Latest / The ACL Athlete Podcast / 281 | Is Knee Soreness Normal in ACL Rehab?

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281 | Is Knee Soreness Normal 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.
• 1:01
  SPEAKER_00: What is up, team, and welcome back to another episode on the ACL Athlete Podcast.
• 1:07
  SPEAKER_00: So today I want to talk about a particular comment or feedback I get from many of my ACL athletes, and that is my knee feels sore.
• 1:20
  SPEAKER_00: Talking about sore, not specifically pain, they just say their knee feels sore.
• 1:26
  SPEAKER_00: So picture this you get through a solid session, maybe some split squats are in there, some single leg work that you were doing, some dynamic work, maybe it's change of direction, maybe it's some jumping.
• 1:39
  SPEAKER_00: You feel strong walking out of the gym or out of your session.
• 1:44
  SPEAKER_00: And then a few hours later, you're sitting on the couch and you notice that soreness.
• 1:49
  SPEAKER_00: Your knee feels a little different.
• 1:51
  SPEAKER_00: It's not your quad necessarily, it's not your hamstrings, the joint itself, right at the the front of the joint, or maybe it's just the kind of knee in general, maybe a little bit behind the kneecap.
• 2:05
  SPEAKER_00: It's talking louder than it was when it was that session, right?
• 2:10
  SPEAKER_00: Or maybe even an hour ago.
• 2:12
  SPEAKER_00: And that's usually when a spiral can start, especially if you've been in this process.
• 2:17
  SPEAKER_00: Maybe you've dealt with some setbacks or some flare-ups in the knee.
• 2:22
  SPEAKER_00: And there can be this kind of thought of, did I do too much?
• 2:26
  SPEAKER_00: Did I just undo months and months of progress, especially if you just got out of a flare-up?
• 2:32
  SPEAKER_00: And in this one session, you just flared it up again.
• 2:36
  SPEAKER_00: And so you're just wondering, is this the start of a setback?
• 2:40
  SPEAKER_00: And so you start potentially kind of gathering some information about this, and maybe it's something that you do message your physical therapist about, or you tell them in the next session.
• 2:51
  SPEAKER_00: Maybe you pull up Google or an AI, and you just kind of type in whatever it is, and you know, it reads out different answers that are all just different, right?
• 3:03
  SPEAKER_00: It might be, you know, you tore your ACL to, oh, this is a Cyclops issue, or this is very bad, to oh, this is normal.
• 3:12
  SPEAKER_00: Just keep working through it, push through the pain.
• 3:14
  SPEAKER_00: It runs the gambit.
• 3:16
  SPEAKER_00: And especially if you get onto different forums like Reddit or Facebook groups, you might really go down a deep rabbit hole.
• 3:24
  SPEAKER_00: And so you're laying in bed feeling the soreness, and it's something that you're trying to process through.
• 3:31
  SPEAKER_00: And I want to talk through this today because there are situations that happen like this all the time.
• 3:39
  SPEAKER_00: Every single ACL are going through this process, they have these moments, and many of you more than once, right?
• 3:45
  SPEAKER_00: Your knee is going to get sore.
• 3:48
  SPEAKER_00: And I know sometimes it's hard to describe this because you're not like, oh, it's in pain or even let's kind of take out stiffness.
• 3:55
  SPEAKER_00: It just feels sore.
• 3:57
  SPEAKER_00: Just like you do a hard workout and the muscles get sore, but instead the joint itself around it gets sore.
• 4:03
  SPEAKER_00: And it could be particular areas.
• 4:05
  SPEAKER_00: It could be, you know, in the front side of it, it could be just the whole joint itself.
• 4:09
  SPEAKER_00: And it's so hard to really specifically describe, especially if it's not pain specifically, which is also just hard to describe sometimes.
• 4:18
  SPEAKER_00: And the first thing I need you to hear before anything else is that sore is not the same thing as, you know, pain or hurting.
• 4:26
  SPEAKER_00: The joint is not the muscle, right?
• 4:28
  SPEAKER_00: And in the vast majority of cases, what you're feeling is not, you know, maybe that disaster that you played out in your brain or what you have read online, right?
• 4:37
  SPEAKER_00: And this is where the nuances of this is so important.
• 4:40
  SPEAKER_00: And just to normalize that soreness is normal, but there is something that we need to dissect a bit more in this episode for us to figure out okay, is this something that we need to really draw attention to, or do we just kind of let it ride?
