Latest / The ACL Athlete Podcast / 257 | Stuck in ACL Rehab: Why So Many ACLers Fall Through the Cracks

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257 | Stuck in ACL Rehab: Why So Many ACLers Fall Through the Cracks · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:07
  SPEAKER_00: So we are at the end of 2025.
• 1:12
  SPEAKER_00: And I wanted to come on here and share something that I consistently see.
• 1:18
  SPEAKER_00: And it's something that I really want to set the tone for 2026.
• 1:22
  SPEAKER_00: If you're listening at the end of this year, you will actually catch this in 2026 when it releases on January 1st.
• 1:31
  SPEAKER_00: And so even if you're catching this later on in 2026, maybe it's 2027 or 2028, you're listening to this.
• 1:38
  SPEAKER_00: I hope that this still resonates and it should.
• 1:41
  SPEAKER_00: Now, the thing that I consistently see, and the focus of this is the ACLers who fall through the cracks.
• 1:50
  SPEAKER_00: And I know many of you will resonate with this episode because it is honestly majority.
• 1:56
  SPEAKER_00: And it's something that I wanted to share because at this point I've consulted with thousands of ACLers at this point.
• 2:02
  SPEAKER_00: And so I just want to kind of share a general theme that I'm familiar with, just being in the healthcare space, being a PT, going through ACL rehab myself twice, but then also just knowing what insurance does for the landscape of healthcare and the system, and knowing honestly what that's going to look like in 2026, which is absolutely just sad for us to even think about.
• 2:29
  SPEAKER_00: I know with premiums and where we land with healthcare, especially here in the US.
• 2:33
  SPEAKER_00: I feel like people in other countries, if you are not in the US and you have a socialized system while you do wait for your care, you probably also laugh at the fact that we just basically take out mortgages for healthcare premiums here in the US, and it is absolutely wild.
• 2:49
  SPEAKER_00: But I'm not going to get on this tangent here, but I do know that that is going to influence a lot of people because limits on visits are coming down even more.
• 2:58
  SPEAKER_00: We're seeing even higher co-pays, we're seeing less coverage and more denials.
• 3:03
  SPEAKER_00: And so I just want to prep you for 2026 or whenever you listen to this.
• 3:08
  SPEAKER_00: But then also, and it's just a matter of when, not if.
• 3:13
  SPEAKER_00: And so I think that that's going to be really important.
• 3:15
  SPEAKER_00: But I want to run through what I consistently see through for these A scalers who fall through the cracks, especially here in the US system, but honestly, it's everywhere.
• 3:24
  SPEAKER_00: We work with people all over the world remotely.
• 3:27
  SPEAKER_00: We see this in Canada, we see this in Europe, we see this in the NHS, we see this in Australian systems, like we see it all over the world, y'all.
• 3:34
  SPEAKER_00: And so the thing is, is like no healthcare system is perfect, but the thing is that in general, physio is not set up well to take care of these long-term rehabs.
• 3:44
  SPEAKER_00: And the thing is, we don't get trained for this in school very well, as I've shared before.
• 3:49
  SPEAKER_00: We come out generalists just like a primary care med would be.
• 3:53
  SPEAKER_00: You don't want them to be treating you for some sort of neurological condition or for some sort of cardiology-based condition.
• 4:01
  SPEAKER_00: Like the thing is that we need to go to specialists.
• 4:04
  SPEAKER_00: And I truly believe that in ACL rehab that you need specialized care because the risk is just too high.
• 4:12
  SPEAKER_00: The reinjury rates are too high.
• 4:13
  SPEAKER_00: When we're talking about 20 to 30% are going to go under re-injure, it's just way too high for us guys.
• 4:19
  SPEAKER_00: And so this is why I really do think having specialized care is so important.
• 4:24
  SPEAKER_00: And so this is why I'm also wanting to share with you guys how the process can look and how people fall through their cracks.
• 4:31
  SPEAKER_00: And then, therefore, you guys can make the best decision on the timing of things and also be prepared.
• 4:38
  SPEAKER_00: So you might be early in this process and you might be post-ACL injury, you might be in prehab, you might be post-surger.
• 4:46
  SPEAKER_00: And so I want you to be prepared for this.
• 4:48
  SPEAKER_00: But even if you are three months out, six months out, nine months out, honestly, you are the people who are going to resonate with this more versus the people who are early on because you might not see this yet.
• 4:59
  SPEAKER_00: And so this is the most common path majority of ACLers will go through.
• 5:04
  SPEAKER_00: You will have the ACL injury, and then you know you'll go through the process of getting some imaging and seeing your ortho and trying to see if that ACL is torn, typically is diagnosed via the MRI, and then therefore you're able to say, okay, now I'm gonna prepare for surgery.
• 5:21
  SPEAKER_00: You may not go the surgical route, but majority of people will.
• 5:24
  SPEAKER_00: And so if you don't go the surgical route, then honestly, this still applies, but with majority going through surgery, we're just gonna take this as the main example.
