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171 | How To Navigate Different PT's For Your ACL Rehab · 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.
• 1:05
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:10
  SPEAKER_00: So today we are answering this topic of how to navigate different PTs or physical therapists, physios for your ACL rehab.
• 1:21
  SPEAKER_00: And so for this ACL rehab process, you can even insert for PT or physio, any other rehab provider that fills in this role.
• 1:30
  SPEAKER_00: But typically for especially the ACL rehab process itself is usually a PT or a physio.
• 1:37
  SPEAKER_00: So that's what I'm gonna roll with for today.
• 1:39
  SPEAKER_00: But this question comes from an ACLer where they are going to physical therapy in person, and the way that it's set up for them, they can often get matched up with different physical therapists for their sessions, or potentially, you know, this also applies to maybe your provider you start with you don't like as much.
• 2:00
  SPEAKER_00: They may be going a vacation or they're sick.
• 2:02
  SPEAKER_00: Um, so someone else has to step in and you like them better.
• 2:06
  SPEAKER_00: But the initial provider returns and they're technically the managing provider for your case, right?
• 2:13
  SPEAKER_00: So this principle applies of what we talk about today to both scenarios, but I want to talk about the first one specifically because this is something that I do see in the space of ACL rehab, especially here in the US healthcare system with insurance.
• 2:30
  SPEAKER_00: Uh, a lot of times there can be some rotating PTs who are just kind of filling in for the day, or maybe it's your varying schedule.
• 2:37
  SPEAKER_00: So this is something that I want to make sure I answer for our ACLers who deal with this.
• 2:43
  SPEAKER_00: And it's especially something that we also see abroad too, um, because of uh socialized uh healthcare and certain medical systems.
• 2:52
  SPEAKER_00: It's just, you know, they go in every two weeks, every four weeks, and it's just whoever's there, right?
• 2:57
  SPEAKER_00: Um, you think about primary care, for example.
• 3:00
  SPEAKER_00: You might have your own primary care provider, but if you don't go that often, you probably just get in and see whoever you want to see, right?
• 3:07
  SPEAKER_00: But these are one-off situations, especially if it's all right, like let's say you just got a cold or there's a sickness, and you're not going to this provider that often, it's just whoever can take you, as long as they're, you know, a qualified professional, hopefully.
• 3:23
  SPEAKER_00: But with that said, ACL rehab can be a little bit different.
• 3:26
  SPEAKER_00: So if we come back to this question here where it might be rotating professionals, if you will.
• 3:33
  SPEAKER_00: So maybe one week it's Pam, the next week it's Dwight, the next one is Michael.
• 3:39
  SPEAKER_00: Hopefully, you guys get my reference here.
• 3:41
  SPEAKER_00: Um, but they find one they might like better or jive with better, right?
• 3:47
  SPEAKER_00: But then they start noticing some details are falling through the cracks.
• 3:52
  SPEAKER_00: The physical therapists are just kind of rinsing and repeating, if you will, um, and they're constantly trying to play catch up because they're also managing maybe two to three other people in the clinic at the same time and have 20 plus people on their caseload that day.
• 4:08
  SPEAKER_00: The other thing that can also happen is whenever there's a physical therapist and maybe an assistant or techs involved, a lot of times what can happen is PTs kind of check in and they might be there for five to 10 minutes.
• 4:20
  SPEAKER_00: They might do some sort of assessment or manual work, if you will, for a short period of time.
• 4:26
  SPEAKER_00: A lot of this ends up coming down to billing more than it is what you need, probably.
• 4:30
  SPEAKER_00: But with that said, that happens.
• 4:32
  SPEAKER_00: And then a lot of times you either pass to the assistant or the tech and they go through this.
• 4:38
  SPEAKER_00: And it could be someone who went through schooling to get their PTA license, or it could be someone who is literally just a high schooler or you know, a college student, or maybe someone who's just a can fill in that technician role that literally doesn't have to have many qualifications outside of existing as a human and can follow directions.
• 4:59
  SPEAKER_00: And this is something that we see a lot of times.
• 5:03
  SPEAKER_00: I've even served as a tech myself at physical therapy clinics.
• 5:07
  SPEAKER_00: Um, whenever I was going through the process of applying to physical therapy school, and I saw so many different models of the insurance-based system and the way that this operates and the things that I was able to do and things I wasn't able to do.
• 5:20
  SPEAKER_00: And so, whether it's you know, assistance or techs filling in for those pieces, especially the exercise prescription aspect, um, and maybe it's some of the stuff you do at home, or maybe it is rotating physical therapist that you're actually working with, right?
• 5:35
  SPEAKER_00: And so this can be hard because there are so many people to manage.
