Latest / The ACL Athlete Podcast / 041 | Preparing for ACL Surgery - Part 2

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041 | Preparing for ACL Surgery - Part 2 · The ACL Athlete Podcast

• 0:19
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:23
  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.
• 0:33
  SPEAKER_00: I'm your host, Dr.
• 0:34
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:38
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:46
  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.
• 0:57
  SPEAKER_00: Thanks for joining.
• 0:58
  SPEAKER_00: Now let's dive into today's episode.
• 1:04
  SPEAKER_00: Welcome back, ACL athletes.
• 1:06
  SPEAKER_00: Today we are diving into part two of this three-part podcast series for preparing you for ACL surgery.
• 1:15
  SPEAKER_00: In part one, we talked about my own experience of my two own ACL reconstructions and setting the expectations for the surgical and rehab process.
• 1:27
  SPEAKER_00: It's a long journey, and sometimes people think that they're done in three to six months, or even just what they might feel right after surgery.
• 1:36
  SPEAKER_00: Some of these uh expectations versus reality can really impact the process.
• 1:42
  SPEAKER_00: So, what I want to do is make sure that you guys have as much of a comprehensive understanding of what this process is like, preparing for it, going through it, and even the immediate days after.
• 1:56
  SPEAKER_00: So you have a game plan in order to make sure you hit this road to recovery as best as possible.
• 2:02
  SPEAKER_00: And I'm pulling from my own ACL experiences as well as working with other athletes who are going through this process themselves.
• 2:10
  SPEAKER_00: So, today in part two, we're going into more detail about more so what that process looks like right after surgery, and a lot of these different buckets that are going to be important to make sure you check off and that you are focusing on, and that way you can maximize this recovery to as best as possible, but also be prepared because we know this.
• 2:34
  SPEAKER_00: If you're going through it, if you've been through it, you know this can get really overwhelming very quick, especially with not knowing what to expect.
• 2:45
  SPEAKER_00: Uh, if it's the first time having surgery, uh, what to do, what's okay, what's not okay, all these different pieces.
• 2:54
  SPEAKER_00: And sure, you may get a sheet of paper that gives you some guidance, but it's still a little vague sometimes in terms of what you need, and there's all these other variables to account for in life that isn't just on the sheet of paper that I kind of want to walk you guys through, and that way you have a very comprehensive look at getting prepared for surgery.
• 3:16
  SPEAKER_00: Before that, if you have not listened to part one, go back and listen to that because that will be super important in this series as it'll create the foundation as we build towards today's episode and episode three as well.
• 3:31
  SPEAKER_00: And before we specifically dive in, if you are listening and you know of someone who's going through this process, maybe they're getting ready to have surgery, uh, please share this with them because hopefully this can help them, even if there's a small little bit of this podcast series that can help them, that would be huge.
• 3:51
  SPEAKER_00: And these are a lot of things that I either made the mistake or I've talked to other athletes going through the process, asking them, okay, what is it that you wish you would have known and what would have helped make the process as smooth as possible?
• 4:06
  SPEAKER_00: So that's the goal today.
• 4:07
  SPEAKER_00: So share this with whoever you know so that way they can have a smoother process and can hit the ground running and get back to the things that they want to do.
• 4:17
  SPEAKER_00: Alright, guys, I hope you're ready for this episode because it's loaded with a lot of good information.
• 4:23
  SPEAKER_00: We're gonna go through this process and hopefully there is a lot that you can take away.
• 4:28
  SPEAKER_00: So, remembering for the purposes of this series, we are assuming a date for surgery has been set.
• 4:36
  SPEAKER_00: You're doing prehab, which is rehab before you're having surgery.
• 4:40
  SPEAKER_00: If not and you have the time and resources, then try and go to at least one physical therapy session in some shape or form before you have the surgery, so you can get used to the process, know what you need to do coming right out of surgery, and that can really help people uh as they're going through this process.
• 5:00
  SPEAKER_00: So, next is the surgery itself, and then you have the surgery, you're done, you're hanging out in the recovery room, and it's time to go home.
• 5:10
  SPEAKER_00: You go home and you're just hanging out, sitting on the couch, and here is where this kind of moves into this specific episode.
• 5:19
  SPEAKER_00: So, the way that I want you guys to think about this is going to be in terms of buckets slash categories because I want to be able to tease this out so you know what's important, what are some of the things that follow into that, and then being able to make sure you're hitting these important buckets of health and wellness and recovery to make sure that you are doing as best as possible for your own ACL rehab process.
• 5:47
  SPEAKER_00: So we're gonna break this down into these different buckets movement, nutrition, sleep slash recovery, stress, support, and then there's gonna be another bucket, okay?
• 6:01
  SPEAKER_00: And that's where it's going to be really helpful for us to be able to delineate these different focuses on these different buckets.
• 6:10
  SPEAKER_00: And what I'm actually going to do is combine this with some potential products or some items for each category that might be helpful for you.
• 6:19
  SPEAKER_00: And the one thing that I want you to think about in regards to products is that we can easily just see a list of things and be like, okay, I need to get all this stuff.
• 6:30
  SPEAKER_00: And I see this in groups, or I'll get these questions all the time, or I'll see people comment, and there's just this huge laundry list of things that people quote unquote need to get.
• 6:41
  SPEAKER_00: And again, these are just products.
• 6:43
  SPEAKER_00: Sometimes we can get super excited to just get all these new gadget and toys when in reality it's us spending money on some things that we potentially don't need.
• 6:55
  SPEAKER_00: So that's why I want you to evaluate these different products from your own framework of what you need versus what you don't.
• 7:03
  SPEAKER_00: And here's the way to look at it.
• 7:05
  SPEAKER_00: Your number one rule is what is my goal I'm trying to accomplish?
• 7:09
  SPEAKER_00: Whether that is helping with your pain, maybe it's to reduce swelling, to increase your quadriceps contraction, maybe it's to increase your range of motion in flexion.
• 7:20
  SPEAKER_00: And then if you're talking about specifically a product or something you want to purchase, then you need to ask: is there something that can help assist to achieve this goal?
• 7:30
  SPEAKER_00: And whether that's the pain, you can think about ice with the swelling, you can think about a compression sleeve with the increasing in quadriceps contraction.
