different uh structures.
• 24:06
  SPEAKER_00: A lot of it's based on your goals, but then also, what does your schedule look like?
• 24:10
  SPEAKER_00: What is your time available look like?
• 24:12
  SPEAKER_00: What do things look like for the foreseeable future?
• 24:16
  SPEAKER_00: So we need to make sure that all that stuff is dialed in so we can individualize it to you.
• 24:20
  SPEAKER_00: So that is really important in my personal opinion with working with so many athletes through ACL.
• 24:26
  SPEAKER_00: It's like we can't just give you this blanket templated program or protocol because it has to be built to you to make it as successful as possible.
• 24:35
  SPEAKER_00: Number 11, get really strong before you start running.
• 24:38
  SPEAKER_00: A lot of times people are given the timeline of, you know, you'll start running at 12 weeks.
• 24:42
  SPEAKER_00: And while I would love to think that everyone's being tested and they're using these certain criteria to start running, more likely than not, people are still given the timeline from their surgeon or PT who might not be using uh criteria or using a time-based protocol, and it hits 12 weeks and you're starting to run, right?
• 25:00
  SPEAKER_00: And I think that this is a red flag in my opinion, because that's gonna set you up for failure for a number of reasons.
• 25:07
  SPEAKER_00: But more importantly, is like what is being determined to help you run, right?
• 25:11
  SPEAKER_00: If it's strength and is time included, and there's pre-running plyometrics, there's some capacity testing, basically different assessments to know you're ready to run, not just because time has passed, right?
• 25:23
  SPEAKER_00: So this is something that's really important because you want to really get strong because I truly think that a lot of times what we do is rush the running process because athletes are itching to do this.
• 25:34
  SPEAKER_00: And I know that this is something that is a big important milestone.
• 25:39
  SPEAKER_00: But what if you take the opportunity to delay that a little bit, especially if you don't like running um or don't care to, then maybe just focus on continuing to get as strong as possible.
• 25:49
  SPEAKER_00: I would rather have an athlete delay running for five months and get really freaking strong and get their numbers to you know 80, 90% symmetry versus an athlete who starts running at month three or three and a half, and it's taking them so much longer to get their strength back up.
• 26:05
  SPEAKER_00: Maybe they don't hit 90% symmetry until six to seven months because they've been integrating running, and it's kind of taking away from being able to get strong.
• 26:15
  SPEAKER_00: One thing that I thought was really funny is that I had a consult with an athlete a few weeks ago, and their PT actually told them that they're gonna get stronger by running.
• 26:25
  SPEAKER_00: And I was like, I don't know where they learned that physiology, but running and strength are two very different qualities.
• 26:35
  SPEAKER_00: And if you look at any type of exercise physiology, the way that our bodies develop, it's not even remotely in the same buckets.
• 26:43
  SPEAKER_00: So I thought that was very fascinating to hear because the need for strength, you know, expressing force, a high force against an object, if you will, versus running, which is more of a repetitive endurance-based sport or activity, different energy systems, different demands of force, different movements.
• 27:05
  SPEAKER_00: Um, it just very interesting that that was something mentioned.
• 27:09
  SPEAKER_00: So, anyways, with that said, running will not make you stronger, running will make you better at running.
• 27:13
  SPEAKER_00: Getting strong, you know, I know that's a little bit broad, but you know, getting those muscle grips, as I had mentioned, your quads, hamstrings, calves, compound movements, but especially isolated movements, your leg extension, leg curl, those types of things, game changers, right?
• 27:29
  SPEAKER_00: And you can always anchor this to your unoperated or unaffected side because that's something that's gonna help give you a better proxy of like how you're actually doing.
• 27:37
  SPEAKER_00: If you're doing 60 pounds on the leg extension machine on your unoperated side and you're doing 10 pounds on the operated side, that's not great, right?
• 27:46
  SPEAKER_00: It could be for someone who's just starting out, but if you're in this process and you've been in it, that's not a good deficit to have.
• 27:53
  SPEAKER_00: So instead of building towards running or aggressively getting at running, we want to make sure we close in on that gap.
• 28:01
  SPEAKER_00: And then maybe you start working towards running.
• 28:03
  SPEAKER_00: So to give you a reference point with our athletes, we're probably looking at anywhere from three and a half, probably four months.
• 28:11
  SPEAKER_00: Four months is usually like at least my minimum.
• 28:14
  SPEAKER_00: And then I like to even kick that a little bit further if possible, because then, man, we're able to work on strength a little bit more, work on positions a little bit better, and then they start to notice the running comes back easier, the knee is not as grumpy.
