Latest / The ACL Athlete Podcast / 291 | Twenty ACL Athletes Later, Complicated Might Be Normal In ACL Rehab

Transcript

291 | Twenty ACL Athletes Later, Complicated Might Be Normal In ACL Rehab · The ACL Athlete Podcast

• 0:18
  SPEAKER_01: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_01: 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_01: I'm your host, Dr.
• 0:32
  SPEAKER_01: Robbie Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_01: 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_01: 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_01: Thanks for joining.
• 0:55
  SPEAKER_01: 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.
• 1:06
  SPEAKER_00: Today's episode is a little different than usual.
• 1:09
  SPEAKER_00: Well, number one is because I'm really nasally and congested.
• 1:13
  SPEAKER_00: My little one is back into the whole school process.
• 1:18
  SPEAKER_00: So therefore, he is bringing back all the germs and he loves to pick his nose and do everything a two-year-old toddler will do.
• 1:26
  SPEAKER_00: And I can only imagine the things he brings home.
• 1:28
  SPEAKER_00: So here I am, congested because we have started the grind of school, and I get the lovely byproduct of the germs.
• 1:36
  SPEAKER_00: But it is another week and we got to show up.
• 1:39
  SPEAKER_00: So let's go ahead and talk through this one today.
• 1:43
  SPEAKER_00: Instead of it being a deep dive on one athlete, for example, I'm gonna walk you through, you know, a cross-section of just cases we're actively working with right now and just a snippet of some of these cases.
• 1:58
  SPEAKER_00: And I just want to kind of present this to you guys.
• 2:01
  SPEAKER_00: And some of you listening might be on our roster right now, and you're like, hey, that's me.
• 2:05
  SPEAKER_00: Cool, awesome.
• 2:06
  SPEAKER_00: Thank you for being with us.
• 2:07
  SPEAKER_00: But with that, I'm going to just kind of share the span of cases because I think this is something that doesn't really get highlighted that much in ACL rehab.
• 2:18
  SPEAKER_00: I think that a lot of people have this kind of visual of what it looks like or version that you picture in your head.
• 2:26
  SPEAKER_00: And I want to give you the range of ACL rehab that it can look like.
• 2:31
  SPEAKER_00: And also for some of you to be able to normalize what you might be going through of like, is this normal?
• 2:37
  SPEAKER_00: Am I truly behind?
• 2:40
  SPEAKER_00: Is this something that I am just an outlier for?
• 2:43
  SPEAKER_00: And I want to help to normalize that a little bit because I think a lot of you in this process are probably thinking that because you don't feel this linear approach.
• 2:52
  SPEAKER_00: And when you look at social media or are in forums, right?
• 2:57
  SPEAKER_00: Like it's really challenging because you see all these ACLPTs who are showing all these people getting back to these things, which is awesome.
• 3:05
  SPEAKER_00: But it's marketing, y'all.
• 3:07
  SPEAKER_00: There is going to be rare times where they're showing the hard cases, the bad cases, the ones that are not getting there.
• 3:14
  SPEAKER_00: So you have to understand that you're looking at a highlight reel, especially on social media, and especially if the company's goal is to sign up people and make money from that.
• 3:24
  SPEAKER_00: Now, there is a better cause of that, of course, but the thing is you have to kind of recognize that.
• 3:29
  SPEAKER_00: And with forums, people are going to go to commiserate.
• 3:32
  SPEAKER_00: So you have to also understand where that is coming from.
• 3:36
  SPEAKER_00: And then most importantly, what I'm getting at is your perception of ACL rehab might be influenced by these things and also what the surgeon says, also what you read online, also what it is that you might search on AI, also what you might be listening to on this podcast.
• 3:52
  SPEAKER_00: So there's a lot of different inputs with information, especially nowadays, that we have to kind of figure out what picture we build in our mind versus what the reality of this actually is.
• 4:04
  SPEAKER_00: And so the script that normally people get going into this injury is, you know, you have the injury, you do prehab, if you can, you have surgery, and then it's on the road to a nine to 12 month recovery, right?
• 4:17
  SPEAKER_00: You're cleared, you get back to your sports and activity, you know, the kind of clean line checklist, and then you're done.
• 4:24
  SPEAKER_00: And for some people, that is genuinely how it goes.
• 4:27
  SPEAKER_00: I'm not gonna sit here and say, like, it's a rare case that you just like are able to go through this that way.
• 4:33
  SPEAKER_00: There are plenty of people who go through this process like that.
• 4:36
  SPEAKER_00: Don't get me wrong, but there's also a lot of people who don't.
• 4:41
  SPEAKER_00: And I don't want to categorize one as the my majority and one as the minority.
