Latest / The ACL Athlete Podcast / 266 | Complex ACL Cases: The More Complicated, The More Opinions You May Need

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266 | Complex ACL Cases: The More Complicated, The More Opinions You May Need · 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: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:07
  SPEAKER_00: So today I'm joining you guys.
• 1:10
  SPEAKER_00: My voice is not 100% if you guys have been following along.
• 1:14
  SPEAKER_00: Our family has battled sicknesses on and off with our toddler being in preschool.
• 1:21
  SPEAKER_00: And it has just been a chain of events of getting sick again.
• 1:26
  SPEAKER_00: And so I have lost my voice and have regained it back a little bit, but I am not 100%.
• 1:32
  SPEAKER_00: But another podcast is due up this week, and I'm not gonna skip because we have been going at it for 265 weeks straight.
• 1:42
  SPEAKER_00: And today is episode 266.
• 1:45
  SPEAKER_00: So let's jump into it.
• 1:48
  SPEAKER_00: Today's episode builds off of episode 208, where I talked about getting a second opinion for ACL surgery.
• 1:56
  SPEAKER_00: But today I want to go deeper on that today, specifically around complex cases, what they look like, and what you need to do when things get a little messy or it's a little gray, it's not as clear-cut black and white.
• 2:11
  SPEAKER_00: So let's start here because quote, complicated unquote covers a lot of ground.
• 2:19
  SPEAKER_00: It could be time-based, it could be nature of the injury itself, it could be what's happened in the weeks, months, or even years since the surgery, right?
• 2:30
  SPEAKER_00: On the other side, you might be dealing with an isolated ACL.
• 2:34
  SPEAKER_00: You might be also dealing with an ACL plus a meniscus plus a PCL plus an LET.
• 2:40
  SPEAKER_00: It could be multiligament involvement, it could be cartilage damage like an OCD in combination or an isolation.
• 2:47
  SPEAKER_00: These could also be impacted initially or later, but it could be a combination of these things.
• 2:54
  SPEAKER_00: And I didn't even mention LCL, PCL, posterior low corner, all the different things that could be impacted in the knee.
• 3:02
  SPEAKER_00: And then, of course, you're talking about potentially also taking a tissue for a graft.
• 3:07
  SPEAKER_00: And this could also be your first ACL, it could be your fourth.
• 3:11
  SPEAKER_00: I know some of you are thinking there's no way it gets to four, but it can for certain people.
• 3:18
  SPEAKER_00: We have worked with many multiple three-time ACLers and a handful of four-time ACL tears, and it's crazy, but it happens.
• 3:27
  SPEAKER_00: And especially if people are going after something and they are relentless regardless of what their body does.
• 3:34
  SPEAKER_00: But the thing is at this point, no knee-related scenario really surprises me.
• 3:39
  SPEAKER_00: Now, I will say Lindsay Vaughn's injury was pretty aggressive in this most recent Winter Olympics after more so her leg injury where her bone basically just shattered and they had to piece it all back together.
• 3:53
  SPEAKER_00: That was an extreme, extreme, extreme example.
• 3:56
  SPEAKER_00: I wouldn't say many ACLers or people are coming to us because they're also not Lindsay Vaughn.
• 4:02
  SPEAKER_00: But the thing is, is it's rare injuries like that happen.
• 4:06
  SPEAKER_00: The thing is, is that these combinations of injuries can happen, right?
• 4:10
  SPEAKER_00: And they could all happen at once, they could all happen at separate occasions.
• 4:13
  SPEAKER_00: And so I think that's what's important to kind of take in stride here.
• 4:17
  SPEAKER_00: And it's always based on when it happens, you know, what are the person's goals, like how determined are they to get to this?
• 4:24
  SPEAKER_00: Is it, you know, life or death type feel, like career related, or is it just like a hobby?
• 4:29
  SPEAKER_00: Is it an interest?
• 4:30
  SPEAKER_00: Is it just to be active?
• 4:32
  SPEAKER_00: You know, there are a lot of layers that play into this in terms of what drives a human after they have this injury, and then also the risk-reward of it, right?
• 4:41
  SPEAKER_00: The other layers to this, and there's history that we would have to layer into it, prior issues like maybe a patellar teninopathy and oshgood slaughters, where there's like some calcified bone based on ongoing development as a young kid.
• 4:56
  SPEAKER_00: And there could be patellof femoral pain issues, there could be some age-related changes like osteoarthritis because you had this injury later in life.
• 5:05
  SPEAKER_00: And as we know, osteoarthritis is more likely to happen later because as we age, you know, the tissue and the cartilage doesn't necessarily hold up as well.
