Latest / The ACL Athlete Podcast / 256 | Proactive > Reactive: The ACL Surgery Prep That Separates Successful Recoveries

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256 | Proactive > Reactive: The ACL Surgery Prep That Separates Successful Recoveries · 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.
• 1:06
  SPEAKER_00: So today I'm excited to dive into this specific episode.
• 1:10
  SPEAKER_00: It's one that I've been thinking about a lot, especially with us nearing the end of the year and especially with the new year happening.
• 1:18
  SPEAKER_00: During these times, a lot of times people are prioritizing ACL surgery just because of the holidays.
• 1:24
  SPEAKER_00: They have more downtime.
• 1:25
  SPEAKER_00: They might be meeting their deductibles or their insurance changes.
• 1:29
  SPEAKER_00: So they may either end the year to try and get that knocked out with the high expenses, or they may start the year.
• 1:35
  SPEAKER_00: So then that way they have the rest of the year to be able to pay into the plan.
• 1:39
  SPEAKER_00: I know it's kind of ridiculous, but it's just the way we make decisions.
• 1:43
  SPEAKER_00: And so it's something that I want to talk about, especially with having our ACLers, a good chunk having ACL surgeries recently.
• 1:52
  SPEAKER_00: And I wanted to share some helpful insights that you know we've been seeing as a team and just myself and working with these ACLers, it's just been something that has been super interesting to see the success of certain ACLers and then also maybe the not so much success of ACLers coming out of surgery, and most importantly, later in the process.
• 2:14
  SPEAKER_00: And so I want to share that insight because we have, you know, seen repeatedly over hundreds of ACLers going through this surgery and the differences in those short and long-term outcomes.
• 2:27
  SPEAKER_00: Being super prepared going into surgery is so, so, so underestimated.
• 2:33
  SPEAKER_00: Now, some of you might be listening post op and you might be months out, right?
• 2:37
  SPEAKER_00: And I still hope that this is helpful and valuable because there are certain things that you can kind of look at and be like, okay, I did those things right.
• 2:43
  SPEAKER_00: Maybe there are some things that were missed.
• 2:45
  SPEAKER_00: But with that said, if you are a PT listening to this, a coach, if you're an ASER that's getting ready for surgery or in the early post-op phases, then this is definitely something that you want to listen to because I think it's so valuable.
• 2:58
  SPEAKER_00: If you can just get this stuff lined up, if you can even just create a checklist for yourself of like, okay, did I tackle all this stuff?
• 3:05
  SPEAKER_00: Do I know what to expect?
• 3:07
  SPEAKER_00: That's going to help you so much in this because there's so much unknown, so much anxiety, especially for people who go through this.
• 3:14
  SPEAKER_00: You know, you don't naturally just know about this process.
• 3:17
  SPEAKER_00: It just happens to you.
• 3:18
  SPEAKER_00: No one chooses it.
• 3:20
  SPEAKER_00: And the thing is, is that it's so reactive.
• 3:22
  SPEAKER_00: It's like, okay, the injury happens, sure.
• 3:25
  SPEAKER_00: And then after that, it's a matter of like, what are the next steps?
• 3:28
  SPEAKER_00: Usually it's imaging, surgery, and then the rehab process afterwards, right?
• 3:33
  SPEAKER_00: And it's rare that people really get ahead of it unless they are a little bit more of a research base, maybe type A, and there's some people who start to look into things a little bit more.
• 3:44
  SPEAKER_00: But I would say a lot of this ends up being just a natural injury.
• 3:48
  SPEAKER_00: You go to see the ortho, you do the imaging, you get the surgery, and then you start the rehab process.
• 3:54
  SPEAKER_00: And so it's just something that I think if we can just break down exactly what we see from the successful people, it's going to really help in terms of making sure that you are prepared, you're not feeling anxious, and that you feel in control of the process versus it being in control of you.
• 4:13
  SPEAKER_00: And so let's talk through some of this because I think a lot of times people think that the ACL surgery is the starting line.
• 4:21
  SPEAKER_00: When in reality, yes, you could say that, but in reality, it actually starts before the ACL surgery.
• 4:29
  SPEAKER_00: And for us, that's super important.
