Episode 177 | Managing Unexpected Challenges in ACL Rehab Using The Reverse Clause

What is up team? Of course, as I literally started this recording, my neighbor decides to start mowing their lawn. If you can hear that, I’m sorry, but this is right on par for the podcast, especially in the early days when I was recording and all the noises were happening outside. Any of you have been with me from the earlier days, this just feels nostalgic so we’re going to roll with it. 

Today, we are diving into, I believe what is episode 177—we’ve been at this up for 177 weeks straight, coming to you with all the ACL rehab things. You guys are probably like, how can this guy keep talking about ACL’s nonstop—but we’re here. Today’s episode is going to be focused on managing unexpected challenges in ACL rehab using the reverse clause. I know that seems like a little bit of a mouthful, but this is something that basically unexpected challenges do come up. We got to navigate those through the ACL rehab process. And we are going to talk about this concept called the ‘reverse clause’ that is used by the Stoics. That is going to be helpful to you guys, especially as this is basically a mindset type of episode. For those of you who are like, no, my mindset is great in this ACL rehab process, take a second and listen to it. This is something that we can never be, to a certain point with our mindset, if you will, we’re always working on it. And this ACL rehab process will continue to test you with this.

If you’re in the earlier stages and you’re riding pretty right now because you’re making your flexion gains, you are through the surgical process and you’re feeling good. There could be some things coming up that you don’t know that it’s going to come up that I think, maybe this episode isn’t as timely for that. But it’s definitely going to be timely for when that thing does happen. And guess what it’s going to happen. And for those of you listening, you probably already dealt with something that has already happened in this process. And so what I mean by this is the unexpected challenges. This is something that I think is so key in this process. And going along the lines of framing expectations for your ACL rehab for this journey, it might be the most important part of it. It’s long. It’s hard. We might assume it’s a straightforward process. Maybe that we won’t be that person that has the setback or the problem because you’re so dialed in and we think it’ll be completely linear. And usually you’re entering it, not well-informed and it’s not by your own fault, it’s just something that’s brand new for you. 

You rely on other resources, whether it’s just your orthopedic surgeon, maybe it’s a PT, your athletic trainer, coaches, any person that is a part of your team. Friends and family, it might be cousin Greg, who did it 10 years ago, or maybe it’s a forum. Be careful of that. But maybe it is also this podcast like I’ve talked about this and you’ve listened and you know that this is something that could be in the horizon. But that’s where you’re gaining all of your information about this process. Some people come into this very uneducated in a sense because they’re just going along with what the process is, or they are the type A may be that is doing their homework and they’re getting prepared for it. 

And then there’s of course, the reactive people that is just like, well, I didn’t know that this was going to be so hard. Or I didn’t know that the healthcare system wasn’t necessarily going to set me up for complete success. Now I’m looking external to that because my insurance or the health care system isn’t necessarily designed to take me from this injury to potentially surgery, to getting me back to being the way that I was before. And honestly, even better than that, feeling like an athlete, feeling like yourself, being able to use your body. And that is something that you want to get back to, but you’re just not aware of. And you’re starting to realize it as you’re going through this process, that what you have might not connect the dots of getting you back to what you want to do. 

This is what I want to talk about today’s episode and this topic, because it’s a very helpful concept from a mindset and an expectation standpoint, and navigating any type of unexpected challenges. No one really knows about this process unless they grow through it. And that’s your firsthand experience of it and even the first, second and  third—may be different. And I hate to say third but it happens. We worked with ACLers who have done it three times, four times. It sucks. You can’t even imagine doing this a second time as you’re someone who’s done at once because of this process—but think about it three or four times. We don’t want to leave that up to chance. With that said, even though you’ve had multiple experiences, it could be different experience to experience.

My first ACL to my second ACL was very different in terms of the stage of life I was in, even the recovery process of it, the way the knee just kind of healed and responded to the rehab and to just as time went on. This is something that is interesting. It gives you that perspective, but it’s not going to capture everyone’s experiences. And maybe you are someone who works with this population from start to finish, then therefore you do get the value of being able to pull from a lot of volume and the quality of outcomes that you potentially get as well. But as we know, it can come with a lot of curve balls, a lot of unexpected challenges. Let’s talk about this idea of the reverse clause in relationship to managing unexpected challenges in ACL rehab and see how this all connects. 