• 4:55
  SPEAKER_00: So I want to give you some more practical strategies around this.
• 4:59
  SPEAKER_00: So let's first get specific about what we're actually talking about.
• 5:03
  SPEAKER_00: Muscle soreness, that could be your quads, hamstrings, glutes, calves, the muscles themselves, they can feel that work the next day.
• 5:10
  SPEAKER_00: And that's one that we're aiming for, right?
• 5:12
  SPEAKER_00: We're trying to rebuild those muscle groups, and so you should feel a lot of work there.
• 5:18
  SPEAKER_00: The muscle soreness is something that we want, right?
• 5:21
  SPEAKER_00: It's telling us that the tissue, those particular areas got a stimulus, and that's helpful.
• 5:27
  SPEAKER_00: Now, also know that just because you're not sore in the muscles doesn't mean that they haven't been worked.
• 5:34
  SPEAKER_00: When you're in a particular block or when you're working through a certain set of exercises, when they're new, the soreness creeps in a bit more.
• 5:42
  SPEAKER_00: If there's more eccentric or kind of muscle lengthening, then you're gonna get a bit more soreness.
• 5:48
  SPEAKER_00: But as you get further in, your body gets used to it.
• 5:51
  SPEAKER_00: So sometimes you don't always get the soreness in those muscle groups, but you can still make progress.
• 5:57
  SPEAKER_00: So just know that you don't need to wake up sore in your muscles every day for it to feel like progress.
• 6:03
  SPEAKER_00: That's a side tangent.
• 6:05
  SPEAKER_00: The real focus here is on the joint soreness, which is different.
• 6:09
  SPEAKER_00: That's the knee itself, the joint line, just the front of the knee.
• 6:13
  SPEAKER_00: Everyone kind of knows this feeling of, you know, it's telling you it's adapting to something, right?
• 6:19
  SPEAKER_00: And here's the thing that we need to make sure we explain well.
• 6:24
  SPEAKER_00: This shows up at different points in your rehab, and it could be for very different reasons.
• 6:30
  SPEAKER_00: Early on, it's your knee relearning how to handle load, especially.
• 6:36
  SPEAKER_00: You think about you have the injury, and then if you go on to have the surgery, then afterwards, it's in a very sensitive state, right?
• 6:44
  SPEAKER_00: We're trying to rebuild after two traumas essentially.
• 6:48
  SPEAKER_00: And so that joint is trying to normalize.
• 6:50
  SPEAKER_00: It hasn't had as much activity or stress on it, so it lowers its capacity, if you will, to be able to handle things.
• 6:57
  SPEAKER_00: So, you know, imagine you were able to run 10 miles and then you took a lot of time off.
• 7:02
  SPEAKER_00: You're not just gonna be able to pick up and run 10 miles, you're gonna probably respond to one to two miles just from a conditioning, and even your joints and your muscles will respond to that.
• 7:12
  SPEAKER_00: This is kind of the same thing.
• 7:13
  SPEAKER_00: The floor has been lowered in terms of what that looks like.
• 7:16
  SPEAKER_00: So then you might feel things at a lower threshold.
• 7:21
  SPEAKER_00: And that's essentially what this joint soreness can be early on, is that your knee is relearning how to handle load and movement again after this surgery.
• 7:30
  SPEAKER_00: It hasn't done it in a while, and so it's essentially recalibrating.
• 7:34
  SPEAKER_00: And then later, as you get past this in the mid and late stages of this process, when you're you know heavier in your strength work, you're working on power focus development, more demanding dynamic movements as well, your joint is going to talk more, it's not always gonna just be completely quiet and calm.
• 7:54
  SPEAKER_00: That joint soreness I see can rear its head.
• 7:58
  SPEAKER_00: It's not a red flag, though.
• 8:01
  SPEAKER_00: Now, if it's pain and swelling that is ramping up, then that is one thing.
• 8:05
  SPEAKER_00: But if we're talking about soreness, that's not a red flag.
• 8:10
  SPEAKER_00: That's barely even like a yellow flag, if you will, but we want to kind of be aware of it.
• 8:16
  SPEAKER_00: That's the cost of doing the work that actually gets you back to sport, though.
• 8:19
  SPEAKER_00: And that's something that's really important in this because it's something that the further you get into this process, the more normal it is to notice this because you're asking for more of the knee.
