Latest / The ACL Athlete Podcast / 233 | Stuck, Lost, and Piecing It Together: The ACL Rehab No One Talks About
Transcript
- 0:18SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
- 0:22SPEAKER_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.
- 0:31SPEAKER_00: I'm your host, Dr.
- 0:32SPEAKER_00: Ravi Patel, performance physical therapist and coach.
- 0:36SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
- 0:43SPEAKER_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.
- 0:54SPEAKER_00: Thanks for joining.
- 0:55SPEAKER_00: Now let's dive into today's episode.
- 1:00SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete podcast.
- 1:07SPEAKER_00: So I've been recently having conversations with ACLers where they might be three months out, they might be six months out, they have been discharged from physical therapy, they have been cleared by their surgeon, maybe cleared by their physical therapist, but they are not there.
- 1:27SPEAKER_00: They know they're not there, and especially if they have been released from physical therapy, and it's just due to typically visits, or just maybe they have exhausted how much they can help them.
- 1:42SPEAKER_00: It's crazy.
- 1:43SPEAKER_00: I literally talked to somebody the other day and they joined our remote team working with us, and they shared that their physical therapist literally said, We cannot offer you any more assistance, but she was having pain with stairs, with jumping, she's not running yet, but she was discharged, and it makes me sad.
- 2:06SPEAKER_00: And the same thing can happen with a lot of you where you're told you're finished, and again, it could be from a number of these reasons, or you feel like your physical therapy is not enough.
- 2:19SPEAKER_00: You are not getting enough of the exercises, or you feel like you need to add more into the mix, right?
- 2:24SPEAKER_00: But usually what I find is that when I'm talking to these ACLers, they are feeling like they're piecing these things together, they are structuring their own rehab sessions, their workouts, they're planning their own things, and that is just very, very, very hard.
- 2:43SPEAKER_00: And I asked them where they're getting things from, and they're like, Well, I'm pulling some things from Instagram and from YouTube, and I saw this influencer on TikTok who was like, do this and it'll help your knee pain.
- 2:57SPEAKER_00: And it's hard.
- 2:59SPEAKER_00: It is really hard in this space of movement with rehab, and especially with so many educational resources, if you will.
- 3:08SPEAKER_00: And it's hard for me to say educational because it's just information that we take in, and a lot of times it is via social media.
- 3:14SPEAKER_00: And I'm not here to throw any shade across any of it.
- 3:18SPEAKER_00: I know that there is a lot of value to it, but it is also a little challenging because we don't necessarily have the best filters to know, okay, what is good, what is bad, and people can sound really convincing.
- 3:31SPEAKER_00: And so, my point of today's episode is you should not be structuring your own workouts and planning your own ACL rehab ever.
- 3:44SPEAKER_00: And I feel very strongly about this, and this is something that I have spent a lot of time thinking about, especially over the years, talking to ACLers who are in positions like this, and it's something that I kind of think to myself, I'm like, okay, why are people in these positions, right?
- 4:02SPEAKER_00: And a lot of times it is due to a number of different things, right?
- 4:06SPEAKER_00: I get there are factors in play.
- 4:08SPEAKER_00: It could be finances, it could be just lack of local resources, like a good in-person physical therapist.
- 4:15SPEAKER_00: Maybe you tried a bunch of different people, maybe it could be the time available for you, maybe it's insurance visits or the healthcare system that you are in, like with other countries that athletes we work with, people are sometimes seeing their physio two times a month, you know, one time a month.
- 4:35SPEAKER_00: And sometimes it's like they don't have a PT visit for four weeks and they are fresh post op.
- 4:42SPEAKER_00: It's wild, y'all.
- 4:44SPEAKER_00: If y'all could literally just be in my mind of the different conversations I've had with ACLers, with just different cases and just different situations where either things fall through the gaps or the way the systems are designed, there are a lot of things in play.
- 5:01SPEAKER_00: And so I don't want to overlook these things, and I understand that people are trying to do their best.
- 5:07SPEAKER_00: And so I know people don't just do this intentionally just to just be in these situations.
- 5:14SPEAKER_00: There are usually a number of factors in play, right?
