Latest / The ACL Athlete Podcast / 172 | Should Your Knee Feel The Same After An ACL Injury?

Transcript

172 | Should Your Knee Feel The Same After An ACL Injury? · 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.
• 1:01
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:07
  SPEAKER_00: So today we are answering the question: Should your knee feel the same after an ACL injury?
• 1:13
  SPEAKER_00: Or maybe it's after ACL surgery.
• 1:15
  SPEAKER_00: Basically, we're answering uh should it return back to normal or feel normal, if you will, after you had this injury or surgery?
• 1:24
  SPEAKER_00: And let's say it's been especially time since that period, should it be feeling the same again?
• 1:31
  SPEAKER_00: And this is actually a very interesting question.
• 1:34
  SPEAKER_00: And I think, you know, if you're an ACLer, um, especially if you've maybe done this once before and you've gone through this process, then there's a different answer there potentially than someone who is on the clinical side who maybe has seen especially a higher volume of ACLs.
• 1:52
  SPEAKER_00: And so I think that there is this general assumption that your knee is supposed to feel the same like it did before the injury.
• 2:01
  SPEAKER_00: And so this is something that I have to talk through with my athletes because sometimes there is this thought, like, okay, well, it just doesn't feel the same as it did before.
• 2:10
  SPEAKER_00: And before, meaning uh before this injury had happened, right?
• 2:15
  SPEAKER_00: And so this is something that I want to tackle because it comes up a lot.
• 2:20
  SPEAKER_00: I think that there is this myth around it, if you will, of thinking that, oh, it's just gonna naturally become normal again because you've had the surgery, you've done the rehab, and you're good to go, right?
• 2:32
  SPEAKER_00: But I really want to tackle this first through the lens as a patient, having two ACL injuries myself and two ACL reconstructions and going through this recovery process.
• 2:43
  SPEAKER_00: And now being out, let's see, it was 2008 when I had my first ACL injury, and then 2013 when I had my second ACL injury.
• 2:54
  SPEAKER_00: So it has been a very, very long time.
• 2:58
  SPEAKER_00: And so I want to make sure I tackle this because my first experience is actually a little different than my second experience.
• 3:06
  SPEAKER_00: Um, and it's two different knees, so it wasn't like it was a retail on the same knee.
• 3:10
  SPEAKER_00: So I want to tackle it through that lens first, and then secondly, I'm going to tackle this question through the lens as a physical therapist, as a performance coach myself, who's worked and consulted with over hundreds of ACLers at this point, from repairs to reconstructions, um, you know, multi-ligament LETs, multiple procedures involved, um, youth athletes to pro athletes, multiple retails, complex cases.
• 3:35
  SPEAKER_00: So these are all from the simple, simple, simple cases from an isolated ACL all the way to these complex cases.
• 3:44
  SPEAKER_00: And so that's another lens that I wanted to speak through because obviously there's more volume with that.
• 3:49
  SPEAKER_00: It's not a one-time experience that I'm just looking through a single lens of my own experience, but also working with a bunch of different athletes and our team working with a bunch of different athletes going through ACL injuries.
• 4:03
  SPEAKER_00: So let's tackle this first through my answer as a patient.
• 4:07
  SPEAKER_00: So I tore my right knee ACL.
• 4:11
  SPEAKER_00: Um, and that was my first one uh that was in high school playing football, um, non-contact injury.
• 4:17
  SPEAKER_00: Um, and of course, I went through that whole process, did my rehab process, and um, I came back and I felt very confident on my knee.
• 4:27
  SPEAKER_00: I almost felt more confident on my ACL reconstructed side.
• 4:33
  SPEAKER_00: And so this was very interesting.
• 4:35
  SPEAKER_00: Um, and looking back at this, I'm almost curious if it's because we didn't really pay attention to my uninjured side very much.
• 4:43
  SPEAKER_00: And there's so much emphasis on my injured side that I just became more confident on it.
• 4:48
  SPEAKER_00: There were more reps with it.
