Latest / The ACL Athlete Podcast / 292 | The One Skill That Separates Good ACL PTs From Great Ones

Transcript

292 | The One Skill That Separates Good ACL PTs From Great Ones · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Robbie Patel, 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: I want to start with something I don't usually lead with.
• 1:04
  SPEAKER_00: I got something wrong early in my career.
• 1:07
  SPEAKER_00: Not a small thing, a pattern I missed on an athlete because I told myself the same thing a lot of well-meaning providers tell themselves.
• 1:17
  SPEAKER_00: Give it more time.
• 1:18
  SPEAKER_00: It'll come around.
• 1:20
  SPEAKER_00: It did not come around.
• 1:22
  SPEAKER_00: And that mistake taught me more about being a good ACL physical therapist than almost anything else has since.
• 1:32
  SPEAKER_00: And that's what I want to talk about today.
• 1:34
  SPEAKER_00: Last week I did an episode walking through 20 different cases off our caseload.
• 1:41
  SPEAKER_00: Different ages, different graph types, different timelines, different procedures, some that were straightforward, some that were really complicated.
• 1:50
  SPEAKER_00: If you haven't heard that one, go back and listen.
• 1:53
  SPEAKER_00: This episode builds off of it.
• 1:56
  SPEAKER_00: But there was a thread running through a lot of those cases that I couldn't stop thinking about afterwards.
• 2:02
  SPEAKER_00: It wasn't about the injuries themselves, it was about how many of them looked normal on the surface right up until they didn't.
• 2:11
  SPEAKER_00: And it took me back to my own early misses.
• 2:14
  SPEAKER_00: And I think about this a lot, especially as I've gotten further in my career, of my early misses, especially the things that I just should have done a little bit better, and how much of what separates a very good ACL PT from a very great ACLPT.
• 2:32
  SPEAKER_00: And it has nothing to do with knowing more of the exercises.
• 2:36
  SPEAKER_00: It's not about I know all thousands and thousands of exercises.
• 2:41
  SPEAKER_00: It's more than that.
• 2:43
  SPEAKER_00: Early on, I had an athlete who was stalling, and many athletes through this process stall, right?
• 2:49
  SPEAKER_00: There's a stall phase where people are trying to get past this kind of point or work through this plateau.
• 2:56
  SPEAKER_00: So there's stallings that exist in the ACL rehab process, but I had an athlete who was stalling.
• 3:02
  SPEAKER_00: Extension wasn't coming back the way it should have.
• 3:04
  SPEAKER_00: Swelling kept lingering longer than it should have.
• 3:07
  SPEAKER_00: And I did what a lot of PTs do when something isn't matching the textbook timeline.
• 3:13
  SPEAKER_00: I told myself it was normal variation, right?
• 3:17
  SPEAKER_00: It's a range.
• 3:18
  SPEAKER_00: I gave it more time.
• 3:19
  SPEAKER_00: I adjusted the program a little bit.
• 3:21
  SPEAKER_00: I waited.
• 3:23
  SPEAKER_00: I thought that I could out-exercise and with time that this would get better.
• 3:27
  SPEAKER_00: And looking back, that was the wrong call.
• 3:31
  SPEAKER_00: There were signs pointing somewhere else, and I didn't have the experience yet to read them.
• 3:37
  SPEAKER_00: I was pattern matching against a small sample size.
• 3:41
  SPEAKER_00: I just didn't have as many reps under my belt compared to what I have today.
• 3:45
  SPEAKER_00: My own limited caseload at that point, instead of against what I know now after seeing this play out thousands of times at this point, that athlete lost time, real time, not because I didn't care, like I cared so much, or that they didn't work hard, or that I didn't work hard, because I was trying to put everything into this, because I just hadn't built the pattern recognition yet to know when normal recovery variation stops being the normal.
• 4:17
  SPEAKER_00: And I think about this case a lot.
• 4:19
  SPEAKER_00: Not because I beat myself up over it anymore, but because it's exactly why I built the systems we have today.
• 4:27
  SPEAKER_00: I'll get into what those actually look like in a minute, but none of this exists because we think we're smarter than anyone else.
• 4:34
  SPEAKER_00: I promise you that.
• 4:36
  SPEAKER_00: It exists because we got burned by not having it.
• 4:39
  SPEAKER_00: And that's the thing that's so important in this process is to be able to take your own personal expertise as a professional physical therapist going through your education, your own anecdote of what you have experienced in this process.
• 4:57
  SPEAKER_00: You take the patient side of things that is really important to be able to experience in this process and to filter through that and what they're sharing.