• 5:15
  SPEAKER_00: And so that could be also the case for some people.
• 5:18
  SPEAKER_00: There could be previous meniscus problems, these all layer into the complexity of this process, right?
• 5:25
  SPEAKER_00: Then you've got the surgical side, graph choices, whether additional structures needed to be addressed, and the complications that can follow.
• 5:33
  SPEAKER_00: Maybe the meniscus repair that just didn't take, right?
• 5:37
  SPEAKER_00: There was a stitch put in there and the stitch just didn't do its job.
• 5:41
  SPEAKER_00: It came undone.
• 5:42
  SPEAKER_00: Maybe you were aggressive, maybe it was just the surgery itself.
• 5:46
  SPEAKER_00: Combination, there could be a DVT, an infection, tunnel widening, scar tissue, cyclops lesion, hardware rejection, nerve-related issues because we are doing surgery, stiffness, sharp pain that never resolves.
• 6:02
  SPEAKER_00: Some of these show up days after surgery, some of them show up six to nine months later or years later.
• 6:09
  SPEAKER_00: Cyclops is a good example of that.
• 6:12
  SPEAKER_00: It can develop in the early months, but not necessarily declare itself until maybe later, or maybe it does develop later.
• 6:20
  SPEAKER_00: I mean, we've had people who were totally fine, and then, you know, at months 11 and 12, for some reason it developed and started to become an issue.
• 6:28
  SPEAKER_00: And there's no predictability for it, right?
• 6:32
  SPEAKER_00: But the thing is that we are dealing with the human body, we are dealing with surgical procedures, injuries, and so the normal human anatomy and physiology and biology has been impacted.
• 6:44
  SPEAKER_00: And we are taking a surgical intervention typically to be able to improve this.
• 6:50
  SPEAKER_00: So then, therefore, we are layering this biological healing with, you know, these kind of synthetic processes that we put into the body in order to make sure we can solve the problem, which is get the ACL to do what it does and any other areas we're trying to fix.
• 7:05
  SPEAKER_00: And here's what makes this even harder.
• 7:08
  SPEAKER_00: In the early post op period, there's always a window where the guidance is to just give it some time.
• 7:15
  SPEAKER_00: Pain, swelling, limited range of motion early on are expected, right?
• 7:20
  SPEAKER_00: The challenge is distinguishing what's normal healing from what's a real problem developing.
• 7:27
  SPEAKER_00: That window exists, but it it has an expiration date, y'all.
• 7:31
  SPEAKER_00: It's not just like let's keep working on it, right?
• 7:33
  SPEAKER_00: Once you're months and months out and things aren't resolving, that's a different conversation entirely.
• 7:42
  SPEAKER_00: And this is more common than what people think, you know, and this is what I want to break down today because I think it's really important for a lot of you who are listening.
• 7:50
  SPEAKER_00: Now I'm not saying go run to you know your PT or your surgeon and say, like, this is my problem, and you know, start to get 10 different opinions about your case.
• 8:02
  SPEAKER_00: And the thing is that you have to go through an audit process of yourself and most importantly, making sure you have the right medical team and ACL team in your corner that is helping to guide through this process.
• 8:13
  SPEAKER_00: And this is where it kind of gets challenging.
• 8:15
  SPEAKER_00: But let me give you some examples of what we've dealt with directly, right?
• 8:19
  SPEAKER_00: And these are just to name a few, right?
• 8:21
  SPEAKER_00: An ACLer doing great for months and then starting to regress with pain and extension loss.
• 8:27
  SPEAKER_00: An ACLer with sharp pain post op that ebbs and flows but never resolves over 10 months, right?
• 8:33
  SPEAKER_00: An ACLer with a catching sensation on the side of their knee that only triggers with certain movements, like when they push your knee over their toes.
• 8:41
  SPEAKER_00: An ACLer six months out with swelling that's mostly contained, but ramps up hard and fast with any increase in load.
• 8:51
  SPEAKER_00: An ACLer who cannot feel their quad and strength is not really improving like the typical route, right?
• 8:58
  SPEAKER_00: This can be referred to as orthogenic muscle inhibition.
• 9:01
  SPEAKER_00: And there's a subset of ACLers who might get this where it just feels like their quad is shut down, it's not working.
• 9:09
  SPEAKER_00: The mind muscle connection activation, getting that thing to fire and build strength is not responding to normal training, usually within six to eight weeks of normal neurological training, physiological training, being able to give it the right stimulus, a muscle should respond.
• 9:29
  SPEAKER_00: That is just normal physiology of the human body.
• 9:34
  SPEAKER_00: The thing is, is that in this case, there is also a neurological disconnect that is influencing things.