• 8:32
  SPEAKER_00: And so sometimes I think people assume that the knee, once they're past the early post-op stages, that it should never respond to anything whatsoever, especially in mid and late stages, because you're no longer early, right?
• 8:46
  SPEAKER_00: But the thing is, is that you are pushing this knee more, or you should be in mid and late stages.
• 8:53
  SPEAKER_00: You're loading it more, the muscles, the tendons.
• 8:56
  SPEAKER_00: If you have a graph site that's taking on more load, you are moving faster with more velocity, you are doing dynamic things like changing direction, decelerating, accelerating, sprinting, cutting, all the things that are going to be involved that are gonna put high force through the knee, which guess where those forces are going through the knee, through all those tissues, all the joints, the muscles.
• 9:20
  SPEAKER_00: But this is why we have to make sure we are strong enough, y'all.
• 9:24
  SPEAKER_00: Because if we're not strong enough, guess what takes the brunt of the load?
• 9:27
  SPEAKER_00: Either the muscle groups that shouldn't be doing it as much because we just don't have as much strength in the quads, for example, or a lot of time the joint takes on the load.
• 9:37
  SPEAKER_00: And that's something that's really important here.
• 9:39
  SPEAKER_00: And a good example I can give you is that imagine if you land from a table, right?
• 9:47
  SPEAKER_00: Let's say the table is, let's just say five feet off the ground, and if you're thinking about landing on the ground and you land with your legs relatively stiff or straight, where do you think that is going to go?
• 10:00
  SPEAKER_00: And how is that going to feel?
• 10:02
  SPEAKER_00: That is gonna feel like absolute crap in your knees and in your body and in your joints because you're not optimizing the positioning of allowing your muscles to help recreate the force to absorb that load.
• 10:14
  SPEAKER_00: Now, imagine landing from that with a good landing position.
• 10:19
  SPEAKER_00: Knees bent, allows the torso to bend a little bit, just like you're trying to really absorb that.
• 10:25
  SPEAKER_00: And so, therefore, yes, you take on force in the joints, but then that is also equally kind of dispersed among the different muscle groups, your shock absorbers that are going to help you.
• 10:36
  SPEAKER_00: So instead of the joints taking on all that load, we allow our muscles and other tissues to help act as shock absorbers, which is so key in this process and why we care so much, especially about getting the quads back online and super strong and being able to tolerate breaking forces, especially, because it's going to help us disperse stress across multiple different ways versus just through the joint itself.
• 11:02
  SPEAKER_00: And so, as you're in these late phases, it's gonna be normal for you to try and push that.
• 11:07
  SPEAKER_00: So then, therefore, that's the cost.
• 11:09
  SPEAKER_00: You're gonna have some more joint soreness, even if you're doing all these things well of dispersing the load, you're just gonna be high impact forces on the joint.
• 11:17
  SPEAKER_00: So then, therefore, it is going to feel that a bit more.
• 11:20
  SPEAKER_00: And the further that you are getting in this, the more that you will typically notice this, especially if you're getting back to your specific sports, if there's a lot of cutting, a lot of impact work, like you think about the kind of typical sports of like soccer or lacrosse or basketball, things like that, or even just activities like skiing or rock climbing, you're just gonna kind of feel those things because it's very specific.
• 11:43
  SPEAKER_00: You know, the stuff you're doing in the weight room or even on the field that isn't replicating those things is not gonna be exactly the same as what the stress is gonna be put on through those sports or activities.
• 11:54
  SPEAKER_00: So just know that.
• 11:56
  SPEAKER_00: Now, here's what most people do get wrong with this, and this is what's really important is that they feel the soreness and then that alarm goes off in their head.
• 12:05
  SPEAKER_00: And I don't blame you guys, I had this many a times in this in my process.
• 12:10
  SPEAKER_00: And their first instinct is to just kind of stop, rest, pull back.
• 12:15
  SPEAKER_00: Maybe something's wrong.
• 12:17
  SPEAKER_00: Or you might be the person that is like, let me push through this, more pain, more gain, right?
• 12:22
  SPEAKER_00: And we see people on opposite spectrums, right?
• 12:25
  SPEAKER_00: And we typically want to kind of land somewhere in the middle.
• 12:28
  SPEAKER_00: The middle is usually the safest, just as a life philosophy.