What is the reverse clause? Comes from stoic philosophy, as I mentioned earlier. So thinking of people like Marcus Aurelius, Seneca, Epictetus, I always say his name weird. Ryan Holliday is a writer. He is an incredible author who has popularized a lot of the stoic philosophy, pulling this ancient history of just writings, if you will, and just created it into basically a way of living in a sense. It’s these principles that these stoic philosophers had pulled from in terms of the way they live life, handling chaos and challenges, creating just like a very ethical life, if you will. This is something that a lot of this writing that Ryan has done has pulled from these people, to make it more practical to humans today. It’s really cool. They have something called the ‘Daily Stoic’ and there’s even some called the ‘Daily Dad,’ which is for parenting. I have read both books or I’m reading technically currently the daily dad and it’s amazing. It’s just these daily principles that you can apply with these stories of, yeah, these stoic philosophers. Bt then also very important people and different stories that you probably never heard of, but it relates to these things that can make you essentially a better person. 

What is the reverse clause? A means of reminding ourselves that our actions and goals may not always go to plan. In other words, although we may try our best, the outcome is, at least to some extent, subject to fate. Now that sounds a little bit out there, but people use this all the time. You’ve heard this thing as I’m going to go do this thing, whether permitting or Lord willing, God-willing, fate willing. There’s things that you kind of tag along at the end. I’m going to do this thing, something permitting. And so the stoics we’ll use this in an example of like, I will be able to accomplish this task weather permitting. Hopefully that all makes sense. We say in one way or another as a safeguard in some certain circumstances. This reminder serves to diminish the pain of disappointment if something does go wrong. It allows us to cope with especially any negative emotions and fight with get with this, the perfection and the linear expectations we can sometimes have for ourselves and for our outcomes. 

Another way to think about this is I’m hoping to get back to running—biology permitting or knee permitting. You’re going to do all your things, but it’s also something related to the healing process that you can’t necessarily control all the way. And so this is something that you want to just kind of keep in stride as you are going through this process, knowing that there are some things that are in your control, for sure, do those things you can control and the things that you can’t control, don’t get so attached to those. This allows us to not get as overwhelmed with things we have no control over. Having a reverse clause is a way to practice just this right. The goal isn’t to just be pessimistic is to be realistic with things. I think sometimes we can live in this world where we expect everything to go planned and perfect. 

And the question I have for you guys is how many times in your life have things maybe not have gone to plan or turned out as you expected? There’s so many things I can think of in my life, with my own rehab, with my injuries, like in general career trajectory, all these things that is so crazy that it just didn’t go to plan. And even for those of you listening, think about just different things in your own life. And take a second. To think about how it just didn’t go as perfect to plan, but think about what that led to in the moment is sucked. But maybe it led to something else, a different door opening, a different perspective, making you a stronger person. This is something that I want to kind of pull from today with this reverse clause and managing unexpected challenges because this is something that’s going to happen in ACL rehab. It’s going to happen in life.

This is something that I want to talk about specifically, even for myself, to give you guys some perspective. And then that way you could be able to see a little bit of this in examples. So for me, as I had mentioned has happened so many times in my life, from the micro to the macro. And it’s healthy to understand that you can expect something, right. 

But be realistic that that process or the outcome could also look different. And so this is because that certain things could be out of your control. And whether you believe in a greater entity. whether it’s God, a different faith, a different religion, or maybe it’s agnostic, whatever it is. This is something that you can kind of lean towards things like that. I’m a faith-based person. And so this is something that I do believe has some control here. There is a bigger story at play. Let me give you guys an example of something where, I think this reverse clause kind of comes into play and even managing unexpected challenges. 

In my last year of PT school, I was going to do a sports residency to work with a professional team as a part of it. I declined another residency offer that I got, because I was set on this particular residency. I didn’t necessarily have a choice to just take one and then wait for the other. I actually had to deny the one and then wait for a while for this second one. Three people made it for the in-person interview out of hundreds of people. I gave everything I got for a full day of interviews and practicals. We walked around and met the whole faculty, staff, everything. I walked out, feeling super positive, laid it all out on the line. And I’ll be honest. I thought I got it. I kind of size myself up with the other two people and I was like, okay, I feel really good about this. I left it all out on the line. I feel like a lot of the things that I’ve aimed for in life. I’ve been fortunate enough, I’ve worked really hard. I’ve been able to earn that. And if not, then there is some sort of other outcome to that. There’s another door that opens. I had to wait two months to find out that sucked and to see what the results were because it was basically kind of like a match day and I didn’t get it. 