- 5:18SPEAKER_00: The other thing is that with health and wellness, including movement and nutrition, so exercising, thinking about the things we take into our body, it is the wild, wild west.
- 5:30SPEAKER_00: Especially nowadays, there's a little bit more proactive health taking on the scene with supplements and biohacking and you know being very uh health conscious, if you will.
- 5:43SPEAKER_00: And so then with that has been the opportunity for more of the space to get flooded with people who share their opinion.
- 5:52SPEAKER_00: And it's challenging because no one has clear ownership of this space.
- 5:56SPEAKER_00: And I'm not here to say one person should or one group should.
- 6:00SPEAKER_00: Sure, there are registered dietitians who go to school and get a license to be able to prescribe meal plans and work with people with different diseases and to be able to help them to get the proper nutrients based on what research and what the education of the foundational pillars of what our body takes in and be able to prescribe things for people, right?
- 6:25SPEAKER_00: And then there are physical therapists, of course, who deal with musculoskeletal-related issues, it could be neurological issues, it could be cardiopulmonary issues, it could be skin-related issues.
- 6:36SPEAKER_00: Did you guys know that there are physical therapists who specialize in wound care?
- 6:40SPEAKER_00: Yeah, so these are things that we go to school for, we get our doctorate for, and it's something that we focus primarily on, you know, the movement piece, how these systems integrate together.
- 6:51SPEAKER_00: But especially when you're thinking about the orthopedic realm, which is where ACL falls into, that is something that is the realm of physios or physical therapists typically who are managing these types of injuries and rehabs.
- 7:06SPEAKER_00: And of course, there is performance and strength and conditioning coaches, there's personal trainers, there's fitness coaches, and other professionals in this space.
- 7:16SPEAKER_00: Now, the barrier to entry is challenging because some of these, yes, they require bachelor's degrees, they require master's degrees, doctorate degrees, and then some of these you can go become a nutritionist after taking an online course, or you can become a personal trainer by taking an online course or a two-day course.
- 7:37SPEAKER_00: I've done it myself whenever I was in college.
- 7:40SPEAKER_00: Before I became a physical therapist and a strength conditioning coach, um, I took a personal training certification that was a three-day event.
- 7:49SPEAKER_00: I took a test, I passed it, and then now I could train people.
- 7:52SPEAKER_00: And there is nothing wrong with this, but the challenge is that if you're just good at taking in information and taking a test, then that makes you qualified, right?
- 8:02SPEAKER_00: And so that's what makes this challenging in this space.
- 8:06SPEAKER_00: And I think the thing that I typically see, and I'm seeing more of, is that it's just with social media, if we take essentially the thought of movement and with nutrition, there are a lot of influencers and just people out there who are like, you know, these supplements can do X, and these supplements are great for that.
- 8:30SPEAKER_00: And then this movement is great for all your knee pain or to bulletproof it, right?
- 8:35SPEAKER_00: And the thing is that the body is so much more complex that yes, there can be benefits to maybe some of these things that they suggest, but we got to look at things as a whole, right?
- 8:45SPEAKER_00: And so Brock, who has 150,000 followers, can't necessarily explain the mechanism of why creatine is beneficial, but therefore he is jacked, and so you're gonna buy creatine from him because it's awesome.
- 8:58SPEAKER_00: Or Melinda, who has the anti-inflammatory keto diet with 500,000 followers, has worked for her, but she has no education or background on this.
- 9:07SPEAKER_00: But it worked and it seemed legit, right?
- 9:10SPEAKER_00: And I get it, y'all.
- 9:11SPEAKER_00: Like movement and nutrition, it's a part of people's lives, it's a part of our everyday lives.
- 9:17SPEAKER_00: We're doing things like this every day.
- 9:19SPEAKER_00: We're putting things in our body, we are moving, and so everyone feels like they have a little bit more of an opinion about what that looks like and what might be the right thing, right?
- 9:29SPEAKER_00: And what works for them.
- 9:31SPEAKER_00: And so this is where it can get a little challenging in this particular space.
- 9:36SPEAKER_00: And the thing that I find always, I don't know, comical, I guess, is that sometimes I'll have people, especially more recently, telling me what are the right exercises that they need to be doing, the problems that they're having, and that they already have the solutions for their goals, the supplements, the nutrition, and they don't really have a background in any of it.