• 5:34
  SPEAKER_00: Now, between ACL injury and surgery, you may do prehab, which is just doing rehab to get you ready for the surgery and to be at a better baseline.
• 5:44
  SPEAKER_00: And so you may do weeks of that, you may not do any of it.
• 5:47
  SPEAKER_00: There are plenty of people we see who go to surgery within two weeks, three weeks, they may not have the visit access or get into PT early enough, and the surgery is soon after.
• 5:58
  SPEAKER_00: So let's just say ACL injury, you may do prehab, you have the ACL surgery, and then your true physio physical therapy starts, right?
• 6:07
  SPEAKER_00: And what we typically see is that people will stay consistent, especially for the first four weeks, eight weeks, maybe even 12 weeks.
• 6:17
  SPEAKER_00: That first three-month mark, people are a little bit more on top of it.
• 6:22
  SPEAKER_00: You see progress during that period of time, it's rare that people don't see any progress.
• 6:29
  SPEAKER_00: Even the worst physical therapists will help you see progress because, as I've shared, because you're so early in this process that you're so constrained.
• 6:39
  SPEAKER_00: So that means your leg is straight as you come out of surgery.
• 6:42
  SPEAKER_00: So you're naturally just gonna get some knee bending and you're gonna get some quads to wake up.
• 6:47
  SPEAKER_00: You're maybe gonna get out of that brace if you have a brace.
• 6:50
  SPEAKER_00: So every day and every week, you might see some progress, especially for the first eight weeks.
• 6:55
  SPEAKER_00: I would say people are consistently seeing some type of progress week to week.
• 6:59
  SPEAKER_00: You might get that brace off, you might get off of two crutches and go to one crutch, and then maybe off full crutches.
• 7:05
  SPEAKER_00: You're able to drive again, you're able to take stairs, even if you got to take them slowly.
• 7:10
  SPEAKER_00: You are able to walk a certain amount of distance.
• 7:13
  SPEAKER_00: Maybe you're limping, but hey, it's better than what you were days one, two, and three post-op, right?
• 7:19
  SPEAKER_00: So you're gonna see progress throughout it.
• 7:21
  SPEAKER_00: And so that's something really important to note because it's harder to discern very good physical therapy until you get further out in the process.
• 7:31
  SPEAKER_00: But what people will do is they'll typically change their lives up as their post-op because you know, you have a surgery, you may take off work, you may take off school, but you essentially move your life around to be prepared for especially that first week, two weeks, and I mean, some people do four to eight weeks, right?
• 7:47
  SPEAKER_00: Depending on the timing.
• 7:49
  SPEAKER_00: So your life is built around this a little bit better.
• 7:51
  SPEAKER_00: So then life is not throwing a ton of things at you.
• 7:54
  SPEAKER_00: Then, of course, as time goes on, one your progress day to day is a little less.
• 8:00
  SPEAKER_00: As you get beyond, you know, that two month, three-month mark, it starts to slow down a little bit.
• 8:06
  SPEAKER_00: You're not seeing nearly as much wins every single day compared to how it was the first week, two weeks, three weeks, and so on.
• 8:13
  SPEAKER_00: And so that's really important.
• 8:15
  SPEAKER_00: And then also, as you go on, the reality of good PT will truly start to show up at months three, four, and on because you're not seeing that progress as much.
• 8:31
  SPEAKER_00: And so that makes things a little challenging early on in the process.
• 8:36
  SPEAKER_00: And so, what will also happen as you progress through this is that the time will go on.
• 8:43
  SPEAKER_00: You will eventually reduce the frequency of PT.
• 8:46
  SPEAKER_00: This is just the natural behavior of what we see is that you might start two to three times a week if you're here in the US based on your insurance visits, even other places, it just kind of depends on what the setup is.
• 8:59
  SPEAKER_00: We've seen the high frequency stuff, if it's included, it could be every two weeks if you're in certain NHS um regions or depending on like the way that is set up.
• 9:09
  SPEAKER_00: But with that said, you'll typically see higher frequency early on post-op.
• 9:14
  SPEAKER_00: And then as time goes on, usually your insurance has a limitation.
• 9:19
  SPEAKER_00: It might be 20 visits, it might be 30 visits, it might be 50 visits, it might be 100 visits, right?
• 9:26
  SPEAKER_00: And the other thing that is also going to be important is is it deemed medically necessary?
• 9:31
  SPEAKER_00: So once you hit a certain limit, or after you get to a certain amount of visits used that are provided, you actually may get denied, or you may also have to reapply for more visits and deem them medically necessary.
• 9:44
  SPEAKER_00: So then that might be from the doctor, it might be from the physical therapist.
• 9:48
  SPEAKER_00: And so it's just this game that's played with insurance, especially to say, hey, this is medically necessary.
• 9:55
  SPEAKER_00: We just had an athlete sign up working with us remotely, and she actually had 60 visits, but she got cut off at 30 because of the insurance company basically said you this is no longer medically necessary.