• 12:32
  SPEAKER_00: The middle is usually kind of the most helpful kind of rule of thumb, if you will, as I found as I've gotten older.
• 12:40
  SPEAKER_00: But I get why sometimes people have these alarm bells go off.
• 12:44
  SPEAKER_00: As I shared, I also did as well.
• 12:46
  SPEAKER_00: You've already been through this enough with this knee and kind of tend to be on the edge about it, especially if you've had previous flares up.
• 12:54
  SPEAKER_00: But that instinct of kind of pulling back, stopping, maybe pivoting the second you feel something is not necessarily the right move every single time.
• 13:03
  SPEAKER_00: And the right move is to really identify it, and that's really important.
• 13:06
  SPEAKER_00: Identify it, don't panic.
• 13:08
  SPEAKER_00: Name it, track it, the soreness becomes a piece of information, and it's something that we can kind of follow along with data points in this process.
• 13:17
  SPEAKER_00: I remember after my second ACL reconstruction, anytime something in my knee fell off, my brain went straight to worst case scenario.
• 13:26
  SPEAKER_00: And I dealt with a lot of patellofemoral issues, like a lot of pain issues around my kneecap.
• 13:31
  SPEAKER_00: Um, and I think this was more so due to poor rehab and loading and just kind of strategizing my programming during that time, which reflecting previously on.
• 13:42
  SPEAKER_00: And so that was something I had to work around a lot.
• 13:45
  SPEAKER_00: And so the thing is, is that that constantly was in the back of my head, especially because I dealt with that early on.
• 13:52
  SPEAKER_00: And then you pile on top of that, I'd already been through one ACL reconstruction on the other side, didn't obviously go as expected because I injured the other side.
• 14:01
  SPEAKER_00: So I didn't really have a lot of patience for the ambiguity of it.
• 14:05
  SPEAKER_00: So it took real time and honestly some good coaching, just learning myself through movements and through what I was going through before I really learned the difference between my knee talking to me and my knee actually yelling at me.
• 14:18
  SPEAKER_00: Once I could tell those apart, I stopped panicking over things that might have really played into that.
• 14:25
  SPEAKER_00: And I've learned that so much over the years now with my various injuries, surgeries, and even my recent HIPAA procedure of, you know, if there's something that starts to, you know, kind of talk to me a little bit versus yelling at me, I'm gonna try and name it, differentiate it, but making sure I'm not necessarily panicking immediately when something happens.
• 14:46
  SPEAKER_00: So let's break this down where this soreness is actually coming from, because not all soreness has the same cause.
• 14:53
  SPEAKER_00: And the cause should change how you think about it.
• 14:58
  SPEAKER_00: The first one is early stage load reintroduction, meaning we're putting weight back on this thing, we're getting this thing moving.
• 15:06
  SPEAKER_00: And so it's been a while, especially let's say someone who has been on crutches and maybe their knee has been locked in a brace or restricted range of motion.
• 15:15
  SPEAKER_00: And let's also say you were someone who had a meniscus repair, a multi-ligament, or your surgeon's protocol was non-weight bearing for a week, two weeks, four weeks, maybe six weeks, right?
• 15:25
  SPEAKER_00: That's gonna be different.
• 15:27
  SPEAKER_00: So your knee is going to be sore because it is just not used to that because it's been some time.
• 15:32
  SPEAKER_00: And as much as I hate it, the knee, the capacity of that knee drops a lot.
• 15:38
  SPEAKER_00: The quad strength drops a lot very, very, very quickly after this injury.
• 15:43
  SPEAKER_00: As we know, yes, this is a joint-related, muscle-related kind of issue that ends up being very much impacted, but there is a very neurological component to this injury that we do not have fully figured out yet.
• 15:57
  SPEAKER_00: And so that shuts things down.
• 15:59
  SPEAKER_00: It makes the kind of joint and the muscles kind of decondition and protect itself, if you will.
• 16:05
  SPEAKER_00: And so this is something that's really important.
• 16:07
  SPEAKER_00: And then you layer surgery on top of that, and maybe it's a complicated surgery or requiring restriction on weight bearing, then that's going to factor into this too.
• 16:16
  SPEAKER_00: So it's going to be normal to feel things as it comes back online and getting back to kind of a normal range of motion, weight bearing that's expected, right?
• 16:27
  SPEAKER_00: Two, it could be a new phase, a new block, new movements.