• 5:04
  SPEAKER_00: And then you have to take in what the research and the totality of the data and what it shows across the spectrum.
• 5:11
  SPEAKER_00: And it's so important to be able to do that.
• 5:14
  SPEAKER_00: And we're going to be filtering through these different lenses to make sure we are able to come up with the right game plan and be able to pivot when we need to.
• 5:24
  SPEAKER_00: And the thing is, is that when you're starting out as a young clinician in a PT, you are trying to get the reps and you're trying to understand and see these patterns and trying to be able to just kind of recognize the nuances of different processes.
• 5:40
  SPEAKER_00: As I shared, there is no single ACL process that is the same.
• 5:44
  SPEAKER_00: And so you're just collecting more and more information.
• 5:48
  SPEAKER_00: It's not an N equals one, eventually it's a two, a three, a four, a five.
• 5:53
  SPEAKER_00: And then you start to get N equals 100, 200, 300, 400, 500 as you get more repetitions.
• 5:59
  SPEAKER_00: And guess what?
• 6:00
  SPEAKER_00: As you get more of that experience, you're gonna get much better at recognizing things.
• 6:06
  SPEAKER_00: But you have to be intentional because I know very many people who have seen tons of ACLs who just repeat the same patterns.
• 6:14
  SPEAKER_00: They never were intentional about trying to update or recognize things, and then they just continue to repeat after one after another and didn't really try to reflect and see what could I have done better.
• 6:26
  SPEAKER_00: And I think that's so important in any professional take or anything that you do, you need to be able to audit the process and reflect on what I could have done better, where were my blind spots, and that is so crucial for myself and for our team, which we talk through every single week.
• 6:43
  SPEAKER_00: That is so important to us to keep showing up, being the best professionals, being able to deliver our best for our athletes and for our mentees, and then also being able to deliver world-class outcomes.
• 6:56
  SPEAKER_00: That is something that we cared so deeply about, and to make sure that athletes are heard.
• 7:02
  SPEAKER_00: And so, byproduct of that, we did have to accumulate reps.
• 7:06
  SPEAKER_00: And here's the thing about pattern recognition it's not a talent, it's not something that people are just gifted with, right?
• 7:15
  SPEAKER_00: It's not something you either have or you don't.
• 7:17
  SPEAKER_00: It's built over a period of time, rep after rep after rep.
• 7:21
  SPEAKER_00: I use the N equals one, and then you know, we started to say two, three, four, and then eventually it's 10, 20 into the hundreds, thousands, right?
• 7:30
  SPEAKER_00: Those are the reps, those are the experiences.
• 7:32
  SPEAKER_00: Every single session, every single communication touch point, every single day that an athlete is completing and going through this process, and we are processing through this with them, those are repetitions.
• 7:43
  SPEAKER_00: And honestly, through being wrong enough times that you start to notice what off actually looks like before it becomes obvious.
• 7:52
  SPEAKER_00: I like to think about this like a Sherpa taking someone up a mountain for the first time.
• 7:56
  SPEAKER_00: And I use this example in the previous episode, and I think that it just depicts this so well.
• 8:02
  SPEAKER_00: The Sherpa isn't fearless because they're built different.
• 8:06
  SPEAKER_00: They've just been up the mountain hundreds of times.
• 8:10
  SPEAKER_00: They've seen the weather turn out on this exact ridge before.
• 8:14
  SPEAKER_00: They know what normal fatigue looks like, they know what the weather and the conditions look like, versus something that's about to become a real problem.
• 8:23
  SPEAKER_00: And they've probably gotten it wrong once or twice, sure, especially earlier in their career, too, which is exactly why they trust their gut now.
• 8:31
  SPEAKER_00: And that is something that we feel is that, yeah, when you start to get your initial reps, man, I if someone who was my first ACL ever is listening to this, I'm sorry.
• 8:42
  SPEAKER_00: I wish I could have done better for you, but I was trying to get my reps, and everyone's got to start somewhere.
• 8:48
  SPEAKER_00: But as you're listening to this, as the ACLer or maybe a clinician listening to this, as the ACLer especially, we understand people have to learn, have to educate, and get the repetitions.
• 9:00
  SPEAKER_00: You just don't want your physical therapist to be the one that is learning on you.
• 9:05
  SPEAKER_00: Let's be honest.
• 9:06
  SPEAKER_00: We know people have to get it from somewhere, and we just don't want it to be especially on you, right?
• 9:12
  SPEAKER_00: That's just not something that is ideal for something that has a one in four re-injury rate, right?
• 9:18
  SPEAKER_00: And especially such a long-term rehab and complexity.