• 10:07
  SPEAKER_00: So even though her plan and premium she's paid into accounts for 60 visits, they said we're cutting you off at 30 because they think that she doesn't need them anymore because she can walk and she can do her daily tasks.
• 10:22
  SPEAKER_00: But as we know, ACLers are not here because they want to just walk and do daily stuff like go to the bathroom, go to take a shower, to take the stairs.
• 10:33
  SPEAKER_00: No, you want to use your body athletically and to be able to go back to doing the thing that you love.
• 10:38
  SPEAKER_00: And so, guess what?
• 10:40
  SPEAKER_00: You might not get the coverage for that.
• 10:41
  SPEAKER_00: And so I think that this is important to consider because that frequency of PT will typically just reduce.
• 10:48
  SPEAKER_00: So it'll go three times a week, and then over time it'll eventually reduce to two times a week.
• 10:52
  SPEAKER_00: And then what we typically see is that people will go once a week, or maybe it's once every other week.
• 10:58
  SPEAKER_00: It just kind of depends on how that's structured with the PT.
• 11:02
  SPEAKER_00: So then what that means is that as the time goes on in this process, you've reduced the amount of PT you're going to in person, and you end up having to do more on your own.
• 11:13
  SPEAKER_00: So you might be going to the gym, you might be doing your own training, you know, you're trying to mimic some of the things you're doing at PT.
• 11:19
  SPEAKER_00: And as I had shared, a lot of this could be due to the insurance limitations or just naturally in physical therapy, the physical therapists will reduce that.
• 11:28
  SPEAKER_00: I'm seeing that with a ton of our athletes where they're no longer in this early 12-week process.
• 11:33
  SPEAKER_00: So they're reducing down the amount of visits they're getting per week.
• 11:37
  SPEAKER_00: And so what we are doing is we're filling in that gap for whenever they don't have the PT in person to make sure that they're getting a comprehensive look at what their week looks like.
• 11:49
  SPEAKER_00: But for the people who don't have that support, you know, if you're reducing your frequency, you're kind of left to your own vices of what you need to be doing outside of PT.
• 11:59
  SPEAKER_00: And so that's the challenge here.
• 12:01
  SPEAKER_00: And sometimes it can be due to just a limitation of skill set as well.
• 12:05
  SPEAKER_00: They're like, well, we're kind of doing the same stuff, so you might as well just reduce your frequency and do some of the stuff at home so we don't burn through your insurance.
• 12:12
  SPEAKER_00: But that's not the way to go in this.
• 12:15
  SPEAKER_00: And the most important thing is that you're left figuring out how to piece things together.
• 12:20
  SPEAKER_00: You get the PT session, maybe that once a week, or maybe it's once every other week.
• 12:24
  SPEAKER_00: And then you're piecing together workouts, you're trying to find stuff online that might look good, and then you're trying to figure out how to build these sessions yourself, in addition to maybe the PT that you're getting once or even twice a week, if that.
• 12:38
  SPEAKER_00: And so the thing that's hard is it's periodic.
• 12:41
  SPEAKER_00: So, you know, the frequency will influence things a lot, like one time per week, once every other week, maybe one time per month.
• 12:49
  SPEAKER_00: But the thing is you're not really sure what exercises to do, the reps, the cess, the intensity, and especially the structure.
• 12:56
  SPEAKER_00: We have a lot of people who come in who are like, I've been doing 20 exercises at home.
• 13:01
  SPEAKER_00: Um, and then they'll go to in-person PT and do some other stuff, and maybe some of those exercises.
• 13:05
  SPEAKER_00: And so when they get to the these points where you know there's less frequency or less specific guidance, especially outside of the sessions, they're just kind of left with this long laundry list of 15 exercises, 20 exercises, and they're doing them.
• 13:22
  SPEAKER_00: So we've had people who are doing two hours worth of straight leg raises and all the other post-op stuff, and they're four or five months out, y'all.
• 13:30
  SPEAKER_00: That has run its course in the first, honestly, like week or two.
• 13:34
  SPEAKER_00: Like there's no need for that to carry on because you need to move on to harder stuff to be able to challenge your leg.
• 13:40
  SPEAKER_00: And so that's the thing that we very consistently see is that people just don't have the structure and the reduced frequency of PT.
• 13:48
  SPEAKER_00: And so you're left figuring it out on your own.
• 13:50
  SPEAKER_00: You're doing the DIY, do it yourself, ACL rehab, and trying to kind of put it all together.
• 13:57
  SPEAKER_00: Some stuff you see, some of the stuff at PT you were doing and maybe are still doing, and then just doing some gym stuff that you feel like would be targeting the right stuff, right?
• 14:07
  SPEAKER_00: The thing is that you just kind of feel guilty, but you also feel stuck.
• 14:11
  SPEAKER_00: But just remember, it's not your fault, and it's more so of the system's fault, and it's not fair to you, and I hate that.
