Episode 168 | The Trade-Off Between Short- and Long-Term Goals in ACL Rehab

What is up guys and welcome back to another episode on the ACL Athlete Podcast. Today, we are talking about the trade-off between short and long-term goals in ACL rehab. People are often trying to get back to something after their ACL injury, usually very goal-oriented, focused humans, 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. 

There’s so many different things people are trying to get back to. You think about the activities and sports that exist out there, and I didn’t even name close to all of them. And we’ve had athletes who go through and do all these different sports and activities and certain things that they just want to be getting back to. And often it’s just multiple. Sure, they might set their sights on one particular thing, but there are often multiple things that people want to get back to. It’s not uncommon for an ACL or 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. 

When working with our team, it’s important to dig into these goals. It’s huge for us and why it’s important for our athletes. Then, it’s talking priorities and timing of these goals. What’s a short-term focus, what’s a long-term focus, any time sensitivity to these short or long-term goals. This might also lead to a trade-off or “sacrificing” the short term to achieve the long term. 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. 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. 

You might have things that might be coming up soon, travel, wedding, hiking, or maybe it’s just walking because you love it. It’s a form of activity you want to do. You get your steps in. It helps you to burn some calories. It helps you to stay normal and sane and not lose your mind. And that’s something that can be quite common, but then there’s more long-term, north star goals. That marathons, the soccer, the skiing, jujitsu, all the things, right? Whatever it is that you are setting your sight on. And typically there is that one thing that you’re looking at to get back to doing. 

The thing about ACL rehab, as I’m sure a lot of you have learned at this point is that there is a lot of sacrifice in this process, a lot of sacrifice. You think about your daily life initially, how much sacrifice you have to give there, your social life, your even work life, 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. Those are things to factor in. As I mentioned, social life, doing rehab, instead of something more exciting. No one is choosing to be in rehab. It’s just a by-product of what needs to happen after this injury occurs after the surgery happens. 

So that is something that you have to sacrifice time, energy and effort to do the thing versus something else you might want to do. It’s a trade-off. The same thing happens with goals. Sometimes you might have to sacrifice the short-term for the long-term goal. Let me explain, and I want to roll through some examples here to help anchor this down. 

You might be dying to walk to accumulate steps. As I had mentioned, maybe that person just wants to get some walking in, that is something that helps you for your brain space, to release some stress, some activity, and 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 the thing you do. You live in an awesome area and you just want to walk around. But, you also want to start running soon. This can play against you because ramping up walking too much, too quickly, can cause the knee to swell and get grumpy and painful. I know many of you have probably experienced this. There’s something that we can see often actually people get the green light to start walking and there’s no parameters around it, then they just start walking, especially if that is 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. This can further delay the other goal that you were aiming for—running. You might have to dial back the steps and 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. 

This is that short-term versus long-term sacrifice. You’re giving up some of the steps initially to get yourself in a better place to run. Because in this case, running might be more important for you. 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. And then eventually because of the demands of both of those things, you might be okay to be doing both. Since you have to walk in order to run and running accumulate a certain amount of steps as you get further away from your surgery. You should be in a good place to hopefully tackle both. But this is in that short window of time, you have to give the short versus long-term trade-off a thought. 

Example number two, you want to run a half marathon, but you also want to play soccer. The race and the pickup league are at the same time. You can’t do both because your rehab and your training would need to be very different given the demands of it. 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. In this case, you would need to decide what’s your number one and put your training focus on that. That doesn’t mean you can’t get to do both.

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 going to take some time. But you can’t chase two rabbits at the same time because “you won’t catch either one of them.” That’s a quote, I don’t know who it’s by at the current moment. But this is something that’s quite common, 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. We are usually not good at any of the things and that’s what can often happen. It might be sacrificing the number two things so you could do the number one thing. For this athlete, it could be the half marathon being the number one thing and waiting on soccer. That’s totally fine. Or maybe it’s the other way around. You are trying to get back to soccer and you’re going to trade off running for the half marathon and training for that so you can get back to soccer; only you can decide that. 

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 something you’ve spent money on, something you’ve spent a lot of time planning, a big priority for you. This might be a trade-off of passing on this short hike, given the context of where you are and knowing you’re working towards something that is very important to you. Long-term. And this is something that can be tough, right? Because we are humans, we like instant gratification, if you will. It’s hard to sometimes play the long game or see the long-term. 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. And it just depends, 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. This is something to consider. The other thing to consider is if there are two conflicting types of things to get back to, and they’re within a similar period of time as well. So that’s another thing to factor in. 

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 goals and short-term things will take away or even set me back if I do. That’s the underlying principle. We are trying to prioritize the number one and avoid the number two. 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—huge priority. 

Sometimes you might say, screw it. I’m just going to do it. I know I’m going to pay for it and you’d need to do it because your brain needs it. You need that win. And I get it. Trust me, I did those things when I had my ACL rehab and I did pay for it. This is where having a good coach with you to support you, to guide you in this process is key to understand the risks/rewards of the situation. And often it’s just choosing what’s most important and knowing you’re playing the long game here, that is what is so important. 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. 

This doesn’t just apply as you guys know to ACL rehab, it applies to life, just like most things in ACL rehab do with lots of overlap. You come away from this typically a little bit more informed about yourself, a little bit more informed about some things you have to work through that are pretty hard. I know that through my two ACL surgeries, that was super beneficial for me to just learn some things, especially being in high school. 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.

This is where you do have to lay things out and decide risk/reward, as I had mentioned, and choose the short versus long-term goals in some circumstances. I’m not saying all circumstances and those factors that I mentioned earlier, the timing, what they are, how much your knee is sensitive to those things or your body. Do you have more time in your schedule to squeeze things out and build around it? Those are all things that factor in. But I don’t want you to take this episode and think, all right, I can only pick one or the other. 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. And that’s just because the long term is what’s most important. But it is sacrificing something in the short term because that long term is just the thing that you really care about. And you know that short-term thing is going to take away from it. If it doesn’t, then do the short-term and the long-term thing, right? 

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. That’s not going to conflict with each other, or maybe you have travel coming up in three months and you want to go walk around the city and you’re also trying to run a marathon or do jiu-jitsu in six months, you’re probably all right. But with that said, you have to 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. 

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. It doesn’t make it easy. But it is normal in ACL rehab and the conversations we have with our ACLers all the time because it’s long. We’re looking at 9 to 12 months at a minimum. There are things you want to get back to, of course, at the end of that, typically, and there are things that you want to do within that. You want to start doing things probably a month in, two months in. You’ve got life things that exist, maybe other activities that might not need the knee or the ACL as much, and you can get by with it. And that’s where just being able to sit down and know, all right, what is it that I’m going to be okay within that short term? And it’s not going to set me back versus something that could set you back, especially for the long term and especially if it is something time-sensitive. 

We have this conversation with our athletes all the time to make sure that there’s no conflicts there. Or if they do decide to take part in both, they know the risk/ reward of what it is, and potentially that could “set” them back or just kind of delay the process or the route in which we have to get there. But as long as that expectation is there and has been communicated, that’s totally fine. 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. That is what is 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. 

I hope that this is helpful for anybody who is listening and who is trying to work through some different goals and just be able to do some things in the short term and the long term. Ideally in your situation, you can do both, but you are going to face some situations where you have to 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. 

Appreciate all of you guys for listening to this podcast, for supporting me, supporting the team, and the ACL athletes. Until next time, this is your host, Ravi Patel, signing off.