It was the first time that I put my everything into something and it didn’t truly work out. I turned that into a positive, creating my own residency, doubled down on my skillsets and to be the best PT and strength conditioning coach I could be. Guess what, I landed an incredible job back home that my beautiful wife. I was able to start my own business and here we are today. And when I think about my life design and the things that I care about, this is led me down to that road versus if I would want the sports residency route. I would have taken a pay cut. Sure, I could have worked with our protein. But at the same time, there’s so much red tape with that. 

Now talking to all my friends who are in professional sports, they’re like, yeah, there’s some limits, man. It’s just funny that there’s different directions that you can go in. And this is something that essentially opened the door for something else. This is the reverse clause in action and specific to my ACL rehab. I expected for things to be flawless. I thought it was going to be linear, I thought I was young, and I thought it’s going to be straightforward. I’m gonna get back to it. I was in high school. I worked really hard. I didn’t know much about the ACL process because I was a high schooler. It was just falling my PTs guidance on a hamstring graft. One time I went overboard and had a massive setback. I was so pissed at myself. No one told me setbacks were normal. I thought it was going to be this linear process, just rolling along and it set off this kind of cascade of negative emotions in me. I thought I was behind, never going to get back to playing all these things. And once I got out of this funk, I was able to use that to my advantage, to understand it won’t be perfect. To make sure I’m more intentional about pushing things and knowing when to back off instead of just push, push, push, even though you’re just kinda like young high schooler. So you just kind of red line everything. 

And in that case, especially in rehab, you can’t always do that. Because, guess what pain’s going to happen. You can get swelling. Other things can kind of break down a little bit, so you have to find the sweet spot. And I saw later it was an opportunity versus in the moment my expectations fail me. So that was really key. Again, reverse clause in action. With that being said, this is not about being complacent or deflecting blame when something isn’t going according to the plan. It can be used to find comfort in the fact that even if we have the best intentions to achieve a more long-term goal, it may not turn out the way we planned and that it could even work out better than we ever could have imagined. Accepting and acknowledging that just because certain barriers and obstacles arise, it doesn’t equate to a failure; it’s just a part of the process. This is so key as we talk about this, because a lot of times we are striving for this perfection or this unexpected challenge comes up. And then therefore we feel like we’re derailed. We are just feeling like it’s just not going to plan in terms of the long-term goal. But maybe it is something that it’s turning into something that is better than you would have thought. And you can’t necessarily see it in that moment. It might not be until later. 

How does this apply to you and your ACL rehab? Things won’t always turn out like we want and that’s okay. The number of ACLers I’ve worked with where they had these goals, this timeline, they’re like, hey, I want to hit this by this. We aim for things like that. And the thing is, is that we cannot control the human body. We can not control it. It has its own biological process, the way that it responds to stress, to the surgery, to the injury, all of these things. We have to be okay knowing that there are some things out of our control and. And we can be better prepared if we expect that could be possible. It’s healthy to have a little bit of that. And you may experience setbacks and I would say to be completely honest, expect to have one. There’s very rarely an ACLer we work with because maybe they push it too hard. The body kind of weirds out for some reason, maybe when they start running. there’s so many things that can happen that, you know, an ACL or having a setback is almost, should be normalized in this process versus it being like, oh, you made an error, you failed, which is what a lot of people feel. We try to normalize this with our ACL because we are dealing with such a dynamic complex system as human beings. It’s not like we could just take all the ACL, put it back in and then expect it to run like a well-oiled machine and we’re back to normal. We are such dynamic complex human beings that it’s not just the sum of its parts. They all interact because of our environment because of the day that it is, the stresses that we put on it. It is constantly up and down and there’s a lot of uncertainty with it. And even with your rehab and with the guidance you’re getting, it’s not perfect. It is something that is an estimate. And we get to collect data points to see how you respond and Anyone who says they have the perfect program or the perfect exercise. You better run the other way, but if they have doubt in principles and guidance and the experience with this, then that’s somewhere that you can trust and be able to use as a part of this ACL rehab process. 

