Episode 189 | The “Honeymoon Phase” of ACL Rehab: Managing Expectations + Momentum

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today, we are covering this concept or this topic: The “honeymoon phase” of ACL Rehab. As a side note, have you guys ever, I’m pretty sure you’re supposed to say “honeymoon phase,” but “it seems like it’s using TV anyways.” I haven’t thought about this too much until I just looked at the way it looks and the way I’m saying it. Anyway, we’re going to move on here, The “Honeymoon Phase” of ACL Rehab.

I’ve talked about this in other podcasts episodes, but I figured it was time to finally dedicate one directly to it. This honeymoon phase or this honeymoon period of ACL rehab. And if you haven’t been married, don’t worry about it. You don’t have to be married in order to understand this reference because it’s pretty simple. It’s that period of time where it’s new, there’s this solid momentum and this energy that you’re feeling. There’s lots of intention behind this certain period of time that you’re in, much like the honeymoon phase after someone gets married. It’s all fresh and high energy and all the things. But we here going to transfer this over to ACL rehab because I transfer everything to ACL rehab. 

Everyone knows what I’m talking about and what this is and has experienced it actually in this ACL rehab process, their own ACL honeymoon, if you will. Maybe you’re going through that right now, as you’re listening to this. It’s that early phase of the process, especially post-op or even post-injury, but especially post-op. You’ve got a new ACL, if that’s the route that you took. You are ready for the journey ahead. You just had the surgery. You’re fresh out. The anesthesia is slowly starting to wear off on that day one. You are ready to hit the ground running. It’s typically on the newer, earlier size since it’s that’s when you have that surgery. You’re not in this kind of burnout feeling and you’re just ready to get things going on the road to recovery. You typically start with the knee in extension post-op. You might be in a brace with that ACE wrap around it. You might not be in a brace, but typically most people have that ACE wrap where it’s protected and underneath that. There is the surgical incisions protected by some coverings on it. Some bandages, some things that help with those incisions and maybe if it’s glued down or if it has been stapled, or maybe there have been sutures put on it. But you guys know what I’m talking about. 

And if you are approaching this surgery, this is something that you are to expect. You are on crutches. You might be weight-bearing as tolerated. You could put some weight on it. You might not be able to put full weight on it yet. You might be restricted to nonweight-bearing for four weeks for certain reasons. It just depends, but you have crutches or some sort of assistive device to help you to walk. You’re not driving typically, especially early post-op because you are post anesthesia and you might be on some pain medications. And especially if this is the driving foot, or if you have a stick shift, then both feet are impacted. So then therefore that might delay you driving even more. 

When I tore my left ACL, I was not impacted nearly as much. Once I got out the pain meds, then I was able to start driving. So that was way faster than when I tore my first ACL, which was my right leg. So then therefore that impacted me being able to drive for a lot longer. Then in addition to driving, you’re not using stairs, or you’re kind of using that assistive device, but you’re not using stairs normally, as you would. Even the way you shower and use the bathroom is modified. You got that leg kicked out straight while you’re using the bathroom if you’re on the toilet. If you’re in the shower, you might have the leg popped out. You might have it covered. You might be doing a sponge bath. Your whole entire life is impacted after you have the surgery, especially the surgery itself. 

Injury, you are still impacted because you’re limited. It’s fresh. Of course things are going to be different, but especially surgery because you’re being more protective of that joint because of the procedure that’s been done. You know there’s open wounds there. There’s that extra caution, if you will. And then not to mention you have the pain, you have this swelling, you have the incisions, etc. Everything that comes with the post-op and post injury, but mostly referring to post op here. 

If you haven’t had the surgery yet and you’re planning to have it, I’ll probably freak you out a little bit because you feel like your life is about to be impacted drastically. It will be for a little bit, but I promise you we’ll get through it and it is very short-lived. But then what I want to paint the picture of is like, all right, you’re in this process. You’re fresh post-op, then you start on your rehab journey. Everyone’s familiar with some of the common movements, you’ll start doing quad sets, heel slides, ankle pumps. And then of course, if you have a little bit more dialed in physio and PT, you might be doing some additional things. But it’s the post-op and post-injury starter pack for basic ACL rehab. Everyone knows what this is. It’s like the first three to five exercises. You might have some hip abduction, four way hip. You might have some other movements that you might be embedding into there. But everyone is familiar with most of these movements when they’re post-injury and post-op. 

And with days that pass, you’re going to notice changes. Your pain gets a little bit better. Swelling improves. Extension gets a little bit better. Your bending is getting better. Your flexion. You can put weight on your foot. Your wounds are starting to heal. You’re able to unlock your brace. You’re able to decrease using your crutches. You’re able to get a full revolution on the bike. You can shower normal again. You can use the bathroom normal again. You can drive. You can walk normal. You can actually get out of your brace. You can do an air squat. You can use stairs. You’re back at the gym. A lot of milestones can happen in the matter of days and weeks. This is your honeymoon phase of ACL rehab. You’re making achievements and these are the things that are going to keep you going, especially in the early post-op. 