• 16:32
  SPEAKER_00: Anytime you introduce a new exercise or a new training phase, there's an adjustment period.
• 16:39
  SPEAKER_00: Your knee hasn't seen that specific movement, that stressor.
• 16:43
  SPEAKER_00: Maybe you were doing something in the previous block or previous exercise that was stressing it in a certain way, but maybe this is something new.
• 16:50
  SPEAKER_00: Like when we're doing something that's working on building the brakes or let's say eccentric development of our quadriceps from a strength standpoint, from a speed standpoint, when we start working in deceleration work where someone is kind of stopping in space, or maybe they're dropping from a box, that could add some soreness.
• 17:09
  SPEAKER_00: One, because that's the muscle lengthening, so that's going to stress kind of the muscle itself, but in the knee joint itself, it's going to take more force too.
• 17:17
  SPEAKER_00: So then, therefore, that could also play into okay, my knee is feeling a bit more sore in the front because we're we're working on this and it's new, right?
• 17:25
  SPEAKER_00: It hasn't adapted to that specific demand yet.
• 17:29
  SPEAKER_00: And that's where the said principle comes in, S-A-I-D, specific adaptations to impose demands.
• 17:35
  SPEAKER_00: This is a foundational principle of strength and conditioning and just human physiology, and it is going to specifically adapt.
• 17:42
  SPEAKER_00: The thing is, is that if you haven't given it that exposure yet, then it's not necessarily going to adapt yet.
• 17:47
  SPEAKER_00: So it's going to have a period of time where it's going to need to just kind of work through that, if you will.
• 17:53
  SPEAKER_00: And this is exactly why we build what I call a launch week into every new block an athlete goes through.
• 18:01
  SPEAKER_00: And that is typically the first week of let's say a four to six week block an athlete is working through, where this launch week is not the week that we just push hard.
• 18:12
  SPEAKER_00: We hit accelerate as hard as we can.
• 18:15
  SPEAKER_00: It's the week where we let the knee tell us how it's responding, how it feels, how it looks, before we really start to load it up.
• 18:22
  SPEAKER_00: So instead of thinking like an RP nine or 10, like 90, 100% all out intensity, maybe it's a 70%, right?
• 18:31
  SPEAKER_00: Maybe it's a 60%, depending on what phase or block you're in.
• 18:35
  SPEAKER_00: But it's a way for us to still get some stimulus, some load without it being super demanding, and also for us to see the dose response.
• 18:44
  SPEAKER_00: We give it a certain dosage in the gym or with certain movements we're doing, and then we see how the knee responds before we continue to build it up in the next week.
• 18:54
  SPEAKER_00: Those are really important pieces, and sometimes people are just thrown into exercises, whether it's jumping or some lifting movements, and they either don't have the prerequisites built or it might have just been a little too intense.
• 19:08
  SPEAKER_00: And the thing that's so important to this, and I think one of the things that really differentiates really amazing physical therapists, strength and conditioning coaches, movement professionals, but especially in ACL rehab or people who are dealing with these types of injuries, is the ability to progress and regress exercises and lateralize exercises.
• 19:31
  SPEAKER_00: What I mean is that when you have a particular movement, there should be automatically three regressions and three progressions of that movement.
• 19:39
  SPEAKER_00: Always, no matter what movement it is, your coach or your PT, your strength coach, should be able to change the movement on a dime.
• 19:49
  SPEAKER_00: And there should always be easy progressions.
• 19:52
  SPEAKER_00: I kind of think about it as like a step ladder, right?
• 19:54
  SPEAKER_00: You want to make sure that every progression isn't just skipping from step one to step four.
• 19:59
  SPEAKER_00: It's like, let's just make sure we can kind of progress this.
• 20:03
  SPEAKER_00: And people are always wondering how are you going to do this remotely?
• 20:06
  SPEAKER_00: And the thing is, is that we have just really tried to take so much value into being such good coaches and understanding movement that we are never giving our athletes exercises that they feel is so over the top, so complicated, or so aggressive, where they're like, I don't know if I can do this.
• 20:25
  SPEAKER_00: Like we have progressions and regressions built out for everything so we can make sure that the stimulus is met, that they feel confident doing it.
• 20:33
  SPEAKER_00: And guess what?
• 20:34
  SPEAKER_00: We can keep bridging it towards more challenging and challenging exercises without it getting very daunting.
