Latest / The ACL Athlete Podcast / 247 | 7 Key Considerations for Strength Testing in ACL Rehab

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247 | 7 Key Considerations for Strength Testing in ACL Rehab · The ACL Athlete Podcast

• 0:18
  SPEAKER_00: Welcome everyone to the ACL Athlete Podcast.
• 0:22
  SPEAKER_00: This is the podcast where we talk about everything related to the ACL, whether that's the injury itself, the rehab process, return to sport, and more.
• 0:31
  SPEAKER_00: I'm your host, Dr.
• 0:32
  SPEAKER_00: Ravi Patel, performance physical therapist and coach.
• 0:36
  SPEAKER_00: Between myself and fellow guests and experts, you'll learn through the lens of the patient, the healthcare professional, and the coach.
• 0:43
  SPEAKER_00: The goal of this podcast is to equip you, the athlete, with the education to make the best informed decision about your care and your ACL journey.
• 0:54
  SPEAKER_00: Thanks for joining.
• 0:55
  SPEAKER_00: Now let's dive into today's episode.
• 1:00
  SPEAKER_00: What's up, guys, and welcome back to another episode on the ACL Athlete Podcast.
• 1:06
  SPEAKER_00: So today we are talking about something that often gets overlooked, but plays a massive role in decision making throughout the ACL rehab process.
• 1:17
  SPEAKER_00: And that is drumroll strength testing.
• 1:21
  SPEAKER_00: Do I talk about strength testing too much on here?
• 1:23
  SPEAKER_00: It's possible, but I think it's important because it's an important part of the process.
• 1:28
  SPEAKER_00: And more specifically today, I want to walk you through seven important considerations when strength testing ACLers.
• 1:38
  SPEAKER_00: So whether you're using isokinetic dynamometer, handheld dynamometer, or even force play setup, maybe it's a knee extension, five repetition maximum.
• 1:49
  SPEAKER_00: And this isn't just for strength testing, if you will, it's for assessments for testing.
• 1:56
  SPEAKER_00: So you could take a lot of this stuff and apply it across a lot of assessments that you may do in this process.
• 2:04
  SPEAKER_00: And so some may apply more to like a knee extension-based test.
• 2:09
  SPEAKER_00: But with that said, I just want to cover some important considerations on this.
• 2:15
  SPEAKER_00: And knowing that these aren't the only ones, but ones that I want to talk about for today because I think it can provide some insight for you, whether you are an ACLer, whether you're a clinician, coach, whatever domain that you're in within this ACL rehab world, it can apply to you.
• 2:31
  SPEAKER_00: And I think for a lot of you too, it can help with some perception of maybe the some of the results or some of the tests that you get, or maybe the lack thereof.
• 2:42
  SPEAKER_00: Because one of the things that we find is that a lot of ACLers in general are not being tested, or they're not being tested appropriately.
• 2:50
  SPEAKER_00: Because sometimes we'll hear people say, Yeah, I got tested.
• 2:54
  SPEAKER_00: I got an MMT or pushed into someone's hand, or you know, they did just a hop test and that was it to be cleared for sport, or they did a single leg squat to a box and that was their strength test.
• 3:07
  SPEAKER_00: So there are different things that can be stated as testing, but we want to make sure we're testing the right things.
• 3:15
  SPEAKER_00: So we want to make sure that we are looking at peak strength, we're looking at power, we're looking at range of motion, we're looking at the way someone can dynamically move, the way that they can also isolate certain movements and strength test those, compound-based movements.
• 3:29
  SPEAKER_00: There are a lot of different criteria within this, depending on where athletes are that we are going to be assessing to make sure that they are physically prepared and also mentally prepared, especially for the demands of what they're trying to get back to.
• 3:43
  SPEAKER_00: We want you to be very prepared for this.
• 3:46
  SPEAKER_00: And that is where tests allow us to know.
• 3:49
  SPEAKER_00: When you get in a car, whenever that dashboard has no lights on it, you can basically know that the KPIs have been met, that this car is doing just fine, there are no problems with it.
• 4:01
  SPEAKER_00: Of course, things can happen, but with that said, usually that light on the dashboard comes on first, right?
• 4:07
  SPEAKER_00: And that's usually something to tell us, oh, well, we need to get it further assessed, but there's a test done, a diagnostic in order to inform, like, okay, what do we need to improve or what do we need to change in order to clear this to make sure the car is safe to work again.
