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296 | The Trust Problem in ACL Rehab and Healthcare · 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: I had a conversation this week with an ACL athlete who told me he'd almost rather someone just say it's over so he could just stop fighting it.
• 1:11
  SPEAKER_00: Let that sit for a second.
• 1:13
  SPEAKER_00: He wasn't someone that was being dramatic.
• 1:16
  SPEAKER_00: He was exhausted.
• 1:18
  SPEAKER_00: And I could just tell this.
• 1:20
  SPEAKER_00: He'd been spending months doing everything he was told to do by everyone else, and he still couldn't get his knee to move in the right direction.
• 1:29
  SPEAKER_00: Here's what I have learned from talking with hundreds and thousands of athletes like him over the years.
• 1:38
  SPEAKER_00: The thing is, is that by the time many of them find us or we're talking to them, the knee is really something that I would say is the second thing that is, if you want to say broken or their situation as a whole is very challenging.
• 1:53
  SPEAKER_00: The first thing that we recognize is that trust has been broken.
• 1:58
  SPEAKER_00: And today's episode is about that.
• 2:01
  SPEAKER_00: How it breaks, why nobody warns you about it, and what it does to the way athletes approach their rehab.
• 2:08
  SPEAKER_00: And I think that this is something that I've been thinking about for quite some time.
• 2:14
  SPEAKER_00: And it's something that I wanted to share with you guys today because it might be in the back side of your mind, or it might be something maybe on the front side, and it's something that bleeds into maybe a lot of your beliefs, and it's something that I've just been really thinking about a lot, and I wanted to talk through a bit more.
• 2:37
  SPEAKER_00: But before we get into it, I want to set it up the right way.
• 2:40
  SPEAKER_00: Healthcare is messy, there's no arguing here about that, it isn't perfect, and it looks very different from country to country.
• 2:49
  SPEAKER_00: There are costs, there are delays, and in the US, insurance adds another layer on top of an industry that runs on volume.
• 2:59
  SPEAKER_00: Most people inside it are working hard within a system that gives them very little time.
• 3:13
  SPEAKER_00: I don't think that, you know, the surgeon who might have ignored you or was rude to you, yeah, there might be some underlying layers there.
• 3:21
  SPEAKER_00: But I don't think that they're in it for the wrong reasons.
• 3:25
  SPEAKER_00: Same thing with your physical therapist who means well, they're nice, but you know, there are things that fall through the cracks.
• 3:33
  SPEAKER_00: You're not getting what you need to.
• 3:35
  SPEAKER_00: We don't get into this because we're like, yeah, we're gonna be crushing it with financial gains on this.
• 3:41
  SPEAKER_00: Like, that's not what you do when you get into physical therapy.
• 3:44
  SPEAKER_00: I promise you, go talk to any physical therapist you see and ask them their student debt ratio to how much they make.
• 3:50
  SPEAKER_00: And the thing is, is that I don't think that there's bad people in this.
• 3:54
  SPEAKER_00: I think what the challenge is is the model, the system, how it has been designed and developed over the years.
• 4:02
  SPEAKER_00: And yeah, back in the day when people had great insurance and it covered things and costs were relatively low, like people had deductibles that were$100.
• 4:11
  SPEAKER_00: Now you can't even find anything with three digits in them.
• 4:16
  SPEAKER_00: And so it's just a very challenging thing that has grown out of control.
• 4:20
  SPEAKER_00: And a big part of this, especially in the US, is that we have an insurance system that just makes it so, so challenging, along with a very expensive healthcare system.
• 4:31
  SPEAKER_00: So it's a model thing, and I'm not here to say that the people inside of it are bad, it's just more so they're working hard within a very challenging system and a model that gives them little time and is focused more on volume.
• 4:45
  SPEAKER_00: Because whenever it's this game of making money, especially for these businesses and hospital systems, it is about volume because if you can't get paid per person as much, you just increase the volume in order to make that happen.
• 5:03
  SPEAKER_00: So, this episode is not about you know trying to throw shade at healthcare today.
• 5:10
  SPEAKER_00: Plenty of athletes have great rehabs with great surgeons and great PTs.
• 5:14
  SPEAKER_00: I want to talk about how these experiences shape the athletes' trust and how that trust shapes their mindset and their decisions, and especially in a rehab as complicated as ACL.
• 5:26
  SPEAKER_00: And that's gonna be the good side of things and also the, yeah, let's say the bad side of things, right?
• 5:32
  SPEAKER_00: Like the bad experiences in healthcare.
• 5:34
  SPEAKER_00: I'm someone who's torn my ACL twice.
• 5:37
  SPEAKER_00: I have had a pretty major hip surgery that is rare for someone my age, and I had delays because of insurance for my first surgery in my ACL.
• 5:49
  SPEAKER_00: My second time, I paid$10,000 for my out-of-pocket max.
• 5:54
  SPEAKER_00: That's how much I owed as a college student.
• 5:56
  SPEAKER_00: I didn't have that kind of money.
• 5:58
  SPEAKER_00: I already had student debt, so I went through that twice, and that was a very hard thing.
• 6:04
  SPEAKER_00: And I have watched my dad go through healthcare scares and my parents as a whole, my mom navigating a potential cancer issue, and also having my dad have a heart attack and then having to have a heart procedure.
• 6:18
  SPEAKER_00: And these are immigrant parents.
• 6:20
  SPEAKER_00: So I'm helping them navigate this healthcare system currently with things that are going on.
• 6:26
  SPEAKER_00: And so having to be in this space, going through the education that I have, having the, you know, literacy that I have within healthcare has helped me, but it's also been hard.