• 7:40
  SPEAKER_00: Maybe that's an NMES device that will send electrical current to it for the range of motion and flexion.
• 7:47
  SPEAKER_00: Maybe it's a strap to be able to maneuver better based on your position.
• 7:52
  SPEAKER_00: Uh, this is no different than the goal of getting stronger and using something like ankle weights, dumbbells, kettlebells, barbells.
• 8:01
  SPEAKER_00: Our goal is to get stronger in a certain way, and then we're using these tools to be able to help us get stronger.
• 8:08
  SPEAKER_00: So here's the same thing.
• 8:10
  SPEAKER_00: We have a goal with certain objectives, whether it's pain or strength or you name it, and then we have tools to potentially assist us.
• 8:18
  SPEAKER_00: And so I'm saying just don't go buy a laundry list of things someone said to and ask yourself why, and then use this podcast series to even think through maybe some things that you would need based on your specific position and circumstance.
• 8:33
  SPEAKER_00: And then rule two is you don't need very much of anything.
• 10:43
  SPEAKER_00: I might list some things and sure they could be helpful, and you can get a hundred percent of these things, but just know that you don't really need 99% of the things that I'll talk about today in terms of products.
• 10:56
  SPEAKER_00: And I'll give you this as an example.
• 10:58
  SPEAKER_00: When I went through my ACL recoveries, I didn't really have anything that is on this list, and my outcomes turned out just fine.
• 11:07
  SPEAKER_00: I'm going to talk about important goals and concepts that you need to know.
• 11:12
  SPEAKER_00: I'll talk about products that can be helped to assist the process, but just know that there is nothing that you have to get, and you can do just as easy with just a towel, uh, a simple band, and maybe just something to prop up your heel with.
• 11:28
  SPEAKER_00: So uh that's where it's going to be dependent on you based on your situation, maybe financially, maybe just like the setup of your home, uh, maybe it's the surgery.
• 11:39
  SPEAKER_00: There are so many factors that play into it, but don't feel any pressure like you need to get all of this stuff, and that you won't have a good recovery without it.
• 11:48
  SPEAKER_00: And sometimes on social media you'll see that all these shiny gadgets, whether it's BFR or NMES or whatever it is, and I've even talked about these things before, but just know you can still have a really great recovery without any type of gadget or electronics, you name it.
• 12:06
  SPEAKER_00: And finally, just know that I don't have any financial affiliations with any of these.
• 12:11
  SPEAKER_00: So these are just from my own experience and suggestions with working with other ACL athletes as well as my own experiences.
• 12:20
  SPEAKER_00: Alright, so let's get into it.
• 12:22
  SPEAKER_00: So let's set the stage.
• 12:23
  SPEAKER_00: You've had ACL surgery, you are home.
• 12:27
  SPEAKER_00: It is day zero, the day of surgery.
• 12:30
  SPEAKER_00: Like I mentioned in part one, walking through this process and getting home, you'll kind of be out of it, you'll feel a little groggy that day, you'll feel the pains and aches, uh, you'll feel a bit sleepy, you'll be slow.
• 12:44
  SPEAKER_00: Uh, all these things are going to be really normal, and that'll slowly start to wear off in terms of the anesthesia, kind of getting that out of your system.
• 12:53
  SPEAKER_00: Uh, you have a nerve block, which we'll talk about in a second, but the the those things will play into kind of how you're feeling.
• 13:00
  SPEAKER_00: And then you're just hanging out, you're chilling, and you're on the road to recovery.
• 13:04
  SPEAKER_00: Now let's get after it.
• 13:06
  SPEAKER_00: Alright, so for bucket one, this is going to be movement, and this is going to encompass all movement, and obviously, the primary focus of your rehab and of your ACL surgery, and that doesn't mean these other areas and buckets that we talk about aren't just as important, but obviously the physical component is a big piece to this.
• 13:30
  SPEAKER_00: So, we're gonna start off with precautions and restrictions after surgery.
• 13:36
  SPEAKER_00: So, this will often be based on what was done in the procedure itself, and the surgeon will let you know.
• 13:42
  SPEAKER_00: Maybe it might be you're non-weight bearing, so you can't put any weight on your foot.
• 13:47
  SPEAKER_00: Uh, and we'll talk about this as well later.
• 13:50
  SPEAKER_00: But that might be one thing, or maybe you'll put a little bit of weight on it, or you can fully put all your weight on it.
• 13:56
  SPEAKER_00: But that might be something you can only maybe bend your knee to 90 degrees in the first four weeks.
• 14:02
  SPEAKER_00: Uh, this can really vary.
• 14:04
  SPEAKER_00: So, my point here is to make sure you know what these are, and this is typically something the surgeon themselves and the assistants that are working with them will let you know exactly what that is right after the surgery because they've done the procedure.
• 14:19
  SPEAKER_00: Maybe they had to do something differently than was pre-planned, and then now they're letting you know, and whoever is with you, here are your kind of guidelines of weight bearing or bending your knee, things of that nature.
• 14:33
  SPEAKER_00: And so make sure you know that.
• 14:35
  SPEAKER_00: And then if we're moving into the next point of this, you need to start PT as soon as possible.
• 14:42
  SPEAKER_00: And PT meaning physical therapy, and there are some situations where I will see some athletes, or I will hear of some athletes where they didn't start physical therapy, you name it, it could be anywhere from a week to I've heard some athletes not doing it for six to eight weeks until after surgery, and they've been either immobilized or they were just like, I don't know what to do, and they never got guided by a professional of like, okay, this is what the next steps are and how soon to do it.
• 15:13
  SPEAKER_00: All right, team, make sure you listen to this.
• 15:17
  SPEAKER_00: Start doing rehab as early as you can.
• 15:21
  SPEAKER_00: If I can see my athletes the day after surgery, that is my ideal situation.
• 15:29
  SPEAKER_00: And that is because I want to see them after surgery, I want to get them set up and just hit the ground running, if you will, in terms of this recovery process and making sure that they're set up and that first week goes as smooth as possible.
• 15:43
  SPEAKER_00: We are initially and immediately setting the foundation for what's to come with the ACL rehab process.
• 15:51
  SPEAKER_00: So, what I love is that if you do prehab, you can be familiar with a lot of these movements prior to surgery, and that's why it's so great.