• 14:21
  SPEAKER_00: And ACLers will do this for weeks and weeks and weeks and months and months and months to no end, with little to no improvement.
• 14:29
  SPEAKER_00: And often what will happen is that they'll follow this cycle of they'll do their workout, they may get a little bit of knee pain or swelling, they may trial the running, even though they're not necessarily ready, but the time feels like it's ready to do that or time to try start jumping, but they're not prepared for it yet.
• 14:48
  SPEAKER_00: But they're just like figuring it out, right?
• 14:49
  SPEAKER_00: That's what you're doing.
• 14:51
  SPEAKER_00: So you'll go through the workout, you might induce some pain or swelling, but then you might have to take a little bit of a break because it it builds up too much.
• 14:58
  SPEAKER_00: So then you rest.
• 15:00
  SPEAKER_00: You're like, okay, I'll rest and like reset.
• 15:02
  SPEAKER_00: But then you get stuck in this cycle of repeating.
• 15:05
  SPEAKER_00: So then you work out again, you get the pain or the swelling, or you do the activity and then you rest, and then it resolves.
• 15:11
  SPEAKER_00: So it always feels like this one step forward, one step back, one step forward, one step back.
• 15:16
  SPEAKER_00: And sometimes it's like one step forward, two steps back, right?
• 15:19
  SPEAKER_00: It rarely ever feels like this positive momentum that you're building towards the thing in a very gradual way, and you're getting there, right?
• 15:28
  SPEAKER_00: It's just kind of like feeling like you're the way I kind of think of it is like you're almost in this like rocking horse.
• 15:32
  SPEAKER_00: You're just kind of rocking, there's movement, but it doesn't necessarily mean that you're moving anywhere.
• 15:37
  SPEAKER_00: And so this is the thing that's really challenging in this process.
• 15:40
  SPEAKER_00: And so then once you get to maybe the six-month mark, maybe it's at eight months or nine months, maybe it's even at 12 months.
• 15:47
  SPEAKER_00: Let's just say that if we have a good surgeon here.
• 15:50
  SPEAKER_00: And you have your last surgeon follow up and they clear you and tell you to quote unquote ease back into it.
• 15:57
  SPEAKER_00: Time has elapsed based on their kind of association of like how long this process should be.
• 16:03
  SPEAKER_00: They don't necessarily test or do anything.
• 16:05
  SPEAKER_00: They do the Lockman test on the table.
• 16:07
  SPEAKER_00: They may push their hand against your leg to kick out to see the quad strength, which is not a test of quad strength, but they're just kind of doing the thing that it they can do within a 10 by 10 treatment room, right?
• 16:19
  SPEAKER_00: Not very big.
• 16:20
  SPEAKER_00: They have limited time with you, and they've basically gauged, okay, you're at this certain time point, so you should be at least decent and good to go.
• 16:29
  SPEAKER_00: And if there's no major things like swelling or pain, or like you're not restricted in range of motion significantly, and you're at that like nine, twelve month mark, they're kind of also at their limit of what they can provide for you.
• 16:41
  SPEAKER_00: So then they're gonna be like, all right, well, no need to come see me again, and we'll tell you just kind of ease back into your activities.
• 16:48
  SPEAKER_00: So now you're in a tough spot because you've had this provider, the surgeon, especially the person who people assume make all the calls in this process, tell you you've been cleared, right?
• 17:01
  SPEAKER_00: But in your gut, you know you don't feel the same as you did pre-injury, and you don't feel ready.
• 17:08
  SPEAKER_00: Like whatever your goal was set, whether it's skiing, running, being able to get back to CrossFit, being able to play soccer, basketball, ultimate, whatever it may be, you know that if you were looking at that sport right in front of you and someone handed you some skis, or if someone gave you a soccer ball and there was a competitive match in front of you, you would not feel ready to do it.
• 17:32
  SPEAKER_00: Even though you've been cleared and they may have said ease into it, you're like, Well, but where do I start?
• 17:37
  SPEAKER_00: Right.
• 17:37
  SPEAKER_00: But it's this like momentary win that feels good because you hear it from someone who you know did the surgery, or maybe it is the PT who told you this, they didn't do any testing, but you have this momentary win where you're like, I'm there.
• 17:52
  SPEAKER_00: But in your gut, you know you're not ready and you don't feel that, but you do trust their word on it because you're like, well, I mean, they are they're professional.
• 17:59
  SPEAKER_00: I mean, who else can I really lean on to trust?
• 20:07
  SPEAKER_00: And I can say that this is crazy how common this path is.
• 20:13
  SPEAKER_00: And there's probably some of you listening who are like, this is crazy how much I just shared your specific path.
• 20:20
  SPEAKER_00: And if you're again early on in this process, or maybe you have amazing care and excellent care and expertise, then either you're not there yet, or you do have just amazing guidance.
• 20:32
  SPEAKER_00: So then, therefore, none of this applies to you because you have someone who's taking you through this whole process step by step as a GPS, right?