• 4:50
  SPEAKER_00: Um, I felt naturally just more confident with that knee with doing certain movements.
• 4:54
  SPEAKER_00: I'm a little weird, I'm left-handed, but lower extremity-wise, like I do stuff with my right foot.
• 5:00
  SPEAKER_00: Um, I'm a little ambidextrous, if you will, with certain movements or just kind of flip-flop on sides with dominance, depending on the task.
• 5:08
  SPEAKER_00: But with that said, you know, my right knee felt very good, to be completely honest.
• 5:14
  SPEAKER_00: I didn't really have any return to sport testing.
• 5:16
  SPEAKER_00: And so who's to say what those numbers really look like, or if I was feeling good, but not necessarily performing at my best?
• 5:24
  SPEAKER_00: But with that said, I came back and I didn't really struggle or think about my knee that that much after my first ACL injury.
• 5:31
  SPEAKER_00: I felt pretty confident I could do all the things, no deficits.
• 5:35
  SPEAKER_00: Um, and I felt really confident.
• 5:37
  SPEAKER_00: When we come around to my second ACL injury, which was in college, and that was whenever I was in my senior year of college.
• 5:46
  SPEAKER_00: Um, this was something that was a little different.
• 5:50
  SPEAKER_00: And so then, therefore, oh, and to back up for my first ACL injury, we did a hamstring graft.
• 5:56
  SPEAKER_00: So, one of the things I did know with that is that my hamstring did feel a little bit weaker.
• 6:00
  SPEAKER_00: That was probably the only thing that I noticed because it was a hamstring graft.
• 6:03
  SPEAKER_00: So I would strain my hamstring a good bit with sprinting and things of that nature.
• 6:08
  SPEAKER_00: So that was probably one noticeable aspect of it.
• 6:10
  SPEAKER_00: But other than that, the knee joint itself and performance felt fine.
• 6:14
  SPEAKER_00: Um, for my second ACL injury in college, um, had a hamstring graft there as well.
• 6:20
  SPEAKER_00: And this one was not my normal run of the course, like my first one was.
• 6:24
  SPEAKER_00: Two very different experiences.
• 6:26
  SPEAKER_00: Had a much harder time with my second ACL injury and the recovery process, where they took the ACL graft, the hamstring graft.
• 6:36
  SPEAKER_00: I didn't like the surgical technique, the incision.
• 6:38
  SPEAKER_00: There was scar tissue that built up with the way he did the technique.
• 6:42
  SPEAKER_00: And so I wasn't a big fan of it.
• 6:43
  SPEAKER_00: So, right off the bat, I was having issues with my knee because of where that surgical incision was, which was on the inside of my knee crease, where that tendon will kind of run into the medial aspect of the knee.
• 6:56
  SPEAKER_00: And so this was very interesting to compare to my first ACL injury and that process.
• 7:03
  SPEAKER_00: But, you know, it's something that I always noticed that it just was a little bit more delayed.
• 7:09
  SPEAKER_00: I didn't have as much of a fluid process.
• 7:12
  SPEAKER_00: And who's to say whether it was because maybe I was younger, I was in high school for my first one.
• 7:17
  SPEAKER_00: Maybe there were some things I did during that rehab process that allowed me to focus more.
• 7:23
  SPEAKER_00: I was focused on sports more, I was training a lot more versus my second ACL injury.
• 7:28
  SPEAKER_00: I was working, I was trying to, you know, kind of build up my own like portfolio, if you will, to be able to get into school, all these different things.
• 7:38
  SPEAKER_00: So I wasn't having as much attention on my knee on the second one.
• 7:42
  SPEAKER_00: And plus the surgical process was a little different as well.
• 7:46
  SPEAKER_00: And so I noticed hamstring deficits, weakness more so on my left side on the second one.
• 7:53
  SPEAKER_00: So this is something that was very interesting.
• 7:55
  SPEAKER_00: And then as I got further out from my second ACL injury and surgery, I still noticed deficits a little bit more.