• 28:26
  SPEAKER_00: So this is just something that is my own personal opinion, and our team utilizes a little bit more versus rushing that running process.
• 28:34
  SPEAKER_00: Number 12, your KPI testing should inform your programming.
• 28:38
  SPEAKER_00: What that basically means is you have certain criteria and certain metrics you're aiming towards.
• 28:43
  SPEAKER_00: I hope you are.
• 28:44
  SPEAKER_00: So quad strength, hamstring strength, maybe certain jumping abilities, range of motion, capacity testing side to side with different muscle groups.
• 28:52
  SPEAKER_00: Um, maybe it's just different positional work, but there's KPIs that we're attaching to those things, key performance indicators.
• 28:59
  SPEAKER_00: So basically, this is giving us numbers around this, and we're able to see, all right, well, this is where you are with testing, and this is where we want to be.
• 29:09
  SPEAKER_00: So knowing what that gap is, that's gonna inform our programming.
• 29:13
  SPEAKER_00: And what we call this is serial testing.
• 29:15
  SPEAKER_00: So instead of this being this like big testing, you know, week or this big testing performance at the very end of rehab, um, what people will typically hear is return to sport testing, it should be serial testing.
• 29:27
  SPEAKER_00: So it should be basically once you clear that eight to 12 week mark, roughly, there's serial testing.
• 29:33
  SPEAKER_00: What I mean is there's regular testing involved at least every four to six weeks of measuring different components of range of motion, strength, power, different dynamic abilities, things of that nature.
• 29:45
  SPEAKER_00: And so what that's gonna do is help inform okay, well, what's our gap or what are our rate limiting factors that are going to be the things that will allow us to kind of step into the next phase of our rehab?
• 29:57
  SPEAKER_00: So a lot of times this is quad strength.
• 29:59
  SPEAKER_00: Um, and so this is something that we're gonna keep working on, right?
• 30:02
  SPEAKER_00: Um, maybe it's a certain contraction type or a speed of a contraction type.
• 30:06
  SPEAKER_00: Um, maybe it is certain positions based on just some pain that you've been dealing with, or maybe things that you've been avoiding.
• 30:13
  SPEAKER_00: So there are a bunch of different areas that you can assess.
• 30:16
  SPEAKER_00: But with that said, the only way you're going to know your programming is individualized and dialed in is only through testing.
• 30:23
  SPEAKER_00: So that should happen.
• 30:25
  SPEAKER_00: Test to allow that to inform your structure and programming.
• 30:29
  SPEAKER_00: And then you're going to kind of repeat that process, right?
• 30:32
  SPEAKER_00: Um, Matt Jordan, great sport scientist, strength coach, uh, researcher.
• 30:38
  SPEAKER_00: He has this feedback loop where it's determine what matters, measure what matters, change what matters.
• 30:44
  SPEAKER_00: And we use that so internally within our system as a team and teach to our mentees because it's the truth.
• 30:50
  SPEAKER_00: We need to know what matters, we need to measure it somehow, and then we need to change it.
• 30:54
  SPEAKER_00: And then there's a feedback loop to come back around.
• 30:56
  SPEAKER_00: Is this thing still important?
• 30:58
  SPEAKER_00: Usually, if it's a rate limiting factor or a bottleneck, we're gonna keep working at it.
• 31:02
  SPEAKER_00: And then we're gonna keep measuring it to see objectively, is it getting better?
• 31:07
  SPEAKER_00: And so that's what's so key through this process is having these feedback loops and a dialed-in framework to make sure we continue to inform our programming.
• 31:16
  SPEAKER_00: And at the end of the day, this is all stuff to get you back to the thing.
• 31:19
  SPEAKER_00: That's what's most important, and that's what's gonna help us dial in our processes.
• 31:24
  SPEAKER_00: Number 13, it's normal to have a setback.
• 31:27
  SPEAKER_00: I can't tell you the number of setbacks I had through my own two ACL rehabs.
• 31:32
  SPEAKER_00: It sucked.
• 31:32
  SPEAKER_00: I remember one time my hamstring popped while I was doing some sort of knee flexion, hamstring work, and I thought I was back to square one.
• 31:40
  SPEAKER_00: And it did set me back for a little bit.
• 31:42
  SPEAKER_00: I had a hamstring string, but I also had a hamstring graph.
• 31:45
  SPEAKER_00: So my hamstrings were working overtime.
