Latest / The ACL Athlete Podcast / 168 | The Trade-Off Between Short- and Long-Term Goals in ACL Rehab

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168 | The Trade-Off Between Short- and Long-Term Goals in 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.
• 1:04
  SPEAKER_00: What is up guys, and welcome back to another episode on the ACL Athlete Podcast.
• 1:10
  SPEAKER_00: So today we are talking the trade-off between short and long-term goals in ACL rehab.
• 1:17
  SPEAKER_00: So people are often trying to get back to something after their ACL injury, right?
• 1:23
  SPEAKER_00: Usually very goal-oriented focused humans.
• 1:27
  SPEAKER_00: Often very specific: running half marathons, soccer, skiing, football, rock climbing, MMA, jujitsu, bouldering, dancing, muay thai, crossfit, skateboarding, hiking, travel, snowboarding, playing with their kids, etc.
• 1:44
  SPEAKER_00: There's so many different things people are trying to get back to.
• 1:47
  SPEAKER_00: You think about the activities, sports that exist out there.
• 1:50
  SPEAKER_00: Um, and I didn't even name close to all of them.
• 1:53
  SPEAKER_00: And we've had athletes go through and do all these different sports and activities and certain things that they just want to be getting back to.
• 2:01
  SPEAKER_00: And often it's just multiple.
• 2:03
  SPEAKER_00: Sure, they might set their sights on one particular thing, but there's often multiple things that people are wanting to get back to.
• 2:10
  SPEAKER_00: And it's not uncommon for an ACLer to say, I want to get back to running half marathons, playing pickup soccer, and hiking, or combine any of the earlier goals I had just mentioned, they want to kind of do all the different things.
• 2:23
  SPEAKER_00: When working with our team, it's important to dig into these goals.
• 2:27
  SPEAKER_00: It's huge for us, and why it's important for our athletes.
• 2:31
  SPEAKER_00: Then it's talking priorities and timing of these goals.
• 2:34
  SPEAKER_00: What's short-term focus, what's long-term focus, any time sensitivity to these short or long-term goals.
• 2:42
  SPEAKER_00: This might also lead to a trade-off or quote unquote sacrificing the short term to achieve the long term.
• 2:49
  SPEAKER_00: And that's the big principle or takeaway for today is that trade-off or the sacrifice that you might have to make between the short and long term.
• 2:59
  SPEAKER_00: That's why we have to figure out what's important to you and your top priorities, especially given how long this ACL journey is.
• 3:08
  SPEAKER_00: You might have things that might be coming up soon, travel, wedding, hiking, or maybe it's just walking because you love it.
• 3:15
  SPEAKER_00: It's a form of activity you want to do.
• 3:18
  SPEAKER_00: You get your steps in.
• 3:19
  SPEAKER_00: Um, it helps you to burn some calories, it helps you to stay normal and sane and not lose your mind.
• 3:25
  SPEAKER_00: And that's something that can be quite common.
• 3:27
  SPEAKER_00: But then there's more long-term North Star goals, right?
• 3:30
  SPEAKER_00: The marathons, the soccer, the skiing, jujitsu, all the things, right?
• 3:35
  SPEAKER_00: Whatever it is that you are setting your sight on.
• 3:38
  SPEAKER_00: And typically there is that one thing that you're looking at to get back to doing.
• 3:44
  SPEAKER_00: And the thing about ACL rehab is I'm sure a lot of you have learned at this point is that there is a lot of sacrifice in this process.
• 3:53
  SPEAKER_00: A lot of sacrifice.
• 3:54
  SPEAKER_00: You think about your daily life initially, how much sacrifice you have to give there, your social life, your even work life, right?
• 4:02
  SPEAKER_00: Especially if there is more of a being present in a physical workspace, or maybe at school, being in college or high school, middle school.
• 4:12
  SPEAKER_00: Those are things to factor in, as I mentioned, social life, doing rehab instead of something more exciting, right?
• 4:19
  SPEAKER_00: No one is choosing to be in rehab.
• 4:21
  SPEAKER_00: It's just a byproduct of what needs to happen after this injury occurs and after the surgery happens.
• 4:27
  SPEAKER_00: So that is something that you have to sacrifice time and energy and effort to do the thing versus something else you might want to do, right?
• 4:36
  SPEAKER_00: It's a trade-off.