• 4:30
  SPEAKER_00: And that's the prehab process.
• 4:32
  SPEAKER_00: Even if you have maybe one week between the injury and the surgery.
• 4:38
  SPEAKER_00: Now, you know, for most people, you're probably waiting more time and ideally a little bit more time than just a week, ideally at least four, if not longer than that, to prehab, get that knee to a good place.
• 4:50
  SPEAKER_00: So then what we're trying to do is just make sure we optimize that period, but it's also just preparing for surgery to come if that's the route that you're going, right?
• 4:58
  SPEAKER_00: And so I just want to share this because we see so many ACLers come through this process and we see both sides of it, especially the later stages of it, because people sometimes don't find us until later.
• 5:10
  SPEAKER_00: And so then we have to take steps back because certain things were missed.
• 5:14
  SPEAKER_00: And we also talk through okay, well, how was post op?
• 5:17
  SPEAKER_00: You know, what were you given?
• 5:19
  SPEAKER_00: Um, what were you told to expect?
• 5:22
  SPEAKER_00: And in terms of the post-op progressions, the exercise program, everything.
• 5:27
  SPEAKER_00: And it's it's just kind of crazy how cookie-cutter it can be.
• 5:31
  SPEAKER_00: And I think the challenges are is that it's just a landscape where we don't have as much autonomy or time to individualize the different people because healthcare is very volume-driven, so PTs don't have the luxury to individualize things too much.
• 5:47
  SPEAKER_00: And so that's the other challenging pieces with this, plus the specialty of ACL doesn't really exist much.
• 5:54
  SPEAKER_00: There are ACL specialists out there, but they're far and few between compared to the number of physical therapists that actually rehab ACLs.
• 6:01
  SPEAKER_00: And so when we look at this process, if we're fortunate enough to get athletes in prehab right before surgery, it is an absolute game changer for not only the early post op process, we're talking days one, two, and three, and then of course longer term into the coming months.
• 6:19
  SPEAKER_00: Why, though, as I had shared, is about preparation.
• 6:22
  SPEAKER_00: And I want to share that so we can make sure we are setting up our ACLers as best and to show who's those are that have solid success and momentum coming right out of surgery.
• 6:33
  SPEAKER_00: And now I've done a detailed three-part series preparing for ACL surgery that you should check out if you're heading into it or you want to recap on it.
• 6:43
  SPEAKER_00: And it's something that I just wanted to make sure that people have something that is very detailed to prepare them.
• 6:51
  SPEAKER_00: Now I should probably go back and update some things with it, but I would say it's a very thorough three-part series for you to just mentally be prepared for it and even equipment, priorities, what to expect.
• 7:03
  SPEAKER_00: So check that out if you are heading into the ACL surgery or soon after it.
• 7:08
  SPEAKER_00: But I just today want to share some themes that we use with our in-person and remote athletes that are key to their success right after post op.
• 7:16
  SPEAKER_00: And here they are.
• 7:16
  SPEAKER_00: So, number one is that we are so, so intentional about trying to make sure that we gather all the information initially before they just jump straight into surgery.
• 7:27
  SPEAKER_00: So we want to know who you are as not only an athlete and what makes you tick, but also as a person.
• 7:32
  SPEAKER_00: It's super important to us.
• 7:34
  SPEAKER_00: And so that way we're not just talking to you right after surgery.
• 7:37
  SPEAKER_00: I think people underestimate how much surgery just kind of influences just how they're gonna interact, just their overall well-being.
• 7:44
  SPEAKER_00: You just put through anesthesia, you had a major ACL reconstruction, you are in pain, you're in swelling, you know, you're a little hesitant to move the knee.
• 7:55
  SPEAKER_00: So the last thing we want to do is introduce ourselves immediately in that moment.
• 7:58
  SPEAKER_00: Now, does that happen?
• 8:00
  SPEAKER_00: It happens in the majority of ACL situations because that's the way the process works, is that people start their rehab after surgery.
• 8:06
  SPEAKER_00: So then, therefore, they see their PT.
• 8:09
  SPEAKER_00: And so then you're kind of having these conversations immediately after surgery, which is fine, totally fine to do that.