• 9:22
  SPEAKER_00: And so the thing is that the reps do have to be built over time, and I think that being able to accumulate that is so valuable.
• 9:33
  SPEAKER_00: And practically, here's what building that actually looks like for our team.
• 9:38
  SPEAKER_00: Just so you guys know, we meet every single week, multiple times a week, and talk through our athletes' cases.
• 9:45
  SPEAKER_00: Not just the easy ones, not just the complicated ones.
• 9:48
  SPEAKER_00: We talk through every single one.
• 9:49
  SPEAKER_00: We hear everyone's name, we know exactly where they're at, we know exactly where they're going, and we also talk through these cases.
• 9:56
  SPEAKER_00: Sometimes we will spend 30 minutes on one case that's complicated enough to just earn that time.
• 10:04
  SPEAKER_00: But it's important to us.
• 10:05
  SPEAKER_00: If people are in sticking points, and if you're listening to this and you're an athlete of ours, I promise you you have been a center of conversation in our team meetings.
• 10:15
  SPEAKER_00: And especially if you're one of the complicated ones, I promise you have had some FaceTime with our team in these team meetings.
• 10:23
  SPEAKER_00: Because we talk through all these, all the complicated ones, all the things that make our scratch our heads, all the ones that we're just like, this doesn't really add up.
• 10:31
  SPEAKER_00: And we're talking about hundreds and thousands of reps of ACLers at this point.
• 10:35
  SPEAKER_00: Going back and forth in these meetings, talking through things, pressure testing what we're each seeing.
• 10:41
  SPEAKER_00: And we're all learning from each other.
• 10:43
  SPEAKER_00: We're all kind of being able to share, you know, this is what we've seen, this is what we think is going to be the best route, this is what we think should happen.
• 10:51
  SPEAKER_00: And sometimes there are situations where it's like, no, I think actually this needs to move a little bit faster.
• 10:55
  SPEAKER_00: Or maybe, hey, let's slow cook this a little bit more because this is what we typically see in a situation like this.
• 11:01
  SPEAKER_00: We don't walk into those conversations with all the answers, nobody does, but we see a huge range of cases.
• 11:08
  SPEAKER_00: Simple ones, and we love the simple ones because, man, it's just kind of fun to be able to see people ride this thing out and feel so smooth.
• 11:17
  SPEAKER_00: And then we see a lot of the really complicated ones, and a lot of the complicated ones end up on our table because they needed more time, more eyes than the typical visit may allow.
• 11:28
  SPEAKER_00: That's not a knock on any individual provider.
• 11:31
  SPEAKER_00: It's what happens inside of a system and a model built around volume instead of the one-on-one detail in depth that we can provide.
• 11:40
  SPEAKER_00: And it's a big part of why we built our week around the opposite of the high volume and the model and the system that exists in the world today.
• 11:49
  SPEAKER_00: That accumulation of the reps, arguing through cases as a team, being able to just kind of troubleshoot those things of saying, like, okay, this is what our opinions are.
• 12:00
  SPEAKER_00: And we have these healthy conversations around this to be able to teamwork these things out.
• 12:05
  SPEAKER_00: Getting it wrong sometimes, we're not perfect, and correcting that's what pattern recognition actually is.
• 12:12
  SPEAKER_00: It's not about being naturally gifted at spotting all these problems, although we are able to really see these things now more than ever.
• 12:19
  SPEAKER_00: But it is about accumulating that exposure, playing attention, close attention, and a system that forces you to track trends instead of, you know, just kind of treating every athlete as an isolated case.
• 12:32
  SPEAKER_00: To be able to track the data, to be able to connect the dots of the data, to see what's trending in the right direction, what's not trending in the right direction.
• 12:41
  SPEAKER_00: All these things are feedback, and you won't know unless you're assessing and keeping up with these things.
• 12:46
  SPEAKER_00: That's where the data and keeping up with these things is so important to us because if things are not going in the right direction, and we're putting in all the knowledge and what we know and our frameworks and processes to do that, then we're gonna start to be like, this is not adding up.
• 13:01
  SPEAKER_00: And in 99% of cases, this is what typically should happen.
• 13:05
  SPEAKER_00: And this is not what's happening.
• 13:06
  SPEAKER_00: So let's be detective here and figure out what is it that we need to do in a situation like this.
• 13:11
  SPEAKER_00: So I want to give you two examples, not because they're rare situations, but because they show up more than people realize in this process and they show how much timing matters.
• 13:22
  SPEAKER_00: First is scar tissue and cyclops lesion.
• 13:25
  SPEAKER_00: I'm just gonna lump these together.
• 13:27
  SPEAKER_00: Lump, probably not good to say that for cyclops because it's a lump.