• 4:46
  SPEAKER_00: Yes, there is a bell curve to this process, but I feel like most of you who are listening to this who has this nonlinear process, especially with setbacks or challenges that were just unexpected, my goal is to hopefully just also talk to you about this because this is something that we see across the board that is a bit more normal than what you would expect.
• 5:08
  SPEAKER_00: So I want to help to reframe this.
• 5:10
  SPEAKER_00: And if you talk to anyone who is actually seeing a high volume of ACL cases, like literally seeing hundreds of athletes a year, they will tell you that there is no clean version of this process or that everyone kind of operates in one lane.
• 5:26
  SPEAKER_00: It is a very much wider road that people are operating on.
• 5:31
  SPEAKER_00: Most people don't really know these other lanes exist because they just have this pictured one in their head until they're maybe already on a different lane, right?
• 5:40
  SPEAKER_00: Like they're on a different journey in this.
• 5:43
  SPEAKER_00: And yes, while we say that everyone has their own journey in this, and it's very important to recognize this, it's also important to recognize, like, okay, is this lane the most efficient and best lane for you to get there?
• 5:56
  SPEAKER_00: And is this more biological, or is it more of a systemic meaning, like, is it a healthcare-related limitation, like the access to care you have, the support you have, the surgical care you have?
• 6:08
  SPEAKER_00: So there are a lot of different things that are going to influence the lanes that you're in and how fast you can go on them.
• 6:15
  SPEAKER_00: And also, do you take the scenic route?
• 6:17
  SPEAKER_00: Do you take the most efficient route?
• 6:18
  SPEAKER_00: There's a lot of things that factor into this, but mostly is you know, someone just feeling like something's uniquely wrong with them when in reality they just didn't know it might be a bit more normal than expected.
• 6:32
  SPEAKER_00: So here's the lens I want you to hold on to today as we talk through this.
• 6:36
  SPEAKER_00: Everything that complicates a case falls into usually one of two buckets, if you will.
• 6:42
  SPEAKER_00: And now I'm not gonna say that there aren't other things at play, but there's really the two things that I think about.
• 6:49
  SPEAKER_00: There's the stuff that's controllable, and there's the stuff that's less controllable, uncontrollable.
• 6:54
  SPEAKER_00: The controllable is you know who you pick on your team, right?
• 6:59
  SPEAKER_00: Like your surgeon, your physical therapist, your coach, like people who are on your team who are helping you.
• 7:04
  SPEAKER_00: And in some cases, that might not be as controllable, but majority of the time you have a choice.
• 7:10
  SPEAKER_00: Like you can fire your PT, you can fire your surgeon, go find a different one.
• 7:14
  SPEAKER_00: And if you're not getting good care, you should.
• 7:17
  SPEAKER_00: But those are controllable factors, right?
• 7:20
  SPEAKER_00: And then you have, you know, the plan that you have and the testing and objective testing or lack thereof, or it might be your program and the individualization of that, and then you have the criteria that it is focused on and the testing versus it being just a calendar, right?
• 7:40
  SPEAKER_00: There are things that you can control, also, you know how frequently you're hitting things, the intensity you can hit things at.
• 7:46
  SPEAKER_00: There are controllable factors, and then if we zoom out, there's obviously the nutrition aspects, the stress management, there is the recovery aspects of sleep and taking care of your body, and then of course the movement side of just being able to manage your load and the stress you're putting on your knee on your body, right?
• 8:05
  SPEAKER_00: And then there's the biological side, the biology, your own healing response.
• 8:10
  SPEAKER_00: You know, how that grass settles in there, any of the other kind of tissues that are healing or could have gotten injured during the injury, and then maybe the surgery was also something that was done to help fix that, right?
• 8:24
  SPEAKER_00: And so it's beyond just the ACL, but obviously that's the main player in this.
• 8:29
  SPEAKER_00: But there are things that your body is doing to be able to go through the healing process, and that is having the inflammatory phase, being able to have the proliferation phase, and then the maturation phase while pulling me back into biology and human healing.
• 8:44
  SPEAKER_00: This is something that all of our tissues are going to go through.
• 8:47
  SPEAKER_00: That's something that even our skin goes through.
• 8:49
  SPEAKER_00: Like when we have a cut, we're gonna go through these phases and these processes to be able to heal and get back to a normal, you know, closure of the skin and it healed.
• 8:57
  SPEAKER_00: So that's the same thing in the knee as these tissues go through this.
• 9:02
  SPEAKER_00: And so, this is something that's really important for us to understand that there are controllable factors around this, and then there's also not as many controllable factors when it comes to some of those biological processes.
• 9:16
  SPEAKER_00: Now, nobody can control as much of the second one, the biological one.
• 9:21
  SPEAKER_00: Yes, you can control those things around it as I share, but in reality, like what that knee is doing through those phases.