• 6:40
  SPEAKER_00: Like even talking to doctor's offices can be very challenging because of some of the miscommunication or because of the differences in language in terms of the way that they speak versus we speak.
• 6:52
  SPEAKER_00: You know, it's just a very challenging space as a whole.
• 6:56
  SPEAKER_00: And so I'm just kind of throwing this all out there to you guys because I think that this is a very common issue that many people face in this process.
• 7:05
  SPEAKER_00: And I just I don't think that it's really talked about a lot in healthcare in general.
• 7:10
  SPEAKER_00: Like people complain about it, yes, but I don't know that we're necessarily thinking about how much our previous healthcare influences and maybe current are influencing our decision making in this process.
• 7:23
  SPEAKER_00: And especially for something like ACL rehab, it could be a little bit of a slippery slope.
• 7:27
  SPEAKER_00: And I'm not blaming anyone here because of that trust being broken or it being fractured in some sort of way whenever they go through this process, and it is not the what they expected, right?
• 7:39
  SPEAKER_00: And there are a lot of people who go through this and it is not even close to what they expected.
• 7:44
  SPEAKER_00: And the thing is, is that I want to just share with you guys that I relate.
• 7:49
  SPEAKER_00: I've been through this, I helping my parents with through this, but then also just talking with so many ACLers, like I see this all across the world, and especially in our US healthcare system.
• 8:00
  SPEAKER_00: I see this every day.
• 8:01
  SPEAKER_00: And so this is something that I just want you to know, I understand the weight that every ACLer carries.
• 8:07
  SPEAKER_00: And those of you who are listening, what you are carrying.
• 8:11
  SPEAKER_00: And I want to go to this story of this ACLer I talked to because I think it's important to share this.
• 8:17
  SPEAKER_00: And I had that conversation and I really couldn't shake it.
• 8:21
  SPEAKER_00: Like there are certain conversations that I have where I'm just like, it really, it really kind of hits me to my core.
• 8:27
  SPEAKER_00: And it's an athlete who opened up to me in a way, usually only when they're like really exhausted.
• 8:35
  SPEAKER_00: But this was like a this was someone who I would not have expected to with the way he came into the call.
• 8:41
  SPEAKER_00: He's you know, a guy.
• 8:44
  SPEAKER_00: And so like he he had this like intensity to him, and it was just something where you could just tell he was tired, and he was just looking for some sort of escape.
• 8:56
  SPEAKER_00: Before his injury, he was in the best shape of his life, he'd been hired into a career he'd worked hard for.
• 9:03
  SPEAKER_00: Then a training accident is how he tore his ACL.
• 9:07
  SPEAKER_00: It was something that was just like a fluke accident that sucks, and that's how he tore it.
• 9:12
  SPEAKER_00: His surgeon wanted range of motion back before operating, which I'm in agreement with.
• 9:18
  SPEAKER_00: So surgery got pushed to about two months out based on how that worked out.
• 9:23
  SPEAKER_00: He did what he was told.
• 9:24
  SPEAKER_00: He was in PT almost every single day.
• 9:26
  SPEAKER_00: His was unique because he had a certain amount of visits.
• 9:30
  SPEAKER_00: He was at the end of the year of 2025, and so he was just trying to max out as much of those insurance visits as he could because he was allotted.
• 9:39
  SPEAKER_00: And so he went every day to try and improve his range of motion and work on his rehab before the year-end reset of his insurance.
• 9:48
  SPEAKER_00: And every visit, the physical therapist would crank on his knee, especially his flexion.
• 9:55
  SPEAKER_00: And y'all have heard me talk about this before, and I've done an episode on this that fired me up.
• 10:00
  SPEAKER_00: But this was one where they would do it during their sessions.
• 10:06
  SPEAKER_00: He told me it was the worst pain he had ever felt.
• 10:09
  SPEAKER_00: He'd walk out of there nauseous, seeing stars.
• 10:12
  SPEAKER_00: And we talked about for that for a minute because of his situation and what he was going through.
• 10:18
  SPEAKER_00: And the thing that stuck with me is that in the clinic, the numbers kind of looked okay in terms of what the PT was reporting.
• 10:26
  SPEAKER_00: He'd hit 125 degrees, for example, then he'd go home, and by the morning, the knee was back to where it started, plus two or three days of it being inflamed and irritated.
• 10:38
  SPEAKER_00: His surgeon was making decisions off the clinic's numbers, so he would see that 125 and be like, okay, that's maybe a good enough point.
• 10:46
  SPEAKER_00: But the surgeon and the PT themselves weren't really talking.
• 10:49
  SPEAKER_00: And on the day of the surgery, the surgeon evaluated his knee, felt that stiffness or that kind of rebound regression of his range of motion.
• 10:59
  SPEAKER_00: And he wasn't really thrilled about it.
• 11:01
  SPEAKER_00: He wasn't really excited to operate, but he did it anyways because you know, it kind of lives in this gray area.
• 11:06
  SPEAKER_00: He had already waited two months, anyways, and he was also shy of extension.
• 11:12
  SPEAKER_00: And so the goal with going into surgery is to get that knee back to a good, restored place, unless there's something blocking it.
• 11:18
  SPEAKER_00: In this case, it didn't seem to be that, but it was just something where, you know, he was working on it, and the approach to rehab, that's what he thought it was.
• 11:28
  SPEAKER_00: That's what he thought was the right way to do it was to crank on it.
• 11:31
  SPEAKER_00: He was trusting his physical therapist, his surgeon, this whole process.
• 11:35
  SPEAKER_00: After the surgery, he kind of had the same cycle.
• 11:39
  SPEAKER_00: He was still kind of stuck with range of motion.