• 5:40
  SPEAKER_00: There are usually high volumes of clinics, especially if we're talking about insurance base, um, because they're trying to get people in.
• 5:47
  SPEAKER_00: It's for reimbursement purposes.
• 5:50
  SPEAKER_00: Um, and so these are things that can just make things fall through the cracks versus there's this one-on-one direct attention, or even like two per hour, for example, if it's set up and structured appropriately.
• 6:02
  SPEAKER_00: And I'm not saying that one-on-one is the only way.
• 6:06
  SPEAKER_00: There are plenty of friends I have in clinics and companies I know that do this incredibly well, but they have built-in systems.
• 6:14
  SPEAKER_00: And if they are passed off to somebody else, it is legit qualified professionals who can carry the torch, who can continue this process.
• 6:23
  SPEAKER_00: But a lot of times the struggle is it's just rotating people who are trying to play catch up.
• 6:29
  SPEAKER_00: And this is corporate PT in a nutshell.
• 6:31
  SPEAKER_00: And while I'm not saying it's all bad, as I had mentioned, it's hard to provide good, solid, individualized care in settings like this, especially with insurance sometimes.
• 6:40
  SPEAKER_00: And so bouncing between the different providers is hard for such a long recovery process where you know re-injury risk is also at stake, right?
• 6:50
  SPEAKER_00: And I know I use a lot of house analogies for this podcast.
• 6:56
  SPEAKER_00: I think it just relates so well because you are in this process of building this home.
• 7:00
  SPEAKER_00: You're trying to build a foundation, you're trying to build um the infrastructure of it, you're trying to build the internal of it, and no details can be left behind because then therefore you're gonna be living in this thing, um, or maybe you're selling it or having it rented.
• 7:14
  SPEAKER_00: Um, the last thing you want is liability of this house coming to crash down, right?
• 7:18
  SPEAKER_00: And so you want to make sure you check all of the corners of this, and there's you know, testing that's done, there's different detail step-by-step processes.
• 7:26
  SPEAKER_00: My parents are actually going through this process right now, and it is crazy the number of steps to get things approved through different phases, and it relates so well to this ACL react process.
• 7:38
  SPEAKER_00: But coming back to this house analogy, I want you to imagine you're building this house, and each week, when you're checking in on the progress, or you know, the company calls you to relay what they've done, you have a rotating project manager who's managing, let's say, 50 homes, 100 homes, right?
• 7:58
  SPEAKER_00: They're rotating, so it's not the same person every single week.
• 8:01
  SPEAKER_00: They'd have to play catch up constantly to review the notes of where the houses are at.
• 8:06
  SPEAKER_00: And you'd feel a bit more nervous as the home buyer and watching them build this home, and this you know, project manager comes on here and they are different people every single week.
• 8:18
  SPEAKER_00: It's almost hard to find your stride and for them to know all of the pieces along in this process versus having one solid project manager through the whole process, like a single GPS system.
• 8:31
  SPEAKER_00: Then they know, okay, where you were at before.
• 8:34
  SPEAKER_00: They know who you are as a person to communicate hopefully well.
• 8:37
  SPEAKER_00: They're able to update you and know what happened the previous week, what happened in that week, what's the plan ahead, versus like if you're filling in, then therefore you gotta look at the notes, you gotta communicate with the people.
• 8:50
  SPEAKER_00: And a lot of times, because it's not just a single home or a single person, there's volumes of people.
• 8:56
  SPEAKER_00: So then what happens is details get lost and they fall through the cracks.
• 9:02
  SPEAKER_00: And this is the same thing that happens in ACL rehab, uh, where there needs to be one person being the GPS.
• 9:10
  SPEAKER_00: Sure, there can be others in on the journey assisting, it's a team-based effort.
• 9:15
  SPEAKER_00: And even with providers we work with.
• 9:17
  SPEAKER_00: So if our athletes are working with us remotely, we work with their physical therapist, coach, trainer, whoever it is to help make sure it's a team-based effort, and we're actually trying to make sure we're all on the same page as much as possible, or they're the direct medium for us, and then that way we make sure the plan is going as appropriately until it is something that maybe is conflicting or too many cooks in the kitchen.
• 9:41
  SPEAKER_00: But this is something we share with all of our athletes because they may want some in-person support and they want us to steer the ship, if you will, through this process because of our background and expertise.
• 9:52
  SPEAKER_00: And so the thing is that there needs to be one person ultimately being this GPS, and as I mentioned, others being in on this, but we don't want things to get lost in translation or fall through their cracks because there's rotating PTs uh who don't see the full journey or potentially your history, right?
• 10:13
  SPEAKER_00: We want to make sure we can kind of see this through.
• 10:15
  SPEAKER_00: Um, and it doesn't need to necessarily be beginning to end, right?