• 8:15
  SPEAKER_00: But we like to try and tackle this before the surgery because then we can get super clear on like, okay, what is driving this person?
• 8:22
  SPEAKER_00: There's no influence of the surgery, the postdoc process, the anesthesia, the pain, and just like that mental barrier that the surgery after hits on people.
• 8:33
  SPEAKER_00: So we're discussing key details one-on-one.
• 8:35
  SPEAKER_00: There, we're trying to gather baselines of their functional range of motion, their abilities to move, certain strength profiles.
• 8:43
  SPEAKER_00: So we're trying to gather that prior to the surgery.
• 8:45
  SPEAKER_00: So then, therefore, we could just make sure that we have that information as we compare it to their rehab process.
• 8:52
  SPEAKER_00: We talk through shorter and long-term goals and get ultra specific on why it's important to you and to why it is something that we need to make sure we map out through this process.
• 9:03
  SPEAKER_00: And then we're gonna also talk about how we're gonna build this around the lifestyle, the schedule, because people think that this process happens in a vacuum and maybe for the first week, two weeks, and if you're lucky, four weeks, you just kind of don't do anything besides this, right?
• 9:19
  SPEAKER_00: But at some point you have to resume life, and that could be school, work, kids, travel.
• 9:25
  SPEAKER_00: We need to know those things.
• 9:26
  SPEAKER_00: So we need to know what life is gonna entail when you go back to quote unquote normal, any roadblocks that may come along, reintegrating back to work and back to life, right?
• 9:35
  SPEAKER_00: And back to school.
• 9:37
  SPEAKER_00: And the thing is, is like we've had people where you know they're teachers, they have a six-month-old, they are, you know, professional athletes, like they are someone who is in school.
• 9:48
  SPEAKER_00: Like it's crazy the variety that we work with, but then at the same time, we also have to understand each context is so different.
• 9:55
  SPEAKER_00: What are you gonna do whenever you have a six-month-old and you're a mom who tore your ACL and had surgery, and you can't carry your six-month-old for the next four weeks, right?
• 10:04
  SPEAKER_00: Because you can't put weight on your foot, right?
• 10:06
  SPEAKER_00: So we have to be ultra specific in this and making sure we understand, okay, what is it that we're planning for coming up?
• 10:13
  SPEAKER_00: And then most importantly, it's just building that plan before surgery, the day of and immediate days to come and weeks.
• 10:20
  SPEAKER_00: And we're trying to do this ahead of time and being like, okay, this is our game plan versus being reactive and being like, all right, let's let the surgery happen and then we'll figure it out, right?
• 10:30
  SPEAKER_00: Let's create a game plan together and then just adapt it once the surgery happens based on the details.
• 10:36
  SPEAKER_00: The next piece is that we go hard on education.
• 10:40
  SPEAKER_00: We are so, so foundational in education.
• 10:43
  SPEAKER_00: That's one of our core pillars as a company.
• 10:45
  SPEAKER_00: And so then, therefore, we are gonna educate our athletes in a very simple way, right?
• 10:50
  SPEAKER_00: We're not gonna just throw everything at them and you know, trying to do water through a fire hose here.
• 10:55
  SPEAKER_00: We're trying to tastefully add in certain educational components through this process, and we kind of space this out based on the timing of how athletes are with us.
• 11:05
  SPEAKER_00: So we talk through understanding one's capacity thresholds.
• 11:08
  SPEAKER_00: It's gonna be a little different when you are pre-surgery versus post op.
• 11:13
  SPEAKER_00: The amount of steps you can take, the amount of time it takes to get back to normalcy of day-to-day is gonna be different.
• 11:19
  SPEAKER_00: So we need to understand what those thresholds are because it's gonna influence symptoms and the strength gains and your range of motion, for example.
• 11:26
  SPEAKER_00: Setting expectations, the graph type, how we rehab the graph type that they're gonna get, also help with choosing the best graph that they could get if that's still a decision point for them.
• 11:39
  SPEAKER_00: We have consults with athletes where they're like, what graph should I get?
• 11:43
  SPEAKER_00: And so we walk through this framework to help them decide and make it fit to them versus the surgeon saying, You should do a quad graph or you should do an allograph.