• 4:23
  SPEAKER_00: Same thing here, in a sense, and that's where testing comes into play.
• 4:27
  SPEAKER_00: Now let's get into it.
• 4:29
  SPEAKER_00: So I'm gonna go through this list, I'm gonna be short and sweet with this stuff because I want you to get to the point.
• 4:35
  SPEAKER_00: I also don't want this to be a long episode for you because no one's got enough time these days.
• 4:40
  SPEAKER_00: So let's keep it short and sweet, Robbie.
• 4:42
  SPEAKER_00: Number one, don't put too much stock in the first test.
• 4:47
  SPEAKER_00: There is a learning curve to testing, especially whenever there's high output demanded or it's a newer movement, right?
• 4:54
  SPEAKER_00: And then let's also not forget just the psychological component of this, right?
• 4:59
  SPEAKER_00: So we want to be mindful of this first test.
• 5:02
  SPEAKER_00: And especially early in ACL rehab, you might be eight to 10 weeks post op, and you might be doing some isometric sub-maximal testing, if you will, like you're not hitting max efforts at that point.
• 5:15
  SPEAKER_00: You may be, but usually at 12 weeks, let's just say cleanly like the three three-month mark, some people are gonna be doing some assessments and max strength testing, and there might be some people who aren't ready for it yet.
• 5:28
  SPEAKER_00: But with that said, when it's the first time, especially someone's first ACL process, first time ever really doing these max outputs, they're still learning how to produce force again, right?
• 5:39
  SPEAKER_00: How to kick that thing out, how to trust that knee.
• 5:43
  SPEAKER_00: There might be hesitation with pushing hard, getting used to it, right?
• 5:47
  SPEAKER_00: Or just the anxiety of being tested itself.
• 5:50
  SPEAKER_00: Everyone has test anxiety to some degree, some more than others.
• 5:53
  SPEAKER_00: And so that first session, think of it as a baseline for behavior as much as it is for performance.
• 6:00
  SPEAKER_00: So don't put too much stock in it.
• 6:02
  SPEAKER_00: Number two, perform serial testing.
• 6:06
  SPEAKER_00: What does serial testing mean?
• 6:07
  SPEAKER_00: We are going to consistently test this thing over a period of time.
• 6:11
  SPEAKER_00: It happens in a series, if you will.
• 6:14
  SPEAKER_00: And so then testing once tells you very little, right?
• 6:17
  SPEAKER_00: Especially every three months.
• 6:19
  SPEAKER_00: There are certain times where certain equipment, like isokinetic dynamometers, the access to it is every three months.
• 6:26
  SPEAKER_00: For example, here there is a group that does it every three months when you go see your surgeon.
• 6:31
  SPEAKER_00: I think that's fine, right?
• 6:33
  SPEAKER_00: Like that gives us a baseline and a good proxy.
• 6:36
  SPEAKER_00: If I had my perfect world, could we do it every six to eight weeks?
• 6:39
  SPEAKER_00: Awesome.
• 6:40
  SPEAKER_00: But those machines are very few around.
• 6:43
  SPEAKER_00: And then also it's just not the way that the current system, especially for a bigger system like them, is set up.
• 6:50
  SPEAKER_00: But with that said, you know, can we do the test more frequently to give us data to be able to be a little bit more targeted?
• 6:59
  SPEAKER_00: Absolutely.
• 7:00
  SPEAKER_00: So that's why testing periodically won't be as helpful versus testing consistently.
• 7:06
  SPEAKER_00: Like let's even say every three to four to six weeks, right?
• 7:11
  SPEAKER_00: We like to say every four to six weeks, we will be conducting an assessment.
• 7:16
  SPEAKER_00: This gives us a trajectory.
• 7:17
  SPEAKER_00: It gives us a very short-term roadmap, if you will, to the longer roadmap.
• 7:22
  SPEAKER_00: But it also allows us to make sure that we are staying very intentional and not wasting time.
• 7:28
  SPEAKER_00: It helps us get the athlete comfortable with the test itself and also helps you to see if the programming is trending in the right direction.
• 7:37
  SPEAKER_00: This also removes pressure.
• 7:38
  SPEAKER_00: When you know the test is not like a one-shot deal, like a pass or fail or return to sport, they're more likely to, you know, kind of give authentic effort every single time this is done.