• 9:41
  SPEAKER_00: And this could be, you know, someone who's three months out, six months out, nine months out, and they're doing solid intentional work.
• 9:48
  SPEAKER_00: It's not like they're skipping, but the thing is that they just are not improving at the rate you would expect.
• 9:54
  SPEAKER_00: An ACL who has had two separate procedures trying to address scar tissue and persistent issues, regresses back each time and is stuck in this cycle of pain and swelling.
• 10:06
  SPEAKER_00: And every time they try to really stress their body and push their knee forward, they just keep hitting roadblocks, right?
• 10:13
  SPEAKER_00: Y'all, we've seen it all, and this is just literally handful of cases.
• 10:18
  SPEAKER_00: And the thing is, is given who finds us and when, it's typically not the first place people look for us.
• 10:25
  SPEAKER_00: You know, the remote ACL coaching that we do or even in person isn't usually the first search people have.
• 10:31
  SPEAKER_00: Most of our athletes find us months or even one to two years out.
• 10:36
  SPEAKER_00: Often after seeing, you know, two, three, four providers.
• 10:40
  SPEAKER_00: We do have athletes who start with us in prehab or early post-op, and that's awesome.
• 10:44
  SPEAKER_00: It's ideal.
• 10:46
  SPEAKER_00: And I would say that just the the difference and the outcomes early and just getting in tune with things and even catching anything that happens, we can get in front of.
• 10:57
  SPEAKER_00: But it's not the most common entry point for a lot of the ACLers we work with.
• 11:02
  SPEAKER_00: So we naturally inherit these hard cases.
• 11:05
  SPEAKER_00: People come to us for the complicated cases because they have seen so many providers.
• 11:10
  SPEAKER_00: And so these are just these are more common than not in terms of the people we work with.
• 11:18
  SPEAKER_00: And so what happens usually the typical route is most people go the standard, you know, insurance-based PT or your local physio if you're in another country and it's a part of that healthcare system.
• 11:31
  SPEAKER_00: But you do it kind of local to you, whatever's a part of that medical system, right?
• 11:35
  SPEAKER_00: And here in the States, you usually go to insurance-based PT and you'll go to someone who takes your insurance, you know, you're seeing them two to three times a week.
• 11:43
  SPEAKER_00: Um, and then you're kind of following that, depending on if it's three months, six months.
• 11:47
  SPEAKER_00: It depends on how many PT visits you get.
• 11:50
  SPEAKER_00: All those kind of different factors influence how often you're going and what that structure looks like.
• 11:56
  SPEAKER_00: Here's the honest reality: even with mediocre ACL rehab, early post-hoc progress will happen.
• 12:03
  SPEAKER_00: Not because the PT is skilled itself, but because of time and just natural regression to the mean after surgery.
• 12:11
  SPEAKER_00: The body is healing, basic movement is happening, things improve somewhat, right?
• 12:16
  SPEAKER_00: You are just going to make some progress because it's rare that someone doesn't get some flexion, some extension, their, you know, swelling and pain starts to improve somewhat after the surgery.
• 12:29
  SPEAKER_00: It's very rare that it doesn't.
• 12:31
  SPEAKER_00: So that makes it hard to sometimes identify that something isn't right until months have passed, right?
• 12:36
  SPEAKER_00: And this is where the gap really opens up.
• 12:40
  SPEAKER_00: And I want to be direct about this.
• 12:42
  SPEAKER_00: Really good, skilled ACL specialist PTE, physical therapy can solve a lot of the problems in this process, a lot of them.
• 12:52
  SPEAKER_00: It's the foundation, but it cannot solve every single thing.
• 12:56
  SPEAKER_00: There is a point where if something isn't responding to rehab, you need further evaluation.
• 13:02
  SPEAKER_00: We need testing, we need imaging, a different set of eyes, a different viewpoint potentially.
• 13:07
  SPEAKER_00: But, and this matters.
• 13:10
  SPEAKER_00: First, you need to fully audit whether good rehab is actually happening and whether the athlete is following through on it and making sure that they're doing it.
• 13:19
  SPEAKER_00: Once that's confirmed, then you start being a detective.
• 13:24
  SPEAKER_00: Step one is usually going back to your orthopedic surgeon.
• 13:28
  SPEAKER_00: Here's some transparency your surgeon might not love.
• 13:32
  SPEAKER_00: And I'm just gonna put it out there.
• 13:34
  SPEAKER_00: In gray area situations, the tendency is to say, keep working on it.
• 13:39
  SPEAKER_00: And I hear this so so much, y'all.
• 13:41
  SPEAKER_00: And again, we deal with these complicated cases, and we just hear this all the time where athletes just get blown off rather than pushing for further investigation.