• 11:52
  SPEAKER_00: Instead, we're like, what are your goals?
• 11:54
  SPEAKER_00: What do you want to do long term?
• 11:55
  SPEAKER_00: Is there any history of injuries to your patellar tendon, quad, to your hamstrings?
• 12:00
  SPEAKER_00: What kind of sports do you play?
• 12:01
  SPEAKER_00: What kind of activities do you want to do?
• 12:03
  SPEAKER_00: And then also the surgeon's expertise, right?
• 12:05
  SPEAKER_00: There's so many layers to picking a graph type versus just being like, the surgeon does this, this is what I'm going with.
• 12:11
  SPEAKER_00: Well, if you're a wrestler and you get a patellar tendon, guess what?
• 12:15
  SPEAKER_00: You're on your knees so much.
• 12:17
  SPEAKER_00: And it might actually be the worst decision because if you have kneeling pain, guess what?
• 12:21
  SPEAKER_00: You're on your knees all the time wrestling, right?
• 12:24
  SPEAKER_00: And then so it's gonna be very different versus a hundred meter sprinter who is going to play college, right?
• 12:30
  SPEAKER_00: Or compete in college.
• 12:32
  SPEAKER_00: If they get a hamstring graph, we got to know the implications of that because the hamstrings are so involved with sprinting that if we take one of this athlete's hamstrings, guess what?
• 12:42
  SPEAKER_00: They're gonna lose some speed and they're likely more prone to hamstring strains.
• 12:46
  SPEAKER_00: And getting full cycle of that knee when you go through the sprint cycle is going to be influenced.
• 12:52
  SPEAKER_00: But these details are not usually discussed.
• 12:54
  SPEAKER_00: It's just like, hey, this is the graph that I do.
• 12:56
  SPEAKER_00: Yeah, you could get some other ones, but this is what I do, so take it or leave it.
• 13:00
  SPEAKER_00: We're going to talk through this stuff with you, especially if it's still a decision point.
• 13:03
  SPEAKER_00: So we help walk through this with an athlete, but then also knowing what to expect if you already had the graph set on it, and also knowing what does that look like with quad, patella, hamstring versus an allograph, and knowing what to expect is huge, including also our bears or even repairs, which also are gaining traction.
• 13:22
  SPEAKER_00: We talk through what non-weight bearing might look like, what weight bearing might look like, how meniscus-related decisions impact this, and other concomitant issues.
• 13:32
  SPEAKER_00: So if there's an MCL injury, uh PCL, an LCL, other cartilage-based injuries, bone injuries, fractures, there's a number of things that can happen with the incident that happens whenever the ACL is injured.
• 13:47
  SPEAKER_00: So we have to understand that.
• 13:48
  SPEAKER_00: Meniscus is typically a common one.
• 13:51
  SPEAKER_00: And so then, therefore, we want to make sure we understand okay, are they gonna repair it or are they gonna cut some of it away via menisectomy?
• 13:58
  SPEAKER_00: Now, this is going to influence a lot because a lot of times, if it's a repair, you're going to have a non-weight bearing for a period of time and maybe limited flexion.
• 14:09
  SPEAKER_00: And so that's gonna be super important in this process because we need to make sure we understand, okay, if we're not weight bearing for four weeks, that changes things versus weight bearing is tolerated from the get-go.
• 14:21
  SPEAKER_00: And so we also let our athletes know, you know, sometimes it's a game time decision for the surgeons.
• 14:27
  SPEAKER_00: They may say one thing, they go into the surgery and they may be seeing something different, and they may have to do something different.
• 14:33
  SPEAKER_00: And guess what?
• 14:34
  SPEAKER_00: You wake up, you thought you were gonna have a menisectomy and could put weight on it, and they restrict you because it's a complex meniscus repair, and you can't put weight on it for six weeks.
• 16:49
  SPEAKER_00: Your life changes for that next six weeks, I promise.
• 16:52
  SPEAKER_00: It's very different, and so then therefore, that is going to influence the recovery and the rehab and also mentally how you progress into the next phases.
• 16:59
  SPEAKER_00: And so that's something we need to talk through to make sure you understand what is worst-case scenario and what is best case scenario.