• 7:50
  SPEAKER_00: And so I think there's a lot of value in this, and I think this can help just remove that anxiety of testing.
• 7:56
  SPEAKER_00: And so then, therefore, people know what this looks like, know how it feels.
• 8:01
  SPEAKER_00: Of course, this can be adjusted, but most importantly, it allows us to target exactly what direction we need to go to and be more surgical in our approach of our programming, the way we adjust things.
• 8:14
  SPEAKER_00: There are times where we might test something while we have a good idea.
• 8:17
  SPEAKER_00: The athlete might surprise us one way or another.
• 8:20
  SPEAKER_00: It might be way worse than it is, or it might be much better, right?
• 8:23
  SPEAKER_00: And then therefore, we could just be like, cool, like we have hit this checkpoint or this bucket.
• 8:29
  SPEAKER_00: Now we can actually prioritize or focus on something else versus waiting another, you know, six weeks, eight weeks with the same exercises or maybe just progressions of those when they've already tackled what we need to from it, right?
• 8:41
  SPEAKER_00: So I think serial testing helps us to just expose any of those gaps that we have, but then also just be more efficient with timing and know are we going in the right direction?
• 8:53
  SPEAKER_00: It's making sure the ship is not going off course by any degree, it's going in the right direction very consistently and keeps you informed, keeps the game plan informed.
• 9:03
  SPEAKER_00: Number three, sometimes the strength test is a tolerance test.
• 9:08
  SPEAKER_00: And what I mean by this is that if the A sailor is experiencing pain, you are not testing their true strength.
• 9:15
  SPEAKER_00: You're testing their pain tolerance.
• 9:19
  SPEAKER_00: Pain becomes the limiter for how much torque they can produce or how much force strength that they can produce for that particular movement or that muscle, right?
• 9:27
  SPEAKER_00: So if we're doing a knee extension test, the front of the knee is bugging you, maybe you irritated it right before, or maybe it's just hurting during because you're doing a max test.
• 9:37
  SPEAKER_00: You had a patellar tendon, you had a quad tendon, you had a complicated knee surgery, you're still early post op, you did a bunch of stupid stuff right before that.
• 9:46
  SPEAKER_00: And so then, therefore, the knee is just not in a healthy state where it's like it can give a full go at this without it talking, right?
• 9:55
  SPEAKER_00: And so it ends up being more of that pain tolerance test, and that pain becomes more of the limiter.
• 10:01
  SPEAKER_00: It's still helpful valuable data, if you will, because it gives us an objective way to track what the pain is and what the strength output with that pain is over time.
• 10:11
  SPEAKER_00: So let's say, for example, you have four out of ten pain, let's just kind of give it a ballpark number, and during the test, and you produced a output on the device of 30 kilograms, right?
• 10:26
  SPEAKER_00: That's how much force you can produce.
• 10:28
  SPEAKER_00: But let's say the next session, you may even have the same amount of discomfort, but you produce 40 kilograms, right?
• 10:38
  SPEAKER_00: Then therefore that allows us to know, well, you can tolerate and produce more force at the same amount of pain, or you know, later on you might decrease that pain and be able to have the same force output, if not higher.
• 10:51
  SPEAKER_00: So these are tolerance tests to give us an idea of okay, how is this athlete looking?
• 10:56
  SPEAKER_00: And a lot of times, especially early in the process, or if someone may be going through a flare-up or a setback, it's a tolerance test versus thinking this strength test is your pure output.
• 11:08
  SPEAKER_00: You gotta factor in if you're dealing with pain, you're going to be limited to some degree because the body is going to put a little bit of a break.
• 11:17
  SPEAKER_00: Imagine you're in your car and you put a little bit of that emergency brake on, even if it's, you know, 20, 30% of that emergency brake, you're gonna kind of have that pulled up while you're hitting the gas pedal.
• 11:28
  SPEAKER_00: Are you gonna be able to go as fast as you could in that car?
• 11:31
  SPEAKER_00: No, that's what pain is kind of doing whenever we are trying to kick out as hard as we can.
• 11:36
  SPEAKER_00: So just know it could be a tolerance test.
• 11:40
  SPEAKER_00: The padding, if especially if we're talking about a knee extension test, the padding matters a lot.
• 11:46
  SPEAKER_00: And I'll see a lot of setups where people, you know, their back of their knee is digging into the box or whatever they're set up on.