• 13:52
  SPEAKER_00: I feel like there's this kind of notion that it's just like I know better than you, and so whatever input you have is probably not likely it.
• 14:01
  SPEAKER_00: And so just trust my advice, right?
• 14:04
  SPEAKER_00: But the thing is, is that when you really audit, when they look at the knee, they may have had five to ten minutes max to just talk to you and look at it, right?
• 14:14
  SPEAKER_00: To be able to fully diagnose the issue.
• 14:16
  SPEAKER_00: And in certain cases, it is black and white, and in certain cases where these complex issues arise or it's gray, more detail needs to be gathered.
• 14:25
  SPEAKER_00: So they're just making judgment calls based on like the timing of the situation, your case, what you're presenting with, and how much of a you know, severity is it, right?
• 14:35
  SPEAKER_00: But the thing is, is that that is something that we see oftentimes with this, is that they'll just say keep working on it rather than further investigation, unless it is something that's blatantly obvious.
• 14:48
  SPEAKER_00: There's a big difference between, you know, being 10 degrees short of your full extension at four months versus maybe four degrees, right?
• 14:57
  SPEAKER_00: Maybe just being at zero, but you're having some pain, right?
• 15:00
  SPEAKER_00: The former is a clear flag, the latter is where it gets a little murky, right?
• 15:05
  SPEAKER_00: And in those murky situations, you'll often hit resistance.
• 15:09
  SPEAKER_00: And I have felt this in situations I've been in, I've felt resistance with different orthos.
• 15:15
  SPEAKER_00: And I felt resistance with orthos in my personal as I'm sharing, but also with my ACLers, and our team has two.
• 15:23
  SPEAKER_00: And then when ACLers are advocating for themselves, because a lot of times that ends up being better than us trying to advocate because they are the patient, so they'll listen more.
• 15:33
  SPEAKER_00: Is that often they'll still hit resistance?
• 15:36
  SPEAKER_00: The option usually looks like nudging them to try and get an order for an MRI, potentially getting a steroid shot, which is often a solution some surgeons will give, or just often being told to wait and see, keep working on it, keep getting stronger.
• 15:51
  SPEAKER_00: It's quad weakness, it's patellar tracking.
• 15:54
  SPEAKER_00: You know, it's just keep doing your rehab.
• 15:56
  SPEAKER_00: And in my experience, if further imaging wasn't their idea, they tend to shrug it off.
• 16:03
  SPEAKER_00: They need to be the ones to bring it up.
• 16:04
  SPEAKER_00: Otherwise, they get kind of frustrated because it's more work on their part.
• 16:08
  SPEAKER_00: They have to look into it, and it's not just as straightforward like, oh, ACL is torn.
• 16:13
  SPEAKER_00: Here's your new ligament, here are the other procedures we may need to do and move on, right?
• 16:17
  SPEAKER_00: It's not so clear cut.
• 16:20
  SPEAKER_00: And I don't think that they like it.
• 16:22
  SPEAKER_00: And I'm just gonna say that because I see it all the time.
• 16:26
  SPEAKER_00: And my goal in this podcast is full transparency with you guys, and the amount of sample data I have across the entire world of talking to human beings is just wild.
• 16:37
  SPEAKER_00: I wish you guys could see the exact profile of all the different people we get to work with and all over the world, and the cases that we work with, and what we hear from different healthcare systems and surgeons and procedures and protocols and all the different things that we see all over the world.
• 16:54
  SPEAKER_00: So I am distilling this down into what currently exists in the space.
• 16:58
  SPEAKER_00: Is there good in this space?
• 17:00
  SPEAKER_00: Yes.
• 17:00
  SPEAKER_00: Is there a lot of challenges in this space?
• 17:03
  SPEAKER_00: A ton.
• 17:04
  SPEAKER_00: And so I'm not saying that I have the perfect solution to this, but I am giving you the tools in this episode and in this podcast in general to take control of it.
• 17:13
  SPEAKER_00: And that is my goal is not to rely on whatever system you have, but more so to find a solution for yourself because you want to get back to what you care about.
• 17:23
  SPEAKER_00: So that is why I'm here and this is what I am doing.
• 17:25
  SPEAKER_00: And so then, therefore, this is where I want to be transparent versus just be nice to everyone because getting nice and being nice is not gonna get anyone anywhere, right?
• 17:37
  SPEAKER_00: And so this is the this is the thing that is challenging with this, is that it'll often get shrugged off.
• 17:44
  SPEAKER_00: And if you've exhausted rehab, if you've fully exhausted it, the doc isn't moving on, or their read doesn't line up with what you're expecting or experiencing, that's when we talk about another opinion.