• 17:05
  SPEAKER_00: And also, side note, if you have a meniscus repair in the short term, it sucks, but I promise in the long term, it's great because you have that cartilage that's preserved versus menisectomy, they have to cut some of it away.
• 17:19
  SPEAKER_00: Now that's great in the short term because you can put weight on it.
• 17:21
  SPEAKER_00: But with that said, longer term, maybe a little bit more risk for osteoarthritis.
• 17:26
  SPEAKER_00: I had to have a menasectomy on my left knee when I had my second ACL.
• 17:29
  SPEAKER_00: So I just kind of know that comes with the territory now.
• 17:33
  SPEAKER_00: But again, it could be a game time decision.
• 17:35
  SPEAKER_00: And the last thing you want to do is wake up not knowing this and being like, oh man, we're gonna do this, and then now I'm locked in this brace or to 90 degrees, and it's gonna be like this for four to six weeks.
• 17:46
  SPEAKER_00: Very different.
• 17:47
  SPEAKER_00: So we talk through what this can look like.
• 17:49
  SPEAKER_00: We talk through the bracing, we talk through nutrition, protein goals.
• 17:53
  SPEAKER_00: Stuff like this is super important because it's overlooked, but it can make a huge difference in this post op process.
• 18:00
  SPEAKER_00: So that's all around like the education and setting expectations.
• 18:04
  SPEAKER_00: And then we roll through our process of what does it look like to rebuild the ACL athlete?
• 18:09
  SPEAKER_00: What are the needs for their specific goals, their activities, and their sports, and what are the demands of that and what we're trying to get back to?
• 18:17
  SPEAKER_00: We talk about auto-regulation, which is dosing proper intensities and volumes, so making sure we can get that accurately to get the right stimulus.
• 18:26
  SPEAKER_00: We talk through feedback loops, which is how to navigate pain and swelling.
• 18:30
  SPEAKER_00: Look, we're not there with you day to day, every single moment, right?
• 18:34
  SPEAKER_00: So we can't necessarily say, hey, you have to do this in the exact same moment.
• 18:39
  SPEAKER_00: And no PT is ever gonna follow you like that.
• 18:42
  SPEAKER_00: You may be seeing your PT in person three times a week max.
• 18:46
  SPEAKER_00: Usually it's two times a week, maybe once a week, maybe it's every few weeks.
• 18:50
  SPEAKER_00: Through working with us, like we have constant communication throughout the week with our athletes through messaging.
• 18:57
  SPEAKER_00: So you get a quick response.
• 18:58
  SPEAKER_00: But with that said, it's important to put this into your own control to educate you.
• 19:03
  SPEAKER_00: So that way, if your next PT visit isn't until two days from now or next week, or you can't get a response within the next six hours, you know what to do if something acts up from a pain standpoint, swelling.
• 19:17
  SPEAKER_00: You know these particular principles and feedback loops that follow.
• 19:21
  SPEAKER_00: And that helps you feel in control versus feeling, oh my gosh, what just happened?
• 19:26
  SPEAKER_00: How do I navigate this?
• 19:28
  SPEAKER_00: We talk about pain management, we assess psychologically how they're doing, get an objective number connected to this.
• 19:34
  SPEAKER_00: So we're getting an idea of this threshold and where someone is.
• 19:38
  SPEAKER_00: And then we also talk about the roadmap.
• 19:40
  SPEAKER_00: What does this look like for their specific journey, your specific journey as an ACL or how can we mold this to you and making sure that step by step you know what the key milestones are and the objective criteria?
• 19:53
  SPEAKER_00: And then tapping into some mindset-related work is gonna also be key starting day one and each week with that.
• 20:00
  SPEAKER_00: So these are things that are super important for us from an education standpoint, along with many other things that we layer in, but it seems like a lot, but we spread it out and we try to educate this in a more visual way.
• 20:13
  SPEAKER_00: So then, therefore, our athletes are very familiar with this, they see this, they're like, okay, I got control of this, and we're right alongside them, walking them through this day to day.
• 20:22
  SPEAKER_00: And then the other pieces that I'll share here, setting up your environment for success.