• 13:31
  SPEAKER_00: This is scar tissue that can form in the front of the knee in front of the ACL and block full extension, can get some symptoms, you know, some anterior knee pain.
• 13:42
  SPEAKER_00: Caught at month four, it's a relatively straightforward, you know, conversation and course correction.
• 13:48
  SPEAKER_00: I just had this happen to one of my athletes where we caught this early and we're able to intervene, have this removed, and hit the road recovery.
• 13:57
  SPEAKER_00: She had been doing everything just right.
• 13:59
  SPEAKER_00: And guess what?
• 14:00
  SPEAKER_00: Scar tissue just showed up, Cyclops showed up, couldn't do anything about it, and it happened.
• 14:05
  SPEAKER_00: But hey, we caught this whenever it started to rear its neck, rear its head, whatever you're supposed to say there.
• 14:11
  SPEAKER_00: And it's something that we were able to say, okay, let's get this cleaned out and onto the road of recovery without it being something that we're having to work around constantly for the next coming months.
• 14:22
  SPEAKER_00: Now, this was caught at month 10 because it got explained away as, oh, it's just tightness, it's normal ACL, normal stiffness, uh, extension looks okay, it's fine, close enough.
• 14:35
  SPEAKER_00: It's completely different.
• 14:37
  SPEAKER_00: Much harder road back.
• 14:38
  SPEAKER_00: Someone at month 10 is now evaluating why they're still potentially just kind of not walking normal or their quad doesn't feel like it's engaging, they're getting more pain in the front of the knee.
• 14:49
  SPEAKER_00: And guess what?
• 14:50
  SPEAKER_00: They're still not back to doing the things they want to do, even at month 10.
• 14:54
  SPEAKER_00: Instead of that being caught earlier, cleaned out, and at month 10, you could be on the field, you could be on the court, you could be on your skis.
• 15:02
  SPEAKER_00: It makes a massive difference.
• 15:05
  SPEAKER_00: And I'm not saying that the scar tissue or a cyclops is going to show up magically early.
• 15:09
  SPEAKER_00: Sometimes it can form later, or it can rear its head later for one reason or another.
• 15:15
  SPEAKER_00: The thing that is really important here is that if that problem was existing in month four and it was never caught and the can got kicked down the road, and month 10 is when it actually got looked into further because of six months of issues, that's a problem.
• 15:29
  SPEAKER_00: That should have been caught at month four.
• 15:31
  SPEAKER_00: And there's no one here that can convince me that there is more value and validity to being able to extend that longer.
• 15:39
  SPEAKER_00: And we have had cases where people go to their surgeon and they're like, oh, keep working on the extension, it'll be fine.
• 15:46
  SPEAKER_00: And we're like, no, this is this is a cyclop solution.
• 15:48
  SPEAKER_00: We have seen this on numerous accounts at this point, and we need some imaging or we need to go see another opinion.
• 15:56
  SPEAKER_00: And guess what?
• 15:57
  SPEAKER_00: They listen because the patient advocated, we equip them with the right things to say, we equip them with the right things to know.
• 16:03
  SPEAKER_00: What are the next steps?
• 16:05
  SPEAKER_00: And if the surgeon doesn't listen, guess what?
• 16:08
  SPEAKER_00: You have the right to another opinion.
• 16:10
  SPEAKER_00: So you can go get another opinion.
• 16:12
  SPEAKER_00: And a lot of times what ends up happening is that they have scar tissue and cyclops in there, get it cleaned out, and then they're on the road to recovery instead of trying to lose all this time.
• 16:23
  SPEAKER_00: The second thing I want to bring out here is just chronic extension loss.
• 16:27
  SPEAKER_00: And you know, it can show up as a limp, for example.
• 16:30
  SPEAKER_00: This one gets normalized a lot as well.
• 16:32
  SPEAKER_00: And people will be told it'll work itself out, they just need to stretch more, or eventually it'll get there.
• 16:39
  SPEAKER_00: Very rarely does that ever work.
• 16:41
  SPEAKER_00: I'm just gonna take a shot and it doesn't.
• 16:43
  SPEAKER_00: In all these cases where someone's like, it'll get better with time, it doesn't.
• 16:48
  SPEAKER_00: But when it persists, past the point when normal variation explains it, that's a signal for us, especially if they are with us.
• 16:56
  SPEAKER_00: Not something, a personality trait of that person's knee, for example.
• 17:00
  SPEAKER_00: It is something that is a signal.
• 17:02
  SPEAKER_00: And neither of these is really about a PT missing something they should have obviously caught.