• 11:42
  SPEAKER_00: He was trying to push it, was pushing it with the physical therapist.
• 11:47
  SPEAKER_00: At around month five, an MRI finally happened to see what was going on in the knee.
• 13:58
  SPEAKER_00: But with hardware in the knee, the images were blurry with the metal hardware he had.
• 14:04
  SPEAKER_00: And as you described it, he was told there was no scar tissue and to keep working on it.
• 14:10
  SPEAKER_00: No plan, no next step.
• 14:12
  SPEAKER_00: The door was essentially kind of closed on this of like just keep working on it.
• 14:17
  SPEAKER_00: And there was some resistance getting this MRI that he had shared as well.
• 14:23
  SPEAKER_00: And this is one of the things that I think is something we see a lot.
• 14:29
  SPEAKER_00: And when we see athletes running into these issues and they've been exhausting, especially their rehab and everything that they can do, and the knee is still not giving, whether it could be like this weird pain sensation, it could be the range of motion is not coming back, the extension, they're continuing to have functional issues, their strength is not coming along like it should.
• 14:53
  SPEAKER_00: There are certain things that through our pattern recognition, we're starting to pick up that there is something that is going on in the knee structurally that is blocking this.
• 15:02
  SPEAKER_00: There's a mechanical block or issue in the knee that is influencing this outcome.
• 15:07
  SPEAKER_00: And when we see this, we try to really encourage the athlete and equip them with the information to get an MRI and to just talk with the surgeon and see what they want to do here, too, to make sure we're all on the same page.
• 15:22
  SPEAKER_00: What we find a lot of times, and what I talk with with other athletes, is that there's just resistance to getting the MRI, which has never stood well with me.
• 15:32
  SPEAKER_00: And it's something that I just find interesting because when the injury happens, they're quick to get it in MRI.
• 15:40
  SPEAKER_00: They're like, Yeah, let's get an X-ray MRI, let's confirm the ACL tear, right?
• 15:45
  SPEAKER_00: For some reason, after the surgery, unless things are not good, there tends to be more resistance around the imaging.
• 15:53
  SPEAKER_00: And I just I can't for the life of me really understand it because it doesn't really, there's no sweat off the back, right?
• 15:59
  SPEAKER_00: Like they're not doing the imaging, they're not the ones who are having to build the insurance, they just got to send a piece of paper referral saying, Can you give this person an MRI?
• 16:08
  SPEAKER_00: That is it.
• 16:10
  SPEAKER_00: And so it baffles me to some degree when the resistance is there, and I understand there needs to be clinical decision making in this, but these people aren't just coming in there being like, I need an MRI.
• 16:23
  SPEAKER_00: It's there is a well-equipped kind of timeline, if you will, of like, hey, here is what has been happening, here are my symptoms, and I understand conservative management first.
• 16:34
  SPEAKER_00: This is where you make sure you're doing all the proper rehab-based things that you can that are in your control.
• 16:41
  SPEAKER_00: Maybe there are some other techniques that you could potentially do within conservative management, like an injection or something like that.
• 16:49
  SPEAKER_00: But even then, we still need to kind of figure out what is going on in a lot of these cases, especially if there is good clinical decision making around, like, hey, we've exhausted X, Y, and Z.
• 16:59
  SPEAKER_00: We continue to see X, Y, and Z.
• 17:02
  SPEAKER_00: And this is why we feel like we need to get an MRI.
• 17:06
  SPEAKER_00: And I think a good case for this is especially when there's scar tissue or a cyclops lesion, or it's just something that is just not normally going the path that it would be in this ACEL rehab process.
• 17:19
  SPEAKER_00: And your gut can kind of tell you this, and our guts have gotten really uh good at being able to see these things pretty early just because we are working with a lot of athletes dealing with these complex cases.
• 17:32
  SPEAKER_00: And so the MRI finally happened, which was great, but again, like the images were blurry.
• 17:39
  SPEAKER_00: The surgeon themselves said there was not really any issue that and no scar tissue they could see.
• 17:47
  SPEAKER_00: So this athlete left that with a knee that felt stuck and no next steps really.
• 17:54
  SPEAKER_00: They were just like, keep working on it.
• 17:56
  SPEAKER_00: He didn't accept that.
• 17:57
  SPEAKER_00: So he found a second surgeon who looked at the same scan, but that surgeon couldn't read it.
• 18:02
  SPEAKER_00: So then that surgeon ordered a different MRI contrast with just the situation he was in, and it showed tons of scar tissue.
• 18:10
  SPEAKER_00: And the surgeon operated on him and said it was the most that he had ever seen, which you know that might be an exaggeration, but he did have scar tissue, had that cleaned up at seven months, and even then, he went back to the PT clinic because he was just like, Okay, I want some guidance here.
• 18:31
  SPEAKER_00: And just as a little background, he after he was getting cranked on and post op, he ended up going his own path.
• 18:39
  SPEAKER_00: Like he wasn't someone who was just stuck with PT the whole time, he went his own path after he just started to lose faith in the process of his range of motion and also just that rebound effect of he'd go to PT, get cranked on, he'd feel nauseous, but then also would rebound and get inflamed, and it wouldn't improve.
• 19:00
  SPEAKER_00: And so he did start doing it all by himself for a little bit, and then he started to go to the other surgeon, had the clean out, and then he went back to the same PT for a week, they started cranking on it, and he started to notice that he was getting that rebound again.
• 19:16
  SPEAKER_00: And so he was like, I'm done, this is it.
• 19:19
  SPEAKER_00: And I'm telling you this because his knee wasn't ready for that, and it should never be.