• 20:27
  SPEAKER_00: So underestimated, but making sure you get everything properly set up and understanding what the ins and outs of that looks like versus getting home and being like, oh, my stuff's upstairs, but I'm downstairs and then navigating stairs.
• 20:40
  SPEAKER_00: So all that's like reactive, and we want to make sure we are proactively setting things up.
• 20:46
  SPEAKER_00: The post op exercises, everyone will likely get a sheet of paper from their surgeon.
• 20:51
  SPEAKER_00: I hate that thing.
• 20:52
  SPEAKER_00: I wish they never gave it to people.
• 20:54
  SPEAKER_00: But it's something where, you know, it might be just basic post-op exercises, and I can tell you 99% of them.
• 21:01
  SPEAKER_00: It is quad sets, straight leg raises, which no one should be doing and they should take them off.
• 21:06
  SPEAKER_00: It's heel slides, it is typically glute sets, it is typically a four-way hip.
• 21:13
  SPEAKER_00: Those are the main ones.
• 21:14
  SPEAKER_00: There might be some other ones in there, uh, but those are the main key ones that you'll see.
• 21:18
  SPEAKER_00: And I'm saying they're bad, right?
• 21:20
  SPEAKER_00: But at the same time, it's something that we need to make sure we tailor to each person through this process.
• 21:26
  SPEAKER_00: And so that's something that's going to be really, really key here.
• 21:29
  SPEAKER_00: And so with the post op exercises, we don't want to overlook these, but we also want to get these a little bit more tailored to each athlete.
• 21:36
  SPEAKER_00: And so we set up specific buckets to tackle based on the number of factors graft, weight bearing, surgeon restrictions, and most importantly the criteria we're driving towards, especially looking at the quiet knee and other areas that we want to work on.
• 21:50
  SPEAKER_00: We go through range of motion streams, which is focused on extension and flexion.
• 21:53
  SPEAKER_00: We look at isometric streams to make sure we're still activating muscles in a proper way and not losing all the work that we had in prehab or prior to that.
• 22:03
  SPEAKER_00: And so we want to make sure we can start dialing those in early versus waiting.
• 22:07
  SPEAKER_00: We don't need to wait until range of motion is full or a certain point.
• 22:11
  SPEAKER_00: Let's start activating and starting to work these muscles in isometric positions and then working them through range of the different muscle groups.
• 22:19
  SPEAKER_00: Gate and running mechanics can start literally day one.
• 22:22
  SPEAKER_00: People are so surprised by this, but we dial in these mechanics to make sure that people are feeling good and that they can start hitting the ground and being able to more so get their gait going, and then that's gonna slowly evolve into running mechanics.
• 22:35
  SPEAKER_00: We want to make sure their specific dosage and cues is lined up so they're familiar with this, and what to feel and the specific benchmarks of each.
• 22:43
  SPEAKER_00: I think that's super key when someone's doing a quad set, when they're using NMES, when they're doing a heel pop, when they're doing an isometric knee extension, we want to make sure that they know what they need to feel, what is normal, what is abnormal.
• 22:56
  SPEAKER_00: So that's gonna be helpful to make sure, like, okay, this is feeling like it's in alignment of that, and this one feels a little different.
• 23:03
  SPEAKER_00: So these all seem to be a little extra, but with what we do, especially from our remote coaching side of things, we educate our athletes through this process in a number of different ways and are able to also provide this framework visually and for them to go through and for us to communicate easily through it.
• 23:23
  SPEAKER_00: And so the thing is with this, is that even though it seems extra or extra detailed, it makes all the difference.
• 23:32
  SPEAKER_00: And the beauty is that you're ready for them, and then we tailor it once we finalize and know what happens in the surgery and after.
• 23:41
  SPEAKER_00: So that way when you are going into the surgery and after, like these exercises are like, I've seen these, I know what these are, and versus being able to say, like, oh, these are unfamiliar, and now you're trying to tackle these while you are post op and a little bit more out of it, and the feel of it just doesn't feel right.
• 24:00
  SPEAKER_00: It's much more than just basic stuff.
• 24:04
  SPEAKER_00: And it's something that can be a huge catalyst in this process.
• 24:08
  SPEAKER_00: And then as we look into this a little bit more, we're gathering proper equipment and getting used to it and set it up before surgery for the max benefits.