• 11:55
  SPEAKER_00: I will see that they have like a strap that's about an inch thick that is around their ankle when they're kicking out for an isometric test.
• 12:02
  SPEAKER_00: And I'm like, y'all, do the test yourself.
• 12:05
  SPEAKER_00: I promise you, it is not gonna feel good.
• 12:08
  SPEAKER_00: And I've done this myself.
• 12:10
  SPEAKER_00: There are times where I I always ask my athlete, I'm like, are you comfortable?
• 12:14
  SPEAKER_00: Do you feel anything digging into you?
• 12:16
  SPEAKER_00: And at this point, I've kind of like perfected our my setup here.
• 12:19
  SPEAKER_00: But the thing is, is like, if you feel any discomfort, as silly as it is, because sometimes you're like, oh, well, it doesn't matter.
• 12:25
  SPEAKER_00: I'm kicking out as hard as I can.
• 12:27
  SPEAKER_00: Exactly.
• 12:28
  SPEAKER_00: If you are kicking out as hard as you can, the only thing you want to make sure is that that pad and everything is comfortable and it's not cutting into their leg because you'll just get false results.
• 12:40
  SPEAKER_00: People will subconsciously hold back to avoid that discomfort.
• 12:44
  SPEAKER_00: So make sure that the setup is comfortable, make sure the pad has good surface area, the strap that you're using is soft enough for them to push into it without having pain or discomfort.
• 12:57
  SPEAKER_00: Super key result because I've seen people when we change that setup, they can output 10, 20, 30% more depending on the setup and how much that was holding them back.
• 13:09
  SPEAKER_00: Number five, the only thing that should be moving is their knee.
• 13:14
  SPEAKER_00: And that is when I'm talking about a knee extension test, a knee flexion test.
• 13:18
  SPEAKER_00: When we are testing isolated strength on the knee, usually when we're talking about here the quads or the hamstrings, which are obviously number one and number two importance of this whole process, we need to make sure the only thing moving is the knee.
• 13:34
  SPEAKER_00: A sailers want that number to go up.
• 13:36
  SPEAKER_00: I promise you, they will do everything in their power to lean back, twist, lift their hips, anything to get that number to go up.
• 13:46
  SPEAKER_00: So keep the system rigid.
• 13:48
  SPEAKER_00: I want you to think about can you lock this person in as much as possible with proper cueing, proper straps?
• 13:55
  SPEAKER_00: Um, usually at least there's a strap around the thigh whenever there's true max testing.
• 14:00
  SPEAKER_00: But the knee joint should be the only thing moving so you're actually measuring knee extension strength and not some type of also full body compensation in it.
• 14:09
  SPEAKER_00: The biggest thing that I see with knee extension and setups is that when people get set up, they will be in that box, they will have the ankle cuff on them, they'll kick out, and as they start kicking out, their hips will start coming off the ground.
• 14:25
  SPEAKER_00: And so that's something that we want to make sure we avoid.
• 14:28
  SPEAKER_00: And you can strap their thighs down with like a seatbelt strap, uh a lashing strap, you can have them hold the side of the box that they're on.
• 14:36
  SPEAKER_00: You could have their back up against a rig.
• 14:39
  SPEAKER_00: There are a bunch of different ways for us to make sure that they don't compensate in order to just make sure it's just the knee.
• 14:46
  SPEAKER_00: And the thing that has been interesting is just seeing other clinician setup, people asking me for feedback, but then also just looking at because we have a lot of ACLers who get tested other places, and we ask for the setup or we ask about it, and it's very different.
• 15:04
  SPEAKER_00: And so then, therefore, sometimes the data on that is challenging because there are other parts moving, like there is a group here where they test and they allow their athletes to lean fully back while they get tested.
• 15:17
  SPEAKER_00: And it's like, I promise you, that is not a standard way, that's not how we do it in the research, and so they're gonna throw their hips into it, and so it's just really challenging whenever there's not a standard practice across this.
• 15:30
  SPEAKER_00: But in general, the rule is can we just keep the knee as the only thing moving?
• 15:36
  SPEAKER_00: And in this case, a knee extension, the quads are doing the work, nothing else is contributing, so we can get an isolated variable and the output from that.
• 17:51
  SPEAKER_00: Number six, making sure they've built up to high outputs and intensities.