• 20:39
  SPEAKER_00: But this is not the common path for people.
• 20:42
  SPEAKER_00: The common path is what I just explained of you know, early on, there's focus, there's reduced frequency as time goes on, and then you're kind of left to picking up the pieces and figuring it out on your own.
• 20:51
  SPEAKER_00: And so that is just the nature of the system of the way ACL rehab currently is.
• 20:57
  SPEAKER_00: And so the thing is that when people are like, why are there so many reinjury rates?
• 21:03
  SPEAKER_00: It's a loaded question, but when I specifically talk about re-injury rates, not your first ACL tear, but your second, third, fourth, god forbid, a fifth, these are the main reasons why this happens, is because it's just the way that it is designed.
• 21:20
  SPEAKER_00: There is no testing, there's no individualization of this process.
• 21:24
  SPEAKER_00: We talk about even graph types of how different the rehab needs to look for a quad hamstring versus a pateller versus an allograft.
• 21:31
  SPEAKER_00: It's crazy, y'all.
• 21:32
  SPEAKER_00: Like there's so many differences that we are gonna put into play based on the graph types.
• 21:37
  SPEAKER_00: And so that's where people's timelines are gonna look different, the progressions are gonna look different.
• 21:42
  SPEAKER_00: And so we need to make sure we test, individualize the process in order to know how people are doing and when they're cleared to be ready for certain criteria.
• 21:52
  SPEAKER_00: And that's the thing that's gonna be important.
• 21:54
  SPEAKER_00: It's not timeline based, it's based on criteria, based on objective tests, based on what the research clearly shows objectively what reduces the risk of another ACL reinjury.
• 22:05
  SPEAKER_00: And we're just not there yet.
• 22:07
  SPEAKER_00: But this is why the reinjury rates continue to occur because people are kind of left to this, they're given a little bit of guidance to ease back into things, but there's no true testing, no assessment.
• 22:17
  SPEAKER_00: It's kind of like having a medical doctor who is a surgeon and not take any board exams and just be like, oh, cool, like you can do surgery now, or you know, you go take your driver's test, but you don't actually take it, but you can get in your car and you can go drive.
• 22:33
  SPEAKER_00: That's essentially kind of how crazy this is.
• 22:36
  SPEAKER_00: But it's just this process of ACL rehab that just makes people think that they're better than they are, or just kind of left to being like, okay, I'm all right, I can figure this out on my own.
• 22:46
  SPEAKER_00: And that's because it is the domain of health and fitness more than anything, it's your body and it's activities.
• 22:53
  SPEAKER_00: So then as time passes, you feel this ownership of like, oh, well, I can just kind of figure it out.
• 22:58
  SPEAKER_00: But in reality, it should be this guided path from start to finish, and there should be testing points and objective data taken periodically through the process, and there's no one who can get past this, no one at all.
• 23:11
  SPEAKER_00: Um, and that's why pro athletes this happens too, and that's why re injuries happen because maybe they didn't get assessed as well, and there are other factors that of course play into this, but this is kind of what makes me sad, and honestly, it just pisses me off.
• 23:24
  SPEAKER_00: And I wanted to share this with you guys because I've just had too many conversations, too many, and I have people DMing me all the time about stuff that they're dealing with that could be avoided.
• 23:37
  SPEAKER_00: But my point in this is I want to share what's the common path because you just don't know what you don't know.
• 23:43
  SPEAKER_00: And after fueling so many conversations and being in this world and making this my life mission, that I am so dedicated to that this is the way that often it will go.
• 23:53
  SPEAKER_00: Not everyone, but often.
• 23:56
  SPEAKER_00: And so that's why I'm gonna say when you're listening to this, if you've made it this far, that you're gonna be better than this.
• 24:04
  SPEAKER_00: You know better, you're listening to this podcast, you're listening to this episode, and so you are going to be better than this, and you are not going to be one that falls through the cracks.
• 24:12
  SPEAKER_00: And because of our system, because of insurance, because of bad care, because you deserve better.
• 24:17
  SPEAKER_00: Now, let me explain how you're gonna look for this and how this is going to change for you in the coming year, 2026, or whenever you listen to this.
• 24:26
  SPEAKER_00: You need to look out for red flags.
• 24:29
  SPEAKER_00: It's huge.
• 24:31
  SPEAKER_00: And the thing is, is that when you start to think about, especially, and I know I keep coming back to US healthcare and the insurance, is that people feel like insurance owes them something.
• 24:44
  SPEAKER_00: It's like, well, does my insurance cover it?
• 24:46
  SPEAKER_00: And I get it.
• 24:47
  SPEAKER_00: You guys, we pay into it.
• 24:48
  SPEAKER_00: We have paid, if I could tell you guys, we have paid over$40,000 in medical costs this year.
• 24:54
  SPEAKER_00: $40,000.
• 24:56
  SPEAKER_00: It's crazy, y'all.