- 10:02SPEAKER_00: And I'm not saying to discredit any of it, but at the same time, it's them being able to feel confident about saying these things because of ex-influencer said it or an ACL guru that said it's legit, right?
- 10:18SPEAKER_00: And I know I'm getting on a little bit of tangent here, so I'm gonna digress a little bit.
- 10:22SPEAKER_00: But here I'm always wanting to share just the transparency of it all because I think it's really important because of conversations that I feel like I've been having more recently.
- 10:33SPEAKER_00: While the planning piece has kind of really flowed through this ever since I started the company and having these conversations, it's been a consistent problem.
- 10:42SPEAKER_00: But I think recently I was just trying to like break down why it is that we feel like we are okay to plan things.
- 10:51SPEAKER_00: And I know the healthcare system doesn't do a good job of you know allowing us to know, all right, are we there yet or not?
- 10:58SPEAKER_00: Because it's a little not great, if you will, um, in terms of just the way the process is, because it could be based on insurance or the quality of the physical therapy you're getting.
- 11:09SPEAKER_00: As we know, testing is not very common.
- 11:12SPEAKER_00: We know that individualization is not very common because it is volume driven.
- 11:16SPEAKER_00: Surgeons are clearing people at six months.
- 11:19SPEAKER_00: Um, surgeons are saying you should be running at three months.
- 11:22SPEAKER_00: So there's a lot of noise within this, so it makes it very, very, very challenging.
- 11:27SPEAKER_00: So I don't want to fault anybody for this, but movement, rehab, nutrition, these things can be a little bit challenging in this space.
- 11:37SPEAKER_00: And as you guys know, I'm all for empowering you guys, wanting to make sure people feel empowered in their own journey and process.
- 11:45SPEAKER_00: It's why this entire podcast exists.
- 11:48SPEAKER_00: But it's really important to know where to draw the line on where it makes sense.
- 11:52SPEAKER_00: And I truly do believe that no one should be managing their own ACL rehab or any complex rehab for that matter.
- 12:01SPEAKER_00: Especially when stakes are high, when we're talking about 20 to 30 percent going to have a reinjury, when we talk about people having a lot of challenges with mental health, people not getting back to what they want to do, and then also the earlier onset of osteoarthritis because they didn't get themselves to a better place.
- 12:23SPEAKER_00: But that is a little bit harder for people to see because when you're going through this process, the arthritis thing might not be for another, you know, maybe 10 years, 20 years, 30 years, 40 years, or maybe it doesn't really set in as much because of the proper combination of just the way your knee tolerated things, and you've done a good, good job to keep yourself strong and mobile.
- 12:45SPEAKER_00: And so those are things that are important in terms of this process to take into account.
- 12:52SPEAKER_00: But when we are connecting the dots here, when you're thinking about all right, doing things and planning things in ACL rehab yourself, especially planning your workouts, your schedule, structuring things yourself and piecing it all together.
- 13:06SPEAKER_00: I'm gonna give you some examples here, guys.
- 13:08SPEAKER_00: So it's like you're trying to build a house without knowing how to read a blueprint.
- 13:14SPEAKER_00: You might know what a house should look like, but without the structure, the tools, and the experience, you're likely to build something unstable or maybe unsafe.
- 13:23SPEAKER_00: You definitely don't want me to build you a house.
- 13:26SPEAKER_00: I know how to build things.
- 13:27SPEAKER_00: I'm fairly handy because of my dad and I learned a lot, but I promise you, you do not want me to build you a house.
- 13:35SPEAKER_00: It could be like hiking through the mountain without a map or a compass.
- 13:39SPEAKER_00: You might eventually get your way there, or you might get lost, take the long way, or eventually end up getting hurt because you just didn't know your route or being able to have any guidance through that.
- 13:53SPEAKER_00: It's like writing your own legal contract after reading some blog posts about it, right?
- 13:59SPEAKER_00: Now, this is something that you know you'd probably want an attorney for, right?