• 4:38
  SPEAKER_00: And the same thing happens with goals.
• 4:40
  SPEAKER_00: And sometimes you might have to sacrifice the short term for the long-term goal.
• 4:45
  SPEAKER_00: So let me explain, and I want to roll through some examples here to help anchor this down.
• 4:51
  SPEAKER_00: You might be dying to walk to accumulate steps.
• 4:55
  SPEAKER_00: As I mentioned, maybe you're that person that just wants to get some walking in.
• 4:59
  SPEAKER_00: That is something that helps you for your brain space to relieve some stress, some activity.
• 5:04
  SPEAKER_00: Um maybe you have kids you want to take on a walk, maybe it's something you do with your wife or husband, a partner, or maybe it's just a thing you do, right?
• 5:11
  SPEAKER_00: You have live in an awesome area and you just want to walk around.
• 5:15
  SPEAKER_00: But you also want to start running soon.
• 5:18
  SPEAKER_00: This can play against you because ramping up walking too much too quickly can cause the knee to swell and get grumpy and painful.
• 5:26
  SPEAKER_00: Um, I know many of you have probably experienced this, and it's something that we can see often actually.
• 5:32
  SPEAKER_00: People get the green light to start walking, and there's no parameters around it, then they just start walking, right?
• 5:38
  SPEAKER_00: Especially if that was a form of activity, then they add up the steps, and then all of a sudden the knee gets super grumpy and irritated and swollen.
• 5:48
  SPEAKER_00: And so this can further delay that other goal that you were aiming for, running.
• 5:52
  SPEAKER_00: So you might have to dial back the steps, work on more strengthening, because honestly, in the early phases of ACL rehab, that should be the main focus, especially if running is more important.
• 6:04
  SPEAKER_00: So this is that short-term versus long-term sacrifice.
• 6:08
  SPEAKER_00: You're giving up some of the steps initially in order to get yourself in a better place in order to run.
• 6:14
  SPEAKER_00: Because in this case, running might be something that is more important for you.
• 6:19
  SPEAKER_00: But in order to essentially accomplish both, you might have to give up the walking or the amount of walking, if you will, to be able to achieve the later goal of running.
• 6:29
  SPEAKER_00: And then eventually, because of the demands of both of those things, you might be okay to be doing both, right?
• 6:34
  SPEAKER_00: Since you have to walk in order to run.
• 6:37
  SPEAKER_00: And running, you'll accumulate a certain amount of steps.
• 6:40
  SPEAKER_00: As you get further away from your surgery, you should be in a good place to hopefully tackle both.
• 6:45
  SPEAKER_00: But this is in that short certain window of time, you have to give the short versus long-term trade-off a thought.
• 6:53
  SPEAKER_00: Example number two, you want to run a half marathon, but you also want to play soccer.
• 6:57
  SPEAKER_00: The race and the pickup league is at the same time.
• 7:01
  SPEAKER_00: You can't do both because your rehab and your training would need to be very different given the demands of it.
• 7:08
  SPEAKER_00: If you're doing a half versus pickup soccer with your friends, they're very different paths, if you will, where you need to have particular training, especially to build up to a half marathon, and you need particular training to build back up to the demands of soccer and gameplay.
• 7:24
  SPEAKER_00: In this case, you would need to decide what's your number one and put your training focus on that.
• 7:31
  SPEAKER_00: Doesn't mean you can't get to doing both, right?
• 7:34
  SPEAKER_00: But realistically, especially because of the sensitivity of the knee, balancing the programming, your life, and all the things, you can't just go off and train for a marathon and play soccer because you're trying to get this knee back to a certain threshold to do all the things, but it's not just going to adapt automatically because you just had surgery and you have a new ACL in there, or maybe you're non-operative, whatever that may be the case, it's gonna take some time.
• 8:01
  SPEAKER_00: But you can't chase two rabbits at the same time because you won't catch either one of them.
• 8:06
  SPEAKER_00: That's uh a quote, I don't know who it's by at the current moment, but this is something that's quite common.
• 8:12
  SPEAKER_00: Think about chasing two rabbits, you can't really catch either one, and that's typically a thing we try to do when we go after too many things.
• 8:20
  SPEAKER_00: We are usually not good at any of the things.
• 8:23
  SPEAKER_00: And that's what can often happen.