• 20:40
  SPEAKER_00: And that's very sound principles in strength and conditioning and rehab.
• 20:44
  SPEAKER_00: And so this is something that's very important because we want to make sure that we can adapt it to our athletes, no matter if they're feeling some soreness or maybe some pain is kicking in, they had something come up, and or maybe it's just a gym setting or situation where we have to adapt the movement.
• 21:02
  SPEAKER_00: But this is really important because in a new block, especially with new movements, this could be very common.
• 21:08
  SPEAKER_00: So that's why the launch week is so helpful for us to feel this out.
• 23:16
  SPEAKER_00: Number three is the one that I think a lot of people end up missing because they have this kind of more is better mentality or doing a lot of things every day.
• 23:26
  SPEAKER_00: And I've talked about this before where this high-low approach is very valuable, where you take a day, let's say Monday, Wednesday, Friday are your high days, and Tuesday, Thursday, Saturday are your low days.
• 23:36
  SPEAKER_00: So then, therefore, you can have intentional focus on those days and then also recover on the off days.
• 23:41
  SPEAKER_00: Versus if you do just moderate output every single day across six days, you're not going to touch high intensities, you're not going to touch low intensity, so your body's not really gonna recover.
• 23:51
  SPEAKER_00: And then the other piece is that you're not really gonna hit a stimulus high enough for you to get an adaptation.
• 23:56
  SPEAKER_00: So that's why this high low approach is so helpful.
• 24:00
  SPEAKER_00: And the thing that we see a lot of times is that people have Have load mismanagement.
• 24:06
  SPEAKER_00: And the other things that could sneak in, maybe it's like walking, people are following maybe a design schedule, but then they ramp up their step count drastically, or maybe they go travel and they're hitting 20,000 steps versus the typical 5,000 with their remote job, right?
• 24:23
  SPEAKER_00: But they're still not in a place where the knee has been used to that.
• 24:27
  SPEAKER_00: So then the cumulative load, and we're talking about how does this compound day to day?
• 24:32
  SPEAKER_00: So if we take a week, if we aren't allowing ourselves to have some recovery built in and we're doing back-to-back demanding days, this is where this can also start to talk a little bit.
• 24:44
  SPEAKER_00: You have a hard lower body session on Monday, you do a pretty intense run on Tuesday, you do another hard lower body session on Wednesday, and then on Thursday, you might start feeling some soreness that's starting to talk and get a little bit louder and a little bit louder.
• 25:00
  SPEAKER_00: And you didn't even change really anything to the program, but you never really gave it the rest that it needed.
• 25:06
  SPEAKER_00: We need to make sure if we dig a hole through our training, we need to fill that hole back.
• 25:11
  SPEAKER_00: We don't just keep digging a bigger and bigger hole.
• 25:14
  SPEAKER_00: And eventually what happens if we don't recover or fill the hole back, we're just gonna keep getting deeper and deeper until this turns into a flare up or a setback.
• 25:22
  SPEAKER_00: So, so, so common in this, especially because when you don't have your entire week structured and planned and you're not adapting it if you're traveling or whatever the week may bring you, and communicating that with your PT or your coach, this is where people get into trouble.
• 25:41
  SPEAKER_00: And we find these problems so often with folks because it's just not structured enough.
• 25:46
  SPEAKER_00: They're doing way too much, way too often, and they could cut it back 50% or strategize it a different way and structure it and really get a lot out of it.
• 25:57
  SPEAKER_00: And this is usually not just from one bad session, it can be, but it's usually just stacking days on top of days without checking in on how your knee is actually recovering between them.
• 26:07
  SPEAKER_00: And if I had to guess which one causes the most unnecessary setbacks out of, you know, one, two, or three, the early stage reintroduction of loading, a new block and movement, or the load mismanagement.
• 26:19
  SPEAKER_00: The load mismanagement is the one that likely creates more of that knee soreness, and it's the one that people have a harder time tracing back to.
• 26:31
  SPEAKER_00: So now, what do you actually do when you feel it?
• 26:34
  SPEAKER_00: Here's the framework I want you to use.
• 26:36
  SPEAKER_00: First, give it 24 hours.
• 26:39
  SPEAKER_00: Soreness after a session is normal.
• 26:42
  SPEAKER_00: The question is what it looks like the next day.
• 26:45
  SPEAKER_00: Is it easing up?