• 20:03
  SPEAKER_00: And so this is where I start to see most stalling for people, and I want to address it directly.
• 20:11
  SPEAKER_00: Clients don't want to break the mold, they feel loyalty to the surgeon who did the procedure, and I get it.
• 20:17
  SPEAKER_00: Don't get me wrong, I get it, right?
• 20:19
  SPEAKER_00: It's the same dynamic as the couple who won't break up because of the history they built together, or the ACL or who stays with the PT, they know isn't helping them just because they've logged a lot of sessions and hours together.
• 20:32
  SPEAKER_00: It feels disloyal.
• 20:34
  SPEAKER_00: It's like if something goes wrong, then therefore they can help fix it.
• 20:38
  SPEAKER_00: But hey, guess what?
• 20:39
  SPEAKER_00: Something's already gone wrong and they're not fixing it.
• 20:42
  SPEAKER_00: So it just kind of feels awkward for people to just break things off or stop.
• 20:47
  SPEAKER_00: Here's what I want you to understand this is your body, guys.
• 20:51
  SPEAKER_00: In our healthcare system, patients are a number.
• 20:55
  SPEAKER_00: When a PT is seeing two to three people per hour, and a surgeon is running through patients every 10-15 minutes, you are not the center of that world.
• 21:08
  SPEAKER_00: I wish it was, and maybe in certain concierge-based practices, you might be, but it just doesn't exist.
• 21:15
  SPEAKER_00: Most operate in a high volume situation.
• 21:19
  SPEAKER_00: It's what pays the bills, it what brings in the profit and revenue.
• 21:24
  SPEAKER_00: And the way that our healthcare system in the US is it's for profit.
• 21:29
  SPEAKER_00: We have insurance systems who own pharmacies, doctors' offices, surgical centers, home health care centers.
• 21:38
  SPEAKER_00: Like, guys, like they are able to take the profit that they make and buy up these companies so that they can dictate the pricing and the way that things are structured, including coverage of care.
• 21:51
  SPEAKER_00: And so the thing is, is that it's a for-profit system.
• 21:55
  SPEAKER_00: So then, therefore, the profit is going to be the highest thing they look at over people.
• 22:01
  SPEAKER_00: It's how much money can we bring in to the shareholders in order to provide the most financial gain.
• 22:08
  SPEAKER_00: It is not to take care of the people, otherwise, it would be a nonprofit system, it would be universal healthcare, and we would get rid of these middlemen insurance players in order to be able to provide a single payer system in order to make it more transparent and more competitive in the market.
• 22:31
  SPEAKER_00: Now, that's my little tangent about this, but that is the thing that is so important to see in this is that while they may have been, you know, high with all of the charismatic tendencies and being able to kind of share their opinion, that's awesome.
• 22:46
  SPEAKER_00: But at the end of the day, like you are not the center of this world.
• 22:49
  SPEAKER_00: And so this is why I feel like you need to know, like, you have to take control of this because it's your body.
• 22:55
  SPEAKER_00: Don't take it personally.
• 22:56
  SPEAKER_00: It's the system as I share because of that system, you have to be your own health at healthcare advocate.
• 23:03
  SPEAKER_00: No one else will do it for you.
• 23:05
  SPEAKER_00: The doctors aren't going to take it personally when you seek another opinion.
• 23:09
  SPEAKER_00: Everyone in medicine understands that complex cases require multiple perspectives.
• 23:15
  SPEAKER_00: The friction you feel is internal mostly, the real friction, the legitimate friction is going to end up being the cost, the insurance navigation, the time, the scheduling.
• 23:26
  SPEAKER_00: That's real.
• 23:27
  SPEAKER_00: Don't get me wrong.
• 23:28
  SPEAKER_00: But it's a different problem than worrying about someone's feelings.
• 23:31
  SPEAKER_00: And so I think that's important for you to hear, and I want to share that.
• 23:35
  SPEAKER_00: And here's where I land after working through a lot of these cases over the years, y'all.
• 23:41
  SPEAKER_00: The more complicated the situation, the more opinions you need.
• 23:46
  SPEAKER_00: I'm gonna repeat that.
• 23:48
  SPEAKER_00: The more complicated the situation, the more opinions you need.
• 23:54
  SPEAKER_00: A straightforward case, cool.
• 23:57
  SPEAKER_00: Two to three opinions is probably enough.
• 23:59
  SPEAKER_00: If you've got a consensus across those, pick the doctor you trust.
• 24:04
  SPEAKER_00: Most and move forward.
• 24:05
  SPEAKER_00: And I even say this in the first initial ACL case.