• 8:04
  SPEAKER_00: Now, I did end up coming around to being able to feel confident playing sports again and training, but it took a lot more time to recover.
• 8:13
  SPEAKER_00: And I felt like I noticed just different things in my knee, in my left side, a little bit more.
• 8:19
  SPEAKER_00: Now, this is something that is interesting because as time has gone on, I have always noticed my knees just don't feel quote unquote normal, right?
• 8:29
  SPEAKER_00: And so it doesn't necessarily mean that it's bad, it's just more so my knees don't feel like nothing's ever happened to them, right?
• 8:38
  SPEAKER_00: And I notice a little bit more now on my right side because I'm dealing with some bone spur issues that could be just some early osteoarthritis stuff that could just happen just due to the nature of ACL injuries and the progression of them.
• 8:52
  SPEAKER_00: Um, but I manage it well um currently.
• 8:56
  SPEAKER_00: And so this is something that is also interesting being years out from my ACL injury, that I just notice some differences in my knee, right?
• 9:07
  SPEAKER_00: And the thing that I want to make sure I touch on with this is that it's not that it limits me from performing or doing things, it's just more so that they feel different.
• 9:18
  SPEAKER_00: I know that something has been done to my knees.
• 9:21
  SPEAKER_00: I know that, you know, when I go to kneel down, for example, sometimes my incision side can feel a little sensitive on the ground on my right side.
• 9:28
  SPEAKER_00: Um, and that's okay.
• 9:29
  SPEAKER_00: It doesn't limit me from kneeling down.
• 9:31
  SPEAKER_00: I just notice it sometimes.
• 9:33
  SPEAKER_00: Um, sometimes my knee joint itself can kind of feel a little bit stiff on just random days.
• 9:38
  SPEAKER_00: And this is just stuff to be completely raw with you guys.
• 9:41
  SPEAKER_00: And I think the thing that's always interesting is that people just expect for us to, you know, have this injury, have this surgery, you move on, and you know, you never feel it again, for example.
• 9:52
  SPEAKER_00: And I know all my ACLers listen to this.
• 9:54
  SPEAKER_00: Now, if you're early on in this process or you're going through it, don't lose hope.
• 9:58
  SPEAKER_00: Don't think that, like, okay, my knees doomed forever.
• 10:01
  SPEAKER_00: It's just something that is different, and that's the thing that I want to really hit home today, is different, but it's not bad.
• 10:09
  SPEAKER_00: And so the next thing that I also want to answer this as a PT and a performance coach is that this ACL injury and this recovery process, whether you go surgical or non-surgical, is so so different for each person.
• 10:23
  SPEAKER_00: It very much is an N equals one type experience.
• 10:27
  SPEAKER_00: And we can line up a hundred people with the exact same injury, where it was injured, the sport they were playing.
• 10:36
  SPEAKER_00: Maybe they had an isolated ACL, or maybe they had an ACL plus an MCL grade two sprain plus a medial meniscus, you know, tear and the tear was the same, right?
• 10:46
  SPEAKER_00: If we lined up a hundred of these people, I guarantee you that every single person would progress differently.
• 10:52
  SPEAKER_00: They would have some variations in what they feel, and that's just because humans are so different, person to person, right?
• 11:02
  SPEAKER_00: There's no person that is exact same, even if you talk to twins and you see twin studies, there are still differences that exist within twin and their genetics as well.
• 11:14
  SPEAKER_00: So the thing is that I want to kind of talk about from this lens is you have to think about the factors that impact this entire recovery and why it can't just be the same outcome for everybody.
• 11:25
  SPEAKER_00: Think about age, think about genetics, the previous injury history to the knee, the injury itself, what happened, how did it happen, the trauma of it, how intense was it, what tissues were impacted, what's done in the surgery if you have surgery.
• 11:42
  SPEAKER_00: Think about an isolated ACL versus menisectomy versus meniscus repair versus you know, maybe an MCL repair, maybe there is an LET that's done, maybe there is an internal brace that's added in.