- 14:04SPEAKER_00: You'd want a lawyer to help write something up or at least proofread it to make sure like you're not making some sort of mistakes, especially with situations where there may be liability or high stakes in place, and especially with the complexity, because on paper, yes, it might look like all right, it sounds legit, but until someone goes through it with a fine-tooth chrome who actually has this experience and background, that's whenever you can be like, all right, I've got the stamp of approval.
- 14:32SPEAKER_00: And so these are things that we wouldn't just necessarily navigate and do ourselves, right?
- 14:40SPEAKER_00: Maybe the hiking piece, depending on your experience and background, but again, these are things that we would want professional help with to help plan these things to make sure that we take it step by step and do it the right way, so we would invest in these situations.
- 14:55SPEAKER_00: The same thing comes down to my hip rehab.
- 14:58SPEAKER_00: So, you guys I've shared earlier that I'm going through a hip resurfacing process and going through my own rehab process, and I could do it myself.
- 15:09SPEAKER_00: I could.
- 15:10SPEAKER_00: But the thing is, is that I don't know my blind spots.
- 15:13SPEAKER_00: I am gonna be biased towards certain things I want to do, and I also want someone who's an expert at this particular thing, and so I have hired my own remote coach that is giving me my programming that is individualized week to week, we're communicating week to week, we have these different testing processes that I go through to make sure things are moving along.
- 15:37SPEAKER_00: And so the thing is, is that even for myself with my background as a physical therapist, having a strength and conditioning background, understanding performance pretty well, I didn't want to do my own hip rehab.
- 17:53SPEAKER_00: And I've worked with a lot of hip rehabs before, y'all.
- 17:56SPEAKER_00: And the thing is, is that I think it's important for me to not coach myself, but to have a coach and to guide me through this.
- 18:04SPEAKER_00: And so the tough love that I want to share with y'all is that I think social media allows people to think that they can get by without doing it themselves.
- 18:12SPEAKER_00: Finding the, you know, five best exercises for X or use this template program for return to sport.
- 18:19SPEAKER_00: But the thing that's always so challenging is that how do we know it's right for you?
- 18:24SPEAKER_00: And do you have the background to put it together to be able to understand like how to test and assess, is this right for you?
- 18:32SPEAKER_00: I've had people who have been doing programs for months and months and months.
- 18:36SPEAKER_00: They're like, I feel great.
- 18:37SPEAKER_00: And then when we actually like do the testing on their knee and look at the different movements, they've been compensating with their glutes and hamstrings for the months and months that they've been doing it.
- 18:46SPEAKER_00: They've been only doing compound lifts where they do squats, deadlifts, split squats, step-ups.
- 18:53SPEAKER_00: There are things that our body are really good at doing, and that is compensating, especially when an injury happens.
- 18:59SPEAKER_00: And especially with ACL, whenever it's a long process and there's a lot going on.
- 19:04SPEAKER_00: And so this is something that we want to make sure is right for you based on your history, your graph type, other procedures.
- 19:12SPEAKER_00: And the thing that is even just so crazy is that I evaluated someone this morning who has a complex ACL case, and she tried the knees over toes program here recently before we connected, and it made her knee worse.
- 19:28SPEAKER_00: Now, am I here to throw a shade of the knees over toes program?
- 19:31SPEAKER_00: No.
- 19:31SPEAKER_00: But the thing is that it has to be for the right person.
- 19:36SPEAKER_00: And I know people have had success with that, but uh we have also had a lot of people who have come to us after and have not had success with it.
- 19:45SPEAKER_00: And the thing is that it's not individualized, it's not accounting for your specific case, your specific needs, your specific gaps or deficits.
- 19:53SPEAKER_00: And so that's the thing that is really challenging with something more templated or pieced together.
- 20:00SPEAKER_00: ACL rehab is complicated, y'all.
- 20:02SPEAKER_00: 80% of physical therapists don't know how to navigate it themselves, if I'm completely honest.
- 20:07SPEAKER_00: We have mentees in our mentorship who are wanting to get better at it.
- 20:11SPEAKER_00: When we're talking through a lot of this, the biggest hiccups are we didn't get educated on this.
- 20:17SPEAKER_00: We only know how to handle maybe the first eight weeks to 12 weeks, and even then it's a big challenge.
- 20:23SPEAKER_00: And then after that, from three to nine months to 12 months, they're like, we don't really know.