• 19:26
  SPEAKER_00: You should never be cranking on the knee.
• 19:28
  SPEAKER_00: And the thing that he finally kind of got to a point where he was like, I was trusting them again just to see, okay, maybe it was a bad knee, but then he did it again and he started to realize this is doesn't feel right.
• 19:40
  SPEAKER_00: And so this is where he started to look externally from that.
• 19:45
  SPEAKER_00: And I'm gonna be fair here.
• 19:46
  SPEAKER_00: The people I hear from are the ones who struggle.
• 19:51
  SPEAKER_00: The athletes who had a great surgeon, a PT who was on top of it, and a smooth recovery finishes rehab and getting back to their sport activities, they're not necessarily the ones who are reaching out for help all the time.
• 20:04
  SPEAKER_00: They may want an opinion, but a lot of times if they have good healthcare providers and they feel like they're progressing, then those aren't necessarily the ones reaching out because they feel like they have a good team.
• 20:15
  SPEAKER_00: So, of course, my view can be a little skewed towards the harder cases, and I know that.
• 20:21
  SPEAKER_00: So I do want to call that out.
• 20:23
  SPEAKER_00: There are excellent surgeons and clinicians out there and plenty of athletes getting great care.
• 20:28
  SPEAKER_00: But there's also a group you never hear from the ones who struggle quietly or settle for, you know, quote unquote good enough, and never find out there was another answer.
• 20:39
  SPEAKER_00: That's what I'm talking about today.
• 20:41
  SPEAKER_00: And it's many of you who are probably listening, and it's ones who just feel a little bit more lost or feeling unheard and feeling like there's some struggle that you're working through, and you're just feeling like the people around you are not necessarily hearing you fully or looking to it as much as they should, and that's influencing your trust in healthcare and in providers, and that's real.
• 21:08
  SPEAKER_00: For most ACL athletes, ACL rehab is their first real medical experience.
• 21:14
  SPEAKER_00: They've never done this before, so they have nothing to really compare it to.
• 21:19
  SPEAKER_00: If the process feels rushed or generic, they assume it might just be how it works for everyone to some degree.
• 21:26
  SPEAKER_00: When you ask most people about their healthcare visits in general, you'll hear the same things.
• 21:32
  SPEAKER_00: I waited a long time.
• 21:34
  SPEAKER_00: They didn't answer all my questions.
• 21:35
  SPEAKER_00: It felt generic, it felt rushed.
• 21:38
  SPEAKER_00: Those experiences, plus what people hear from friends and the media shape what they expect before they ever walk into this whole ACL rehab process as a whole.
• 21:48
  SPEAKER_00: And to some degree, the align is the same for everyone.
• 21:51
  SPEAKER_00: You get injured, maybe do some rehab, have surgery, and then you go through the post-op rehab process and on.
• 21:59
  SPEAKER_00: But it can look very different depending on the injury itself, the support you have, your rehab provider, your surgeon, and the overall game plan.
• 22:07
  SPEAKER_00: There are a lot of layers, and most of them are invisible until you're actually in the middle of it doing it.
• 22:13
  SPEAKER_00: Think of the factors that shape an ACL rehab into three buckets: the things in your control, like consistency, how much you communicate, the rehab programming that you're getting and doing.
• 22:26
  SPEAKER_00: Those are the things that can be in your control, things not in your control, how your body responds to your surgery, things largely shaped by your providers, like how they test, when they are going to progress things, or when are they gonna escalate it to the next step, and how well your team talks to one another, for example.
• 22:44
  SPEAKER_00: The trouble is that athletes usually can't see the third bucket until it's already affecting them.
• 22:51
  SPEAKER_00: And this is one of the things that's really important here.
• 22:54
  SPEAKER_00: Through this whole process, you're asking one question over and over: Do I trust this person?
• 22:59
  SPEAKER_00: And is this the right call?
• 23:01
  SPEAKER_00: Your PT and your surgeon are the ones helping steer the ship.
• 23:05
  SPEAKER_00: Every visit is essentially a data point for that.
• 23:09
  SPEAKER_00: Trust starts to slip when your knee is potentially being pushed and cranked on, like this athlete was, when your therapist is potentially seeing three, four, five people in an hour, when your questions are not necessarily being answered.
• 23:25
  SPEAKER_00: Maybe you're not necessarily getting the guidance that you need for the week, especially between the visits that you have, which is not very common with physical therapy.
• 23:35
  SPEAKER_00: You're just kind of waiting till the next visit.
• 23:37
  SPEAKER_00: Or you're just kind of feeling lost.
• 23:39
  SPEAKER_00: There's not a lot of structure, right?
• 23:41
  SPEAKER_00: And these are the things that people will often feel with this of like, where am I heading?
• 23:46
  SPEAKER_00: What should I be doing?
• 23:47
  SPEAKER_00: Am I doing the most?
• 23:49
  SPEAKER_00: Am I testing properly?
• 23:50
  SPEAKER_00: Am I testing at all?
• 23:52
  SPEAKER_00: Your trust slips more when you say something is off with your knee and it isn't taken seriously.
• 23:57
  SPEAKER_00: We have a lot of people who, whether it's their in person PT or whether it's the surgeon.
• 24:04
  SPEAKER_00: Sometimes what they say is not taken seriously.
• 24:07
  SPEAKER_00: And that can also influence trust.
• 24:09
  SPEAKER_00: And it keeps slipping when you aren't progressing, when you feel stalled, you feel stuck, or you keep regressing, or you try to go forward and you take five steps back, right?
• 24:20
  SPEAKER_00: That's the athlete's story.