• 31:47
  SPEAKER_00: Um, they weren't able to pull a max capacity.
• 31:50
  SPEAKER_00: And so, guess what?
• 31:51
  SPEAKER_00: I had to, you know, kind of take a step back, if you will, in order to allow that thing to do its thing and heal.
• 31:59
  SPEAKER_00: But there are a number of things that can come up, right?
• 32:02
  SPEAKER_00: And I want to normalize this.
• 32:04
  SPEAKER_00: I think a lot of people feel like they're failures if they haven't hit a certain time target, or especially if some sort of setback happens.
• 32:11
  SPEAKER_00: We are dealing with the human body, people.
• 32:14
  SPEAKER_00: You had an injury that just honestly really threw some confusion into the knee and the brain and the spinal cord and all these things that can change from locally to globally in your body, right?
• 32:26
  SPEAKER_00: So give yourself a little bit of grace here.
• 32:28
  SPEAKER_00: You also probably had a surgery if you went this route, um, reconstruction or repair, whatever that might be.
• 32:35
  SPEAKER_00: So then there's also another altered state of the knee.
• 32:38
  SPEAKER_00: And so now you're dealing with this knee that is a little different than what it was that you were born with.
• 32:44
  SPEAKER_00: And so it's normal for your body to maybe not react normal.
• 32:49
  SPEAKER_00: And it's also normal for our plans to not necessarily be so perfect where it allows the knee to respond in such a perfect way that you'll never have a setback.
• 33:01
  SPEAKER_00: It's just not the reality of the way our lives exist, the way these surgeries are, the way that um muscles respond, joints respond.
• 33:08
  SPEAKER_00: Um, you're taking a tendon and turning it into a ligament.
• 33:12
  SPEAKER_00: So there's so many different things going on.
• 33:15
  SPEAKER_00: And so, with that said, it's normal to have a setback.
• 33:19
  SPEAKER_00: And so the most important thing is to make sure you have an adaptable plan, going back to that point earlier, that when that setback occurs or something comes up, you can have a redirection back onto the the right plan, right?
• 33:32
  SPEAKER_00: And so that's what's really key here.
• 33:34
  SPEAKER_00: I always tell athletes, it's like, you know, you're you're on the road, you got your GPS, and maybe there's some sort of roadblock, right?
• 33:41
  SPEAKER_00: Well, maybe there's a detour you got to take, but there's options for detours, right?
• 33:45
  SPEAKER_00: You could take a really long way around, or you could take a really, really short way.
• 33:49
  SPEAKER_00: Hopefully, you just get off the interstate and you get right back on, right?
• 33:52
  SPEAKER_00: So that's the goal we're trying to do with uh roadblock here is that we're trying to make sure that people can get back on track and handle these setbacks in a more time-sensitive situation and be as efficient as possible.
• 34:07
  SPEAKER_00: Number 14, run your own race.
• 34:11
  SPEAKER_00: Run your own race.
• 34:13
  SPEAKER_00: This goes back to the point of everyone's timeline is different.
• 34:16
  SPEAKER_00: Comparison is literally the thief of joy, and this ACL process will rob you of that.
• 34:21
  SPEAKER_00: If you start watching other people, comparing yourself to other people, the same person who had the same procedure, the same week as you, and they're doing quote unquote better or they're ahead.
• 34:32
  SPEAKER_00: Run your own race because you are the only person you need to compete against.
• 34:37
  SPEAKER_00: And last but not least, celebrate the small wins.
• 34:40
  SPEAKER_00: Now, I talked to you guys about the honeymoon phase.
• 34:43
  SPEAKER_00: You're gonna have more small wins there because you're gonna be making progress on your flexion, hopefully, your extension, you're getting off the crutches, you get that first bike cycle, right?
• 34:52
  SPEAKER_00: That revolution.
• 34:54
  SPEAKER_00: Um, you're starting to take the stairs, you can drive yourself around, all these things that open up the door, right?
• 34:59
  SPEAKER_00: So you feel like week to week to week, you're making those wins.
• 35:03
  SPEAKER_00: And then there becomes a certain point where it kind of has these gaps in between, right?
• 35:08
  SPEAKER_00: So it's harder to measure or see that week to week because your life is less impacted.
• 35:12
  SPEAKER_00: You don't notice maybe the five-pound gain on your knee extension, right?
• 35:16
  SPEAKER_00: But that's a huge win, right?
• 35:18
  SPEAKER_00: And so I encourage you to celebrate the small wins.