• 17:07
  SPEAKER_00: Although I will, eh, with the the Cyclops lesion, a little bit questionable, especially if it was very obvious in month four and it was just not addressed.
• 17:18
  SPEAKER_00: But it is about how much experience it takes to know where this line is between, I'm gonna use quotes here of a normal recovery noise and an actual signal.
• 17:30
  SPEAKER_00: And this is the thing we have to differentiate in this process.
• 17:34
  SPEAKER_00: And the more that you get to experience and you learn about this process and you become detectives and you see so many that you are able to really figure out what is that signal between the noise.
• 17:47
  SPEAKER_00: And that line moves depending on how many of these you've seen personally, and that is so important that the volume of ACL is important and the amount of outcomes.
• 17:57
  SPEAKER_00: I think volume plus outcomes.
• 18:00
  SPEAKER_00: I don't think that volume alone is truly a very good proxy.
• 18:04
  SPEAKER_00: I don't think that someone saying I've treated or did surgery on 100 ACLs this year is actually that much of a proxy of a good PT in ACL or a surgeon.
• 18:15
  SPEAKER_00: I think they need to be able to say, yes, they have done this volume, plus have proof, actual proof of the outcomes that these athletes are getting.
• 18:27
  SPEAKER_00: And that is something that is important to me to stand by.
• 18:30
  SPEAKER_00: So, you know, if you're trying to look for us and like our proof, our page has tons of stories about ACLers and their experiences that you can find.
• 18:39
  SPEAKER_00: You can Google us and look at our Google reviews.
• 18:42
  SPEAKER_00: That is so important to me to be able to show the proof of people in the weeds sharing their experiences.
• 18:49
  SPEAKER_00: And I think that's really important in the surgeon side of things, too, is that yes, there needs to be reviews, there needs to be social proof, especially in today's economy of lacking trust, AI, a lot of people trying to kind of sell snake oil, if you will, of like trying to convince people that they're the gurus.
• 19:09
  SPEAKER_00: I think there needs to be proof of the volume.
• 19:11
  SPEAKER_00: I need think that there needs to be proof of the outcomes.
• 19:14
  SPEAKER_00: And I think those two things combined, plus obviously the skill set, the background that shows the expertise, which is the education, that is some amazing fuel to be like, oh yeah, I think I'm kind of landing on someone who really knows what they're talking about.
• 19:31
  SPEAKER_00: So, what I want to share with you is the decision tree or the process of thinking through this and what to do actually when something does feel off.
• 19:43
  SPEAKER_00: And you guys know I want to always make this practical, so I think that is really key.
• 19:47
  SPEAKER_00: This is where I think the real value is because it's not just about noticing something, it's about knowing what to do next as well.
• 19:55
  SPEAKER_00: And that is something that we need to make sure we can do and be able to have this process of like, okay, what are our next series of events that are gonna happen if step one doesn't work, step two doesn't work, step three doesn't work, and we have to exhaust all of our measures.
• 20:11
  SPEAKER_00: And this usually ranges from, yeah, the most conservative to maybe the most aggressive approach.
• 20:17
  SPEAKER_00: And depending on what's picked up, we might have to jump some of those because it might not do it justice.
• 20:23
  SPEAKER_00: Like, as much as I would love to say your Cyclops lesion and we can work on the extension pieces, yeah, you might work on some and see if it actually like gets to a good point.
• 20:32
  SPEAKER_00: But at some point, we're gonna have to really jump.
• 20:34
  SPEAKER_00: We're not gonna do an injection, we're gonna get that thing cleaned out if it's really rearing its head and is in the way, right?
• 20:41
  SPEAKER_00: So let's walk through this decision tree and talking through this and knowing what to do next.
• 20:47
  SPEAKER_00: Sometimes it's adapting the program, small adjustments based on how the athlete is responding.
• 20:52
  SPEAKER_00: Sometimes it's pivoting the approach entirely because what has been working isn't working anymore for that specific case.
• 21:02
  SPEAKER_00: Sometimes it's referring out for imaging and x-ray, MRI, maybe it's a CT scan.
• 21:08
  SPEAKER_00: You might ask why.
• 21:10
  SPEAKER_00: Well, maybe we need to see the tunnel, how wide they are, the positioning, to actually see what's happening instead of just kind of guessing.
• 21:17
  SPEAKER_00: We're collecting more information.
• 21:19
  SPEAKER_00: Along with this, we are also collecting assessments, testing the knee data with this as well to be able to have all the information possible, like we're playing detective to figure out okay, how can we connect all these dots and be able to think through these solutions?
• 21:35
  SPEAKER_00: So we do the imaging and the assessments, of course, be able to make sure that we have things that we're just not truly guessing for.