• 24:21
  SPEAKER_00: Great numbers, you know, in the room in this situation, whenever it was on paper.
• 24:27
  SPEAKER_00: But the thing is that it would rebound.
• 24:29
  SPEAKER_00: And here's the practical point.
• 24:31
  SPEAKER_00: If your range of motion looks great in the clinic, and let's say it regresses back, it's a signal.
• 24:38
  SPEAKER_00: Just keep that in mind.
• 24:39
  SPEAKER_00: It's something that, yes, in that momentary, sometimes PTs can almost get ahead of themselves of trying to get that win where they're like cranking on it or pushing as hard as they can, but it might not be the place where it stays.
• 24:51
  SPEAKER_00: Now, that's something to just kind of track with data and find the trends with it.
• 24:55
  SPEAKER_00: In my clinical opinion, forcing range of motion often triggers just a negative response, inflammatory, muscle guarding.
• 25:03
  SPEAKER_00: And so what you're pushing into may not even be that true restriction that you're working into.
• 25:09
  SPEAKER_00: I just in the years that I've been doing this, and we've seen a lot of stiff knees, a lot of knees that won't go.
• 25:17
  SPEAKER_00: The pushing on it is rarely ever going to be super successful.
• 25:22
  SPEAKER_00: And usually there's always a negative feedback loop with it that makes it rebound and doesn't do well.
• 25:28
  SPEAKER_00: I've done a whole podcast episode on cranking on the knee that talks about this in more detail.
• 25:33
  SPEAKER_00: So I will save you guys from that today.
• 25:36
  SPEAKER_00: But that is something that's really important in terms of the PT side of things when you're talking about cranking on it and also just like maybe what those numbers look like and how the knee presents itself.
• 25:47
  SPEAKER_00: And then sometimes the right answer really is to keep working on it and give it time.
• 25:54
  SPEAKER_00: I'm not saying that's never true, but sometimes it's clear there needs to be a next step, like imaging or an intervention given what's going on.
• 26:03
  SPEAKER_00: And this comes back to the point I made earlier of, you know, when something isn't right after surgery, getting imaging can have a little bit more hesitation for some reason.
• 26:16
  SPEAKER_00: So it's something that we're still trying to help our athletes work around, especially if there's resistance.
• 26:24
  SPEAKER_00: So we're equipping every one of our athletes with what to say and the proper verbiage to say, and to make sure that they can be a bit more direct in terms of like, we do need to get this a little bit faster.
• 26:36
  SPEAKER_00: And the thing is, is that we also have to consider other opinions, and we're seeing this a lot more because sometimes the provider is not necessarily on board with doing that, and there could be one reason or another.
• 26:52
  SPEAKER_00: We have this on a weekly conversation with different athletes where they might need imaging and the surgeon is not necessarily on board with it.
• 27:00
  SPEAKER_00: Again, not all of them.
• 27:01
  SPEAKER_00: We need to know what's going on, or we kind of have an idea there's some scar tissue or a cyclops, or there's something else going on, but there's no attention being addressed to it.
• 27:12
  SPEAKER_00: And the other thing that I'm just gonna point out here is that it's so hard for someone to walk into a room for five minutes, assess your knee, and all the questions were likely taken with an assistant prior to, and they're asking you, yeah, how are you doing?
• 27:29
  SPEAKER_00: What's up with your knee?
• 27:30
  SPEAKER_00: And then they, you know, test it out on the table.
• 27:33
  SPEAKER_00: And in five, maybe 10 minutes max, they see you, they talk to you, you maybe have your questions answered, and they make a clinical decision on that without necessarily looking at the past three months of rehab or what has that timeline truly looked like.
• 27:51
  SPEAKER_00: It's more of an in there type of moment, and they're kind of using their, you know, kind of decision making in those moments to be able to do that.
• 28:00
  SPEAKER_00: But it's on such little data in reality.
• 28:04
  SPEAKER_00: So this is where it's so important for the physical therapist to equip the athletes with the proper information to be able to relay and yeah, communicate it to the surgeon if that's possible and if there's an easy way to do that.
• 28:16
  SPEAKER_00: But we find that there's red tape and it's challenging.
• 28:19
  SPEAKER_00: So a lot of times athletes have to advocate for themselves.
• 28:23
  SPEAKER_00: It's just something that's really important, and so that's where equipping you with all the information possible to move this along.
• 28:30
  SPEAKER_00: When the PT and surgeon are not necessarily on the same page with that, the athlete becomes that messenger.
• 28:36
  SPEAKER_00: And I think that's really important in these situations because of potentially that red tape that can kind of exist.
• 28:44
  SPEAKER_00: And honestly, it's really hard to get them on the phone to communicate and get responses back.
• 28:49
  SPEAKER_00: And that's where the athlete being in control of the process and being able to communicate that is very helpful.
• 28:58
  SPEAKER_00: Now, here's where I want to shift to where athletes go when that trust breaks.
• 29:03
  SPEAKER_00: And people who lose trust, they don't just stop looking for answers, right?
• 29:08
  SPEAKER_00: They just start looking elsewhere.
• 29:10
  SPEAKER_00: Often that's online, social media, podcasts.
• 29:13
  SPEAKER_00: Now AI is a big part of this.
• 29:16
  SPEAKER_00: But forums, especially are a big one too.
• 29:18
  SPEAKER_00: People go there to vent, to share what they've been through and see if it's relatable, if they've seen a story similar to theirs, and to hear other people's opinions.
• 29:28
  SPEAKER_00: A lot of the time, it comes down to this they don't feel heard in their process, they feel lost in the process, their gut is telling them something doesn't seem right, and they want confirmation, or maybe they want to be validated or just to be heard.