• 24:57
  SPEAKER_00: And we also, that's not even on top of our insurance premium we pay, which is absurd for a family of three now, four.
• 25:04
  SPEAKER_00: And so the thing is, y'all, is that we're waiting for insurance to owe us something, but at the end of the day, you pay premiums and then you expect them to cover something, but then they're so quick to deny things or to say this is not medically necessary anymore.
• 25:19
  SPEAKER_00: And so these are the things that we just need to be mindful of in this process.
• 25:24
  SPEAKER_00: And I have people who are like, well, I gotta, you know, really look at my costs and everything.
• 25:28
  SPEAKER_00: And I get that.
• 25:29
  SPEAKER_00: Life is expensive.
• 25:30
  SPEAKER_00: The current climate of things, it's expensive as hell, y'all.
• 25:33
  SPEAKER_00: But at the same time, your health is such an investment.
• 25:37
  SPEAKER_00: I can't think of anything better to spend money on than your health.
• 25:41
  SPEAKER_00: People sit with phones in their pockets and computers and they spend$1,000 on these and they're like, man, I just can't budge to pay for this session, right?
• 25:50
  SPEAKER_00: And it's just kind of crazy to me sometimes when the scope of certain sessions versus the value of their goals, especially the things that they care about is so important.
• 26:00
  SPEAKER_00: Yet there's almost this mismatch of like, what's the cost benefit of this?
• 26:05
  SPEAKER_00: Especially when you start to look at what's the cost of another ACL injury.
• 26:09
  SPEAKER_00: And that's what this ends up coming down to is like, what is the cost of another ACL injury to you?
• 26:14
  SPEAKER_00: And that's what we're kind of playing with in terms of basically doing this right this time versus not doing it right, and then that potentially being the outcome.
• 26:22
  SPEAKER_00: And so what I want to do is make sure to point out some red flags for you to be able to look at.
• 26:27
  SPEAKER_00: Number one, is your rehab being progressed based on timelines and protocols?
• 26:32
  SPEAKER_00: Like, are they just looking at a sheet of paper?
• 26:34
  SPEAKER_00: You're at week 12, so you should start running, or you know, you're at six months, you can return to sport, right?
• 26:41
  SPEAKER_00: If it is based on just time alone, that is a red flag.
• 26:47
  SPEAKER_00: The biggest litmus for me is testing.
• 26:50
  SPEAKER_00: That is the pure litmus for me in terms of ACL rehab.
• 26:54
  SPEAKER_00: Is like, do you have a physical therapist or a coach who knows what is going on?
• 26:59
  SPEAKER_00: They're with the times, they are up to date on the research.
• 27:02
  SPEAKER_00: And to me, the purest single most test is do they test?
• 27:06
  SPEAKER_00: And so if they don't test via an isokinetic machine, a handheld dimometer or a strain gauge, which is this small device, you can almost think about it as like a crane scale to pick up luggage, it puts out an objective measure.
• 27:20
  SPEAKER_00: It gives you a number.
• 27:21
  SPEAKER_00: Like you step on a scale, it tells you how much you weigh.
• 27:24
  SPEAKER_00: It puts out a number, not kicking into someone's hand.
• 27:27
  SPEAKER_00: It is putting out a number, and that is going to help you to be able to make sure you know objectively what your quad strength is and your hamstring strength.
• 27:36
  SPEAKER_00: Worst case scenario, you can do a three to five repetition maximum on a knee extension or a leg curl machine.
• 27:43
  SPEAKER_00: That said, they should be able to explain that very clearly when you ask, How are you going to test my quad strength and how are you going to test my hamstring strength?
• 27:52
  SPEAKER_00: That is the ultimate litmus for me of are you with the times?
• 27:56
  SPEAKER_00: Tell me you're you don't know what you don't know, right?
• 28:00
  SPEAKER_00: And that's the thing that is going to be so helpful for you guys in terms of working with your physical therapist and just knowing this doesn't mean you need to drop them immediately.
• 28:11
  SPEAKER_00: Now, if you're in the mid to late stages, you probably should.
• 28:13
  SPEAKER_00: But if you're early on, maybe the PT will get you through the first you know eight weeks, and then eventually just know that like you need to part ways with this person because they're not gonna get you there because they're not with the times.
• 28:25
  SPEAKER_00: Ideally, as early as possible, or make a switch, find someone new who does do these things and are very research-based, objective-driven, data-driven, and do tests based on the research.
• 28:37
  SPEAKER_00: But that's gonna be the biggest and best red flag and litmus for me to know like, are you a legit PT or not?
• 28:44
  SPEAKER_00: There are other things to decide, but if they're Ice isolating the quads and hamstrings and objectively testing them, that at least like captures a good majority of like what I think at least you are somewhat up to date.
• 28:57
  SPEAKER_00: Like I said, the straight leg raise, if you're doing that for weeks and weeks and months, that is something that you start a yellow flag into a red flag.