• 21:43
  SPEAKER_00: Sometimes it's a conservative medical route.
• 21:47
  SPEAKER_00: Maybe it's an oral medication because the knee is responding to some sort of swelling or inflammation, and we need something to really bring this down and take the edge off.
• 21:55
  SPEAKER_00: Sometimes that happens.
• 21:57
  SPEAKER_00: Or it's an injection to calm something down locally.
• 22:00
  SPEAKER_00: Or maybe it is an injection to diagnostically differentiate things.
• 22:04
  SPEAKER_00: For example, sometimes people have a screw-related issue, and sometimes they can get a numbing solution to see in that local area to be able to notice, okay, is it really dedicated to this issue, or maybe it's something else?
• 22:17
  SPEAKER_00: So sometimes the injections can be diagnostic versus being the solution.
• 22:22
  SPEAKER_00: And so these are things that we can help think through in terms of being like, okay, this is what we're seeing.
• 22:28
  SPEAKER_00: These are the things that we're gonna potentially suggest, along with the surgical team or the ortho.
• 22:34
  SPEAKER_00: And as a team as a whole, we're kind of working through this together, right?
• 22:37
  SPEAKER_00: And making sure you feel equipped, especially as the ACL or as the person who has to advocate for their health, especially in today's healthcare.
• 24:50
  SPEAKER_00: And sometimes it's a more invasive route.
• 24:53
  SPEAKER_00: Now we don't love this.
• 24:54
  SPEAKER_00: I'm a physical therapist.
• 24:55
  SPEAKER_00: My biggest bias is to make sure you don't go under the knife.
• 24:59
  SPEAKER_00: But what I have learned in many situations now over the years is that sometimes this is what's needed.
• 25:05
  SPEAKER_00: And this is the quickest route and the only route in some instances to be able to get the outcome we need.
• 25:11
  SPEAKER_00: Scar tissue clean out, a revision, a repair, something that rehab alone was never going to fix.
• 25:17
  SPEAKER_00: And we feel strongly about something and the surgeon we're working with dismisses it, we help that athlete get another opinion.
• 25:25
  SPEAKER_00: Not because we think we know better than any surgeon or every surgeon.
• 25:30
  SPEAKER_00: That is very important to say here.
• 25:32
  SPEAKER_00: But is because we've learned that sitting on a gut feeling for months almost never turns out to be the better call.
• 25:38
  SPEAKER_00: It's very rare that whenever someone's like, Yeah, let's just see how it goes.
• 25:44
  SPEAKER_00: There are some instances, but this is where the pattern recognition and being able to see these things is so valuable.
• 25:51
  SPEAKER_00: And we have had many people get shrugged off to be like, well, just keep working on it, keep strengthening the quad, keep working on extension, keep doing your PT.
• 25:59
  SPEAKER_00: Take some time off, right?
• 26:01
  SPEAKER_00: We had one athlete recently who has been dealing with some extension issues, and we do believe that there's some scar tissue formation going on.
• 26:09
  SPEAKER_00: She went and saw her surgeon five minutes.
• 26:12
  SPEAKER_00: She flew back in out of the country to be able to do that.
• 26:15
  SPEAKER_00: Saw her surgeon for five minutes, and the surgeon was like, knee looks great, and then carried on.
• 26:20
  SPEAKER_00: She flew in especially for that.
• 26:22
  SPEAKER_00: And she's a younger athlete, and she did not feel you know equipped to advocate for herself necessarily.
• 26:28
  SPEAKER_00: And now we are seeking another opinion just because of this.
• 26:32
  SPEAKER_00: And it was so frustrating because now she has lost time and she's in a system that is not as easy to just jump to the next surgeon.
• 26:40
  SPEAKER_00: And so we're having to help her navigate through these hurdles and also some of the boundaries or constraints around the healthcare system she's in.
• 26:48
  SPEAKER_00: And so this is something that could have been addressed, but the time and attention wasn't taken to be able to really hear this person and maybe, you know, the the quote unquote expertise of the other person was almost clouding the judgment too much.
• 27:05
  SPEAKER_00: Almost like, oh, like you don't know any better.
• 27:08
  SPEAKER_00: And it's something that, you know, I think we need to be able to listen to our athletes better and because it's their body.
• 27:16
  SPEAKER_00: And yeah, there are situations where they might kind of overreact to things and whatnot, but how are you going to be able to discern that in five minutes of seeing somebody?
• 27:24
  SPEAKER_00: You can't.
• 27:25
  SPEAKER_00: And so therefore, there needs to be more advocacy around being able to help athletes do this.
