Episode 143 | Choosing What’s Available vs. What’s Needed in Your ACL Rehab

What is up team? Jumping straight into it today. At this point, 143 episodes in counting, posting every single week for almost three years. I hope I’ve earned the ability to just shoot it to you straight, which is what I’m going to do today. And if you are new, go and listen to other episodes, then come back if you don’t like my vibe today.

But today is a full transparency and honesty episode because I care about you guys. I care about this space of ACL rehab and this whole process. And we have a huge problem and I’m here to make that aware and most importantly, provide solutions to all of you who are listening. 

There has been an increasing number of conversations around ACLers feeling like they’re getting bad care, like very obvious bad care, but don’t want to switch providers or practices. Why? Honestly, most of the time it’s because it’s available and it’s convenient. And I’m just going to shoot it to you straight this episode. Just because this is what I think is really needed right now, based on a lot of these conversations that I’m having. But honestly, I think a lot of times it’s just choosing what’s available and what’s convenient for you.

People have insurance or are in socialized medicine. It’s a part of the system. They allow that to provide for them versus finding the best solution for their own situation and problem which I totally get, don’t get me wrong. It’s something that you want to utilize something that you’ve been given. The system that’s been provided, hopefully provides the solution for what you want. But with that said, that can also lead to some problems because you are left to their control. You’re left to what it provides for you and what’s going to be convenient within that ecosystem versus figuring out what is best for you. 

The other option here is for people can go private or seek other options, but those have their costs, right? It’s inconvenient as well. You have to find someone else that might not be in your network. It’s something that might not be close to you. A lot of people will choose a physical therapy clinic or physio that’s close to them. It makes sense. It’s convenient for your schedule, it might be on the way home or it might be on campus. It’s just something that is convenient and I get it. There is a time cost to what you do. 

But with that said, it’s something that if you have to seek out better care, you’re going to have to go out of your way a little bit in order for you to be able to get what is best. And that’s not choosing what’s convenient. And this is out of network or private or other options, not only is it inconvenient, but it could be also different. 

For example, maybe the mode of delivery has to be done remotely. Many people think that that’s impossible with ACL rehab and return to sports training, but we have been doing it for years with hundreds of ACLers having incredible results. It’s something that also might be a little different than what you’re used to. And that’s just adapting to the times. I get that change is hard. People don’t want to do the hard thing of searching out something else, especially the local changes or even the remote changes, because that could just add an extra layer of complexity and it’s just change.

What happens with this same group of people is that they are hoping that things will just improve or change over time. Maybe they’ll turn a corner or maybe they’re just in this weird phase with their physical therapist or their training. They’ll eventually get there, the guidance and maybe they’ll unleash a little bit more as time goes on. Or maybe it’s just something where it’s good enough for right now and you’ll deal with it later because that might seem like a lot for the current time being. And I get all this. 

But these are the reasons a lot of times people will — whether they want to think about it or not, are the reasons why they don’t necessarily want to switch providers or practices regardless of if they know in their internal gut they’re having bad care. But then people tell me about their experiences so far. They’ll say that they barely talk with their actual physical therapist. The physical therapist has multiple patients at one time. And while this isn’t always terrible if the setting is set up appropriately.

But in the majority of cases because of our insurance system and the way that this is, the majority of the time it takes away from what you need. Unless you have this very skilled-sports-related type clinic that is developed and built into a model that can supplement and support these multiple patients. Most of the time, it’s just deterring from what you really need because we’re just trying to fit in the most number of people within the hour so we can make the clinic money. That’s really in reality what happens. 

And I’m being fully out there with this episode, guys, because in all honesty, it just pisses me off whenever I have this conversation with people. And they know it’s bad care. They know that it’s not serving them well. I’ve been one of those people, and I don’t want you to fall into these cracks, and then later in three months, six months, one year, two years, you’ll be like, man, I should have just done something different. This is your wake-up call today to be able to really vet yourself to reflect internally and to be able to see: am I just taking the comfortable way or am I actually choosing what is going to get me the best outcome? 