- 20:28SPEAKER_00: It's the wild, wild west.
- 20:29SPEAKER_00: There are so many different ways to go about doing this.
- 20:32SPEAKER_00: And so the thing is, is that it's challenging for us.
- 20:35SPEAKER_00: We have a three-year doctorate studying the human body and movement, and it still is challenging, right?
- 20:42SPEAKER_00: And so this is something just to provide some context around, you know, if you feel like you have been doing that, then I want you to just kind of take a step back, especially if you feel like you've just been spinning your wheels, things have not been progressing in the right direction, to be able to find a different signal within all this noise and to see, all right, what other alternatives do I have outside of trying to piece these things together yourself?
- 21:11SPEAKER_00: And lastly, I don't want to overlook this one important point.
- 21:15SPEAKER_00: And that is that maybe there are some of you who can't necessarily afford additional help or don't have the resources nearby.
- 21:23SPEAKER_00: And so that is something that I know is hard and I get it.
- 21:27SPEAKER_00: I was in debt really bad after my second ACL surgery, having$10,000 worth of deductibles and out-of-pocket maxes for my surgery.
- 21:38SPEAKER_00: And it's just sad, right?
- 21:41SPEAKER_00: And I do get it.
- 21:42SPEAKER_00: Sometimes you do need to tackle it yourself for a minute.
- 21:45SPEAKER_00: Maybe you've been with somebody for six months and you just feel like you need a break just to kind of be yourself.
- 21:51SPEAKER_00: I understand that.
- 21:53SPEAKER_00: But I do think that even with the lower socioeconomic and with people with lack of resources, that with the way that technology has evolved, that there are other opportunities now.
- 22:06SPEAKER_00: And maybe it is just like these one-off consults, or maybe it's connecting with somebody locally and saving up, and then just figuring out, like, all right, can I at least find a starting point, right?
- 22:17SPEAKER_00: Can I even borrow or find out if there is some sort of scholarship or some sort of opportunity?
- 22:23SPEAKER_00: That is something that we have done in the past and do, and so that is something that is important because we want to make sure that we can also help people who don't necessarily have the resources or the means, right?
- 22:36SPEAKER_00: And so that is something that I think is important to consider within all this.
- 22:41SPEAKER_00: So I don't want to overlook that because I know that not everyone can just go and throw out investments and finances towards just a bunch of different resources and different maybe remote options or in-person options.
- 22:55SPEAKER_00: And I know sometimes the at a network or cash-based options can get kind of pricey, and so then therefore, I think that it's important considerations with this.
- 23:03SPEAKER_00: But with that said, if you're listening to this and you're like, I do have the means and you're scheduling and creating your own workouts and your own ACL rehab, then I would highly recommend you reconsider, especially if you haven't had any testing, especially if you don't know what your next steps are in terms of what you need to do, like what metrics you're working towards.
- 23:29SPEAKER_00: If you find yourself kind of showing up in the gym and you're like, I don't really know what to do, or I feel like I'm just kind of throwing stuff together, the rep schemes are all random, and especially if you don't feel like things are moving in the right direction, getting you closer to what you want to do, then I would strongly consider finding some additional help.
- 23:52SPEAKER_00: Someone who is an ACL expert, someone who knows this stuff really well, and I promise you guys that this is something that I've seen this where it has actually.
- 24:04SPEAKER_00: Added a year, two years to people's ACL rehab when it could have been cut down to three to six months.
- 24:10SPEAKER_00: I kid you not.
- 24:12SPEAKER_00: I see it all the time, talk to people all the time, where they just spin their wheels.
- 24:16SPEAKER_00: And I know that this is more than just them.
- 24:19SPEAKER_00: It's just more so of like a system and just like a healthcare-based issue that we face.
- 24:25SPEAKER_00: But now with technology and with the resources that you don't have to be tied to just where you are geographically, especially with remote ACL coaching, that is something that can be done from anywhere.
- 24:37SPEAKER_00: And we have people all over that we work with, and that is something that I do think will be a very, very strong force with years to come, because I think there are very many people who can benefit from this.
- 24:52SPEAKER_00: And we have worked with hundreds and hundreds of ACLers all over the world, never seen them in person.