• 27:31
  SPEAKER_00: And that's why it's important to be able to make sure we can equip our athletes with what to say, what to ask for, and to be a bit more direct on it, not just being like, oh, okay, it'll get better with time.
• 27:43
  SPEAKER_00: Like, yeah.
• 27:44
  SPEAKER_00: No, like let's let's be direct about this because sometimes that opportunity is there and you got to strike while you're there, versus it could be another few months before you have another ability to check in with someone else, especially from the surgical side based on the constraints there.
• 28:00
  SPEAKER_00: So this is super, super key here.
• 28:02
  SPEAKER_00: I had someone recently on a call.
• 28:05
  SPEAKER_00: She's eight months out and still mentioned that she's occasionally limping.
• 28:10
  SPEAKER_00: And while you might be like, wow, that's crazy.
• 28:12
  SPEAKER_00: This happens way more than you think.
• 28:14
  SPEAKER_00: Some of you listening might be in this same category.
• 28:17
  SPEAKER_00: But the thing is that it had been normalized the whole way.
• 28:20
  SPEAKER_00: Her surgeon said, Oh, it's fine.
• 28:22
  SPEAKER_00: The surgeon didn't watch her walk.
• 28:23
  SPEAKER_00: She was like, I just sat in the office for five minutes, and yeah, did some testing on my knee and said, Oh, it's fine.
• 28:30
  SPEAKER_00: Didn't watch her walk, even though she complained about potentially limping.
• 28:34
  SPEAKER_00: And then her PT was like, Oh, it'll get better.
• 28:37
  SPEAKER_00: And give it time.
• 28:38
  SPEAKER_00: And I could tell you with confidence, y'all, there's something underlying that hasn't been addressed as we talk through her case.
• 28:45
  SPEAKER_00: And the time by itself is not going to fix it.
• 28:48
  SPEAKER_00: It's just going to cost her more of the time, honestly.
• 28:51
  SPEAKER_00: And here's what I want you to take from that.
• 28:53
  SPEAKER_00: And this is for the athletes listening more than anyone else.
• 28:57
  SPEAKER_00: If something in your gut is telling you this isn't normal, it doesn't feel right, that feeling is data.
• 29:04
  SPEAKER_00: It's not just you being dramatic or impatient, asking questions, pushing for answers, seeking a second, third, fourth opinion.
• 29:13
  SPEAKER_00: None of that is betrayal of your provider.
• 29:16
  SPEAKER_00: Just know that.
• 29:17
  SPEAKER_00: It's you advocating for your own recovery.
• 29:20
  SPEAKER_00: It's your body, it's your livelihood, it's your outcomes.
• 29:24
  SPEAKER_00: You have to take control of this.
• 29:25
  SPEAKER_00: And it is the number one thing that is so important in today's healthcare, no matter what system you are.
• 29:31
  SPEAKER_00: There's no perfect system that exists.
• 29:33
  SPEAKER_00: And right now it is easy to fall through the cracks.
• 29:35
  SPEAKER_00: And so you have to advocate for yourself and take control of this process yourself.
• 29:40
  SPEAKER_00: Because if you lean on the medical system, you will fall through.
• 29:44
  SPEAKER_00: If you really think that it's going to take care of you from start to finish and be able to identify things proactively, we are incredibly good at keeping people alive.
• 29:53
  SPEAKER_00: We are not still so good at being proactive about people's health.
• 29:56
  SPEAKER_00: And this is something that is really important to note here about any system that exists currently in this world.
• 30:02
  SPEAKER_00: And this is not just okay, it's exactly what we need to be doing.
• 30:06
  SPEAKER_00: So just note that for yourself.
• 30:09
  SPEAKER_00: So if you're an ACL athlete listening to this or you know a supporting personnel, the takeaway is simple.
• 30:16
  SPEAKER_00: Trust what you are feeling in your body.
• 30:19
  SPEAKER_00: Ask questions, a second opinion, a third opinion can be normal.
• 30:23
  SPEAKER_00: It's honestly expected, and any provider worth working with should welcome it.
• 30:28
  SPEAKER_00: We welcome it too.
• 30:29
  SPEAKER_00: If someone feels like they need another opinion, I'm not going to take offense to that.
• 30:33
  SPEAKER_00: It's exactly what is important in this, and you should not feel threatened by it.
• 30:38
  SPEAKER_00: If you're a clinician or coach listening, here's the takeaway from your side.
• 30:43
  SPEAKER_00: Pattern recognition isn't something, you know, that just naturally happens, right?
• 30:47
  SPEAKER_00: You don't just become born with it.
• 30:50
  SPEAKER_00: It's something that is built over repetitions.