• 9:28
  SPEAKER_00: Not you, not your surgeon, not me, not your physical therapist can even really do something about this, right?
• 9:33
  SPEAKER_00: But even the stuff you can't control still has a controllable response wrapped around it.
• 9:39
  SPEAKER_00: And this is so important, y'all.
• 9:41
  SPEAKER_00: And the longer I've been doing this, this is probably one of the most important things about working with someone who is really good in this process.
• 9:47
  SPEAKER_00: You can't control whether your body forms scar tissue, for example.
• 9:51
  SPEAKER_00: And this might be one of the number one issues that people deal with in this process that they really can't control fully.
• 9:58
  SPEAKER_00: Now, if you pissed this knee off for weeks and weeks and months and didn't listen to anything and didn't do your rehab, and it was swollen, inflamed, and you knew better and you didn't, then yeah, that's something you could have controlled, or having a good physical therapist to guide you around that.
• 10:16
  SPEAKER_00: But at the same time, there are also people who do this perfectly and try to stay to a T and they still have the biological processes not always work in their favor, and it could be a number of reasons why.
• 10:30
  SPEAKER_00: And so one of those things that can happen is scar tissue.
• 10:33
  SPEAKER_00: For example, a cyclops lesion can come up, right?
• 10:37
  SPEAKER_00: The thing that I'm trying to point out here is that you still have a controllable response wrapped around this uncontrollable situation.
• 10:44
  SPEAKER_00: You can control whether someone catches it in month four versus month eight, for example.
• 10:51
  SPEAKER_00: Now it's gonna depend on when it rears its head, but I think one thing that's really important here is to be able to catch that.
• 10:58
  SPEAKER_00: And I would say our team has gotten so good at this is being able to catch things that just don't seem right.
• 11:06
  SPEAKER_00: And I think in this process, what we see a lot is that it kind of kicks the can down the road.
• 11:10
  SPEAKER_00: And I know so many of you listening are like, yeah, it does feel that way.
• 11:14
  SPEAKER_00: It's like my extension is not there yet, but I've been kind of bringing this up, or it's kind of concerned me.
• 11:19
  SPEAKER_00: I'm limping while I'm walking, and I'm weeks and months out from this, and it should be better by now.
• 11:24
  SPEAKER_00: You're realizing that your flexion is not really budging, or there's a sharp pain you're dealing with that is not improving, your knee is kind of shifting and it doesn't add up.
• 11:32
  SPEAKER_00: There is a pain in the front of the knee that is just really stopping you from being able to do something, right?
• 11:37
  SPEAKER_00: There's so many different layers to this that I know a lot of you recognize, and it's one of those things that kind of in your gut, you probably are like, this doesn't seem right.
• 11:47
  SPEAKER_00: But then when you check with the professional, they're like, oh, we'll keep working on it, keep getting stronger, keep working on range of motion.
• 11:54
  SPEAKER_00: And we see this a lot.
• 11:56
  SPEAKER_00: I mean a lot, y'all.
• 11:57
  SPEAKER_00: And it's one of those where I have seen cases that should have been resolved within, you know, a few months, and it drags out to be six months, nine months, twelve months beyond whatever their normal timing is.
• 12:11
  SPEAKER_00: So I really do think in some of these cases, even for scar tissue, for example, someone's trying to hammer extension and you know the PT is pushing on it, and you've got the surgeon saying, keep working on it, and you're in month three or four and it's not budging.
• 12:27
  SPEAKER_00: Well, there needs to be a pattern recognition of testing and being able to do the right things to see, okay, should we take further steps and not let that drag out to being, you know, five, six months.
• 12:39
  SPEAKER_00: And then guess what?
• 12:40
  SPEAKER_00: That's kicking also the can down the road of like what you can get back to, your livelihood, your goals, especially if it's time sensitive.
• 12:47
  SPEAKER_00: So these are things that are really important.
• 12:49
  SPEAKER_00: You have a controllable response around the uncontrollable stuff.
• 12:54
  SPEAKER_00: And I do want to spend a minute on this kind of second part, if you will, because it's actually the whole point of today's episode.
• 13:03
  SPEAKER_00: The people who end up finding us have often already hit a wall somewhere else, right?
• 13:09
  SPEAKER_00: They have been working with a physical therapist in person.
• 13:14
  SPEAKER_00: A lot of times, people, you know, are kind of struggling with guidance, they don't feel like they have structure, they feel lost, they just don't have what they feel like they need whenever they're in PT with the attention or even outside of it with what they should be getting.
• 13:30
  SPEAKER_00: And that is influencing their progress or lack thereof.
• 13:34
  SPEAKER_00: And so people might go through one PT, two PT, three PTs.