• 17:57
  SPEAKER_00: If they haven't done any isolated knee extensions in their program, a max test will destroy them, especially early on in ACL rehab.
• 18:07
  SPEAKER_00: You have to prepare the knee extensor mechanism for high force.
• 18:11
  SPEAKER_00: That means the quads, the patellar tendon, the patella, and the soft tissues, including the quad tendon, too, all those create the extensor mechanism, which goes from that bone underneath your patella tendon all the way up to your thigh.
• 18:29
  SPEAKER_00: That's the thing that is going to straighten out your knee.
• 18:32
  SPEAKER_00: And so we want to make sure that this knee has been tested with that and has been prepared to do high force.
• 18:40
  SPEAKER_00: So you want to think of it as a progression over weeks or over months, shifting from higher volume and low intensity towards low volume and high intensity, building them up so the test isn't a shock to the system.
• 18:53
  SPEAKER_00: What I mean here is that if you're early post-op, you should be doing knee extensions.
• 18:57
  SPEAKER_00: You should be doing them in a very strategic way.
• 19:00
  SPEAKER_00: You might have some isometrics done at 90 degrees at a light intensity, and then building up over time to let that intensity increase.
• 19:09
  SPEAKER_00: And then, yes, you might hold it for a duration of 30 seconds, 45 seconds, and then slowly bring that down and have higher outputs of effort.
• 19:17
  SPEAKER_00: In addition to that, you will also be trying to do knee extensions.
• 19:21
  SPEAKER_00: So you want to have some weight on the end of the ankle, and maybe you start high repetitions, maybe you're doing 15 to 20 to start for a few sets.
• 19:30
  SPEAKER_00: Maybe you don't go full range of motion, 90 to zero.
• 19:34
  SPEAKER_00: You might go 90 to halfway to 45 degrees, 30 degrees, right?
• 19:39
  SPEAKER_00: But the thing is we need to build them up towards higher outputs.
• 19:43
  SPEAKER_00: So that'll slowly look like all right, if we're doing 15 to 20 reps, then we're going down to 10 reps, five reps.
• 19:50
  SPEAKER_00: But that's over a course of weeks and months, right?
• 19:53
  SPEAKER_00: And so that's gonna be super important here and making sure that the output or the intensity of it is matching what the reps are.
• 20:01
  SPEAKER_00: So if you're gonna do five reps, you're gonna be doing heavier weight.
• 20:04
  SPEAKER_00: So you shouldn't be doing a weight that you can do 20 times that you're doing for five reps, right?
• 20:10
  SPEAKER_00: That's not a stimulus.
• 20:11
  SPEAKER_00: You need to do something that you could maybe only do six, seven, eight times, right?
• 20:17
  SPEAKER_00: Maximum with the weight assigned, and maybe you're doing it for five reps at a time.
• 20:22
  SPEAKER_00: But what I'm saying here is that this needs to be built up over a period of time.
• 20:26
  SPEAKER_00: There needs to be some gradual exposure to it.
• 20:28
  SPEAKER_00: Because what I see happen sometimes is that ACLers they'll go and get tested somewhere.
• 20:33
  SPEAKER_00: Maybe it's with their surgeon's office, or maybe it is somewhere else that doesn't do the testing.
• 20:39
  SPEAKER_00: They haven't been doing any knee extensions or open kinetic chain.
• 20:43
  SPEAKER_00: And as sad as it is, the belief out there is still very strong that people think it'll stretch the graft.
• 20:50
  SPEAKER_00: And we have research to refute that at this point because walking itself puts more stress on the ACL graft early post-op than an open chain knee extension when you're putting very light load on it.
• 21:03
  SPEAKER_00: And so the other thing too is that when you are between 30 to zero degrees of knee extension, that's where the ACL is being on tension, especially between 90 and 45 degrees, you're not putting the ACL on any stress.
• 21:18
  SPEAKER_00: So you're you're good to rock there.
• 21:20
  SPEAKER_00: So we should strengthen in the quads and do knee extensions.
• 21:24
  SPEAKER_00: So that's gonna be really important though, because when people go to get tested and do an isokinetic test at three months or six months and they haven't been doing much knee extensions, they haven't really been training the thing that they're gonna be doing.
• 21:37
  SPEAKER_00: And I'm not saying we need to get good at the test, but more so we do need to incorporate that thing to get it stronger.
• 21:44
  SPEAKER_00: So then, therefore, when you go to do a max effort, you're used to it.