• 15:59
  SPEAKER_00: And so that way you're not left trying to figure out okay, what do I need to do while you're also fresh out dealing with pain, swelling, uh immobilized, uh just life in general moving around.
• 16:12
  SPEAKER_00: So that's why I like to kind of do this beforehand to make sure that as soon as you get out of surgery, you know some of the basic things that you need to do.
• 16:21
  SPEAKER_00: And sometimes surgeons office and after surgery will give you this paper of some of the things that you can start doing, which are a good guide to kick off.
• 16:31
  SPEAKER_00: But you typically can do this the day of or the day after, and there are not very many cases that I've seen where you can't start doing some of that stuff, uh, especially anything from like quad sets to even some assisted heel slides.
• 16:46
  SPEAKER_00: But you don't need like 200, 300 different exercises.
• 16:50
  SPEAKER_00: Uh, your surgery is going to limit you and be your constraints.
• 16:54
  SPEAKER_00: So just focus on the basics.
• 16:56
  SPEAKER_00: Let's get the quad going.
• 16:57
  SPEAKER_00: So, quad sets, uh, make sure that you are contracting a lot with that, assisted heel slides, ankle pumps to keep the blood flowing, glute sets, maybe there's some hamstring isometrics in there.
• 17:10
  SPEAKER_00: Uh, unless you had a hamstring graph yourself, then that might be of caution.
• 17:15
  SPEAKER_00: But something along these lines, something really simple, maybe a list of five different movements that you're just kind of working on throughout the day.
• 17:22
  SPEAKER_00: And what sometimes you'll hear is a protocol that is given, and sometimes that's given to the patient.
• 17:29
  SPEAKER_00: Maybe you won't see that until you see the PT.
• 17:32
  SPEAKER_00: But remember what I mentioned earlier: it's a guide, but don't get too caught up with the timelines.
• 17:38
  SPEAKER_00: Sure, you want to be active and you're making the most of your time, but do not get too caught up in that because that can really push you up against a wall, and you just don't want that.
• 17:48
  SPEAKER_00: And you want to make sure that you are progressing how Sally should or how Jim's doing, like you compare yourself to you and don't let the protocol dictate your success or failure, if you will.
• 18:01
  SPEAKER_00: Now, let's talk about goals immediately after surgery.
• 18:06
  SPEAKER_00: And I've talked about this before, so if you guys have not gone through the quiet knee series, I highly suggest going through it because it can be really helpful for you to get a better grasp of what is important after surgery to get the knee restored and the foundations in place.
• 18:23
  SPEAKER_00: So these goals are gonna be the quiet knee, gait retraining, and preventing deconditioning.
• 18:29
  SPEAKER_00: These are your foundations, and I cannot stress this enough.
• 18:33
  SPEAKER_00: So toss out all of the other stuff.
• 18:36
  SPEAKER_00: These are what you need to be focusing on primarily 95% of the time.
• 18:42
  SPEAKER_00: And so these are going to be your range of motion and try to get your extension as quickly as possible.
• 18:49
  SPEAKER_00: So you want to get that to match the other side, and while you're also working on your flexion to progressively improve that over time, you want to make sure you can get a voluntary quad contraction.
• 19:00
  SPEAKER_00: So, can we squeeze that quadricep and activate it?
• 19:03
  SPEAKER_00: And this can be super hard after surgery with the pain, with the swelling, um, with all the things that have happened and the nerve block.
• 19:12
  SPEAKER_00: So, getting a good quad contraction, getting your gait normalized, managing your swelling and pain to make sure that that is improving over time, and then preventing deconditioning.
• 19:24
  SPEAKER_00: And this is keeping other areas moving and other ways to train aerobically.
• 19:29
  SPEAKER_00: Now, don't go too crazy with this.
• 19:32
  SPEAKER_00: A lot of times people will just be like, Oh, I gotta do all the things like my knee plus train my other leg and my arms.
• 19:39
  SPEAKER_00: You still want to have that as a big priority, but in that first week, give yourself a little bit of grace.
• 19:47
  SPEAKER_00: You're dealing with the knee and a lot of discomfort there, and you know, you'll hear a lot of clinicians say, Oh, minimize as much deconditioning, get them on the bike and the ropes and all this stuff.
• 19:58
  SPEAKER_00: If you've gone through the surgery, that first week is a bit of a doozy, and the last thing you want to be doing is all this crazy aerobic work.
• 20:04
  SPEAKER_00: So, with that said, you still want that to be important, but even in that first week, give yourself a little bit of grace and don't create another problem.
• 20:13
  SPEAKER_00: I've had one person who just went ham on single leg, squats to a chair, and they ended up developing patellofemoral pain discomfort, so kneecap discomfort in the non-operated side, and then we were dealing with two limbs that were just having trouble with pain.
• 20:30
  SPEAKER_00: So don't do that.
• 20:32
  SPEAKER_00: Alright, so getting into the goals here, so range of motion.
• 20:37
  SPEAKER_00: One statistic I want to share with you is about atrophy that I think is important to emphasize how much uh atrophy can happen.
• 20:46
  SPEAKER_00: And research has shown you can lose up to 350 grams of muscle tissue and a reduction of 30% of muscle protein synthesis for every two weeks you're immobilized after surgery.
• 20:57
  SPEAKER_00: Now, this is a general statistic, and if you take the 350 grams, it could be somewhere around the average size of your heart.
• 21:05
  SPEAKER_00: Don't freak out, it's totally fine.
• 21:08
  SPEAKER_00: And guess what?
• 21:09
  SPEAKER_00: Your quad's gonna get smaller.
• 21:11
  SPEAKER_00: There's not any single person I've worked with or talked to who hasn't experienced some atrophy to their quads.
• 21:18
  SPEAKER_00: And if you guys look up Saquon Barkley, he's the New York Giants running back, he tore his ACL last year, and this guy is known for his quads, he's got tree trunk quads.
• 21:29
  SPEAKER_00: And if you look at his ACL side, he has less muscle mass than the side where he did not have his ACL injury.
• 21:39
  SPEAKER_00: And this is not uncommon to see, and it will tell you also that atrophy is a real thing, and also if it happens to the 0.001% of elite athletes who has all the resources possible and it's their full-time job, if it happens to you, just know that it's normal.