There’s the post honeymoon period where the momentum might slow down a little bit. You might still be going, but it’s slowing down a little bit. You’ve been in it for a minute. The progress isn’t as noticeable day to day. Mostly because your daily life is back to normal for the most part. Now, you might be working on that last little bits of range of motion. You might have some lingering pain and swelling. There’s a huge focus on strength and this takes time. Strength development, even with someone who is uninjured takes time. And so then therefore, when we take a joint that has been impacted and all the nervous system issues that also come along with this, in terms of the brain trying to process this knee and trying to fire the quad and get things in sync again. And just in general, getting yourself stronger, it takes time and it’s less noticeable than something like your flexion range of motion, for example. Because it is a very visual difference of you being able to slide your heel back and forth. And while you might be able to objectively say like, all right, I can now do this many step-ups or do this on knee extension, it’s less impactful on your day to day outside of those day-to-day things like maybe taking stairs or being able to walk or being able to drive, doing stuff in the gym, for example. But your day to day itself is not super impacted once you get through these early milestones. You’ve been in it for a minute now. Your next big milestone might be running or adding in some lower level jumping. So that’s in the distance. But that could be a minute, especially depending on your journey, especially if your quad strength is taking some time to get back which is something that is very common. People are often told it’ll take maybe 12 weeks to start running again. 

In my opinion, it should be four to five months in reality, as a more healthy target, plus you can focus on strength for longer. But with that said, a lot of protocols that are outdated and just based on time. We’ll say in 3 months or 12 weeks, you’ll be able to start running. But with that said, it’s probably going to take longer. So then you are in this kind of window, if you will, you’ve moved past these honeymoon phase milestones and you’ve seen that progress. And then all of a sudden, you get hit with this window where you’re in the gym or you’re doing your rehab, but you’re not noticing those progressions as you did in those first one to two months. 

So what’s my point here in sharing all of this. It’s to look at expectations, managing expectations and being able to anchor those to reality, managing your energy in this process, controlling for burnout and ultimately playing the long game. I’ve talked about this in previous podcast episodes, but this is one that I did want to dive in a little bit more specifically, because most ACL owners don’t see this coming because it’s new, especially for someone who’s torn their ACL. And why would you know, especially if it’s your first one. This is something that you’re not able to necessarily be prepared for or expect, especially if you’ve never had experience with it.And they hit it really hard can overdo it. And this can eventually lead to burning out as well. I see it a lot in the three to four month range, especially if they’re not back to running yet. This lingering time between that honeymoon phase and this next big milestone of being able to run. And that strength is slowly coming along and they’re not seeing the progress like they once did whenever it was the first one to two months. 

What can you do about this? Number one is managing your expectations well and understand what this period is. You will hit a lot of milestones and progress, but don’t be fooled by it because you are playing a very long process. And knowing that even those first two months is just a fraction of the length of time that you will be rehabbing during this injury. And so this is something important too, to anchor to is understanding the expectations versus the reality and especially what those first even four weeks of rehab will look like. And then managing your energy. This means putting a hundred percent into your rehab. I’m not saying hold off and preserve it for later. But this just means put that energy into it, but just know that you going 150% or a thousand miles per hour, isn’t necessarily going to allow you to return faster. There’s a sweet spot for pushing it and making sure that you’re putting that effort into the rehab, but not going overboard with it. Because what can happen is athletes can flare their knee up. But more importantly the energy, it’s a lot of demanding things, especially early post-op. You’re going to be doing things very often throughout the day. It’s not like it’s just this one single session that you’re going to do two or three times a week. It’s like you’re doing stuff that is multiple times a day, especially whenever it’s associated with range of motion like flexion and extension or athletes are doing it at least two to three times a day, in addition to working on some of the specific rehab stuff where it might be a focus block for 30 minutes or 45 minutes of other additional stuff. And this is the stuff that helps to really move the needle. When we’re talking about this ACL rehab process. But if you go hard too early and you’re doing this for maybe one to two months, then you hit that window where you are going to see the day-to-day stuff resolve and this range of motion stuff and the things that you were struggling with, or just weren’t able to do before. Those are okay now. Now you’re in this window where you just got to build strength, but you put so much energy into those first two months that it starts to wean off after maybe three months or four months when we still have a long way to go. So that’s a part of being able to manage your energy and not going off board. But still being very, very present with the rehab process and where you’re at with it. 