• 35:21
  SPEAKER_00: And if you're like, I don't really have any wins, come on.
• 35:24
  SPEAKER_00: Now, if you're doing the thing and if you're working hard, I really encourage you to look at this past week, even today, and be like, what is one small win that I had, right?
• 35:34
  SPEAKER_00: It could be literally I made it to the gym.
• 35:37
  SPEAKER_00: And the past few days I would haven't wanted to, but today I made it to the gym, right?
• 35:42
  SPEAKER_00: Maybe it's you worked out for 30 minutes instead of an hour, right?
• 35:45
  SPEAKER_00: Like it's any little thing that is going to help create that momentum in the right direction.
• 35:52
  SPEAKER_00: And it's basically focusing on being never zero, right?
• 35:55
  SPEAKER_00: You just don't ever want to be zero.
• 35:57
  SPEAKER_00: You just want to have, even if it's just the smallest degree of momentum in the right direction, that's what those wins are and what you're showing up for to get back to the thing you love to do, right?
• 36:07
  SPEAKER_00: And so we just want to make sure our momentum never hits zero.
• 36:11
  SPEAKER_00: So that's where I think celebrating the small wins, even if you are in your last week of this process, celebrate that small win, whatever it is, and literally list that stuff out.
• 36:21
  SPEAKER_00: Maybe you want to list it on your phone, put a reminder in your phone of being like, What's my small win today?
• 36:27
  SPEAKER_00: Um, some gratitude moments I think are so helpful as humans because it's easy to get trapped into, oh, well, like, you know, this isn't as ideal or not perfect, or you know, I'm not necessarily seeing any progress, which can happen all the time in ACL rehab.
• 36:43
  SPEAKER_00: So if you're an ACL or listen to this, I hope that this is helpful to go through this stuff because it is really key.
• 36:51
  SPEAKER_00: I wish someone had told me this stuff in my ACL rehab.
• 36:54
  SPEAKER_00: That's why these are 15 timeless reminders I wish I had during mine, because I know that if I was reminded of these things, I can zoom out for a second and be like, all right, do I feel like I have this stuff dialed in?
• 37:05
  SPEAKER_00: What areas could I potentially work on to be able to move the needle in, right?
• 37:11
  SPEAKER_00: And so those 15 points are number one, expectations are everything.
• 37:16
  SPEAKER_00: Number two, it's long, manage burnout early.
• 37:19
  SPEAKER_00: Number three, it's okay to take a short break.
• 37:21
  SPEAKER_00: Number four, master the basics very, very well.
• 37:25
  SPEAKER_00: Number five, strength is the foundation for athletic development.
• 37:28
  SPEAKER_00: Number six, less is more.
• 37:30
  SPEAKER_00: Number seven, your quad is the most important muscle.
• 37:34
  SPEAKER_00: Period.
• 37:34
  SPEAKER_00: Number eight, eat lots of protein and fuel yourself.
• 37:37
  SPEAKER_00: Number nine, the timeline is different for every ACLer.
• 37:41
  SPEAKER_00: Number 10, have a clear, structured, and adaptable plan.
• 37:45
  SPEAKER_00: Number 11, get really strong before you start running.
• 37:48
  SPEAKER_00: Number 12, your KPI testing should inform your programming.
• 37:52
  SPEAKER_00: Number 13, it's normal to have a setback.
• 37:55
  SPEAKER_00: Number 14, run your own race.
• 37:58
  SPEAKER_00: And number 15, celebrate the small wins.
• 38:02
  SPEAKER_00: I hope this was helpful, guys.
• 38:04
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• 38:05
  SPEAKER_00: If it was, leave us a review.
• 38:08
  SPEAKER_00: Um, five stars on Spotify go a long way.
• 38:11
  SPEAKER_00: Um, it helps us to reach more and more ACLers.
• 38:15
  SPEAKER_00: If you're on Apple Podcasts, just leave us a five-star review.
• 38:19
  SPEAKER_00: Super helpful, and we are so appreciative of any love that we get and any of the messages.
• 38:24
  SPEAKER_00: I appreciate all of you who send me emails, messages.
• 38:27
  SPEAKER_00: I read and save every single one of those and respond back.
• 38:30
  SPEAKER_00: So thank you all so much for just being so supportive of this podcast and our general mission.
• 38:37
  SPEAKER_00: I'm gonna sign off here.
• 38:39
  SPEAKER_00: Appreciate all of you for listening and your ongoing support.
• 38:43
  SPEAKER_00: This is your host, Ravi Patel, signing off.