• 29:44
  SPEAKER_00: People just want to be heard in this process.
• 29:47
  SPEAKER_00: And I can't tell you how much these conversations I have with ACLers where they're like, thank you for taking this time.
• 29:54
  SPEAKER_00: I don't think I've ever told anyone any of this.
• 29:57
  SPEAKER_00: And, you know, they haven't necessarily been able to fully open up to be able to share their story or what's going on or what's on their mind.
• 30:05
  SPEAKER_00: There's always interruptions.
• 30:07
  SPEAKER_00: Did you know that there was a study that showed that when a patient and doctor encounter comes together, how quickly it takes for the provider to interrupt them in healthcare by the time the patient starts speaking?
• 30:21
  SPEAKER_00: So you walk into the room and they ask you a question and you start answering the time it takes for the provider to interrupt.
• 30:30
  SPEAKER_00: Eight seconds.
• 30:32
  SPEAKER_00: Eight seconds.
• 30:34
  SPEAKER_00: That's the amount of time that typically people will get to be able to start to share their story.
• 30:41
  SPEAKER_00: That's not even close to what needs to be communicated, not even close, but again, high volume running through this kind of process can just add speed, and so then trying to get to the point, but then the details get missed.
• 30:55
  SPEAKER_00: So people want to be heard.
• 30:57
  SPEAKER_00: That is my point here.
• 30:59
  SPEAKER_00: And they want to be better equipped, and that's why they come to these forums or social media in these places to be able to ask better questions and to bring up the things their providers haven't paid enough attention to.
• 31:10
  SPEAKER_00: I get that, and that gut feeling is often picking up on something that is real for you.
• 31:16
  SPEAKER_00: In the story I told you, his gut was right.
• 31:18
  SPEAKER_00: But here's the limit: a forum can tell you you're not alone.
• 31:24
  SPEAKER_00: It can't examine your knee, neither can a post or a podcast, this podcast, an AI tool, for example.
• 31:31
  SPEAKER_00: They can help you ask better questions or get educated.
• 31:35
  SPEAKER_00: They can't really tell you what's going on in your specific knee.
• 31:38
  SPEAKER_00: Not even AI, you can put it in there, but you're still going to need someone who understands this at an expert level to be able to discern this.
• 31:47
  SPEAKER_00: And when you're already frustrated, it's easy to collect information for the worst version of the story or for the most confident opinion in the thread.
• 31:57
  SPEAKER_00: Yes, this podcast is one of those resources.
• 31:59
  SPEAKER_00: So the same limit applies to me as well, which is where a lot of athletes make the next move, doing it themselves.
• 32:08
  SPEAKER_00: When that trust breaks, a few things happen.
• 32:11
  SPEAKER_00: First, there's delays, athletes wait and hope it comes with time, or they don't get the imaging or the help that they need, and months go by.
• 32:21
  SPEAKER_00: And this compounds more than people think.
• 32:24
  SPEAKER_00: And then second, the sunk cost.
• 32:27
  SPEAKER_00: They've used their insurance visits, they've already invested a lot of time and money.
• 32:31
  SPEAKER_00: So they think maybe I can just finish this out.
• 32:35
  SPEAKER_00: I understand that.
• 32:36
  SPEAKER_00: I really do.
• 32:38
  SPEAKER_00: Third, they take matters in their own hands, they research, build their own plan, buy their own equipment, the DIY do-it-yourself route.
• 32:47
  SPEAKER_00: There are usually four reasons someone ends up here.
• 32:50
  SPEAKER_00: They've lost trust in the process itself, they feel they've exhausted what they've tried, they think they can do it better than the people they've worked with.
• 33:01
  SPEAKER_00: The resources ran out, like the insurance business or maybe the financial aspects.
• 33:06
  SPEAKER_00: I don't blame anyone for any of those.
• 33:09
  SPEAKER_00: When you've been treated like a number, you haven't gotten the results, and you haven't been heard, and it feels like you haven't had another choice, taking control makes sense.
• 33:19
  SPEAKER_00: But the DIY should not be the goal.
• 33:23
  SPEAKER_00: And here's why, y'all.
• 33:26
  SPEAKER_00: This is a complicated recovery, and we should treat it like one.
• 33:29
  SPEAKER_00: Think about people handling other complex health situations.
• 33:33
  SPEAKER_00: If someone has a neurological condition or a heart condition or has cancer, and their first provider isn't working out, they don't decide to figure it out on their own, they find another provider.
• 33:44
  SPEAKER_00: I'm not comparing an ACL to those.
• 33:46
  SPEAKER_00: I get it, they're not on the necessarily the same scale, but I think it is so important to be able to think about it to some degree as if it were in the context of those, because this can be a crossroads for many people between health, the things they want to get back to, mental health, and also a crossroads of just like metabolic health long term.
• 34:10
  SPEAKER_00: And so I think that this is very, very important to be considering in these cases to find another provider.
• 34:18
  SPEAKER_00: And I'm saying that this recovery is complex.
• 34:22
  SPEAKER_00: We need to look for the right guide, and an ACL deserves the same instinct as any of these other organs that might feel a bit more major.
• 34:31
  SPEAKER_00: The other reason is objectivity.
• 34:33
  SPEAKER_00: It's hard to stay objective about your own body, your own rehab, and it's hard for anyone to do this alone.
• 34:39
  SPEAKER_00: Even if I tore my ACL again, you know, God forbid, and I've worked with thousands of athletes and teach other PTs how to do this.
• 34:47
  SPEAKER_00: I would not do this on my own.
• 34:49
  SPEAKER_00: I would have someone else program, guide my own rehab.