• 21:48
  SPEAKER_00: Even if someone's asking you to go, hey, run a 5k, at least have one, two, three miles in your tank, right?
• 21:56
  SPEAKER_00: Don't just be running, you know, uh a quarter of a mile of a track, and then all of a sudden someone's asking you to run a 5K.
• 22:03
  SPEAKER_00: Like, let's get some reps in the tank so then that way you're used to it, ideally running a 5K.
• 22:08
  SPEAKER_00: So then therefore you can test it with a true exertion and what's accurate.
• 22:13
  SPEAKER_00: So make sure that you have built up to high outputs and intensities.
• 22:18
  SPEAKER_00: And then number seven, the last thing is it's not a pass fail test.
• 22:22
  SPEAKER_00: Just know these tests are not pass fail.
• 22:24
  SPEAKER_00: A lot of times people look at it as like, man, if I get over this point, I'm good.
• 22:28
  SPEAKER_00: And I get it, we're trying to achieve getting that quad to I know the biggest thing people want to see is like, can we get that deficit to less than 10%, right?
• 22:38
  SPEAKER_00: Can we get the absolute value to around 100% body weight or 3.0 newton meters per kg?
• 22:44
  SPEAKER_00: Can we get there?
• 22:45
  SPEAKER_00: Yes, that is everyone's dream in this process and to surpass that.
• 22:50
  SPEAKER_00: But at the same time, like just know that testing is not a pass or fail.
• 22:55
  SPEAKER_00: Every test is just a data point, and so the goal is to educate the athlete and the ACL or that we're not judging success or failure.
• 23:03
  SPEAKER_00: We're not doing that.
• 23:04
  SPEAKER_00: We're collecting info, we're looking for gaps, we're looking for asymmetries, we're looking for progress or potentially lack thereof.
• 23:12
  SPEAKER_00: And then we get more targeted, we get more surgical in our program design.
• 23:16
  SPEAKER_00: It allows us to move forward in such a very specific way.
• 23:19
  SPEAKER_00: It's like us being able to recalibrate the GPS based on more information coming in and being like, okay, so we're on this path.
• 23:27
  SPEAKER_00: You know, we started here.
• 23:29
  SPEAKER_00: Now we're, you know, 20 minutes in of this three-hour trip.
• 23:33
  SPEAKER_00: And now we're able to update based on how many cars are on the road, what wrecks we see, maybe some detours.
• 23:40
  SPEAKER_00: So these are all things that are data coming in for us to adjust and calibrate to be like, okay, what is the estimated ETA now that we have this information?
• 23:49
  SPEAKER_00: What are the most efficient routes?
• 23:51
  SPEAKER_00: You might take the scenic route, who knows, right?
• 23:54
  SPEAKER_00: But with that said, that allows us to recalibrate the roadmap and the route that we are going to take.
• 24:00
  SPEAKER_00: And I think that's super key in this process.
• 24:03
  SPEAKER_00: So So, to recap, don't overvalue the first test.
• 24:07
  SPEAKER_00: Test regularly in a serial process.
• 24:10
  SPEAKER_00: Respect the pain because that could be potentially a limiter when we're doing this, and we might be testing tolerance over true strength.
• 24:19
  SPEAKER_00: Manage the setup, isolate and make the system rigid, eliminate compensations as much as possible.
• 24:26
  SPEAKER_00: Build towards higher outputs.
• 24:28
  SPEAKER_00: It should look like a step-by-step approach versus this on and off switch of I've never done this.
• 24:33
  SPEAKER_00: Now go do this.
• 24:34
  SPEAKER_00: And it's a high output, not in this process.
• 24:36
  SPEAKER_00: It should always be built up and should be a graded approach.
• 24:40
  SPEAKER_00: And treat every test as data, not like a verdict or not this final end all be all.
• 24:46
  SPEAKER_00: These are the small details that make a huge difference in how we interpret results and how you will experience this, how ACLers will experience this through the testing process.
• 25:00
  SPEAKER_00: But that's going to be really important because I think testing has this kind of feel around it of like make or break it.
• 25:07
  SPEAKER_00: And I think the nuances and details of this are important.
• 25:11
  SPEAKER_00: I think also that we just need to know that it's not just going to be this like all right magical day.
• 25:18
  SPEAKER_00: It's just information for us to know, okay, have we at least met this minimum criteria?