• 11:55
  SPEAKER_00: There's so many different things that could be done in there, even something as easy as, you know, cutting away some loose debris in the knee or a chondroplasty, for example, something where you're kind of shaving the back of the kneecap a little bit.
• 12:09
  SPEAKER_00: This could all change, you know, the interfaces and how the knee is responding to those surgical procedures.
• 12:16
  SPEAKER_00: Or maybe there's a non-aw process that's different in and of itself, too.
• 12:20
  SPEAKER_00: What about the graph that's used?
• 12:22
  SPEAKER_00: A cadaver graft?
• 12:23
  SPEAKER_00: What type of cadaver graft?
• 12:24
  SPEAKER_00: Is it a bone patellar tendon bone?
• 12:26
  SPEAKER_00: Is it an Achilles?
• 12:27
  SPEAKER_00: What kind of like body was it harvested from?
• 12:30
  SPEAKER_00: We don't typically know these details, but it's just factors that think about whenever we think about okay, should I feel normal after this?
• 12:38
  SPEAKER_00: If the graph is taken from yourself, was it taken from the quad, the hamstring, the patellar tendon?
• 12:45
  SPEAKER_00: Those are things that factor in.
• 12:47
  SPEAKER_00: What's the rehab process like?
• 12:49
  SPEAKER_00: How is your rehab from the post-op to the mid-stages to late stages?
• 12:54
  SPEAKER_00: And honestly, the thing that is just the uncontrollable factor in all of this is how your human body decides to respond to all of this.
• 13:04
  SPEAKER_00: The healing, how your physiology changes, the biology of your body, like all these things are going to play such a huge role in terms of the knee feeling, quote unquote, the same.
• 13:14
  SPEAKER_00: So, as far as expectations go, sure, you can hope that the the knee itself feels exactly the same as pre-injury, and hopefully even better, where you don't notice anything.
• 13:26
  SPEAKER_00: I hope so.
• 13:28
  SPEAKER_00: And that is something that I feel like I felt for a decent window of time with my right knee.
• 13:33
  SPEAKER_00: Um, I didn't really notice anything.
• 13:34
  SPEAKER_00: I felt strong, no deficits, and that was awesome, right?
• 13:38
  SPEAKER_00: But then my second ACL injury was very different.
• 13:41
  SPEAKER_00: And so this is the same person with two different knees.
• 13:45
  SPEAKER_00: Now you can imagine this with different ACLers and their experiences, even based on the factors that I mentioned prior to, right?
• 13:52
  SPEAKER_00: But instead, understand that this might be different, the knee might feel different.
• 13:59
  SPEAKER_00: So answering this question, should your knee feel the same after an ACL injury?
• 14:04
  SPEAKER_00: Honestly, it just kind of depends.
• 14:07
  SPEAKER_00: And I would say more often than not, it's going to feel different.
• 14:12
  SPEAKER_00: And I'm not saying different is bad, it's just different.
• 14:16
  SPEAKER_00: And that's what I tell my athletes because we got to think about this because something that has been done to the knee that has basically interrupted what you were born with, right?
• 14:28
  SPEAKER_00: And so this is something where there has been trauma to the knee, the ACL has been torn, so that native ACL tissue will never be the same, even if it heals.
• 14:37
  SPEAKER_00: We don't know what it's comprised of.
• 14:39
  SPEAKER_00: Is it just scar tissue?
• 14:41
  SPEAKER_00: Does it still have the same tensile strength, the ability to load and handle stress the same way as it did before?
• 14:48
  SPEAKER_00: We don't really know that yet.
• 14:50
  SPEAKER_00: Um, even with the emerging research of ACL's healing.
• 14:53
  SPEAKER_00: And so, with that said, this is all things that we need to make sure we factor in to our thinking, if you will, because the knee itself has just been traumatized.
• 15:04
  SPEAKER_00: Um, and then you go and have a surgery and you think about a second trauma to it that it needs to heal from, and you just have things in there that are just not naturally in the body.