• 26:46
  SPEAKER_00: Is it staying about the same, or is it getting worse?
• 26:49
  SPEAKER_00: This is our 24-hour feedback loop that we use, and it's that window where it tells us everything that we essentially need to know.
• 26:58
  SPEAKER_00: The second thing is listen for whether it is whispering.
• 27:02
  SPEAKER_00: Is it getting louder or is it getting to a point where it's yelling?
• 27:06
  SPEAKER_00: And so you can kind of think about this spectrum of completely quiet, whispering, getting louder, and then yelling, right?
• 27:14
  SPEAKER_00: And you kind of think of it that way.
• 27:16
  SPEAKER_00: A knee that's sore for a day after a hard session and then settles, you know, that might be a little bit of a whisper, but a knee that's louder three sessions in a row, it's whispering, and then you're noticing it getting louder and louder, and that's starting to escalate, right?
• 27:31
  SPEAKER_00: Like someone is yelling.
• 27:32
  SPEAKER_00: That's not something to ignore anymore.
• 27:34
  SPEAKER_00: It's something that we need to really kind of dial in because that trend is going to start mattering more than any single data point or day.
• 27:42
  SPEAKER_00: And you can almost think of it as like the green, yellow, or red light or the check check-in with yourself, right?
• 27:49
  SPEAKER_00: Green, it's there, but it's easing, keep going as planned.
• 27:52
  SPEAKER_00: Yellow, it's holding steady or showing up a little more than usual, back off slightly and keep watching.
• 27:58
  SPEAKER_00: Or red, it's getting louder over multiple sessions, or it's actually changing how you move.
• 28:04
  SPEAKER_00: That's when you bring it up to your coach or your PT and you actually adjust the plan.
• 28:09
  SPEAKER_00: Now, this is essentially something that you can look at and follow whenever soreness comes up.
• 28:16
  SPEAKER_00: I would say you probably want to bring it up more in the yellow side than the red, but this is something that we want to make sure we get in front of and be proactive about versus something that we are waiting till much, much later and then all of a sudden it becomes a bigger problem.
• 28:30
  SPEAKER_00: So if it's whispering, then if it starts to get a little bit louder, then just let your PT coach know.
• 28:37
  SPEAKER_00: Cause then we can really dial it in and see, okay, is this something worth adjusting or just kind of working through it?
• 28:44
  SPEAKER_00: Because then we can kind of step back and take into context and say, okay, are they closer to surgery than not?
• 28:50
  SPEAKER_00: Are they starting a new block or doing some new movements?
• 28:54
  SPEAKER_00: Did they have some other life circumstances that played into this?
• 28:57
  SPEAKER_00: Is there just certain days where you know their schedule was kind of off?
• 29:01
  SPEAKER_00: So they kind of tried to do Tuesday, Wednesday, Thursday back to back instead of having those recovery days.
• 29:07
  SPEAKER_00: We get to be detective, but we need to have that information from our athletes to know okay, how can we make these adjustments properly to make sure the knee is progressing in the right direction and mostly be proactive in case it is starting to yell at you.
• 29:22
  SPEAKER_00: And so the last thing I want to bring up here, and this is a big one, is in the mid and late stages, the stress on your knee should be going up.
• 29:29
  SPEAKER_00: That is something that's important.
• 29:31
  SPEAKER_00: That's the plan working, right?
• 29:33
  SPEAKER_00: The mistake is how athletes introduce that stress.
• 29:35
  SPEAKER_00: A lot of you come off of maybe a D load or you're excited about a new block.
• 29:40
  SPEAKER_00: I'm sure some of you listening, you're like, yes, new movements, let's hit this hard, you're feeling good.
• 29:45
  SPEAKER_00: And you go zero to a hundred, max effort, RPE 10 in the first session.
• 29:50
  SPEAKER_00: You're like, oops.
• 29:51
  SPEAKER_00: That's a light switch.
• 29:53
  SPEAKER_00: On and off, right?
• 29:55
  SPEAKER_00: There's only zero or a hundred.
• 29:56
  SPEAKER_00: And your knee almost always lets you know it did not like that.
• 30:00
  SPEAKER_00: And most of the time, you guys are like, I shouldn't have done that.
• 30:02
  SPEAKER_00: I should have eased into it.
• 30:04
  SPEAKER_00: And so, what I want you to use instead, as I've shared before, is that dimmer switch.