• 8:25
  SPEAKER_00: So it might be sacrificing the number two thing so you can do the number one thing.
• 8:30
  SPEAKER_00: For this athlete, it could be the half marathon being the number one thing and waiting on soccer.
• 8:34
  SPEAKER_00: That's totally fine.
• 8:36
  SPEAKER_00: Or maybe it's the other way around.
• 8:38
  SPEAKER_00: You are trying to uh get back to soccer and you're gonna trade off running for the half marathon and training for that so you can get back to soccer.
• 8:46
  SPEAKER_00: Only you can decide that.
• 8:48
  SPEAKER_00: Number three example here is you want to go on this short hike coming up, knowing it'll likely flare up the knee with where you're currently at, but you have this big hike trip coming up and planned in about three months, let's say.
• 9:02
  SPEAKER_00: Something you've spent money on, something you've spent a lot of time planning, big priority for you.
• 9:08
  SPEAKER_00: This might be a trade-off of passing on the short hike, given the context of where you are, and knowing you're working towards something that is very important to you long term.
• 9:18
  SPEAKER_00: And this is something that could be tough, right?
• 9:21
  SPEAKER_00: Because we are humans, we like instant gratification, if you will.
• 9:26
  SPEAKER_00: It's hard to sometimes play the long game or see the long term.
• 9:30
  SPEAKER_00: Sure, we're determined by it, but it seems so far away that whatever we do in the short term won't necessarily impact that long term.
• 9:39
  SPEAKER_00: And it just kind of depends, right?
• 9:41
  SPEAKER_00: It depends on what it is, how connected are the two, how much sensitivity or bandwidth that you have, how much time do you have in between those two things, but they are typically going to influence each other to some degree, especially if it's in a shorter time span, right?
• 9:56
  SPEAKER_00: And so this is something to consider.
• 9:58
  SPEAKER_00: The other thing to consider is if they are two conflicting type things to get back to, and they're within a similar period of time as well.
• 10:05
  SPEAKER_00: So that's another thing to factor in.
• 10:08
  SPEAKER_00: The underlying principle here is it might just be as simple as saying, I'm not going to do this thing that's coming up soon because I want to do something later that means way more to me, that long-term goal.
• 10:21
  SPEAKER_00: And this short-term thing will take away or even set me back if I do.
• 10:26
  SPEAKER_00: That's the underlying principle.
• 10:27
  SPEAKER_00: We are trying to prioritize the number one and avoid the number two.
• 10:32
  SPEAKER_00: Not saying you have to, but there are situations like this in ACL rehab where we got to avoid this short-term thing because this long-term thing really is the main thing that's important to you.
• 10:44
  SPEAKER_00: Huge priority.
• 10:45
  SPEAKER_00: And you know what?
• 10:46
  SPEAKER_00: Sometimes you might say, screw it, I'm just gonna do it.
• 10:50
  SPEAKER_00: I know I'm gonna pay for it.
• 10:52
  SPEAKER_00: And you need to do it because your brain needs it.
• 10:54
  SPEAKER_00: You need that win.
• 10:55
  SPEAKER_00: And I get it.
• 10:56
  SPEAKER_00: Trust me.
• 10:57
  SPEAKER_00: Trust me.
• 10:58
  SPEAKER_00: I did those things when I had my ACL rehab and I did pay for it.
• 11:02
  SPEAKER_00: And this is where having a good coach with you to support you, to guide you in this process is really key to understand risk reward of the situation.
• 11:12
  SPEAKER_00: And often it's just choosing what's most important and knowing you are playing the long game here.
• 11:17
  SPEAKER_00: That is what is so important.
• 11:19
  SPEAKER_00: The short-term goal might feel good in that moment when you do it, but if it takes away from getting to the number one goal or that long-term goal, then it might be worth considering if it's worth it with that number two or the short-term goal that you're aiming for.
• 11:33
  SPEAKER_00: This doesn't just apply, as you guys know, to ACL rehab, it applies to life, just like most things in ACL rehab do, lots of overlap.
• 11:41
  SPEAKER_00: And you come away from this typically uh a little bit more informed about yourself, a little bit more informed about some things you have to work through that are pretty hard.
• 11:51
  SPEAKER_00: Um, I know that through my two ACL surgeries, that was super beneficial for me to just learn some things, especially being in high school.