• 24:09
  SPEAKER_00: A lot of times people will find the first surgeon or they'll be like, this is the pro team surgeon.
• 24:13
  SPEAKER_00: Good, great, set.
• 24:15
  SPEAKER_00: And yeah, cool, that's great.
• 24:17
  SPEAKER_00: But I would still suggest go get a second opinion.
• 24:19
  SPEAKER_00: You're about to have your knee cut into, let's see what someone else has to say, right?
• 24:24
  SPEAKER_00: But if it's complex, and if you're listening to this episode and nodding your head at any of those examples I mentioned, it might be three, four, five.
• 24:35
  SPEAKER_00: It's not excessive, it's due diligence, y'all.
• 24:39
  SPEAKER_00: And here's why.
• 24:40
  SPEAKER_00: If you go to the first two or three, and they all say the same thing, great.
• 24:45
  SPEAKER_00: You have a consensus.
• 24:47
  SPEAKER_00: Choose the one that you align with best.
• 24:50
  SPEAKER_00: But if someone breaks from the pack and says something different, that's a signal.
• 24:54
  SPEAKER_00: Then you need a third, a fourth, or potentially a fifth to find where the truth actually lands.
• 25:01
  SPEAKER_00: I did this with my own hip when I had my hip surgery, which I'm coming up on a year from, which is crazy.
• 25:08
  SPEAKER_00: This time last year, my case was super complicated being a young person and being relatively healthy overall.
• 25:17
  SPEAKER_00: But the thing is, is that I wanted to consult with some of the best specialists in the world because it's not often you find a young 30-year-old who has moderate OA in their hip and has been going for years and years and years with just limitations.
• 25:33
  SPEAKER_00: And then all of a sudden this has progressed.
• 25:36
  SPEAKER_00: And then now you're looking at some type of hip replacement option.
• 25:39
  SPEAKER_00: And you know, a lot of times people are like, Well, you could either get it scoped.
• 25:44
  SPEAKER_00: A lot of surgeons wouldn't want to do that.
• 25:46
  SPEAKER_00: You could get it replaced, and you could either get a resurfacing done or a true hip replacement, which is the thing that most people think of when you know their grandma or someone in their like 70s needs a hip replacement, right?
• 25:59
  SPEAKER_00: So I ended up having a hip resurfacing, which I did episodes on.
• 26:03
  SPEAKER_00: So you can catch those, which was about a year ago that I touched on this episode talking about it and breaking that down.
• 26:10
  SPEAKER_00: And I walked through getting multiple opinions on this.
• 26:12
  SPEAKER_00: And the thing is, is that I consulted with different people all over the world.
• 26:16
  SPEAKER_00: Like I consulted with some people in Australia, I consulted with people in the UK, and I also consulted with different people in the US because I wanted to have the best surgeon, best opinions of what are my alternatives with this.
• 26:32
  SPEAKER_00: And while most people might say that's crazy, Ravi, it's my hip, it's my body.
• 26:36
  SPEAKER_00: I want to do a lot of things for my life.
• 26:39
  SPEAKER_00: And I have young kids and I want to be able to sprint and run around and be active with them and not just settle, right?
• 26:44
  SPEAKER_00: I have a complicated history of a lot of injuries, ACL tears.
• 26:48
  SPEAKER_00: So I just wanted to be smart because it's something that is complex.
• 26:53
  SPEAKER_00: So I decided to pursue a lot of different opinions, and that's even with my own knowledge base of knowing rehab and just the human body and this world, right?
• 27:04
  SPEAKER_00: And so this is something that I think is very important for you to hear because that's something that I think is important, especially on the complexity of your case, because a lot of times, if it is truly complex, like some of the cases that I had mentioned, then therefore you will likely have surgeons who will have different opinions on the way to tackle things.
• 27:26
  SPEAKER_00: When I have these complicated procedures and I walk through the different options, but also have athletes reach out to different surgeons.
• 27:34
  SPEAKER_00: It's bizarre how different of cases that we have that people will come with in terms of like the surgeon solution.
• 27:41
  SPEAKER_00: And they could all be very, very, very different.
• 27:44
  SPEAKER_00: And that could very much influence the way your rehab could be.
• 27:48
  SPEAKER_00: So it is very, very much worth all the friction and the finances and everything to be able to make sure because you only get one body.
• 27:57
  SPEAKER_00: And once you have these surgeries, they are done, right?
• 28:00
  SPEAKER_00: You can of course go back in and repair and and influence them.
• 28:04
  SPEAKER_00: But once you have these true surgeries, like those are permanent changes on your body.
• 28:09
  SPEAKER_00: So we want to make sure we do it right, especially when it's complicated and when your livelihood, your ability to move, your ability to feel fulfilled and happy, and your metabolic health and everything is on the line, right?