• 15:14
  SPEAKER_00: You've got some buttons or some screws, you've got some different wires that are helping to anchor this thing down and wrap around these screws or buttons.
• 15:23
  SPEAKER_00: You might have some other additional supportive screws.
• 15:26
  SPEAKER_00: Uh, there's so many other things in that knee, especially post-surgery, that you're having to consider that your knee is starting to quote unquote normalize.
• 15:35
  SPEAKER_00: And sure, some of these things are biodegradable where the knee absorbs it, but then there's some things in there that are just anchored in there like a button.
• 15:42
  SPEAKER_00: It's just there and it's not going to go away as long as you have that knee there, right?
• 15:48
  SPEAKER_00: So these are things to just consider and think about when we are expecting our knee to feel normal after this ACL injury and surgery when it's really gone through these series of events.
• 16:00
  SPEAKER_00: So there's this sense of knowing the joint really has gone through something and it's different now.
• 16:06
  SPEAKER_00: Different again, not being bad, just different.
• 16:08
  SPEAKER_00: And guess what?
• 16:09
  SPEAKER_00: Just know that's okay.
• 16:11
  SPEAKER_00: What's important is that for that different to not be negatively described as a more painful, swollen, weak, limited mobility type knee, etc.
• 16:21
  SPEAKER_00: That's what your rehab should hopefully clear up and help address.
• 16:25
  SPEAKER_00: Getting you back to performing at a top level, just like you were before, and better ideally than pre-injury.
• 16:32
  SPEAKER_00: That is something that is doable.
• 16:34
  SPEAKER_00: That doesn't necessarily mean the knee is back to normal.
• 16:37
  SPEAKER_00: It might just perform at the same level or better.
• 16:40
  SPEAKER_00: But with that said, does it feel normal?
• 16:43
  SPEAKER_00: Like it's never been operated on or injured.
• 16:46
  SPEAKER_00: Probably not.
• 16:47
  SPEAKER_00: And that's okay.
• 16:48
  SPEAKER_00: It's different.
• 16:49
  SPEAKER_00: But as long as you can do what you love to do and continue to take care of it, we can be good with that.
• 16:55
  SPEAKER_00: And this is that N equals one perspective more than anything, due to the factors I mentioned before, because there are plenty of people who probably have this surgery and go on to say, Yeah, my knee feels completely normal.
• 17:06
  SPEAKER_00: I don't notice it anymore, just like I did after my high school surgery.
• 17:10
  SPEAKER_00: Um, you know, I've got a 13-year-old.
• 17:12
  SPEAKER_00: Whenever I talk to her, she is someone who says, Yeah, my knee feels normal.
• 17:17
  SPEAKER_00: I don't notice anything at all.
• 17:18
  SPEAKER_00: And then there's, you know, a high schooler that's like, yeah, it just doesn't feel the same.
• 17:24
  SPEAKER_00: But when we compare their injuries, you know, even their rehab process, the graphs that were taken, it makes sense.
• 17:30
  SPEAKER_00: It's just different.
• 17:32
  SPEAKER_00: And so this is something that I don't want people to feel pressure on themselves of thinking that it needs to feel normal, um, or this expectation of feeling normal, especially if you've been told by this by your surgeon or your physical therapist or whoever it is that is communicating, oh, it should get back to normal.
• 17:50
  SPEAKER_00: And the thing that I would encourage you to do is define what you mean by that.
• 17:55
  SPEAKER_00: Like before the injury, because sorry, it's gonna be really hard to chase that feeling because at the end of the day, you had an ACL injury.
• 18:04
  SPEAKER_00: This is your story.
• 18:06
  SPEAKER_00: It's a part of, you know, the fingerprint, if you will, of your injury history.
• 18:10
  SPEAKER_00: And that's okay.
• 18:12
  SPEAKER_00: It's something that will honestly make you a better person, and it's something that will just be a part of your specific story that you get to tell.