- 24:57SPEAKER_00: And it's something that we're able to get them back to what they love to do.
- 25:01SPEAKER_00: And it's fun.
- 25:02SPEAKER_00: And so this is something that I would suggest if you find yourself struggling with this, feeling lost, feeling like you don't have structure, feeling like there's no plan, or what are the next steps, then finding someone local to you who is an expert in this, or finding someone who remotely does this.
- 25:19SPEAKER_00: And the thing I want to share is like how should this look and how we do it with our ACLers, just so you have a reference, right?
- 25:29SPEAKER_00: You provide your work, school, life schedule of what that looks like, your days you have available, the time, your equipment access, and what is most feasible to you.
- 25:40SPEAKER_00: We're not just trying to max this schedule out, right?
- 25:43SPEAKER_00: We're trying to figure out what is the minimum needed for you to be able to move the needle with these particular priorities and goals, right?
- 25:52SPEAKER_00: And so this is where the testing pieces come into play, being able to break down your profile, your history, and your background, your case, and being able to assess and see, all right, these are the gaps that we see with Patricia, right?
- 26:06SPEAKER_00: And Patricia, we got you.
- 26:08SPEAKER_00: Like this is what the game plan is gonna look like.
- 26:10SPEAKER_00: And this is where we are gonna build this out specific to Patricia and her life to fit it around her.
- 26:16SPEAKER_00: We're not having her fit our mold, we fit the mold of her life, right?
- 26:20SPEAKER_00: And so that's our job as physical therapists, performance coaches, is to build it to you so then that way it disrupts your life as least as possible as needed, and you get the minimum outcome you need to be able to do that, right?
- 26:33SPEAKER_00: And so then, therefore, we're gonna build it to that, and yeah, we could always add more, we could always do less.
- 26:39SPEAKER_00: Like there are always a lot of variety to the way that we do things, but that is left to us, right?
- 26:45SPEAKER_00: We are the ones who can help in terms of deciding those priorities, the exercise, and what to do.
- 26:51SPEAKER_00: And so this is something that needs to be built to you because life is going to have things come up, and it needs to be adaptable.
- 26:59SPEAKER_00: You might get sick, you might have a family member that something happens to you, you have work, travel.
- 27:05SPEAKER_00: There are so many things that I can't even explain that people have come up where they have to have adapted programs.
- 27:14SPEAKER_00: They, you know, I have an athlete right now, she's at a camp for three weeks.
- 27:19SPEAKER_00: We had to adapt things.
- 27:20SPEAKER_00: She didn't get technology uh or wasn't supposed to have technology, and so we were supposed to find a middle ground for this in order for her to be able to access what she needs to do, um, especially with the phase that she's in, right?
- 27:33SPEAKER_00: But we have to adapt things and make sure that we move things forward for you.
- 27:37SPEAKER_00: And it's not just set in stone like a set and forget it program, it's continuously getting updated to meet you where you are.
- 27:44SPEAKER_00: So if I could leave you with anything, if you feel like you're building your own programs, structuring your own rehab, or feeling lost in this and don't have any structure, please find a trusted source who knows ACL rehab, who can back it up, that they have worked with ACLs, who have worked with cases similar to yours, and just make sure that you are not the one left to doing it yourself.
- 28:11SPEAKER_00: No one should ever do their own ACL rehab.
- 28:14SPEAKER_00: And I believe that firmly.
- 28:17SPEAKER_00: I may change that in the future, but honestly, I probably won't because I feel that we don't need to be our own coaches during this process.
- 28:26SPEAKER_00: It's already enough having to drive the car.
- 28:29SPEAKER_00: Let's find someone else to be the GPS for us.
- 28:31SPEAKER_00: And so that's our goal here at the ACL Athlete is we want to be the GPS.
- 28:35SPEAKER_00: We're here to help.
- 28:36SPEAKER_00: If you do need help or if we need to point you in a different direction of someone local or some other resource, we're happy to do so.
- 28:44SPEAKER_00: I just want to make sure that you feel like you have a little bit more than just feeling like you're left to your own devices to navigate this process by yourself because it is already enough to deal with on our own, y'all.
- 28:56SPEAKER_00: Until next time, this is your host, Robbie Patel, signing off.