• 13:38
  SPEAKER_00: I mean, y'all, we've seen it all all across where people have like changed different PTs, but it almost feels like you're just kind of putting yourself in the same kind of situation, and it ends up being not much of a change.
• 13:52
  SPEAKER_00: Now, some people do, and it's amazing.
• 13:54
  SPEAKER_00: Like at the end of the day, all we care about is that you have good help to get you there, but it is really challenging in this space with the way that the system is designed.
• 14:02
  SPEAKER_00: And that's one of the biggest things that's hard is that I always tell you guys that it's not going to be a matter of if, it's a matter of when.
• 14:10
  SPEAKER_00: You're going to have to decide when is the time that you're going to have to figure out to find an expert to help you with the rest of this process.
• 14:18
  SPEAKER_00: And it's ideal to start with this, but then there's some of you who will go to use your in-person PT.
• 14:24
  SPEAKER_00: And then it's a matter of if insurance runs out or if the skill set is just not valuable anymore.
• 14:29
  SPEAKER_00: There's a certain threshold where your physical therapist might not necessarily know how to get you all the way back to full functioning, or they are in a clinic and a system that is designed to just not help.
• 14:43
  SPEAKER_00: I've talked to so many ACLers who are like, I have a great PTE, I like them, and they're nice.
• 14:49
  SPEAKER_00: And some will even say, you know, they're smart and helpful.
• 14:52
  SPEAKER_00: But then they say, I only get 10 minutes with them, I only get 20 minutes with them, and it's once a week, twice a week, you know, whatever the frequency that they're going.
• 15:00
  SPEAKER_00: And it's like, it's still really hard.
• 15:03
  SPEAKER_00: You can give the best construction worker or carpenter or builder to build this house.
• 15:12
  SPEAKER_00: And if you only give them a hammer and they need so much more, it's gonna be really hard.
• 15:16
  SPEAKER_00: It doesn't matter how smart they are.
• 15:18
  SPEAKER_00: It's like if they don't have the tools and the time and the skill set available, that it's gonna be really hard.
• 15:26
  SPEAKER_00: But even with the skill set, if you don't have the proper tools or the resources, it's gonna be really hard to do that.
• 15:32
  SPEAKER_00: And so that's one of the challenges with this.
• 15:34
  SPEAKER_00: And so, my point of bringing this up is that while there are challenges in the system, people hit these walls with physical therapists where they just feel like they're just not gonna get good enough care with where they are or who they're seeing.
• 15:48
  SPEAKER_00: And so I want to also make sure that's clear that like trying the local insurance covered route, I'm not saying that that is a bad route.
• 15:57
  SPEAKER_00: Like, I understand that we pay into these things, and so you want to get out of it what you have paid into.
• 16:03
  SPEAKER_00: So that is justified.
• 16:05
  SPEAKER_00: I just think you need to know what you could be expecting based on that, and based on just what the average is.
• 16:12
  SPEAKER_00: And I have amazing friends and colleagues who are in, you know, out of network, no insurance connections and clinics, and then I have people who are also in insurance base who absolutely crush it again, state specific, country specific, all these things that can kind of influence things.
• 16:31
  SPEAKER_00: But we know as a whole that it is not necessarily the best system designed to get ACLers from point A to point B with as much support and guidance as possible.
• 16:43
  SPEAKER_00: And so, you know, it's not lost on me on that, and the cost is real, I understand, and that's not a knock on anyone's judgment in terms of going to do the insurance-based route.
• 16:54
  SPEAKER_00: But it does mean like what I'm sharing here is that what we see can kind of skews towards cases that didn't resolve cleanly the first time.
• 17:03
  SPEAKER_00: And yeah, we get the proactive people who are like, I just want y'all's help.
• 17:07
  SPEAKER_00: I want to be able to like go through this from start to finish, which is amazing.
• 17:11
  SPEAKER_00: We're able to make it a fairly smooth process overall, but then there are a lot of people who are like, I'm on you know, number three PT, or I just feel like my PT isn't getting there.
• 17:21
  SPEAKER_00: So then we understand we will naturally see the more complex cases.
• 17:25
  SPEAKER_00: Here's what that actually gives you, though.
• 17:27
  SPEAKER_00: And it's not about being the smartest person in the room, it's about pattern recognition.
• 17:32
  SPEAKER_00: When you've worked with such a wide range of cases across different surgeons, different graph types, different sports and activities, you start to recognize things faster.
• 17:44
  SPEAKER_00: A knee that isn't responding the way it should, a symptom that doesn't fit the usual timeline, a small red flag that's easy to miss the first time you see it, but it's pretty obvious on your 50th or your hundredth or your two hundredth.
• 17:59
  SPEAKER_00: And that pattern recognition is the entire difference between catching something in month two, month four versus month eighth or month you know nine, ten, eleven, twelve, wherever you are.