• 25:25
  SPEAKER_00: And that's the way we need to look at it.
• 25:26
  SPEAKER_00: It's not like, all right, I'm 110% there.
• 25:29
  SPEAKER_00: It's have we met this minimum criteria to get to this certain point?
• 25:34
  SPEAKER_00: And okay, what does that calibration, recalibration look like as we move forward?
• 25:39
  SPEAKER_00: So I hope this helps y'all.
• 25:41
  SPEAKER_00: I hear of ACLers, you know, we have ACLers who get tested, and there can all be all these feelings around it.
• 25:48
  SPEAKER_00: But I was hoping that this can just be informative of just not putting too much stock in things, understanding the sequencing of it, the nuances of how important that is, and also just the buildup and perception of it because testing is so important in this process.
• 26:03
  SPEAKER_00: First off, I hope you're getting tested.
• 26:06
  SPEAKER_00: If you're not, then that is a major red flag.
• 26:09
  SPEAKER_00: My basically tell me you're not a good updated provider without telling me you're not a good updated provider is if you have to ask about strength testing, if you ask them, do you do isolated quadricep testing, do you use anything to measure it?
• 26:26
  SPEAKER_00: And they say, I don't know what you're talking about, or we'll get there.
• 26:30
  SPEAKER_00: Or, you know, I you'll kick into my hand.
• 26:33
  SPEAKER_00: Um, if they don't tell you, or if you ask, there are three main options.
• 26:37
  SPEAKER_00: Maybe something else exists I'm not familiar with, but right now they could do a repetition maximum on a leg extension if we're talking about quads, usually like a three to five repetition max, maybe one, using a dynamometer that is anchored, that gives an objective value, or an isokinetic dynamometer.
• 26:56
  SPEAKER_00: Those are really the three things.
• 26:58
  SPEAKER_00: Yeah, could we explore other potential options?
• 27:01
  SPEAKER_00: Yes, but in reality, those are our methods of getting objective data.
• 27:06
  SPEAKER_00: And the way for us to make sure we can kind of vet the professional or make sure that we kind of know what they're talking about and they're legit is do they test?
• 27:16
  SPEAKER_00: That's my general litmus for like, okay, they're at least up to date enough to be doing strength testing and making it objective and making sure that they can explain that to you.
• 27:28
  SPEAKER_00: The other side thing I'm gonna note, because I've just been hearing this a lot lately, is that PTs have been like kind of dodgy with ACLers' questions.
• 27:35
  SPEAKER_00: They've just kind of been like, oh, we'll get there, or like we can talk about that, or like they just kind of make something up.
• 27:40
  SPEAKER_00: You can kind of tell.
• 27:42
  SPEAKER_00: Red flag.
• 27:43
  SPEAKER_00: So just something to share with you guys because have a lot of these calls, talk with a lot of ACLers, and it's super frustrating.
• 27:51
  SPEAKER_00: But I want you guys to be equipped.
• 27:52
  SPEAKER_00: I want you guys to be ready for this process and not be a statistic in this process.
• 27:57
  SPEAKER_00: And that starts with educating yourselves and making sure you find the best care for you.
• 28:02
  SPEAKER_00: So that's gonna do it for today.
• 28:04
  SPEAKER_00: If you found this helpful, please share it with somebody, whether it's another clinician, an ACLer.
• 28:10
  SPEAKER_00: And then if you do not mind, what helps us the most in this podcast and getting reached to serve more ACLers in this whole community is to leave us a review.
• 28:21
  SPEAKER_00: That would be huge.
• 28:22
  SPEAKER_00: Spotify, it takes literally three seconds on Apple Podcasts.
• 28:25
  SPEAKER_00: Same thing.
• 28:26
  SPEAKER_00: You don't even have to say any words.
• 28:28
  SPEAKER_00: Don't say any words.
• 28:29
  SPEAKER_00: If you have good words to say, say it.
• 28:31
  SPEAKER_00: If you don't have good words to say, then maybe don't leave it.
• 28:35
  SPEAKER_00: I'm just kidding.
• 28:36
  SPEAKER_00: Do whatever you feel is in your comfort.
• 28:38
  SPEAKER_00: I appreciate you guys.
• 28:39
  SPEAKER_00: Thank you for this community.
• 28:41
  SPEAKER_00: Until next time, this is your host, Robbie Patel, signing off.