This is something that I want to continue to build on with people and their experience. They’ll continue to say, okay, well, exercises haven’t been updated in the clinic or especially when they’re at home. They might go to PT, two or three times a week, but then they either have this laundry list of exercises with no rhyme or reason, or they are not doing anything at home.

You think about the time you spend at PT, it might be two to three hours maximum. Think about the time outside of that and the amount of time you need to dedicate to this process. It’s not just going to be something where you can get by with two hours a week. If you want to do that, then it’s not necessarily going to connect with your goals and what you’re trying to do. This is something that needs to be fulfilled in the clinic, but then also outside of the clinic. 

The other things they’ll say is following a protocol, and using time as a guide to the process. No testing is available. If they say they test, they might say, Oh, here’s an MMT or a manual muscle test where you kick into someone’s hand to “test” your quad strength when it’s really just knowing you can kick into a hand, that’s really it. And then maybe there’s a hop test involved. The clinic has weights that only go up to 30 pounds. This is something that’s kind of a red flag for their experience so far. You don’t really know your direction, you don’t know your goals, you don’t know your targets of what you’re working towards. You’re just given exercises and then you’re just left to just do the thing. You don’t really know what you’re aiming at. And there’s no clarity on the roadmap. What does this timeline look like? What does the next short-term goal look like? The long-term goal? What are these different pieces that play into your ACL rehab process that are specific to you? All of these and all transparency are red flags with any physical therapist. If they’re saying all of these things, even a portion of these things, really just one or two of these things that I have listed, this is usually a red flag.

And no matter how much you want to be hopeful that this thing is going to improve, it’s likely not. And I think this is the thing to get across in this podcast episode. We’re hoping that things will change or maybe think it’s good enough for right now, but then there’s an opportunity cost to that.

And the hardest thing about this process in ACL rehab is you don’t know what you don’t know. And I promise you, I know a lot about this process after two ACL injuries and reconstructions myself and walking hundreds of athletes through this process now. I do know what is on the other side of this. And so this is something that I want to make sure you guys can feel and know through this podcast episode. As you can tell, I’m really fired up because this is something that I get all the time I’m like, you just got to get out of your own way. And if you do, you can make those changes. And this is something that I know is really tough. Many people will assume that this is what all physical therapy and rehab is, or what ACL rehab should look like. No one expects you to know that any different, and that’s okay. I’m here to say like, you shouldn’t take the blame for this or the fault for this. But the thing is, is that you do have to know when it is something that doesn’t seem like it’s adding up. And usually, your gut is the thing that’s telling you something doesn’t feel right. This is the gut test that we talk about. This is something where you feel like there are some red flags or you’re just feeling like this doesn’t seem right for what I should be getting. And your gut’s telling you this thing, listen to that. And when you know better, you do better. You owe that to yourself as a human, as someone who deserves really good care. And this is something that is very important in this process. 

Let me give you this example. Imagine a parent sending their kid to school down the road, and so they’re there, over a little bit of time. You start getting feedback that the teachers are not great from your kid. The kid looks like they’ve stalled in their learning. And you recognize it’s not your kid, it’s the school and the teacher. What would you do? If this was your kid right in front of you, what would you do if you felt like your kid was stalling and you started to realize, wow, the work that they’re giving them when they come home, the homework isn’t really productive. It’s not very helpful. And then when you ask them what they learned at school, they’re just like, yeah, we did the same thing we’ve been doing for the past few weeks. How would you act in that? What is that situation that you would do? I know if this was my kid and were expecting a kid on the way. I would 100 percent be going to that school, trying to figure out what it is that they are not doing, and then I would be finding another place to make sure my kid is very much in the right place for where they are at.