• 11:59
  SPEAKER_00: You know, we think that it's the end of the world, and it does suck, but I promise you there are other things in life that will come along, and this will help build some resilience with that.
• 12:08
  SPEAKER_00: So, this is where you do have to lay things out and decide risk reward, as I had mentioned, and choosing the short versus long-term goals in some circumstances.
• 12:19
  SPEAKER_00: And I'm not saying all circumstances, and those factors that I mentioned earlier, the timing, what they are, how much that your knee is sensitive to those things or your body.
• 12:29
  SPEAKER_00: Um, do you have more time in your schedule to squeeze things out and build around it?
• 12:35
  SPEAKER_00: Those are all things that factor in.
• 12:38
  SPEAKER_00: But I don't want you to take this episode and think, all right, I can only pick one or the other, right?
• 12:43
  SPEAKER_00: This is where you just have to understand some of those factors that play into it and then have to make that decision because there are situations where you will have to give up the short term for the long term.
• 12:56
  SPEAKER_00: And that's just because that long term is what's most important.
• 13:00
  SPEAKER_00: But it is sacrificing something in that short term because that long term is just the thing that you really, really care about, and you know that short-term thing is gonna take away from it.
• 13:10
  SPEAKER_00: If it doesn't, then do the short term and the long-term thing, right?
• 13:14
  SPEAKER_00: If you've got something coming up in a month that is a hike, for example, and then nine months from now you're going to play soccer.
• 13:21
  SPEAKER_00: Well, cool.
• 13:21
  SPEAKER_00: Like that's not really gonna conflict with each other.
• 13:24
  SPEAKER_00: Or maybe you have travel coming up in three months and you want to go walk around a city and you're also trying to run a marathon or do jujitsu in six months, you're probably all right.
• 13:35
  SPEAKER_00: But with that said, you have to kind of factor those pieces in because we don't sometimes think of the cumulative effect of what we do in the short term can impact the long term.
• 13:44
  SPEAKER_00: So that's why I wanted to come on today to talk about this and understand that having this dilemma or working through it is normal.
• 13:52
  SPEAKER_00: It doesn't make it easy, but it is normal in ACL rehab.
• 13:56
  SPEAKER_00: And it's conversations we have with our ACLers all the time because you know it's long, right?
• 14:00
  SPEAKER_00: We're looking at nine to 12 months at a minimum.
• 14:03
  SPEAKER_00: There are things you want to get back to, of course, at the end of that typically.
• 14:07
  SPEAKER_00: And there are things that you want to do within that.
• 14:09
  SPEAKER_00: You want to start doing things probably a month in, two months in.
• 14:12
  SPEAKER_00: Um, you've got life things that exist, maybe other activities that might um not need the knee or the ACL as much, and you can get by with it, right?
• 14:21
  SPEAKER_00: And that's where just being able to sit down and know, all right, what is it that I'm gonna be okay with in that short term and it's not gonna set me back versus something that could set you back, especially for the long term, and especially if it is something time sensitive, right?
• 14:37
  SPEAKER_00: And we have this conversation with our athletes all the time to make sure that there's no conflicts there.
• 14:42
  SPEAKER_00: Or if they do decide to take part in both, they know the risk reward of what it is, and potentially that could quote unquote set them back or just kind of delay the process or the route in which we have to get there.
• 14:54
  SPEAKER_00: But as long as that expectation is there and it's been communicated, that's totally fine, right?
• 14:59
  SPEAKER_00: And you just have to know that trade-off, and you just have to know if you're going after the main thing to keep that the main thing.
• 15:07
  SPEAKER_00: That is what is really important here, and making sure that the short term doesn't get in the way of it and that you are trying to play the long game here.
• 15:16
  SPEAKER_00: So I hope that this is helpful for anybody who is listening, that is trying to work through some different goals and just be able to do some things in the short term and the long term.
• 15:26
  SPEAKER_00: And ideally, in your situation, you can do both, but you are gonna face some situations where you gotta decide on one or the other and what is most important, especially based on the priorities of what's number one, number two, maybe even number three, and so on.
• 15:42
  SPEAKER_00: Appreciate all of you guys for listening to this podcast, for supporting me, supporting the team and the ACL athlete.
• 15:51
  SPEAKER_00: Until next time, this is your host, Ravi Patel, signing off, and then you're gonna be able to get it.