• 18:21
  SPEAKER_00: And this is something that we just want to make sure that it's just not something that's this expectation that you're putting hard on yourself to be able to achieve when you know that there has been a difference in that knee.
• 18:35
  SPEAKER_00: But if it's the deficits in the knee that you're dealing with, then maybe it is something you still need to tackle with good rehab training and guidance, right?
• 18:42
  SPEAKER_00: So that's where we need to come back to defining, I just don't feel normal right now, or my knee doesn't feel normal.
• 18:48
  SPEAKER_00: Is it deficits that you're feeling, or is it just doesn't feel the same as it did before, but you could still do all the things that you want to do.
• 18:55
  SPEAKER_00: Well, in that case, that's okay, right?
• 18:57
  SPEAKER_00: But just know if it is that different feeling that's normal.
• 19:02
  SPEAKER_00: I would say majority of ACLers know that something has been done to their knee and they're not just walking around being like, yeah, it feels the same, and majority of those people feel that way.
• 19:12
  SPEAKER_00: When in actuality, most people know that something has been done there.
• 19:18
  SPEAKER_00: So allow yourself to exhale and not set an expectation uh you may not be able to control the outcome of.
• 19:25
  SPEAKER_00: And that's the biggest thing that I want to hit home here with this episode, because I do see a lot of ACLers putting that pressure on themselves when it's not necessary, or they're kind of waiting for it to come or find this threshold when it honestly doesn't arrive.
• 19:41
  SPEAKER_00: And so that's where we got to make sure we check the boxes of symptoms and you know physical performances that you have, all based on criteria and testing and you being able to do the things you want to do, cool.
• 19:53
  SPEAKER_00: Then that is something that I would say, all right, then if the knee is still feeling different or just not normal, then that's okay.
• 20:00
  SPEAKER_00: But if there's still deficits that exist, then it's fair for you to still be concerned about the knee not feeling the same because we still need to get it to a certain place for you to do those things you want to do.
• 20:13
  SPEAKER_00: So I hope this hit home for you guys, especially for those of you that might be worried about the way your knee does feel and you might be months and years out.
• 20:22
  SPEAKER_00: You can exhale a little bit and allow yourself to have that space and making sure that you just kind of keep doing the thing, keep working on your knee, and just understanding your story and where you're at with this process.
• 20:36
  SPEAKER_00: That is going to be it for today, guys.
• 20:38
  SPEAKER_00: Before I sign off, two things.
• 20:41
  SPEAKER_00: One, there's the new texting feature where you can send us a message sharing how this episode or podcast has helped you, or you want to relay any message to us.
• 20:50
  SPEAKER_00: It's only one way where you can send me the message.
• 20:53
  SPEAKER_00: I can't see your number, it's private.
• 20:55
  SPEAKER_00: So don't sweat that.
• 20:56
  SPEAKER_00: If you're wanting to send us a message, I will not bother you.
• 20:59
  SPEAKER_00: Um, don't delete that code that's in there if you do decide to do that, because that's how it connects us to the texting and the podcast.
• 21:07
  SPEAKER_00: You can find that in the show notes.
• 21:09
  SPEAKER_00: Second point here is that we have a form that you can actually fill out.
• 21:15
  SPEAKER_00: It is also in the show notes, but I want to include you guys more in on these conversations.
• 21:21
  SPEAKER_00: So I created a form where you can submit any type of ACL question or topic you'd like for me to tackle.
• 21:27
  SPEAKER_00: And we might be rolling out some QA's here.
• 21:30
  SPEAKER_00: So um, if you do have any of those, I'll start to uh tackle some of those questions.
• 21:35
  SPEAKER_00: Uh wanted just a central place where you can go um and be as specific and helpful with this podcast as we can.
• 21:44
  SPEAKER_00: So then that way we can tackle any questions or particular topics that you guys might want addressed.
• 21:51
  SPEAKER_00: So as always, appreciate all of you for listening.
• 21:54
  SPEAKER_00: This is your host, Robbie Patel, signing off.