• 24:17
  SPEAKER_00: So electrical stimulation using a neuromuscular, electrical stem, so NMES.
• 24:22
  SPEAKER_00: If BFR is in the mix, blood flow restriction, we're getting them used to that, getting the occlusion pressure, getting that used to what we're going to be doing.
• 24:30
  SPEAKER_00: And then taking it for multiple test drives until you feel fully dialed in.
• 24:34
  SPEAKER_00: You could set up that NMES, you could set up the BFR, you could set up any other type of equipment you might be using in the process to make sure that's dialed in.
• 24:44
  SPEAKER_00: And the one thing I want to share is that we've had four fresh post op ACLers these past two weeks, and they've all been cruising since surgery, all sharing how they felt since day one, which has been really awesome to hear.
• 24:57
  SPEAKER_00: And it's something they knew what to do, what to expect.
• 25:01
  SPEAKER_00: And so mentally and physically they felt ahead.
• 25:03
  SPEAKER_00: Instead of surgery being this big roadblock, it was just kind of like a speed bump, right?
• 25:07
  SPEAKER_00: And they just kept rolling as they went past it.
• 25:11
  SPEAKER_00: And the funny thing is that this is also despite a couple surgeons saying, don't do anything for your first week or so until your first post-op visit with the surgeon.
• 25:21
  SPEAKER_00: And that's very common.
• 25:22
  SPEAKER_00: You know, you have the surgery and then the post-op visit follow-up where they might check the knee, change the bandage, whatever it might be, in that maybe take out stitches.
• 25:31
  SPEAKER_00: But the thing is, is like some will give exercise and some will say, just wait until you see me and then you can go to PT.
• 25:37
  SPEAKER_00: And some of these might say it's a week, or maybe it's two weeks, or maybe scheduling differences don't allow for time.
• 25:44
  SPEAKER_00: But for both of these, it was roughly around a week and a half from surgery to the follow-up, which is ridiculous to do nothing.
• 25:50
  SPEAKER_00: So we had them doing stuff day of surgery, and they went to their post op follow-up a week and a half in.
• 25:57
  SPEAKER_00: And the doc and the physician's assistant, they were like shocked.
• 26:02
  SPEAKER_00: They were like, why is your knee look like this?
• 26:05
  SPEAKER_00: And it's like, because we could start this stuff day one.
• 26:08
  SPEAKER_00: And so they have made a ton of progress and it's been awesome.
• 26:12
  SPEAKER_00: But I attribute a lot of this to them getting prepared prior to the surgery and being dialed in and staying dialed in day to day.
• 26:20
  SPEAKER_00: And therefore, they're not starting their starting line at a week and a half post-op.
• 26:25
  SPEAKER_00: They're actually starting day of surgery and before that.
• 26:28
  SPEAKER_00: So then, therefore, it's just a continuation of the process.
• 26:31
  SPEAKER_00: And so, why do we do this?
• 26:33
  SPEAKER_00: This makes it proactive versus reactive.
• 26:36
  SPEAKER_00: I think proactive healthcare is the way to go.
• 26:39
  SPEAKER_00: We want to make sure that we are proactive in everything that we do.
• 26:42
  SPEAKER_00: You don't want to wait until you get sick, until something bad happens to do something.
• 26:46
  SPEAKER_00: You want to be proactive, especially if there are certain things that you know are in your control.
• 26:51
  SPEAKER_00: If you wait till after surgery, it's just too much, y'all, if I'm being honest.
• 26:55
  SPEAKER_00: In pain and swelling, you're apprehensive, you're working with a knee or quad that just feels completely foreign.
• 27:02
  SPEAKER_00: You can't feel it.
• 27:03
  SPEAKER_00: And so we have them do a lot of this prior to surgery, and it's an absolute game changer.
• 27:08
  SPEAKER_00: And I view this instead as having an abrupt start, starting post op when it's already hard as it is.
• 27:17
  SPEAKER_00: And we do it pre-surgery during the prehab, ideally, when it's easy, it's smooth continuation since you're familiar and know it versus being brand new and also abrupt after a major reconstruction.