• 28:25
  SPEAKER_00: And that seems extreme, but it is very true because I've seen people go the other side of this where they no longer are active, they don't do anything they love, they fall into depression, anxiety, and it really wrecks them and it breaks my heart to hear these stories.
• 28:40
  SPEAKER_00: But it doesn't mean that they can't still turn it around.
• 28:43
  SPEAKER_00: But there are certain situations where due diligence wasn't done and they ended up having to pay because of that.
• 28:51
  SPEAKER_00: And it's not necessarily their fault.
• 28:53
  SPEAKER_00: I blame our medical system more than anything, but at the end of the day, like once you know better, you have to do better.
• 29:00
  SPEAKER_00: And when you're listening to this podcast, if you made it this far through this long podcast episode, you know better at this point.
• 29:07
  SPEAKER_00: So if you're nodding your head or you're listening to this, you need to make sure you put it in action versus saying, like, I heard it and I didn't do anything about it, right?
• 29:17
  SPEAKER_00: And the one last thing that I do want to name because I've seen it cost people, just going back on what I just said.
• 29:27
  SPEAKER_00: Orthopedic surgeons are not a timid group of people.
• 29:30
  SPEAKER_00: I have never met a single shy orthopedic surgeon.
• 29:35
  SPEAKER_00: They walk into a room with high confidence, they speak authoritatively about things that are new and foreign to you, especially if it's complicated and you're looking for answers.
• 29:46
  SPEAKER_00: They sound completely reasonable and they tell you what they recommend as if it's their only one right answer.
• 29:54
  SPEAKER_00: Now, don't get me wrong, it's not all.
• 29:56
  SPEAKER_00: There are plenty who are like, here are your options.
• 29:59
  SPEAKER_00: I recommend you to get other opinions, X, Y, and Z, but I would say a great majority of them are wanting to keep you as a patient.
• 30:07
  SPEAKER_00: So they will make a recommendation, which I'm not saying is a bad thing, but the thing is that they will come off this way.
• 30:13
  SPEAKER_00: So when you're in those sessions in that evaluation and consultation, they will sound like, yeah, this is the thing to do.
• 30:21
  SPEAKER_00: And you're in a vulnerable position as someone who doesn't understand this stuff, as someone who is not trained, who is not educated on this, and they come in with, you know, the white coat tripe syndrome, right?
• 30:35
  SPEAKER_00: Where they come in with this feel you're injured, you're looking for answers, someone who sounds that certain is super compelling, y'all.
• 30:43
  SPEAKER_00: But the recommendation is an opinion.
• 30:46
  SPEAKER_00: Remember that it's an opinion.
• 30:48
  SPEAKER_00: Think about it this way: who looks at the first house they see and just buys it?
• 30:54
  SPEAKER_00: No one.
• 30:55
  SPEAKER_00: You shop, you compare, you get a feel for what the market looks like before you commit.
• 31:01
  SPEAKER_00: This is your knee, this is your body, the same logic applies here.
• 31:05
  SPEAKER_00: Make sure the person you're committing to is actually the right person on your team.
• 31:11
  SPEAKER_00: A big part of why I'm recording this right now is because we're actively navigating many complex cases for our entire roster.
• 31:20
  SPEAKER_00: Myself, our team, again, like I said, athletes who came to us with complicated histories and incomplete answers.
• 31:28
  SPEAKER_00: It's basically the norm.
• 31:30
  SPEAKER_00: Our job isn't just to program their rehab or test them, it's to walk each ACL or we work with, remotely or in person, no matter where they are in the world, to walk them through each step of this process to guide them, to help them to understand the landscape and make sure that they have the right team around them.
• 31:50
  SPEAKER_00: And if we can't be that, then we make recommendations on who that could be.
• 31:54
  SPEAKER_00: I can't tell you the number of calls that I've had where we finish a call and I send someone a recommendation of a surgeon, a group of surgeons, a group of PTs, or someone to connect to in the area, right?
• 32:07
  SPEAKER_00: Where I'm not saying like I get on a call and it's like sign up for us.
• 32:11
  SPEAKER_00: It's more so of like, let's find you the right solution, even if that's not working with us, it's finding you the next step, right?
• 32:18
  SPEAKER_00: That in this includes being willing to say you might need another opinion, even from us.
• 32:26
  SPEAKER_00: I don't take offense to getting another PT opinion, a different viewpoint.
• 32:30
  SPEAKER_00: I've referred other people out to that, maybe of a certain specialty, right?
• 32:35
  SPEAKER_00: No one on your team should ever feel offensive with that.