This leads me to the next point, which is playing the long game. It is a 9 to 12-month process. We don’t have an accelerated process. Whoever tells you there’s an accelerated process as of September of 2024, there’s no way to accelerate that biological healing of the ACL, not yet. Hopefully, one day and I will be happy to say there’s an accelerated way once the research shows it, but we’re not there yet. Right now, what we know is that we’re injury rates are reduced significantly up until nine month process. And then after that, it is even beneficial to delay after that. But everyone is in their own place in terms of what that looks like, but also developing athletes. It really is a 9- to 12-month process at minimum, to be able to really get athletes back to the thing, just knowing how much this thing does really decondition you in a sense, and having to rebuild the strength and having to rebuild the athleticism—it takes a long time. The 9- to 12-month process is a proxy, if you will, of time to be able to redevelop an athlete. We also know the biological healing of the ACL is also an important piece of that. This is not only that one to two months of the post-op, is not the only phase that you might feel the burnout from this. Now that’s the honeymoon phase, because you are feeling that energy. My goal is to share, to look out for this phase, but maybe afterwards, if you have been hitting it hard or you’ve been having some lingering issues, we might see this at other moments, whether it is that three to 4- to 5-month mark. And then it might also kick in a little bit later. It might be in the 7th, 8th month. There are few moments where athletes might start to kind of trail off, if you will. It’s mostly just because they’ve been at it for a minute—9 to 12 months of rehab is a long time. 

I remember this very clearly for my own rehab where I was trying to push and stay dedicated. But I remember feeling like there were moments where man, this is just long and I feel burned out. I know a lot of my ACLers listening to this, this is something that you probably feel too. And so the thing that can play into this is if you are dealing with an issue that I mentioned is lingering, that’s not resolving soon, or it keeps rearing its head or you haven’t really seen a milestone in a minute. It’s tough whenever you are doing this and you’re not seeing progress or you don’t see any end in sight for even the current phase that you’re in. There are some ACLers who kind of get stuck in this cycle. The goal is to break through this and to be able to, of course, take a break as needed. What I mean by a break? That doesn’t necessarily mean just stop for months and months. Because there’s a very good chance if you stop, you’re not going to come back around to it. I’ve seen this time and time again, people sometimes they’re like, I need a break. The thing is, is that they end up just satisfying themselves with where they are or not really satisfied. It’s just more so they’re just like, this is good enough. In reality, that is not good enough. It’s just managing the energy and making sure that the path and that roadmap is looking as dialed in as possible, and then that way we can control for this. This is something coming back to taking a break as needed for when these burnouts or anticipating these burnouts. 

I literally gave one of my athletes non-ACL rehab last week. And what that means is basically it’s like kind of their break week. they’ve been at it for a while. They’ve been making really good progress. But I could tell the energy and even just the things that they were doing, like it wasn’t necessarily there. And so I decided, hey, let’s not get in the gym, kind of go do your own thing for the week. And it was great because we were ending a block and, you know, we had finished up some testing. I was like, hey, let’s just take this break and make the most of it. And then they came back and hit it super hard. It was awesome because then therefore that helped their energy. It helped him to disconnect for a minute and then allow them to get back into the group this week. And that’s where a custom plan, this roadmap that you need and would have, is going to be helpful. 

And especially having a guide to help adjust for these things. So that can be really huge in this process because they can look out for these things, create detours as needed before you, or possibly even avoid it by knowing this process so well, and they’re athletes so well. This is something where all of us as a team are trying to gauge our athletes and know like, all right, what kind of factors are playing into their lives, whether they’re parents, they’re a high performing workers or business owners, maybe they are just juggling a lot of things with school. These are all things that we need to factor in to make sure that we are helping our athletes with their energy and the expectations of this process because it can be a lot. This is where having a good coach can be really helpful because they know you and they can play these factors into how they’re going to program and guide this process. And also just look out for signs, especially if something like burnout is happening, then therefore we can be able to manage that. 

It’s important to know what this honeymoon period is. I’ve referenced it a lot. And so I just wanted to share that today so that you can best manage these expectations as you move forward through your ACL rehab and more importantly, your energy avoiding burnout, because it can happen over this nine to 12 month process. As I had mentioned, it did for both of my ACL rehabs, and I know for our athletes, we do have to be mindful of this, especially, for example, we’ve had athletes, they go through breakups and it’s just something that we have to be in tune with this to know, hey, this athlete is going through a hard time. And so then therefore, maybe we’re going to pull back a little bit, especially if they’re in a rough part of the process. Because that is going to factor into how much they can put into it, how much they want to show up, but you stay. So knowing our athletes and knowing what’s going on with their lives is important. And then also being able to manage these pieces, knowing what to expect with this honeymoon period and ultimately what we’re aiming for is playing the long game. We’re not trying to sprint through a week. We’re not trying to sprint through our particular phase. We’re trying to play the long game in this process, allowing athletes to get back to sport at high performance, better than they were before. But then also reducing that risk of reinjury. 

Those are goals that we are focusing on and we want them to step on the field on the court, on their skis, on the mountain, whatever that might be a better athlete and feeling confident in their knees. So that is our goal. And that is our, focus, especially even for today’s episode is to make sure that you feel in the know of the journey. I hope that this helps with, especially that honeymoon period and phase of the ACL rehab process. Until next time, team. This is your host Ravi Patel, signing off.