• 18:12
  SPEAKER_00: It's not this magic thing, and it's not about having all the answers.
• 18:16
  SPEAKER_00: We still have tons of answers that we are still trying to find and learn at together as a team.
• 18:21
  SPEAKER_00: But it is about having seen enough of the pattern to know when something needs a closer look and knowing what question to ask next.
• 18:31
  SPEAKER_00: That's what good guidance actually does.
• 18:33
  SPEAKER_00: It doesn't control your biology, it makes sure the controllable side of your case never becomes the reason an uncomfortable or uncontrollable complication turns into a lost year.
• 18:47
  SPEAKER_00: And that is so key.
• 18:49
  SPEAKER_00: There's such an opportunity cost to this, and I'm not saying we're perfect in this, but I will say that our team has gotten incredibly good at being able to recognize these things with these cases.
• 19:02
  SPEAKER_00: And I'm able to like test this out from like even initial consultations to when people start working with us and we start collecting data and being able to assess and see where they're at, we're able to say pretty quickly, like, okay, like this is what we're seeing.
• 19:16
  SPEAKER_00: This is your history that you've told us about, and this is the data points we see, and this these are the next steps, right?
• 19:23
  SPEAKER_00: In case we need to kind of go further beyond just a rehab process.
• 19:27
  SPEAKER_00: And I would love to say that we can out-exercise any issue, but we just can't.
• 19:32
  SPEAKER_00: It's why medicine exists, it's why surgical processes and other non-invasive processes exist.
• 19:39
  SPEAKER_00: The thing that is so key in this is being able to recognize this quick and make decisions quick.
• 19:46
  SPEAKER_00: And it's the thing that when I'm seeing what these athletes are saying about working with us and being able to just tackle these issues quickly is so important.
• 22:03
  SPEAKER_00: And so the one thing that is really important is that I understand that we might have a selection bias towards people needing more complex help, but I will say that I want to also normalize that this might be more of the normal than what most of you think.
• 22:21
  SPEAKER_00: And again, it's because of the exposure that you might have to this process that I think is really important to share.
• 22:27
  SPEAKER_00: And so what I would like to do is just dive into some of these cases, and I'm just gonna go rapid fire into these.
• 22:34
  SPEAKER_00: So I have 10 that I have that I'm gonna kind of expand in more detail, and then I have 10 that I'm going to like really rapid fire for you guys to get a get an idea of this.
• 22:44
  SPEAKER_00: And my goal of this is to help normalize some things, but also for you to maybe feel seen in this.
• 22:49
  SPEAKER_00: Like, you know, sometimes people are like, well, I feel like I might be the only person who's in this situation.
• 22:54
  SPEAKER_00: I feel like X, Y, and Z.
• 22:56
  SPEAKER_00: So I want to be able to showcase to you guys like this is just a drop in the bucket of being able to share some athletes and some cases that we work with to be able to see the wide range of what exists in this world and to normalize this a little bit.
• 23:11
  SPEAKER_00: So you don't also feel crazy about this either.
• 23:14
  SPEAKER_00: Number one, a sophomore in college, pre-op surgery about a week and a half out, worried about her post-op physical therapist near the school isn't going to be the right fit for a varsity athlete, and wants to come back and play varsity.
• 23:28
  SPEAKER_00: That's a pretty traditional one that we hear about, right?
• 23:31
  SPEAKER_00: Number two, a finance professional based in another country, 13 weeks post op.
• 23:36
  SPEAKER_00: Nothing biologically unusual happened there, but there's been zero objective testing anywhere in her care, and she's stuck in a one step forward, two steps back kind of pattern with no way to explain why.
• 23:50
  SPEAKER_00: There was no like kind of digging into it.
• 23:52
  SPEAKER_00: Beach volleyball is her top priority.
• 23:55
  SPEAKER_00: Number three, 14 year old managing a partial tear conservatively about two months post injury.
• 24:03
  SPEAKER_00: Dad's Biggest fear is the reinjury, of course, in the fall without proper preparation over the summer, wants to be strong and confident heading back into the season.
• 24:13
  SPEAKER_00: A physical therapist, you know, she is further out on one ACL.
• 24:21
  SPEAKER_00: I mean, she has had quite a long process of tearing her ACL to being someone who had the procedure, and then she was told that what she was feeling in her knee was not necessarily real, if you will, or maybe in her head a little bit.
• 24:37
  SPEAKER_00: And turns out she had a screw-related issue that ended up getting that hardware taken out, improved that, but then had some complications after, and then also had some tunnel widening and some other kind of scar tissue related issues.
• 24:51
  SPEAKER_00: And so it's been a long, long, hard process.
• 24:55
  SPEAKER_00: And so all that needed to be cleaned out and fixed.