• 34:53
  SPEAKER_00: I'd make sure that I am not the one that is doing that.
• 34:57
  SPEAKER_00: That is so important to me.
• 34:58
  SPEAKER_00: And it's something that I just want you to be able to think about as you're going through this process.
• 35:04
  SPEAKER_00: And I also hear this a lot PT didn't work.
• 35:08
  SPEAKER_00: But one PT not working doesn't mean the next one won't.
• 35:11
  SPEAKER_00: So just keep that in mind, even if you are trying your third, fourth, fifth, sixth PT, right?
• 35:19
  SPEAKER_00: I know that that seems exhausting, but just make sure to do your research.
• 35:24
  SPEAKER_00: And I think it's a combination of finding the volume that they do ACLs the right way up to what is current standards, but also the outcomes.
• 35:34
  SPEAKER_00: So see what people are saying.
• 35:36
  SPEAKER_00: You need to see people who have ACL injuries.
• 35:39
  SPEAKER_00: You need to see your own story within the reviews that people are sharing about working with said provider or said company.
• 35:46
  SPEAKER_00: I think it's so important.
• 35:48
  SPEAKER_00: Just like anything you buy online these days, you're going to read the reviews, read the reviews, see the stories, see if they have the proof there along with the volume to back it up.
• 35:59
  SPEAKER_00: And I think that's so important for us to be able to do.
• 36:02
  SPEAKER_00: So please search us if you're ever skeptical.
• 36:05
  SPEAKER_00: If you think I'm just talking out of one side and the other after almost 300 episodes here, but please do that and be able to see that we want to make sure that we align with what I'm sharing here of volume plus the outcomes.
• 36:19
  SPEAKER_00: And a lot of times these people will say PT doesn't work.
• 36:24
  SPEAKER_00: And again, it doesn't mean the next one won't.
• 36:27
  SPEAKER_00: They are not all created equal.
• 36:29
  SPEAKER_00: It's like a relationship that didn't work out while you were dating.
• 36:32
  SPEAKER_00: You just don't quit dating forever.
• 36:35
  SPEAKER_00: You try again until you find the right person.
• 36:38
  SPEAKER_00: This is no different.
• 36:40
  SPEAKER_00: The same thing with a surgeon if you need help, the same thing with a PT provider.
• 36:43
  SPEAKER_00: Even for a primary care, if you feel like you need them, keep finding it until they align with what you need.
• 36:49
  SPEAKER_00: You could be right that your last provider wasn't good, and still be wrong that the answer is doing it alone.
• 36:57
  SPEAKER_00: And yes, this is a part of the business that we run.
• 37:02
  SPEAKER_00: We do ACO remote coaching, it's something that we're passionate about.
• 37:06
  SPEAKER_00: And so, weigh what I'm saying with that in mind.
• 37:09
  SPEAKER_00: I'm not saying it has to be us.
• 37:11
  SPEAKER_00: I'm saying find someone who cares and has the knowledge to get you from A to B.
• 37:17
  SPEAKER_00: That is all that I care about that in this process is that you have the right guidance and get good care because it can really change your life.
• 37:25
  SPEAKER_00: And so here's the last piece as we land this episode: the practical part.
• 37:31
  SPEAKER_00: You don't need to be a clinician to check whether your care is earning your trust, and you don't need your PT and surgeon on the same call to do it.
• 37:39
  SPEAKER_00: These four questions work with the team that you have.
• 37:43
  SPEAKER_00: Number one, what are my priorities and how are we objectively measuring them?
• 37:47
  SPEAKER_00: Ask what numbers are and whether they hold up outside the clinic, especially in a case like this, right?
• 37:54
  SPEAKER_00: Making sure we're not fudging any numbers that the numbers hold up and they're standard.
• 37:58
  SPEAKER_00: If your range of motion looks great in the room and is gone by the morning, I think is something important to also share and consistently share.
• 38:06
  SPEAKER_00: What criteria and milestones are we working towards, like return to the gym, jumping, running, sprinting, change of direction, and performance, also relative to your goals, whether it's a sport or activity.
• 38:18
  SPEAKER_00: And are we progressing those by criteria or just by time?
• 38:23
  SPEAKER_00: It's not just six weeks past and we progress those.
• 38:26
  SPEAKER_00: It's because we're hitting specific criteria and milestones.
• 38:30
  SPEAKER_00: Number three, if I'm not progressing by a certain point, what is the next step and what triggers it?
• 38:36
  SPEAKER_00: Imaging, a second opinion, a referral, your surgeon, it may be hard to reach.
• 38:41
  SPEAKER_00: So it's fair to ask your PT how they'd handle that referral.
• 38:45
  SPEAKER_00: Number four, will my questions get answered and how?
• 38:48
  SPEAKER_00: Between visits, not just during them.
• 38:50
  SPEAKER_00: And I think that's such an undervalued thing for us.
• 38:55
  SPEAKER_00: Like you have support throughout the entire week through a messenger as well as other communication mediums that are asynchronous and synchronous.
• 39:03
  SPEAKER_00: But there's so much that happens in between the sessions that I think is so important for you to be able to have support.
• 39:10
  SPEAKER_00: If you're having to wait from your PC session from Thursday until the next following Tuesday, it's a very long time.
• 39:17
  SPEAKER_00: If something happens, you have questions, you need changes, updates.
• 39:21
  SPEAKER_00: And it could be something that can give you anxiety that could be put at bay on Friday or the day of on Thursday, or you could ride that through the weekend and have to wait till Tuesday to get that answer that you're looking for, right?
• 39:34
  SPEAKER_00: So I think that is something that is huge in this process.