• 21:57
  SPEAKER_00: So atrophy does happen, and a lot of times this is because you are immobilized, and it can lead to just the muscle decreasing in size.
• 22:07
  SPEAKER_00: With that said, um, as long as you start moving in terms of doing some of the exercises like quad sets and getting the muscles kind of going and starting your PT earlier, you're gonna be in totally fine shape, and you got plenty of time to build your quads back up the way that you want to.
• 22:23
  SPEAKER_00: You'd literally have to be a vegetable or like a couch potato for a very, very, very long time.
• 22:29
  SPEAKER_00: So just don't do that.
• 22:31
  SPEAKER_00: And plus, you're going to start exercises on day one, so we're good to go, right?
• 22:36
  SPEAKER_00: Now that leads me into my next point CPM devices.
• 22:40
  SPEAKER_00: These are called continuous passive motion devices.
• 22:43
  SPEAKER_00: Uh I'm not a really big fan, guys, and the research doesn't support it at all of its use.
• 22:50
  SPEAKER_00: Some surgeons will recommend it or even require it potentially.
• 22:54
  SPEAKER_00: But to me, it's not backed up by research.
• 22:57
  SPEAKER_00: I'm also someone who has had anecdotal experience, one ACL surgery without, one with it.
• 23:03
  SPEAKER_00: And with my first one, I did it without, had a great recovery, full range of motion.
• 23:09
  SPEAKER_00: My second one, I did it with it, and I felt like I relied on the CPM a little too much.
• 23:15
  SPEAKER_00: And it's a passive device, so it kind of moves your knee.
• 23:18
  SPEAKER_00: For those of you who don't know, you kind of sit in this machine, you put your leg into it, and it essentially kind of bends and extends for you, but it's all kind of passive, and you can kind of change the degrees, and it's it can be good, but with that said, it's all passive, and the way that we move our legs and things like that are active, and so you get muscle involvement with it, which can be a huge benefit.
• 23:43
  SPEAKER_00: So, in my opinion, if you're working on range of motion, try to work more towards the active piece, and you know, maybe save that cost for something else that you might want to invest in through this process.
• 23:54
  SPEAKER_00: The bracing question can come up a lot in terms of locking range of motion.
• 23:59
  SPEAKER_00: This will really vary based on the surgeon that you have.
• 24:02
  SPEAKER_00: Some surgeons love a Locked brace where they'll lock you into extension for a bit.
• 24:07
  SPEAKER_00: Some of this will also depend on the procedure itself in terms of a meniscus repair.
• 24:13
  SPEAKER_00: Maybe they'll limit you to only a certain degree, or maybe they'll limit you and unlock the brace after a certain period of time.
• 24:22
  SPEAKER_00: This can all really vary.
• 24:24
  SPEAKER_00: They've done studies on this as well for post-op, and there hasn't been much conclusion in terms of like there is a benefit versus not.
• 24:35
  SPEAKER_00: I do think for some people it can feel very protective, which I totally understand that.
• 24:40
  SPEAKER_00: I had braces in both of mine, but I see tons of athletes now who do not get a brace post-op and they do just fine.
• 24:48
  SPEAKER_00: You just have to be smart with it.
• 24:51
  SPEAKER_00: So this can vary really based on the surgeon and even the procedure that you have.
• 24:56
  SPEAKER_00: And then the range of motion itself, this it's self-directed.
• 25:00
  SPEAKER_00: So you'll go into this active assisted range of motion where you might use like a belt loop to help assist you.
• 25:07
  SPEAKER_00: Um we see that as more of like a passive type movement.
• 25:12
  SPEAKER_00: And then knee extensions, usually it's a heel prop, low load, long duration stretch is something that I love to build into when athletes can tolerate it.
• 25:33
  SPEAKER_00: So these are the range of motion goals and buckets that we're aiming for.
• 25:39
  SPEAKER_00: Now let's talk about your quadriceps.
• 25:41
  SPEAKER_00: These are the absolute prize possession of your ACL rehab.
• 25:45
  SPEAKER_00: There's not a single muscle that is more important than your quadriceps.
• 25:49
  SPEAKER_00: They will shrink, as we talked about earlier, it's going to happen.
• 25:52
  SPEAKER_00: The first day, it's going to be very difficult to even feel like you can contract it because of the pain and the swelling, and you're just fresh out of surgery.
• 26:02
  SPEAKER_00: That's totally fine.
• 26:03
  SPEAKER_00: Keep working on that, and there's something about a mind muscle connection.
• 26:07
  SPEAKER_00: So, you know how you like flex your bicep, but then if you think about flexing that muscle, there's actually a better neural connection and activation when you kind of think about it.
• 26:17
  SPEAKER_00: So, same thing here, we're gonna try and get that mind-muscle connection back to our quadriceps because we know not only is a local thing with the pain and the swelling, but it's also a neural connection that we're trying to re-establish and retrain.
• 26:33
  SPEAKER_00: So, try to get that working and getting going as soon as possible.
• 26:37
  SPEAKER_00: One of my big things is quad sets right after surgery.
• 26:41
  SPEAKER_00: And I give all my athletes this 10 by 10 role.
• 26:44
  SPEAKER_00: So every single hour I want them to do at least 10 quad sets with five to ten seconds hold.
• 26:51
  SPEAKER_00: That is the goal every day, all day.
• 26:54
  SPEAKER_00: If you can do more, then do more.
• 26:56
  SPEAKER_00: And then they have certain concentrated times where they do end up doing more work specifically.
• 27:02
  SPEAKER_00: But I have never heard of someone doing too many quad sets.
• 27:05
  SPEAKER_00: And because of the importance of the quads, I can't stress this enough how much that activation piece is going to help.
• 27:12
  SPEAKER_00: And then that comes into place where you have the NMES, which is the neuromuscular electrical stimulation.
• 27:18
  SPEAKER_00: I did a podcast episode on this in the past, but this can be of incredible benefit, and the research shows us that there can be huge benefits post op to get the quads going.
• 27:30
  SPEAKER_00: And then lastly, I'm gonna talk on this loosely as future episodes are going to talk about this.
• 27:36
  SPEAKER_00: I'm a big proponent of blood flow restriction training, and until research proves me wrong, which right now it's pretty exhaustive in terms of the benefits versus the risks of it.