But the thing is here is that you may experience those setbacks, as I had mentioned. We talked about this earlier. But knowing as possible and allowing it to be an opportunity, if it does happen, that’s the biggest thing. Can we view this as an opportunity or is this something that we’re going to just be sad about or beat up about. For ACL rehab, let’s say you’re someone who’s, had a Cyclops lesion, scar tissue, where there’s a bundle of scar tissue around the ACL, where it is limiting your extension. You might be dealing with the extension pain, your quads aren’t activating very well. You might be dealing with some residual swelling. There’s all these things that can layer into a Cyclops lesion. And there’s sometimes nothing you can do about it. It could be just the nature of the ACL, your body. I’m sure working on extension stuff can be helpful. But there have been people we’ve seen three months out who have developed it, doing all the things perfectly. There’s people we’ve seen where it develops later. And so this is something that just kind of sucks because you can do all that work. But the thing is, is that still might need to be something that gets removed. It wasn’t what you expected, but it happens. I literally just evaluated an athlete where she had a Cyclops lesion at three months. She’s now at seven months. Her entire process has kind of been derailed a little bit in terms of the timing of it. So instead of it being this seamless, getting back to all the things that six months, progressing back into soccer and playing at nine months. We’re looking at a little bit more of a delayed timeline because the scar tissue development that happened earlier in a rehab. This is something that’s a bummer, but we’re using it as an opportunity. And that’s the thing we have to frame it as. 

And so the thing that we come back to is knowing that we’re dealing with the human body. We can’t always control how it responds to the injury, the surgery, the type of graft do you get, the other procedures that potentially happen with it? So it is an opportunity from learning to be patient, to allowing yourself, to dial in mindset from adversity and also continue to become physically more resilient. Also to know that there are factors outside of your control and is something I see can make or break ACLers mindsets. If they get their sights set too much on a perfect process or being linear or being like, all right, I’m doing everything I can. The likelihood of a setback is pretty low. And while that can be the case, that doesn’t necessarily mean that one won’t happen. We’ve seen them happen out of the blue and we can’t explain why. 

Cyclops lesion is a great example of that, but then therefore it’s something that we have to be aware of and manage our expectations around it. And the ACL tear in general, we talk about this as opportunities. But when we talk about this ACL injury itself, it was not what you expected. You were doing something that you were loving to do. You feel very yourself with that activity typically, unless it was just like a freak accident. Most of the time our athletes are injuring this, doing the thing that they love to do. It’s not what you expected. But you can turn it into an opportunity to become a better athlete and a better human. 

And while this might not be what most people want to hear: what choice do you have? And I heard the same where you could either be better or you could be better. It’s your choice on how you react because it’s already happened. So then you have the choice. Do you want to be bitter or do you want to be better? You can sit in this sadness and be better, or you can allow it to rebuild you into a better athlete and a better human being. 

As we finish up here for this episode, expectations are everything having a reverse clause. So meaning just you can go through this process and sure you can add something as like knee permitting, body permitting, whatever you want to put is to save as a reminder, to know that there are things that we’re going to be dealing with in this process that we can’t always control. Now, the key is that you’re doing everything you can to pull on the levers that you can control. And then of course, whenever something like the weather comes along, then you have no control over that. So in your sense, and your weather is like what your body is potentially doing to heal in this process. So having a reverse clause can help to flip anything you may feel that’s negative. Because that’s what we typically feel in this is that we did something wrong or had that setback, or doesn’t go as expected. But really it’s just a matter of maybe it’s something that we couldn’t control. And then therefore we need to just handle navigating this. So I want to finish with this quote: “Make the best use of what is in your power. And take the rest as it happens.” – Epictetus. 

This is something that I hope is helpful for you ACLers. I hope I hit this message home of having a reverse clause, understanding that unexpected challenges are going to happen. And being able to make sure we have tools to navigate this because, even if you are six months in and you’ve been flying pretty for a while, just know that there is something that could come along in the process and as best prepared as you are for this will allow you to bounce back faster and to not use this as something. Where you maybe are out of it for a low, for a lot longer than you should be. Meaning it’s something I give my athletes where you are on the highway, you’re driving, instead of it being this massive detour you take to get back onto the road is just literally this pit stop where you had this kind of road bump, or you had to get off just to adjust a few things and then you’re right back on. You have a choice in how you handle that and how you control that. 

I hope this was helpful for you guys, for my ACLers who are potentially starting this process. And especially those of you who are in this, who are probably resonating with dealing with a setback or two, or maybe you have had 5, 10 of them, and maybe you’re dealing with having to approach another surgery or manipulation or something that hasn’t gone to plan. Just know that if we have these tools, then that could be something that can help from the mindset aspect. It allows us to keep just tackling this brick by brick, hitting 1%, every single day, a big theme and a big focus for us in this ACL rehab process and for ACLers.  Until next time team, this is your host, Ravi Patel, signing off.