• 32:39
  SPEAKER_00: Remember this rule, which is going to be just if you take one thing away, the more complicated the case, the more opinions you need.
• 32:47
  SPEAKER_00: Follow your gut, find the right provider, do not rush a complicated decision.
• 32:54
  SPEAKER_00: Speed is the wrong priority here.
• 32:56
  SPEAKER_00: While it might feel like it will get things over with and it sounds good enough, it will be worth every bit of friction to get this right.
• 33:06
  SPEAKER_00: And I promise you guys this.
• 33:09
  SPEAKER_00: And if you are someone who is just lost, don't feel like you have direction, don't have structure, are kind of fighting this multiple opinion type situation and are looking for help, we're here to help.
• 33:21
  SPEAKER_00: Like you can reach out to us, you can book a call with us, you can send us a message, whatever that may be.
• 33:29
  SPEAKER_00: We are here to help.
• 33:30
  SPEAKER_00: I respond to every message, our team responds to messages, and we are here to support you.
• 33:35
  SPEAKER_00: But I wanted to record this episode because it I just get these questions so much, we get these complex cases, and I feel like ACLers are stuck.
• 33:45
  SPEAKER_00: And the thing is, is that you don't necessarily need to be stuck.
• 33:49
  SPEAKER_00: I think it's just a matter of having a plan, not taking anything personal, working through the friction, because I know it's easier to just stay with the status quo as is, just keep it simple.
• 34:03
  SPEAKER_00: But that could be adding months, it could be adding years to an ongoing process, and you might just feel like you know, you're kind of in a like a rocking chair, right?
• 34:12
  SPEAKER_00: Like you're moving, but you're not getting anywhere.
• 34:15
  SPEAKER_00: And so the thing is that we need to make sure that we audit this process very carefully, and most importantly, the guidance and care you get is specific to you, and that you have someone walking you through this.
• 34:31
  SPEAKER_00: You are not the person setting up your workouts, you're not the person setting up your milestones, you are not that person.
• 34:38
  SPEAKER_00: Your PT, especially, is going to be your GPS.
• 34:42
  SPEAKER_00: They are the one creating your roadmap, the turns, how long it's going to take, the criteria, the testing, the structure.
• 34:49
  SPEAKER_00: They do that.
• 34:50
  SPEAKER_00: You are the person driving the car and showing up and putting in the work, providing the feedback.
• 34:55
  SPEAKER_00: And that's what our athletes do for us when they work with us remotely or in person.
• 34:58
  SPEAKER_00: Like we are doing that for them.
• 35:01
  SPEAKER_00: So that way it takes anxiety, the stress, just all the things that are mulling over in your brain, and especially you feel in your gut that you might not be getting in your rehab, right?
• 35:11
  SPEAKER_00: You don't need to be doing that.
• 35:13
  SPEAKER_00: That's where your guide and your team is going to do that for you.
• 35:16
  SPEAKER_00: So if you need help, reach out to us.
• 35:19
  SPEAKER_00: We can point you in the right direction.
• 35:21
  SPEAKER_00: And just most importantly, if you have a complicated case, make sure to audit this process first.
• 35:27
  SPEAKER_00: Don't just go running to your surgeon or getting other opinions.
• 35:31
  SPEAKER_00: First off, audit and make sure you've done your due diligence with your rehab provider.
• 35:35
  SPEAKER_00: And then from there, work together to get some additional opinions, especially if it's complicated.
• 35:41
  SPEAKER_00: And from there, what you can do is make sure that you're on the right path and get a good game plan in place.
• 35:46
  SPEAKER_00: So I hope this helps y'all.
• 35:47
  SPEAKER_00: I know it was longer, but it was so overdue and something that I feel like I really needed to talk about and go deep on.
• 35:55
  SPEAKER_00: So if you're with me, still at the end, I appreciate you.
• 35:59
  SPEAKER_00: I appreciate all the support.
• 36:01
  SPEAKER_00: I appreciate that you tolerated me probably sounding like I've smoked 20 packs in a day.
• 36:07
  SPEAKER_00: Um, but I really enjoyed doing this despite me probably losing my voice for the rest of the day.
• 36:14
  SPEAKER_00: But I hope you guys get something out of this.
• 36:17
  SPEAKER_00: I'm gonna sign off for now.
• 36:19
  SPEAKER_00: And if y'all need anything from our end, please reach out.
• 36:23
  SPEAKER_00: Details are in the show notes to contact us, and please just make moves.
• 36:27
  SPEAKER_00: That is all I ask for you to say.
• 36:31
  SPEAKER_00: Go do the thing.
• 36:33
  SPEAKER_00: This is your host, Ravi Patel, signing off.