• 10:19
  SPEAKER_00: Um, especially with the way that this works with insurance where skill sets serve their roles, like maybe um you're passing off to a coach in the mid to late stages potentially.
• 10:29
  SPEAKER_00: But with that said, there needs to be kind of one person overall helping to guide this, if you will.
• 10:36
  SPEAKER_00: But then there can be the team who is inserting, you know, details and context to be able to steer the ship.
• 10:42
  SPEAKER_00: So, how to navigate this situation specifically, it can be tough, right?
• 10:49
  SPEAKER_00: Because we don't want to hurt people's feelings, we want to be sensitive.
• 10:53
  SPEAKER_00: It's been a process, so there are a lot of things that factor into this.
• 10:57
  SPEAKER_00: Well, first, I do recommend starting with a conversation with your provider or whoever's in charge.
• 11:03
  SPEAKER_00: Um, even if it's that rotating PT situation, have a conversation with them or with one of them at least to start that ball uh to get it rolling.
• 11:12
  SPEAKER_00: And so this is the thing that you want to make sure to share your concerns honestly.
• 11:18
  SPEAKER_00: And if it's hard for you to do that, then I would almost question the provider and what environment they have set up for you.
• 11:25
  SPEAKER_00: Because any of our athletes, we hope that they can share anything openly that may be concerning them or something that's on their mind.
• 11:32
  SPEAKER_00: Um, and we don't create this barrier of like, hey, like whatever we say, go.
• 11:36
  SPEAKER_00: So open up the conversation, ask questions and address your concerns that you're feeling.
• 11:42
  SPEAKER_00: Yeah, as I mentioned, any good PT or provider and company will understand what you're sharing and likely agree, especially if you're noticing something that is to the detriment of your recovery, and see if there's a way to have one person leading the journey.
• 11:57
  SPEAKER_00: So if you have this rotating physical therapist, then maybe you can have one person who's leading the show.
• 12:04
  SPEAKER_00: Um, and then maybe that's someone that you trust who's great at communicating, who can provide a structured plan, goals for you, targets to aim for, right?
• 12:15
  SPEAKER_00: For both both short and long term, who does testing and provides research and evidence that is needed to kind of be embedded in the process.
• 12:25
  SPEAKER_00: Um, and most importantly helps educate you on where you're at in the process.
• 12:29
  SPEAKER_00: I was talking to an athlete and a parent the other day, and our goal with our education, you know, is to set you up for success, to make sure that you feel confident in your process and each step that you take, but also very important to make sure that we are being proactive about things versus reactive.
• 12:46
  SPEAKER_00: There's so many things that I see that just gets missed through uh lack of education, and it could have been, you know, told on the front end and it could have been completely avoided, and you were able to be proactive about it versus reactive, and then now you have to take time away or take a step back, or it's you know, just disrupting life and the process altogether.
• 13:08
  SPEAKER_00: So education is key, and most importantly, providing guidance being that GPS for you, especially when things don't go as planned, um, because they will at some point in the ACL rehab process.
• 13:21
  SPEAKER_00: So it might mean adjusting your own schedule to make this happen with that particular provider because they're rotating schedule.
• 13:30
  SPEAKER_00: So you're trying to figure that out.
• 13:32
  SPEAKER_00: It might mean finding a different clinic or provider altogether local to you, it might mean doing it remotely because anything locally to you doesn't fit the bill of what you're looking for, you know, your insurance doesn't really cover great uh clinics close to you, um, or you're just feeling like you're not getting what you need, right?
• 13:49
  SPEAKER_00: And one side note that I do want to share here and mention is that athletes will often feel quote unquote stuck because they've had this history with the provider, or that they're nice, the nice PT, if you will.
• 14:02
  SPEAKER_00: Um, and so going back to the project manager building your house, you're going to live in, or maybe rent outright, so you're liable for it.
• 14:12
  SPEAKER_00: Would you stay with that project manager just because they've been with you from the start, or you get along with them, but they suck at their job, or they're, you know, just not great, you're not getting that feeling of like they're doing what they need to be doing, um, and it's in your gut, and you know that, and maybe you do get along with them, but the thing is is that they're not doing their job very well.
• 14:39
  SPEAKER_00: It almost puts you in a harder place because they're such a nice person, but at the end of the day, you gotta live in a house or rent a house out, and you're on the line for that.
• 14:49
  SPEAKER_00: Um, and so that's gonna be really important.
• 14:51
  SPEAKER_00: So you're not gonna just deal with that provider or that uh project manager just because they're nice.
• 14:58
  SPEAKER_00: Absolutely not.
• 14:58
  SPEAKER_00: So the same thing goes here.
• 15:00
  SPEAKER_00: It's your health, it's your opportunity cost, and you don't want to do that.