• 29:06
  SPEAKER_00: If you're not having anything progressed over three weeks, four weeks, five weeks, like if you're doing just the same stuff at home, if you're doing like 20 exercises at home, then that is not something that I would say is going to be productive and you're gonna end up wasting your time, and it's gonna be something that you're gonna eventually find out at months three, four, or five that you were wasting your time.
• 29:29
  SPEAKER_00: So that is something that you just need to know, needs to be progressed, and you need to be educated on why you're doing those things and have structure to it.
• 29:38
  SPEAKER_00: If you're not lifting heavy, especially out of the acute early phases of ACL rehab, if you're in, you know, some of the mid and laser stages, especially, and you're not lifting heavy weights where you're like really pushing maximally on certain movements or going to failure where your quad cannot push anymore, you are not getting good rehab.
• 29:58
  SPEAKER_00: The last thing I will say is that I consistently hear from ACLers that when they ask their PT a question, they just kind of kick the can down the road.
• 30:07
  SPEAKER_00: And what it is is like, oh, we'll get there, or they don't have a clear answer to whatever you ask them, like, how do you test?
• 30:14
  SPEAKER_00: It ends up being vague.
• 30:16
  SPEAKER_00: There's not really clarity on it.
• 30:18
  SPEAKER_00: And I promise you, if you ask me or any of our team members, any of our mentees, if you ask them a question about ACL rehab, I promise you there will be specific answers to it, numbers to it if it's based on some testing.
• 30:31
  SPEAKER_00: And then also, if we don't know, we will say, I don't know.
• 30:35
  SPEAKER_00: I will find out the answer for you.
• 30:36
  SPEAKER_00: To be honest, in a lot of situations, we do have some type of answer to be able to share with you just being in this for so long.
• 30:43
  SPEAKER_00: But there should be very clear answers and clarity on any answers and any questions that you you ask, right?
• 30:50
  SPEAKER_00: And that's gonna be super important.
• 30:52
  SPEAKER_00: So those are some of the main red flags for you to be able to look out for.
• 30:55
  SPEAKER_00: And I would say testing is gonna be the number one thing for you to be able to say, okay, I need to know when my end point with this PT is if they don't do it, or just change.
• 31:05
  SPEAKER_00: My suggestion is change as soon as you can.
• 31:07
  SPEAKER_00: Now, my recommendation is as soon as you hear this episode and are like, okay, Robbie, you've been talking about this for almost 30 minutes.
• 31:17
  SPEAKER_00: Unless you've got the incredible expert ACL PT guidance, you do need to plan when and not if you need a new P tier coach.
• 31:28
  SPEAKER_00: That's just gonna be the point blank here.
• 31:31
  SPEAKER_00: And so for 2026, or whenever you hear this, I'm just gonna ask you one thing.
• 31:36
  SPEAKER_00: I want you to find a guide, an expert who knows ACL rehab like the back of their hand, who can talk to you about this process, who can talk to you as a human, not a robot or transactionally.
• 31:53
  SPEAKER_00: And to be able to look at you and have a conversation, understand what you care about, what are your goals, what are the things that are in your way, what are the things that bring you joy and happiness, and what are ways to be able to get there?
• 32:09
  SPEAKER_00: To be able to give you structure every single day so you're not waking up being like, all right, what do I do today?
• 32:15
  SPEAKER_00: How many reps are sets?
• 32:16
  SPEAKER_00: To be able to know when you enter Monday, you know what your week looks like.
• 32:20
  SPEAKER_00: If you're traveling, if you have holidays, if you have something come up, there is adaptations made to make sure it fits so you can keep the momentum going.
• 32:29
  SPEAKER_00: So that you know what you're aiming towards in the short term.
• 32:32
  SPEAKER_00: These are the objective measures, this is what we're aiming for, and this is the long-term measures that we're aiming for.
• 32:38
  SPEAKER_00: Someone who's there to be able to guide you to get rid of your anxiety, to answer all your questions, as I said, to objectively test you.
• 32:46
  SPEAKER_00: And most importantly, is that you can just kind of exhale and have clarity knowing during this difficult process that you have someone who can guide you.
• 32:56
  SPEAKER_00: No one at all, not even the ACL experts, should do their own ACL rehab, in my personal opinion.
• 33:01
  SPEAKER_00: If it happened to me again, knock on wood, I would not do it.
• 33:04
  SPEAKER_00: Just like my hip surgery rehab, I had an expert in hip surgery who knows this stuff who is still guiding me, who's still providing remote rehab for me up until this point, because I want to make sure I get there and I'm not wanting to be the one who builds that myself because this is not my expertise in the hip and that procedure.
• 33:23
  SPEAKER_00: But then also, I just don't think anyone in a complex rehab should ever do their own rehab, no matter what situation they're in.
• 33:30
  SPEAKER_00: Don't figure it out yourself.
• 33:32
  SPEAKER_00: Always come back to the house analogy.
• 33:34
  SPEAKER_00: If you are building your dream home, it could even just be your next home, right?