• 39:37
  SPEAKER_00: If you can't get clear answers to these, this isn't something that is a you thing, or this should be normal.
• 39:44
  SPEAKER_00: It's just information to be able to make a decision in terms of is this going to be sustainable?
• 39:51
  SPEAKER_00: Is this going to be the thing that is going to get me to my end goal?
• 39:55
  SPEAKER_00: And this is where I think communication is the foundation of this process.
• 40:00
  SPEAKER_00: If you take our team, the remote athletes, the in-person athletes we work with, the communication is the foundation.
• 40:08
  SPEAKER_00: And so if we can't answer questions, if we cannot communicate on a regular basis, and it works both ways, it's us, but then it's also the athletes and everyone involved.
• 40:18
  SPEAKER_00: That is so, so key.
• 40:20
  SPEAKER_00: But this is something that we need to make sure to be able to make decisions around and you get the support that you need.
• 40:26
  SPEAKER_00: Trust is not something that just breaks just off of one bad day, y'all.
• 40:31
  SPEAKER_00: It breaks in small, specific moments, kind of like a compounding factor: a rush visit, an unanswered question, a scan nobody follows up on.
• 40:42
  SPEAKER_00: And once it breaks, athletes stop following a process and they start to try and DIY it a little bit more, start to look outside of that.
• 40:50
  SPEAKER_00: And I'm not saying it's a bad thing, but it's something that continues to fracture that relationship or that trust with healthcare, with the providers, and is something that they stop trusting altogether.
• 41:04
  SPEAKER_00: And if you're in the middle of this right now and it feels like you're being pushed down, maybe it's a conveyor belt, you're not feeling heard.
• 41:12
  SPEAKER_00: It's something that I want you to know that even though it is normal in healthcare, I wouldn't say that it should be the standard.
• 41:20
  SPEAKER_00: And I'm not saying that it's okay.
• 41:22
  SPEAKER_00: Just because it's normal doesn't mean it's okay.
• 41:24
  SPEAKER_00: Just because you don't get heard doesn't mean it's okay, or it's just this is what happens, right?
• 41:30
  SPEAKER_00: We don't need to normalize these things and say it's okay.
• 41:33
  SPEAKER_00: You deserve a plan, you deserve real answers, you deserve just structure around this and someone in your corner who knows what they are doing.
• 41:42
  SPEAKER_00: And if this episode hit home, send it to someone who's going through it.
• 41:47
  SPEAKER_00: And if you have a story about your own rehab, good or bad, I want to hear it.
• 41:50
  SPEAKER_00: You can send that to me via email, messenger, whatever that might be.
• 41:56
  SPEAKER_00: This is something that is really important to be able to share with other people, just so we can all continue to improve this process, advocate for ourselves, and take control of your own health because no one is gonna care as much as you do.
• 42:09
  SPEAKER_00: So make sure to be able to make these moves.
• 42:12
  SPEAKER_00: Don't let time compound on each other and let months get away.
• 42:17
  SPEAKER_00: And just make those decisions now.
• 42:20
  SPEAKER_00: Don't see if it's gonna get better.
• 42:22
  SPEAKER_00: And I promise you, if it's been this way for weeks and weeks and months, just because of maybe one conversation could change it, but it's rare that it's gonna change it.
• 42:33
  SPEAKER_00: It's likely gonna stay the same that it is.
• 42:36
  SPEAKER_00: But with that said, just make the changes so then that way when you are scoring your team and you have a one to 10 scale, and you're like, How do I trust my surgeon?
• 42:46
  SPEAKER_00: How do I trust my physical therapist?
• 42:48
  SPEAKER_00: And whenever you're just talking about your overall support and your plan, you feel like you can score a 10 out of 10.
• 42:55
  SPEAKER_00: If you can't, and if you're not at least at an eight, nine, or 10, then something needs to change.
• 43:02
  SPEAKER_00: And again, this is not something that we should just be able to say, oh, well, this is just the way it is.
• 43:09
  SPEAKER_00: There's other options that exist out there, and your knee isn't important enough, your health is important enough, your mental health is important enough to make sure that you get the support and care that you need.
• 43:19
  SPEAKER_00: It's not just reserved for professional athletes or these athletes in these certain levels.
• 43:24
  SPEAKER_00: It should be for every person that exists to be able to get the care that they deserve.
• 43:28
  SPEAKER_00: And so if this hit home for you guys, please reach out.
• 43:33
  SPEAKER_00: We're here to help in any way.
• 43:35
  SPEAKER_00: I appreciate you for listening to this very long episode, but it's something that's been kind of sitting on my heart for a little bit.
• 43:41
  SPEAKER_00: And I felt like this storying case just felt like it really connected.
• 43:45
  SPEAKER_00: And so I just wanted to kind of put some words around this, probably too many, to be able to connect why someone's trust might be influenced in this process and not to also blame people for when they go to try and do it themselves, but just a caution when you go to do that and to just know, like, we need to treat this like a pretty major diagnosis and to be able to find the next person, just like you're dating, right?
• 44:09
  SPEAKER_00: You're not just gonna stop dating because it didn't work for that one relationship.
• 44:13
  SPEAKER_00: You're gonna keep going until you find that person.
• 44:16
  SPEAKER_00: This is the same thing.
• 44:17
  SPEAKER_00: Keep going until you find that person.
• 44:19
  SPEAKER_00: And I promise when you find that person, you will know, and you'll be like, This is it.
• 44:26
  SPEAKER_00: And so, this is something that I'm gonna end with.
• 44:29
  SPEAKER_00: This is your host, Robbie Patel, signing off.