• 15:06
  SPEAKER_00: You want to make sure you make the most of every single day and time that you're there.
• 15:10
  SPEAKER_00: You don't have to question things.
• 15:12
  SPEAKER_00: There's no sense in compromising your results and recovery for especially your mental health and physical health because of history with a provider, or maybe because it's the easiest route, right?
• 15:23
  SPEAKER_00: Especially if they're just right down the road.
• 15:26
  SPEAKER_00: Pick what is the best for you.
• 15:28
  SPEAKER_00: Pick something that you would, you know, take whether you're a parent, you would take your your kid to, if you are a sister brother, your your your sibling to, um, your grandparent to, uh, your best friend to, right?
• 15:43
  SPEAKER_00: Think about who you would share uh that person with in terms of like, all right, is this the best route for them or should they make a change?
• 15:51
  SPEAKER_00: Um, think about it in the sense of them instead of you, and see if your answer would be different.
• 15:57
  SPEAKER_00: If it is different, then it sounds like you need to make some changes.
• 16:01
  SPEAKER_00: So coming back around to navigating different providers, communicate with them, make sure to ask questions, right?
• 16:08
  SPEAKER_00: Um, there shouldn't be any guarding unless you're just being rude.
• 16:11
  SPEAKER_00: Don't be rude.
• 16:12
  SPEAKER_00: But with that said, there should be welcoming of questions or any concerns, and they should hear you out and propose solutions, right?
• 16:19
  SPEAKER_00: Um, and see if you can solidify that one person to steer the ship and not alternate because that can get really confusing.
• 16:26
  SPEAKER_00: And I would hate that.
• 16:27
  SPEAKER_00: That just is not fun, right?
• 16:29
  SPEAKER_00: And you want to make sure that there is alignment in the process and details are not falling through the cracks.
• 16:35
  SPEAKER_00: And if you need to make the switch to a different clinic, to um remotely, whatever it is, do it.
• 16:42
  SPEAKER_00: Do what's in your best interest, especially if your gut is telling you you need to make a change.
• 16:48
  SPEAKER_00: So this is a massive opportunity cost, if not.
• 16:50
  SPEAKER_00: And I see so many ACLers get stuck in this process.
• 16:54
  SPEAKER_00: And so I just wanted to tackle this topic for today.
• 16:56
  SPEAKER_00: I've talked about a different podcast episode of the quote unquote nice PT.
• 17:01
  SPEAKER_00: And it's something that people really do get stuck with, and then they're, you know, three months out, six months out.
• 17:07
  SPEAKER_00: It's the easiest thing because their insurance probably covers it.
• 17:10
  SPEAKER_00: Um, they quote unquote know their history.
• 17:13
  SPEAKER_00: Um, they're good enough, if you will, but you might not know what just is better is.
• 17:18
  SPEAKER_00: Um, and so that's the thing that I want you to factor into these decisions, especially with navigating um different PTs, providers through this process because it's a long process, and you can just leave it up to chance.
• 17:32
  SPEAKER_00: I always tell you guys, this is something that you need to reduce your risk as much as possible.
• 17:37
  SPEAKER_00: And that's gonna be with an ACL expert in your corner to be able to make sure they can guide this process, test you appropriately, make your plan as individualized as possible so you can feel as confident as you can getting back to who you want to be and what you love to do.
• 17:54
  SPEAKER_00: So if this is something that is what you're struggling with, I hope you're able to do something about it.
• 18:00
  SPEAKER_00: If you need any help, you know where to find us.
• 18:02
  SPEAKER_00: Two things we're doing uh that I want you guys to uh participate in if you're up for it.
• 18:09
  SPEAKER_00: So one is that you can find a form that is uh podcast questions or topics that you can basically submit to me and we will work on trying to answer them.
• 18:21
  SPEAKER_00: Um, I know I get questions all the time or things people want me to talk about.
• 18:25
  SPEAKER_00: So I do want to make sure that I open this up to all of you who support and listen.
• 18:31
  SPEAKER_00: So you can find that in the show notes.
• 18:33
  SPEAKER_00: There's also a way to text directly to the podcast, it's our podcast platform that's pretty awesome.
• 18:39
  SPEAKER_00: And so basically, you could send over a message.
• 18:42
  SPEAKER_00: So any wins, anything that you've gained from this podcast, maybe just a special message of some sort that you want me to read, that's also available in the show notes.
• 18:51
  SPEAKER_00: So that would be awesome if you guys could just take part in that.
• 18:55
  SPEAKER_00: And we're gonna look to continue to level up this podcast as much as we can.
• 18:59
  SPEAKER_00: Until next time, team.
• 19:00
  SPEAKER_00: This is your host, Ravi Patel, signing off.