• 27:49
  SPEAKER_00: And so that's another thing that I really enjoy to be able to load muscle groups that can't get loaded heavy, for example, right after ACL surgery where there's pain and swelling and all these limitations.
• 28:01
  SPEAKER_00: Alright, so next up is getting your gait or your walking retrained.
• 28:06
  SPEAKER_00: And this is all going to be dependent on your weight bearing status.
• 28:10
  SPEAKER_00: So there can be typically three different categories.
• 28:14
  SPEAKER_00: So you'll see non-weight bearing where you can't put any weight on the leg.
• 28:19
  SPEAKER_00: This can be typically after a meniscus repair or maybe some other things that had to get repaired in there where they stitch it down.
• 28:27
  SPEAKER_00: But this can vary anywhere from two to six weeks, typically after surgery, where you might not be able to put any weight on it.
• 28:33
  SPEAKER_00: I just had an athlete who had to wait six weeks because of her procedure.
• 28:38
  SPEAKER_00: But what you'll typically see is somewhere around four weeks, and then sometimes surgeons will allow athletes to start putting weight on it even earlier.
• 28:47
  SPEAKER_00: So then there's something called toe touch weight bearing, and so that means that you can only put a little bit of weight on your toes, and this may be a precaution just to limit how much weight you can fully put on that leg.
• 29:00
  SPEAKER_00: I don't see this as often.
• 29:02
  SPEAKER_00: Um, weight bearing is tolerated.
• 29:04
  SPEAKER_00: It's typically if it's just an ACL reconstruction alone, or maybe you had a menisectomy, which is what I had.
• 29:11
  SPEAKER_00: And so, in some meniscus repair cases, even you're starting to see maybe they will allow some weight bearing, but it can really vary.
• 29:20
  SPEAKER_00: I'd probably say most of the time, if you have a meniscus repair, most surgeons will limit weight bearing for a little bit.
• 29:28
  SPEAKER_00: Um, but this can again vary.
• 29:30
  SPEAKER_00: This is where going back to those precautions and restrictions that you get are really important to be able to know where you're at with this.
• 29:38
  SPEAKER_00: And then something that gets overlooked crutches.
• 29:42
  SPEAKER_00: I would suggest practicing with crutches if you can before.
• 29:46
  SPEAKER_00: If you can't, that's still okay.
• 29:49
  SPEAKER_00: But it can be helpful with especially different terrain, so different surfaces, as well as if you have to use some stairs, which likely you are going to have to use some sort of change in steps or level of a surface.
• 30:03
  SPEAKER_00: And this is where again prehab has its pros and wins with it because you can also practice this along with other post-op and rehab prehab exercises.
• 30:15
  SPEAKER_00: And so I'm gonna go through this really quick.
• 30:17
  SPEAKER_00: Make sure your crutches are at the right height.
• 30:20
  SPEAKER_00: I had an athlete the other day where the doctor's office gave her the wrong set of crutches, and so she had to for a day use two short of crutches, which really did limit her.
• 30:32
  SPEAKER_00: Um, so then she had to go get those switched out.
• 30:35
  SPEAKER_00: So if you're going into this, here's some just good rules of thumb.
• 30:39
  SPEAKER_00: So you want majority of the weight through your hands, and you don't want to rest your top of your crutches into your armpits because you have important neurovascular structures in there.
• 30:52
  SPEAKER_00: So you want to make sure there's at least two inches, or just think about two finger widths between the top of the crutch and the top of your armpit.
• 31:01
  SPEAKER_00: Your elbow angle, you want to have a slight bend.
• 31:04
  SPEAKER_00: So you want it to be roughly around 15 degree bend.
• 31:07
  SPEAKER_00: Your hand grip of where that falls is if you were to just kind of drop your arms by your side, that hand grip should fall in line with your wrist joint.
• 31:17
  SPEAKER_00: And if that lines up appropriately, that should line you up best for that 15-degree elbow bend.
• 31:23
  SPEAKER_00: Here's some things to think about if you feel like it's not fitting right.
• 31:27
  SPEAKER_00: So if you're set up too tall, so the crutches are too tall, typically you'll see your shoulder shrugged up, digging into your armpits, and then the elbows bend too much and kind of flare it out in order to compensate for it.
• 31:39
  SPEAKER_00: If the crutches are too low underneath your armpits, you'll typically lean forward way too much, and your elbows and arms will be pretty straight.
• 31:47
  SPEAKER_00: And you want to make sure you have that bend, and you'll typically feel if you go for longer distances, how you know you're doing it right is if your triceps start to fatigue a lot, because that is going to be an important muscle group that's kind of holding you up.
• 32:02
  SPEAKER_00: And now, what I want to do is talk about one important principle for this early phase that will be really helpful.
• 32:09
  SPEAKER_00: I can't stress the importance of frequency in this early phase.
• 32:14
  SPEAKER_00: I'd rather have my athletes spread out the work that they are doing, the range of motion, the quads, the gate training, anywhere from three to five to even seven times per day than focus on this one concentrated period of time in the day.
• 32:29
  SPEAKER_00: I tell my athletes to think about it in terms of at least breakfast, lunch, and dinner, or it could be morning, late morning, early afternoon, evening, and night.
• 32:38
  SPEAKER_00: However, you want to split this up to keep yourself a reminder, but also tell them to set something in their phone to remind them to do things.
• 32:47
  SPEAKER_00: And that way it can be easy to remember, and that's how you're going to make these small little changes over time, as opposed to these concentrated bouts, which may not necessarily give you as much as uh you would hope.
• 33:02
  SPEAKER_00: And this is especially for your range and your quads, and as you build up your gait, that'll be important to get your reps in the day as well.
• 33:10
  SPEAKER_00: Alright, let's talk about pain and swelling.
• 33:13
  SPEAKER_00: So just remember, as I talked in episode one, nothing is linear, and you can feel the most random things, guys.
• 33:20
  SPEAKER_00: And especially in the first week, honestly, two to four weeks, as the body adjusts to the acute changes and this fresh stage of ACL surgery, you're gonna feel a lot of things.
• 33:33
  SPEAKER_00: It's inevitable, it's gonna feel funky, but it's important to kind of just track this over time.