And this goes for also vetting the place that they’re going to. So that should have been on me to check in and look at their reviews, be able to vet the process and look at how their outcomes are. That is stuff that we need to do for anything that we want to invest in, whether it’s our kids, whether it’s our health, whether it’s in our own personal things that we want to develop and grow in as humans. These are things that we want to vet. And look, I get factors play into this. Sure, not everyone has the luxury to just change due to a number of factors. People have certain financial situations, time limitations, where they live, geography, what is local to them, and the way that people practice and philosophy matters a lot. So many factors that can contribute to this possibly not changing. And I get that. Don’t get me wrong here and I want to be fully open and understanding that not anyone can just jump on a whim because there’s so many different factors playing into this. But let’s say you are a person listening to this and you’re in a position to possibly do that, or even just explore options, go and do that. 

And I’m going to give you guys another example here of how ridiculous sometimes our human, just natural tendencies can get in our way. I had a call from a guy who talked about these exact problems, the things that he was listing. Man, you’re talking about he is just absolutely obsessed with this goal of getting back to playing soccer and he just felt really stuck. He was just like, man, I just don’t think what I’m doing right now with my rehab is really good. He really believed in what we were doing and was really wanting to work with us for remote coaching. He said he wasn’t in a position given his finances. He was a college grad student. I completely understood that. I had a 10k out-of-pocket max as a senior in college for my second ACL surgery. Don’t get me started on debt for ACL rehab. So I understand debt. I had to put down $2,500 with my brother to schedule my surgery. I do get that there are financial things that happen and this is not to even add to my undergrad and grad school debts. But I am a no-pressure-type person. I don’t ever want people to feel like they need to sign up or anything like that. If you ever talk to us, that is something that we never do. We always want to make sure people feel well-informed in their decisions and feel committed and want to work with us. 

What’s interesting was that at the end he said, well, I could just not get the new iPhone that just released. I was curious and asked why he wanted it, thinking he might have broken his or didn’t have a good one. He said that he had the 13 and the 15 just dropped and wanted it. So there were no problems with it. I just found this interesting of the cognitive dissonance and I get this is someone that’s a very particular example. But this is something that I’ll get actually more often than you think of is just a matter of people and where they want to shift their priorities and might also do a number of things to get in the way of avoiding any changes. I think a big part of this is priorities, the change, and embracing the heart of doing something new and different that would help them solve this problem. 

I have one question to ask you: if your best friend or loved one is in your position, they are struggling with their ACL rehab, they’re not getting served very well, and they are in this feeling of choosing what’s available and convenient. versus what is needed. They’re feeling that loss, mental health is suffering, and they just want clarity and direction on their next steps and also feeling like they have a plan to move forward. What would you tell them to do? Would you tell them to stay in their current physical therapy situation or with a provider? Or would you tell them to find another option? Pause on that answer for just a second. That’s your answer. Go, do it, make moves. Don’t leave it to chance. I promise you if you find a provider who cares, who is an ACL expert, who makes your gut go this is the right person and I trust them in three months, in six months, you’ll say I should have done that much sooner. I’ve had hundreds of messages from people literally tell me this.

So what are you waiting for? Go and do the damn thing, seriously. Don’t do what’s convenient or what’s available, do what’s needed for you to give the best care and the best support for you on this ACL journey, seriously. And if this is you and you go and do it, please send me a message. I would love to hear about it. 

But this is something that has been near and dear to my heart recently talking to other ACLers. They’re just not getting served what they deserve and being able to get back to the thing they want to do. Then I’ll get messages where they’re dealing with mental health issues where they are not able to even do the daily things right and being able to just do the things that give them joy and happiness and that really hits me really hard. Because that’s something that I had dealt with and something that I have worked with other ACLers dealing with this exact same thing.

And the way that we end this is by being able to choose not what’s available, but choosing what is right for your situation, what’s needed. And so this is the guidance that I want you to leave with this podcast episode. If you guys have any questions at all, you know where to find me. This is your host, Ravi Patel, signing off.