• 24:59
  SPEAKER_00: And so once to get back to being able to do the stuff that she wants to do, she's very active and she's a physical therapist.
• 25:05
  SPEAKER_00: So, like, this is someone who has some of this knowledge, but is choosing to also work with us to be able to try and get through this process without also doing it herself.
• 25:16
  SPEAKER_00: An executive in his 40s that is in the early weeks post-op on his second ACL on the same knee, having managed the first one without surgery earlier.
• 25:27
  SPEAKER_00: Heavy travel work schedule, top goal is to be skiing, which tells you exactly how much he needs to trust his knee to rebuild it in that knee, and skiing being heli skiing specifically.
• 25:39
  SPEAKER_00: Number six, a working professional whose complexity has nothing to do with surgery date at all, has a metabolic-related condition that has influenced a lot of her process and progress until you know it finally got captured and then started to realize, oh, we need to address this, and then started to see some progress.
• 25:58
  SPEAKER_00: Once to get back to being able to run, be able to lift again, being active as a professional.
• 26:05
  SPEAKER_00: And this is something for a lot of these cases, these are not ones we start with from the beginning.
• 26:11
  SPEAKER_00: These are all ones that we are starting later in this process.
• 26:14
  SPEAKER_00: And so this is something that's really important because you know they're kind of coming in at certain points with certain issues that they're dealing with.
• 26:21
  SPEAKER_00: Number seven, a professional acrobat, six weeks post-op on second knee, bilateral kneecap fractures, um, six months apart.
• 26:30
  SPEAKER_00: This one's actually not an ACL, but she is rebuilding two with hardware put in, trying to trust those knees.
• 26:36
  SPEAKER_00: Imagine two, you know, patella fractures.
• 26:39
  SPEAKER_00: That's not great at all, and it's challenging to deal with.
• 26:43
  SPEAKER_00: So that is something that we're also trying to manage to get her back to doing these things and performing well.
• 26:49
  SPEAKER_00: Number eight, a woman in her 60s, pre-op, her ACL went untreated for quite a while after being told years that she wasn't athletic enough to need the surgery.
• 27:00
  SPEAKER_00: A recent fall had created a fracture and also had a second ligament sprain on top of the original injury.
• 27:08
  SPEAKER_00: I call that collateral damage.
• 27:10
  SPEAKER_00: And this is something that had she maybe seen a different surgeon back in the day, that could have been a little different.
• 27:15
  SPEAKER_00: But she wants to walk without a limp and you know be able to get on the floor with her grandkids.
• 27:20
  SPEAKER_00: Number nine, an adult athlete, six months posts a full ACL revision.
• 27:25
  SPEAKER_00: Newer graph alternative, used the first time around, re-injured it, and is now managing a revision with a meniscus-related repair, chasing a competitive season that's ahead, where trying to get his strength numbers in a good place.
• 27:39
  SPEAKER_00: So definitely a complex process, especially going one procedure and then now another.
• 27:44
  SPEAKER_00: And then number 10, an adult athlete currently in mid of two-stage revision.
• 27:50
  SPEAKER_00: The most layered case, I would say, probably on our entire roster, with especially the history that unfolds with this.
• 27:58
  SPEAKER_00: But two prior repairs on the same knee with both did not do well.
• 28:03
  SPEAKER_00: Then also had an infection scare and some antibiotics-related issues, and then had an unrelated reaction metabolically.
• 28:12
  SPEAKER_00: And so this is, and I'm saying this because I'm like, man, this has definitely been a wild journey.
• 28:17
  SPEAKER_00: And also came up with some anemia with blood work, so a lot of metabolic related things and some autoimmune, and then also dealing with doing a two-stage revision, which is you know, you go in and you put the tunnels, fill them back in, let them heal for three to six months typically, and then have a new ACL procedure.
• 28:37
  SPEAKER_00: So it's a lot of things stacking on top of them.
• 28:41
  SPEAKER_00: And then that's 10.
• 28:43
  SPEAKER_00: Are you guys with me so far?
• 28:44
  SPEAKER_00: You're like, come on, Robbie.
• 28:46
  SPEAKER_00: But I want to share these.
• 28:47
  SPEAKER_00: Some of you are might be relating to these, you're like, wow, this is quite a spread.
• 28:50
  SPEAKER_00: So now I'm gonna give you 10 and just kind of give you the slice of it to just give you another kind of wide example of this.
• 28:58
  SPEAKER_00: A PE teacher, mother of two, choosing non-operative route, and you know, wanting to get back to being active, especially being a PE teacher and being able to do all these things.
• 29:08
  SPEAKER_00: A teenage national level team player for soccer overseas has been getting back to things, but then, you know, has had some things during the process that weren't super straightforward, but it's something that they needed that structure, they needed more of the education with the dad helping and the mom helping in this process.