• 33:39
  SPEAKER_00: And when we're talking about pain specifically, just know it's normal to have the aches and pains.
• 33:44
  SPEAKER_00: They literally just did carpentry work to your knee, you're gonna hurt, and it's a part of life.
• 33:50
  SPEAKER_00: And it will really depend on the surgery, the graft, what nerve block they did, how your body responds, uh, lots of factors to play into this.
• 34:00
  SPEAKER_00: And let's talk briefly about nerve blocks.
• 34:03
  SPEAKER_00: Most people get them as they're having ACL surgery.
• 34:06
  SPEAKER_00: The two different ones that you'll typically hear are femoral or adductor.
• 34:10
  SPEAKER_00: So, femoral is actually the nerve that innervates your quadriceps, and adductor is the one that is for your groin muscles.
• 34:17
  SPEAKER_00: Those are the two most common ones you'll hear.
• 34:20
  SPEAKER_00: And these can really help with the pain in the first anywhere from eight to seventy-two hours on average.
• 34:27
  SPEAKER_00: My experience for my own nerve blocks was around 24 to 48-ish hours, and I do remember my second day was always much harder than my first day, and that was mostly related to my nerve block.
• 34:43
  SPEAKER_00: After it wears off, you know, you will 100% know, and the pain will be a little bit more obvious, and you'll be able to feel all these like specific ones that you might not have been able to feel before.
• 34:56
  SPEAKER_00: In general, if you have an option, in my opinion, go with the adductor uh block if you can.
• 35:02
  SPEAKER_00: That way, we can preserve the quadriceps muscle and the femoral nerve.
• 35:07
  SPEAKER_00: Um, you don't necessarily always have a choice, and I will do a specific podcast in detail about this, but just so you know, it's gonna happen.
• 35:16
  SPEAKER_00: Um, I had actually femoral nerve blocks for both of mine, and I did get my quads back, guys.
• 35:22
  SPEAKER_00: So at the end of the day, it's totally fine.
• 35:25
  SPEAKER_00: Um, I've even had some athletes who have opted for no nerve block.
• 35:29
  SPEAKER_00: You just gotta know if you don't get a nerve block, those initial few days are gonna be more painful, and that's just up to you.
• 35:35
  SPEAKER_00: And also talking with your team, your surgeon, assistants, your parents, if they're involved, or whoever else, just know that they need to be involved in that process.
• 35:45
  SPEAKER_00: Um, so let's kind of talk about pain medication and NSADS.
• 35:49
  SPEAKER_00: And you know, at the end of the day, I want you guys to make sure you're going based on your recommendations per your surgeon and doctor.
• 35:57
  SPEAKER_00: But the goal here is to get off of these, right?
• 36:00
  SPEAKER_00: No one ever wants to be taking these for a long time.
• 36:02
  SPEAKER_00: You don't want to be reliant on them, but it also depends on how you're recovering, so don't give yourself too much of a hard time.
• 36:10
  SPEAKER_00: Early on, stay on top of the pain meds if you need to.
• 36:14
  SPEAKER_00: And one kind of personal piece of advice is especially at night, pain can really disrupt your sleep.
• 36:21
  SPEAKER_00: And sleep is going to be really tough for you, and we'll talk about this in the next episode.
• 36:27
  SPEAKER_00: But sleep is going to be really important for recovery, and pain can really disrupt that.
• 36:32
  SPEAKER_00: So you might have to schedule it to wake up to take your pain meds.
• 36:36
  SPEAKER_00: One thing that is the advice here is don't wait till the pain hits super hard and then take it, or you'll kind of be in misery for a little bit until that takes the edge off.
• 36:46
  SPEAKER_00: And I personally learned this a hard way.
• 36:48
  SPEAKER_00: I was trying to be tough, and I remember that I decided not to take it, and then I got to a point where I was in pretty bad pain, and then I ended up taking it to help take the edge off.
• 37:00
  SPEAKER_00: So I took some early, I gauged it based on my pain experience and how disruptive it was to my daily life and my sleep, and there was a sweet spot somewhere in there, and only you'll be able to figure that out based on your pain tolerance, your body's response, but don't try to sacrifice all of your sleep or recovery just by not trying to take it.
• 37:24
  SPEAKER_00: So use that as your guidance as well as making sure you're following your surgeon's recommendations with that, and then just know like that is going to be a part of the process.
• 37:35
  SPEAKER_00: In addition to pain, ice really does help.
• 37:37
  SPEAKER_00: I know I enjoyed the feeling of ice to help provide almost like a numbing sensation to just kind of ease some of that pain that I was feeling.
• 37:45
  SPEAKER_00: And then tens unit is another thing that people will use to help block pain.
• 37:49
  SPEAKER_00: Um, I'm not gonna go into the details of it here, but it is something that can be combined.
• 37:54
  SPEAKER_00: Uh, typically, the NMES units can have some sort of function to be able to provide a tens unit type uh setting to be able to help with the pain and muscle pump.
• 38:05
  SPEAKER_00: Alright, so now moving into swelling.
• 38:07
  SPEAKER_00: Just know it's gonna be normal to have the swelling ebb and flow through this process.
• 38:12
  SPEAKER_00: Let's say you might have had a bone bruise, it depends on the type of surgery, the nerve block, how your body responds.
• 38:18
  SPEAKER_00: Again, all those factors we talked about this.
• 38:20
  SPEAKER_00: Your NSAIDs or your ibuprofen or whatever you've been given, your anti-inflammatories will also help aid in this.
• 38:28
  SPEAKER_00: Uh, the big thing that you'll hear is making sure that you elevate, so elevate above your heart level.
• 38:34
  SPEAKER_00: Um, and then ice will help with the pain.
• 38:37
  SPEAKER_00: Um, in terms of the swelling, you know, that's kind of a toss-up.
• 38:41
  SPEAKER_00: I wouldn't say that the ice is necessarily going to be the thing that's just going to get rid of the swelling.
• 38:47
  SPEAKER_00: Your balance and recovery, as well as your body's response to it, is going to be at the end of the day the most helpful.
• 38:53
  SPEAKER_00: Another additional piece that we just talked about was the TENS unit.
• 38:57
  SPEAKER_00: That can help with muscle pump, and muscle pump helps to move fluid up towards your heart.