• 30:08
  SPEAKER_00: You ease into the new demand, the new movement.
• 30:11
  SPEAKER_00: That's exactly what launch week is built for for us.
• 30:14
  SPEAKER_00: That first week.
• 30:15
  SPEAKER_00: It's not a throwaway week, it's a week for your knee to get use and adjust to the new movement and give you honest feedback before you ask it for everything, right?
• 30:24
  SPEAKER_00: The full green, you know, 100 miles per hour go.
• 30:29
  SPEAKER_00: So that's really important in this.
• 30:30
  SPEAKER_00: And I always use the undercook versus overcook analogy.
• 30:34
  SPEAKER_00: I tell all of our athletes, you know, our team communicates this to everyone is like, if you have a steak, would you rather undercook it or overcook it?
• 30:42
  SPEAKER_00: You'd rather undercook it every single time because guess what?
• 30:46
  SPEAKER_00: You could throw it back on the grill, you could do a little bit more.
• 30:48
  SPEAKER_00: Same thing here is that you can always add a little bit more in the next session, but if you overcook it, it's done.
• 30:55
  SPEAKER_00: And if you overcook the knee, it starts yelling at you.
• 30:59
  SPEAKER_00: It's going to be nothing more than just giving Mother Nature some time to be able to allow it to calm down.
• 31:05
  SPEAKER_00: And then you're just going to be pissed at yourself.
• 31:08
  SPEAKER_00: And then you might even be pissed at your PT or your coach or your programming and at the world.
• 31:12
  SPEAKER_00: And the thing is, is that this could have been prevented.
• 31:15
  SPEAKER_00: But the thing is that we have to make sure we have a good framework and approach for this to be able to make sure that we manage this soreness.
• 31:23
  SPEAKER_00: So here's what I want you to walk away with.
• 31:25
  SPEAKER_00: Soreness in the joint during ACEO rehab is normal.
• 31:28
  SPEAKER_00: And it's actually more common as you get further into the process, not less, as some people may say.
• 31:34
  SPEAKER_00: Now you shouldn't be dealing with pain and swelling.
• 31:36
  SPEAKER_00: We're putting those in different categories.
• 31:39
  SPEAKER_00: Soreness is something that you will feel on and off in that joint through this process.
• 31:44
  SPEAKER_00: And a lot of times, people don't really understand this unless they go through it.
• 31:50
  SPEAKER_00: Because joint soreness is something that if you haven't had an ACL reconstruction or a major knee-related issue, then this might not be like something that's familiar with the rehab professional you're working with or someone who has been dealing with this.
• 32:05
  SPEAKER_00: But especially when this knee gets kind of broken down, if you will, after this surgery and having to get rebuilt back up, this soreness can creep in at multiple time points in this because we're rebuilding that floor and bringing that floor up and bringing that ceiling up of your capacity.
• 32:22
  SPEAKER_00: And so this can be super common in this, especially as you go through this.
• 32:27
  SPEAKER_00: Managed well, this is just a part of the process, a few uncomfortable days, it eases up, you make adjustments, and you move into the next block, barely remembering what happened in that situation.
• 32:40
  SPEAKER_00: Managed poorly or ignored, or just trying to force it, stacked on top of more bad days with no recovery, was started as something that was soreness, can actually turn into now we're in the pain, swelling, stiffness category that lingers, and a few rough days that could turn into maybe weeks of regressions, having to kind of take that step back and be in a flare-up.
• 33:04
  SPEAKER_00: And maybe it's also if it doesn't improve a conversation with your surgeon, which we know we don't want to have either.
• 33:10
  SPEAKER_00: So this is something that we just want to make sure we manage well.
• 33:13
  SPEAKER_00: And so the next time you feel it, don't spiral.
• 33:17
  SPEAKER_00: Ask yourself one question.
• 33:19
  SPEAKER_00: Is this whispering or is this yelling?
• 33:22
  SPEAKER_00: That one question will tell you almost everything about what to do next.
• 33:27
  SPEAKER_00: And if you want to actually find out how the actual programming for athletes go, or if you need some help with this, then you can reach out.
• 33:35
  SPEAKER_00: We are here to help.
• 33:37
  SPEAKER_00: That's gonna do it for today.
• 33:38
  SPEAKER_00: This is your host, Robbie Patel, signing off.