• 29:29
  SPEAKER_00: An engineer under treated twice by the same kind of generalist provider on two separate knee issues that she's dealing with, a dance-related professional, you know, in the earlier parts of this process, tracking her own extension numbers because the PT just wasn't really prioritizing it and she was walking with a limp.
• 29:51
  SPEAKER_00: Operating room nurse that was discharged from PT early, has dealt with yes, a quad that has been challenging to recover, but had recovered over time, and then had a hip labral issue that had to get repaired, and then also got that repaired, and now having to rehab from both and trying to get back to things.
• 30:11
  SPEAKER_00: A college athlete who managed to torn ACL without surgery for two years before re-injuring it, now seeing by three different surgeons, orthopedic surgeon himself, who tore his own ACL skiing, and then, you know, had surgery going through this process, needing to get back to work, being able to do his total knee replacements, be able to support that leg, super key in this process for him.
• 30:37
  SPEAKER_00: A missionary working overseas tore ACL hiking near a cliff, then tore her ankle mid-rehab, requiring its own separate surgery on the same leg.
• 30:47
  SPEAKER_00: A hypermobile athlete managing some hormonal transitions alongside additional ligament repair and early cartilage wear.
• 30:55
  SPEAKER_00: A mom who self-diagnosed her own scar tissue lesion after a PT dismissed it, confirmed it herself, roughly two and a half years into this journey.
• 31:07
  SPEAKER_00: So this is something that is just a range, y'all.
• 31:11
  SPEAKER_00: It's a range.
• 31:12
  SPEAKER_00: Every single one of those is still just biology or the circumstance, right?
• 31:18
  SPEAKER_00: Not a failure on anyone's part.
• 31:20
  SPEAKER_00: But 20 cases across this episode.
• 31:23
  SPEAKER_00: Every one of them fits into that same lens I gave you at the start.
• 31:28
  SPEAKER_00: Biology, which nobody necessarily controls, or the controllables, which is you know the guidance and the structure around it, which can absolutely be managed well or managed poorly and influence this process a lot.
• 31:42
  SPEAKER_00: And here's what I want you to actually take from today.
• 31:45
  SPEAKER_00: This range isn't just rare, it's normal.
• 31:49
  SPEAKER_00: And if your recovery hasn't looked like that kind of cleaned version that you pictured walking in with, or what you see on the highlight reels, or social media, or whatever it might be, or what you had you know asked AI about, that doesn't mean something's wrong with you.
• 32:06
  SPEAKER_00: It means you're closer to this middle of the pack than the outlier, even if nobody around you has really told you that.
• 32:12
  SPEAKER_00: And I think that's really important to share with you.
• 32:15
  SPEAKER_00: The other piece I want you to leave with is this nobody can promise you control over your own healing.
• 32:22
  SPEAKER_00: What good guidance actually does is catch the pattern early.
• 32:27
  SPEAKER_00: Recognize the thing that doesn't fit before it becomes a bigger problem.
• 32:32
  SPEAKER_00: Always tell people like we are able to catch things and get ahead of things of problems that could have happened because we are able to track these things ahead of time and just know what that could look like.
• 32:42
  SPEAKER_00: And that's the thing that you are looking to invest in and to be able to work with somebody is to be able to know what that path looks like.
• 32:51
  SPEAKER_00: It's like the Sherpa trying to do Everest, right?
• 32:53
  SPEAKER_00: And I know that seems extreme, but you're trusting someone who has done this already, who has walked this with many, many people, done this miles after miles after miles, different conditions, different cases.
• 33:07
  SPEAKER_00: That's essentially what you're trying to sign up for is finding the best Sherpa, the best GPS to take you through this.
• 33:13
  SPEAKER_00: And that's the real value of working with someone who's seen a wide range of these cases.
• 33:19
  SPEAKER_00: And this is something that I confidently can say about our team and what we do.
• 33:26
  SPEAKER_00: And this is something that I used to just try to be a little bit more like kind of uh don't talk about this.
• 33:32
  SPEAKER_00: But after the years of us working and what we're doing and us meeting weekly multiple times to talk through athletes' cases, every single case gets discussed that we talk through.
• 33:44
  SPEAKER_00: We are not missing anyone who is going through this process with us.
• 33:48
  SPEAKER_00: And the thing is that you get a whole team behind you.
• 33:51
  SPEAKER_00: And more importantly, is that we talk through things and we're learning about things and we're always trying to figure out what we can do better to help these athletes.
• 33:59
  SPEAKER_00: And it might be referral sources, it might be exercise prescription, it might be the ability to structure things a little differently, but we are trying to also catch things ahead before they turn into you know kicking the can down the road.
• 34:13
  SPEAKER_00: And it's the thing that bothers me the most about this, is because as ACLers, I think there's a lot of guilt in this, and I think sometimes it can be warranted and sometimes not.