• 39:02
  SPEAKER_00: So TENS units can help with that.
• 39:05
  SPEAKER_00: And using a compression sleeve, make sure your wound is healed.
• 39:09
  SPEAKER_00: Uh, you know, make sure that you have uh washed it.
• 39:13
  SPEAKER_00: But a compression sleeve or compression stocking is super great for this process because what it does is that sure it can help push some fluid out, but it limits fluid from getting in because we're not letting the skin expand and the joint expand uh and allow fluid into the joint.
• 39:30
  SPEAKER_00: So I'm a huge fan of it.
• 39:31
  SPEAKER_00: I've had a lot of athletes who have benefited from it, and it's pretty simple and easy, and it's a nice little hug to the knee that makes it just feel nice and protected, if you will.
• 39:41
  SPEAKER_00: But uh that's one of the things that can really help with swelling.
• 39:45
  SPEAKER_00: And then some other pieces to this process, bruising is completely normal.
• 39:51
  SPEAKER_00: So you might look like you got beat up and someone went to war with your knee, which is essentially what happened with surgery.
• 39:57
  SPEAKER_00: They just kind of beat you up, drilled some holes, put a new ligament in.
• 40:00
  SPEAKER_00: You know, nothing, no big deal.
• 40:02
  SPEAKER_00: But bruising is completely normal.
• 40:04
  SPEAKER_00: You might feel random temperature changes, which can be normal, but it's important to track if it goes very cold or very hot for a long time.
• 40:13
  SPEAKER_00: And one of the things that can get talked about, which we'll talk about in a second, is something called a DVT, which is a deep vein thrombosis.
• 40:21
  SPEAKER_00: Actually, let's just go ahead and talk about it.
• 40:23
  SPEAKER_00: So, this is essentially to keep it super simple.
• 40:27
  SPEAKER_00: Um, you know, people can make this uh very scary and almost kind of really like fear-monger you.
• 40:36
  SPEAKER_00: But uh no, it's a reality of this process and moving forward, you know.
• 40:41
  SPEAKER_00: So, especially early on when you're mobilized, blood can pull, and when that blood doesn't flow properly and slows too much, clots can form.
• 40:49
  SPEAKER_00: And yeah, sure that they can lead to a pulmonary embolism.
• 40:53
  SPEAKER_00: Let's like not get too caught up in some of these possibilities.
• 40:58
  SPEAKER_00: The percentages that they've tested are incredibly low.
• 41:01
  SPEAKER_00: But with that said, that brings up the point and the concept of blood flow and making sure that your muscles are helping to pump fluid.
• 41:10
  SPEAKER_00: So that's how we keep our blood flow going through our veins is through movement and through muscle pumps.
• 41:15
  SPEAKER_00: And when you're mobilized, we don't get to use that as much.
• 41:19
  SPEAKER_00: So you'll see ankle pumps prescribed.
• 41:21
  SPEAKER_00: And I have all my athletes do a ton of ankle pumps uh every single hour as they're awake, you know, to be able to keep blood flowing and to keep that muscle pump going.
• 41:32
  SPEAKER_00: And some things to just kind of look out for are obviously changes in color that have stayed a long time, and then also, you know, a very strong pain or increase in swelling in the lower leg or pain in the back of the knee.
• 41:48
  SPEAKER_00: So those are things that you will feel, and it'll be something that you just want to kind of keep a radar on, but don't uh take this in the sense of like, okay, like I'm feeling this, I'm feeling that.
• 41:59
  SPEAKER_00: So then um thinking that that's what it is.
• 42:02
  SPEAKER_00: Be safe, be smart, uh, watch the trends and things when in doubt.
• 42:06
  SPEAKER_00: Always ask your PT or your surgeon uh in this situation, right?
• 42:10
  SPEAKER_00: In terms of sensation, 99% of people will have some sort of like random patch skin on their shin area or somewhere around the incisions, and that can last anywhere from just literally half a day to maybe even years after your surgery.
• 42:26
  SPEAKER_00: And this is all just going to kind of depend on the surgery, your sensory nerves, and all these different areas, but just don't worry, it is pretty normal.
• 42:37
  SPEAKER_00: Every single athlete I've worked with, uh, there can be some weird sensations on the shin and around that area, and most athletes will have full recovery of it.
• 42:46
  SPEAKER_00: It could just be kind of a weird feeling.
• 42:48
  SPEAKER_00: Make sure that you give it some input so you can kind of scratch it, you can put different textures on it, um, just different things like that to see if your body can recognize some of those different sensory inputs to see if that can just be improved as time goes on.
• 43:03
  SPEAKER_00: But totally normal, as I mentioned in the previous podcast, I still have one area that is a little sensitive and weird.
• 43:10
  SPEAKER_00: Uh, you know, you ask half of my athletes, and they've got maybe this one little spot uh that might feel a little funky, and you know, the body is not used to being cut in on.
• 43:20
  SPEAKER_00: So when you have the surgery, sometimes that can be the response of it.
• 43:25
  SPEAKER_00: But as long as it's not your entire lower leg, and as long as you don't lose any motor function, you should be in the clear.
• 43:33
  SPEAKER_00: But just know that this is completely normal.
• 43:35
  SPEAKER_00: Again, when in doubt, call your surgeon's office, ask your PT, whoever you're working with.
• 43:41
  SPEAKER_00: And the last part of this movement bucket before we get into products, which will be the start of next episode.
• 43:49
  SPEAKER_00: The last thing that I want you to focus on is preventing deconditioning.
• 43:53
  SPEAKER_00: And I mentioned this at the start of this episode that sometimes people can go too hard with this, and then they create another problem in the other knee because they get so stir crazy.
• 44:05
  SPEAKER_00: So just find a sweet spot of knowing you are in recovery mode, but then also keep the other areas moving.
• 44:11
  SPEAKER_00: So, one of the concepts I want you to think about with this is since we can't necessarily do as much with the knee, well, let's try and train above and below the joint.
• 44:20
  SPEAKER_00: So we're talking about the ankle and the hip.
• 44:24
  SPEAKER_00: And one of the things that we talked about with the ankle is the ankle pumps, right?
• 44:29
  SPEAKER_00: And one thing we talked about is that it can help with the blood flow as well as getting some activity to your calf muscles.