• 33:39
  SPEAKER_00: And you're sitting there and you're like, okay, am I gonna be the one who's gonna design this house?
• 33:45
  SPEAKER_00: Am I gonna be the one who's going to, you know, build the first floor and second floor?
• 33:48
  SPEAKER_00: No, you're gonna give this to an expert project manager, not the generic builder.
• 33:53
  SPEAKER_00: Like you're gonna give this to them to be able to handle the scope of this, bring in the subcontractors and everyone that's gonna be needed for this, but they're the ones who are who are the GPS steering the ship and this project.
• 34:04
  SPEAKER_00: And you're not at the end, you're not at 80% saying, like, all right, well, you guys got the floors done.
• 34:10
  SPEAKER_00: Um, I guess I'll finish up the roof, right?
• 34:12
  SPEAKER_00: Like, and I'll put the doors on.
• 34:14
  SPEAKER_00: No, like they're gonna finish the thing throughout because that's not your area of expertise.
• 34:19
  SPEAKER_00: So that's the same thing here is that you need to imagine you're building your dream home, right?
• 34:24
  SPEAKER_00: And except this is for your knee.
• 34:26
  SPEAKER_00: The same thing with pro athletes.
• 34:28
  SPEAKER_00: I just kind of think about like pro athletes are not the ones doing their own rehab, they're being coached by so many different people, having so many people on their team.
• 34:37
  SPEAKER_00: Same thing with collegiate athletes.
• 34:39
  SPEAKER_00: So it's just kind of crazy to me sometimes when we kind of think about this process and we're like, no, I can figure it out, but even the professional athletes don't even figure it out.
• 34:47
  SPEAKER_00: They have people to serve them in this, and so I don't see why anyone in this process doesn't deserve the same level of quality of care, is the point I'm making here.
• 34:59
  SPEAKER_00: So the thing is you might just have to find it on your own, given the way that healthcare is, the way that PT is, and that's just what I wanted to share today, and what people will typically go through this process, and they almost feel crazy when they get to the mid to late stages because they're like, okay, like I don't have as much guidance.
• 35:20
  SPEAKER_00: I'll just kind of piece things together.
• 35:21
  SPEAKER_00: I'm good enough.
• 35:22
  SPEAKER_00: I might be like 60% there, 80% there, but you're not all the way there.
• 35:27
  SPEAKER_00: And that's when it's honestly the hardest because you have more moving pieces to navigate, more things to train, more things to balance, and your life is obviously still going on.
• 35:38
  SPEAKER_00: So that's where people get stuck a lot of times, and sometimes they just don't even expose themselves to harder things, and then therefore they go play their sports or activities, and that's where they run into issues.
• 35:50
  SPEAKER_00: So just know you might not get it all the way there with currently the where the landscape is and the expertise or lack thereof of what we get in school.
• 35:59
  SPEAKER_00: So your call to action for 2026.
• 36:01
  SPEAKER_00: Hopefully, you have made it this far.
• 36:04
  SPEAKER_00: Um, or whenever you listen to this, make a change, y'all.
• 36:08
  SPEAKER_00: And there's some of you listening to this right now.
• 36:11
  SPEAKER_00: You were listening to episodes a year ago, a year and a half ago, who might have said the same thing this time last year.
• 36:19
  SPEAKER_00: 2025 will be my year.
• 36:21
  SPEAKER_00: I'll get back to doing the thing, you'll make the change, and you've reverted back to whatever it was, doing it yourself, figuring out yourself, and you're finding yourself here again.
• 36:34
  SPEAKER_00: And so, what I'm telling you here is find the care that you deserve.
• 36:37
  SPEAKER_00: Don't do it yourself.
• 36:39
  SPEAKER_00: We are opening up spots for us to be able to work with people.
• 36:43
  SPEAKER_00: I don't care if you ever reach out to us or not.
• 36:46
  SPEAKER_00: My goal here is to just make sure you're educated to know that you need to find expert help.
• 36:53
  SPEAKER_00: But if you need help to be pointed in the right direction, we're here to help.
• 36:57
  SPEAKER_00: And so that's the thing that is going to be important.
• 36:59
  SPEAKER_00: Set the tone for the year to come or whenever you listen to this, because you deserve better care.
• 37:05
  SPEAKER_00: You deserve to be informed, you deserve to get back to what you want to do and you care about.
• 37:09
  SPEAKER_00: And just don't leave this to chance.
• 37:11
  SPEAKER_00: That is all that I'm saying.
• 37:12
  SPEAKER_00: Don't do your ACEL rehab yourself, no matter where you are in the process.
• 37:16
  SPEAKER_00: So I'm gonna wrap this up.
• 37:19
  SPEAKER_00: I hope that you guys had had a good 2025 or up until this point when you're listening, and let's just kickstart 2026 the best that we can.
• 37:29
  SPEAKER_00: Do the thing, y'all.
• 37:30
  SPEAKER_00: This is your host, Robbie Patel, signing off.