• 34:23
  SPEAKER_00: And you're trying to do right by what resources you have, but then you have to look otherwise, and it's really hard in this, and so I think that this is something that with what a good ACL professional, if they've seen a wide variety of cases, then they're able to pick up on these things.
• 34:44
  SPEAKER_00: And the thing that is also hard is that there are also professionals who see ACLs local and they see it from one, two surgeons, maybe three surgeons, and so their sample size is a little bit more selected to that, right?
• 35:00
  SPEAKER_00: They see those same procedures, same types of processes, and usually from start to finish, maybe they come in later, but that's a little different even for the high volume cases.
• 35:12
  SPEAKER_00: The thing that we have a just unique snapshot of is that we get to pull across the entire world, different surgeons, different graph types, different techniques, different types of physical therapy that we hear about and different goals, different types of populations, different types of resources.
• 35:32
  SPEAKER_00: And so this is something that has pulled over hundreds and hundreds of ACLers and thousands and thousands of ACLers to this point of this company.
• 35:39
  SPEAKER_00: And so this allows us to have so many repetitions to be able to focus on one thing, and that is ACL rehab.
• 35:48
  SPEAKER_00: And that is why this podcast is almost hitting 300 episodes, is because this is the thing that I obsess about.
• 35:53
  SPEAKER_00: This is what I care about.
• 35:55
  SPEAKER_00: And I think that is the thing that I want to get across to you guys today is that one, I want to try and normalize maybe some of the craziness you feel to know that there is a wide range of cases.
• 36:06
  SPEAKER_00: And I think anyone who's seeing a high volume of cases that they will say, yeah, this is actually not abnormal.
• 36:13
  SPEAKER_00: This is literally just a week for us, and we will continue to get the crazy cases all the way down to the most simplest case, right?
• 36:20
  SPEAKER_00: And we welcome them all.
• 36:22
  SPEAKER_00: And it's awesome to be able to work with them.
• 36:24
  SPEAKER_00: And if that is something that you're interested in, that we would love to help you.
• 36:28
  SPEAKER_00: And I do think that if you are someone who is struggling, does not have structure, do feel like you need better guidance and better overall just support, then we are here to help.
• 36:42
  SPEAKER_00: You know, after doing this for such a long period of time, I want to just kind of welcome and keep the door open for you guys if that's something that you need more support in.
• 36:52
  SPEAKER_00: But that's where the real value comes, is from being able to work with someone who can see these cases, not because they have all the answers.
• 37:01
  SPEAKER_00: I'm not sitting here saying we have every single answer possible, but we have a lot of them.
• 37:05
  SPEAKER_00: We have a lot of them.
• 37:06
  SPEAKER_00: And I promise you, if we don't have the answer, we will find it and we will figure it out together.
• 37:11
  SPEAKER_00: But the thing is that they have seen enough of these cases to be able to recognize and ask the right question sooner.
• 37:20
  SPEAKER_00: And this could be literally that difference of you getting back in, you know, within that year versus it being a two-year process.
• 37:28
  SPEAKER_00: And I see this so much.
• 37:29
  SPEAKER_00: And I look across our roster and I'm like, man, if we could have just gotten you from the start, this would have been so different.
• 37:36
  SPEAKER_00: And that's the thing that I want to just like save you guys from is like just make sure that if you feel like something does not feel right, make sure that you find the help sooner.
• 37:46
  SPEAKER_00: And worst case, yeah, it's some if you had to spend some funds on it, okay.
• 37:51
  SPEAKER_00: Like we have to invest in our health, and that's important.
• 37:54
  SPEAKER_00: Number two is that like if there's nothing that comes up, great, just keep moving forward, just make sure you find the better support and help for it.
• 38:01
  SPEAKER_00: But this is something that I wanted to share today.
• 38:05
  SPEAKER_00: I think it was really important to open it up to you guys to be able to see this and to also just transparently talk about you know what it is that we do and also being able to help anyone who is feeling the need that they need some more support.
• 38:20
  SPEAKER_00: And so this episode touches on that real clinical side.
• 38:23
  SPEAKER_00: It touches on the emotional side of things.
• 38:25
  SPEAKER_00: So if any of that of what you heard today is hitting close to home, then please reach out, you know, whether it is to your own care team, a mental health professional if you feel like you're kind of needing support in that, or reaching out to us if you need advice on next steps, because we are here to help in any way that we can.
• 38:44
  SPEAKER_00: Thank you guys so much for being here.
• 38:46
  SPEAKER_00: If you need anything, we got you.
• 38:49
  SPEAKER_00: I'll see you in the next episode.
• 38:52
  SPEAKER_00: This is your host, Robbie Patel, signing off.