• 44:36
  SPEAKER_00: But you're gonna do ankle pumps all day, every day.
• 44:39
  SPEAKER_00: You can even do ankle circles.
• 44:41
  SPEAKER_00: There's something called a band four way that you can kind of keep the muscles around the ankle still active and going, depending on what you're up for.
• 44:51
  SPEAKER_00: At the hip, you know, there's glute sets, you're gonna be a little bit limited because you can't move that whole entire leg around on those first few days.
• 44:59
  SPEAKER_00: So you might do glute sets where you're activating your glute, you might do hamstring sets or isometrics.
• 45:06
  SPEAKER_00: Uh, then a lot of times people will build into a four-way hip where they're kind of moving it about, and so these are things that you can start working on and doing pretty soon after surgery, and especially on the unoperated side, you can definitely hit some of this stuff and be good with continuing to maintain.
• 45:25
  SPEAKER_00: And then, like I had said, the other leg is no longer just taking 50% of the weight, it's taking 100%, especially if you're non-weight bearing.
• 45:35
  SPEAKER_00: So don't give yourself that additional problem.
• 45:38
  SPEAKER_00: But just be mindful, find the sweet spot here and make sure you're able to keep moving.
• 45:44
  SPEAKER_00: And that way you don't decondition, if you will.
• 45:47
  SPEAKER_00: That's a term that we use is deconditioning.
• 45:49
  SPEAKER_00: Essentially, let's keep your fitness level up uh as best as we can while you're recovering in this early stage.
• 45:56
  SPEAKER_00: And then if we're talking about upper body, you got two arms, and hopefully you can move those around pretty well.
• 46:03
  SPEAKER_00: So get you some bands or some dumbbells, keep it super simple.
• 46:07
  SPEAKER_00: Uh, prop the leg up, you could do some shoulder presses, some rows, some bench pressing, but just keep it simple.
• 46:14
  SPEAKER_00: And then some other options are going to be circuits.
• 46:18
  SPEAKER_00: I have athletes do some aerobic conditioning.
• 46:20
  SPEAKER_00: So maybe I'll set them up in a circuit where they'll do some battle ropes, uh, some slam balls, maybe just do the bike with just their arms, uh, movements not involving the ACL side, and that way we can get maybe a little bit of a sweat, a little bit of some heart rate, and that makes them still continue to feel like they're moving and doing stuff without feeling like they're compromising the operated side.
• 46:44
  SPEAKER_00: So these are all things to consider, especially in this early rehab process.
• 46:49
  SPEAKER_00: So we talked about the quiet knee in very, very specific detail, and then we talked about preventing deconditioning to make sure that we keep up our fitness during this process.
• 47:02
  SPEAKER_00: So just remember, guys, this is a balance of stress and recovery.
• 47:09
  SPEAKER_00: And there's a big stress that has been put on your body after surgery, it's essentially a quote unquote trauma, and your body is recovering and it's healing.
• 47:19
  SPEAKER_00: It's trying to protect the site to make sure that you ultimately can get back to a state where things feel normalized and healthy and healed.
• 47:29
  SPEAKER_00: And so pain and swelling will be your guides early on.
• 47:33
  SPEAKER_00: And sure, you might have to push into a little bit of that, especially the pain, but you don't need to be at eight, nine, ten out of ten pain because that's going to be really tough, and it's also going to make your recovery process even harder.
• 47:48
  SPEAKER_00: So just know that that first two to four weeks after surgery is definitely more variable.
• 47:54
  SPEAKER_00: There can be some days where you have some really solid days, and then there could all of a sudden be a day where you just have some sharp pain.
• 48:02
  SPEAKER_00: Okay.
• 48:02
  SPEAKER_00: And generally you want to see that trend improving, but it can still vary a good bit.
• 48:08
  SPEAKER_00: And this is based on my own experiences as well as working with lots of other ACL athletes who have gone through this process.
• 48:16
  SPEAKER_00: And generally speaking, pain shouldn't be significantly higher outside of those first few initial days.
• 48:24
  SPEAKER_00: Uh, and this is in general, and it should progressively improve as time goes on.
• 48:29
  SPEAKER_00: That still doesn't necessarily mean that you won't have some of those days.
• 48:33
  SPEAKER_00: And then generally speaking, for the swelling, that should decrease over time too.
• 48:38
  SPEAKER_00: But if it does increase the next day, something that you can think about is that's a good sign that you might have done too much the day before.
• 48:46
  SPEAKER_00: And you might need to adjust and see maybe taking a step back in terms of all the stuff that you did, and maybe having to adjust the volume, or maybe it was a specific exercise, and to make sure that you're respecting this healing process and the body's ability to recover from stress.
• 49:06
  SPEAKER_00: Again, at the end of the day, it's stress versus recovery.
• 49:10
  SPEAKER_00: There's been a lot of stress, the focus is on recovery, and then finding that feedback system, if you will, or that feedback loop of okay, how is my pain as time goes on and how is my swelling?
• 49:23
  SPEAKER_00: And then taking those other metrics of your range of motion and your quadriceps, your gait, all these things in these early phases and tracking those as time goes on as well.
• 49:35
  SPEAKER_00: But that's going to be your main guides, and that's going to be a big part of phase one, which is the movement piece and restoring these foundations, and again, stressing the importance of these foundations and how it will set the tone for the rest of your recovery.
• 49:52
  SPEAKER_00: That's going to be it for part two.
• 49:54
  SPEAKER_00: And what we will do is dive into part three next episode with the products related to this process.
• 50:02
  SPEAKER_00: And so I want to make sure that we cover some of these things that can be helpful.
• 50:07
  SPEAKER_00: Again, not necessary, but can be helpful.
• 50:10
  SPEAKER_00: And then we're going to go into some of these other pieces, some of some other areas that could be really helpful with this recovery process.
• 50:18
  SPEAKER_00: And then we're going to break down nutrition and sleep, stress, support, all these things that need to be tied into and thought about as you're approaching your surgery, or maybe your after surgery and planning the road ahead.
• 50:33
  SPEAKER_00: So that's going to be it for today, guys.
• 50:36
  SPEAKER_00: Thank you all so much for listening.
• 50:38
  SPEAKER_00: This is your host, Robbie Patel, signing off.