• 27:30
  SPEAKER_00: We also see the flip side of this in many ways, which sucks, but people don't often find us until they are dealing with these problems, right?
• 27:39
  SPEAKER_00: Later on, or they notice their care is not great, or maybe insurance runs out.
• 27:43
  SPEAKER_00: It's hard to tease this out, especially in the first weeks of post op because it's very basic at a lot of clinics.
• 27:49
  SPEAKER_00: You're going to see progress even with the worst of worst PTs because it's just the nature of the ACL process.
• 27:55
  SPEAKER_00: You go from a straight knee, you bend it some, you get it straighter, you start to get off crutches typically.
• 28:00
  SPEAKER_00: But that is something that you don't figure out until a little bit later.
• 28:04
  SPEAKER_00: So things that are really important.
• 28:07
  SPEAKER_00: So then we hear what they did for these ACLers, of course, meeting them after the post op process later in.
• 28:16
  SPEAKER_00: And we hear about, you know, the bare bones protocol, basic exercises that Bertha, the you know, 79-year-old with a total knee gets.
• 28:25
  SPEAKER_00: And it's not progressed.
• 28:26
  SPEAKER_00: And we see that the impact it's having in their early and late stages.
• 28:31
  SPEAKER_00: And that could be the difference of smoothly walking two weeks post-op with no crutches versus six weeks of crutches or limping around for a while after.
• 28:39
  SPEAKER_00: And we see this a lot, y'all.
• 28:40
  SPEAKER_00: That trickles into the later months because these initial road bumps or honestly roadblocks cause delays in their other aspects of the process, like return to running, return to jumping, getting their quad strength to a certain point, swelling sticking around for an obscene amount of time.
• 28:56
  SPEAKER_00: So if you're heading into surgery, I promise you this can be the thing that makes the first six to eight weeks a win versus feeling fully anxious and impacting either positively or negatively the weeks and months ahead.
• 29:09
  SPEAKER_00: So be proactive.
• 29:11
  SPEAKER_00: If you can lock in even the first visit, second visit, prehab visits, that'll help get the ball rolling.
• 29:18
  SPEAKER_00: But just be prepared.
• 29:19
  SPEAKER_00: You're not going to have this much detail going into PT.
• 29:23
  SPEAKER_00: And it's just hard for PTs to find the time to do it.
• 29:26
  SPEAKER_00: And also if it's their sole focus.
• 29:28
  SPEAKER_00: We're just weirdly obsessed with this.
• 29:30
  SPEAKER_00: So we've had years and years plus thousands of data points to dial this in and make sure our ACLers are prepared.
• 29:38
  SPEAKER_00: I just encourage you to find the proper care that can provide this for you because each person deserves it.
• 29:45
  SPEAKER_00: And I believe that truly, regardless of status, level of play, age, etc.
• 29:50
  SPEAKER_00: I think that it's something that everyone deserves good care, no matter who you are.
• 29:55
  SPEAKER_00: So being super prepared, going into ACL surgery, gathering important data for our ACLers, not only as athletes, but also as a human, including baselines and what's important to them, knowing what that roadmap and plan looks like, education being the foundation of this, setting up your environment, getting individualized programming and exercise prescription that will be regularly updated, and equipment essentials is going to be so key.
• 30:20
  SPEAKER_00: Be proactive, y'all.
• 30:21
  SPEAKER_00: Don't react to this.
• 30:23
  SPEAKER_00: Start early before surgery.
• 30:25
  SPEAKER_00: And I promise you it will make or break this process, especially in the first weeks and months to come.
• 30:32
  SPEAKER_00: And so I hope that this is helpful.
• 30:35
  SPEAKER_00: If you need any help, if you're finding yourself feeling lost, please reach out.
• 30:38
  SPEAKER_00: We do help ACLRs all over the world remotely.
• 30:41
  SPEAKER_00: And most importantly, all we care is to just make sure you find good help and expertise.
• 30:47
  SPEAKER_00: And that's our mission here.
• 30:49
  SPEAKER_00: So if you have any questions, reach out.
• 30:51
  SPEAKER_00: Otherwise, I will catch you guys in the next episode.
• 30:53
  SPEAKER_00: This is your host, Ravi Patel, signing off.