• 30:53
  SPEAKER_00: Start tracking trends across your caseload instead of treating every athlete in isolation.
• 30:59
  SPEAKER_00: Build in real time to talk through your complex cases, even if it's just with one other colleague, and be honest with yourself about the ones you've gotten wrong, especially the ones that don't get better or don't get back to the thing.
• 31:11
  SPEAKER_00: Those are the ones you really need to audit and think about.
• 31:14
  SPEAKER_00: Not the ones that were success stories.
• 31:16
  SPEAKER_00: You need to audit the ones that don't get there or the ones that struggle.
• 31:20
  SPEAKER_00: And that's the ones that we spend the most time on team calls about.
• 31:24
  SPEAKER_00: It's the ones that don't add up and the ones that are really challenging because those are the cases that will actually make you better as a professional and especially help our ACLers through this process because it's already complicated and hard enough.
• 31:39
  SPEAKER_00: I'm not sharing any of this because we have it all figured out.
• 31:42
  SPEAKER_00: Far from it, y'all.
• 31:43
  SPEAKER_00: We really don't.
• 31:45
  SPEAKER_00: We're still building this every single week for years and years and years, continuing to build and reiterate, still getting better at it, still occasionally getting humbled by a case that doesn't fit the pattern we expected.
• 31:57
  SPEAKER_00: But that's kind of the whole point.
• 31:59
  SPEAKER_00: We're going to continue to keep learning from these cases.
• 32:04
  SPEAKER_00: And if you feel like you're handling every case with perfection, then I would almost say that you're probably not getting a lot of complicated cases because there are still ones that we get that scratch our heads that are like multiple revisions, that are ones that have no pain association or sensation that you can even find on Reddit, to be honest, of someone complaining of it.
• 32:28
  SPEAKER_00: And it's just something that's very interesting that we're continuing to always improve and get better at, and always making sure that our athletes know what is the next step one, next step two, next step three, next step four, and we're with them alongside them the entire way.
• 32:43
  SPEAKER_00: And so if there's one thing that I could just really say that is so valuable that really separates the good from the great in ACL rehab and physical therapists and professionals, one thing of many different characteristics, but this one I think is so valuable is being able to learn from those mistakes, accumulate the reps, show the outcomes, and be able to have pattern recognition in this process because it can really save the ACL or from having a nine-month process become an 18-month process, a 12-month process become a three-year process.
• 33:19
  SPEAKER_00: And we have seen it.
• 33:21
  SPEAKER_00: We have seen it repeatedly, and it was nothing more than maybe not being able to recognize these things earlier.
• 33:28
  SPEAKER_00: And then so people go on to think it's normal and then they never get it resolved.
• 33:33
  SPEAKER_00: And then it continues to impede the process even as weeks and months go on.
• 33:38
  SPEAKER_00: And they kind of know it in their gut.
• 33:40
  SPEAKER_00: That's the thing that makes it so sad is that you know it in your gut if something doesn't add up based on the care you're getting or based on the way that things feel.
• 33:48
  SPEAKER_00: And it's it's continuing to stick with that.
• 33:51
  SPEAKER_00: So if you feel like you're feeling that, then evaluate the opportunity cost of not doing anything.
• 33:58
  SPEAKER_00: And so, what I suggest is to do something about it, to be able to make moves, do the thing, be able to make sure that you are moving in the right direction, having a team around you that knows this and can help you.
• 34:12
  SPEAKER_00: And if you're feeling stuck, lost, if you're feeling like you need clarity, if you feel like you're a complex case, if you're a simple case, and you're just like, man, I just need a plan, I need the clear weekly structure, and you're looking for guidance, someone who can recognize these things, but make all of the anxieties be able to just disappear.
• 34:36
  SPEAKER_00: And so you can exhale and be like, okay, I feel like I got this, I got the right GPS with me, the right guidance and the right team.
• 34:43
  SPEAKER_00: We are here to help.
• 34:45
  SPEAKER_00: Please reach out to us.
• 34:46
  SPEAKER_00: We would love to help you, even if it's just to be able to point you in the right direction.
• 34:51
  SPEAKER_00: You can find all our information in the show notes.
• 34:53
  SPEAKER_00: We just want to make sure that as a whole, the ACL or community, our ACLPTs, coaches, everyone can get better.
• 35:01
  SPEAKER_00: And that is something that is really important to us because we are really here to try and change this for the better.
• 35:08
  SPEAKER_00: So reach out if you need anything.
• 35:11
  SPEAKER_00: Otherwise, I will find you guys in the next episode.
• 35:14
  SPEAKER_00: This is your host, Robbie Patel, signing off.