Episode 231 | Regression ≠ Failure: Reframing Setbacks in ACL Rehab

What is up team? And welcome back to another episode on the ACL Athlete Podcast. Today, I’ve got my coffee, it’s the morning, and I am super pumped to dive into today’s episode. And this one is going to be a little bit more of a mindset-focused episode for today, and it’s about navigating a setback or maybe not being able to progress to the next thing in this process. 

And let’s face it, y’all, every ACLer will deal with some type of setback or at some point have to deal with not being “where they were hoping to be for the most part.” This is something that might manifest through the knee flaring up or getting grumpy, or maybe it’s a test that didn’t go as expected.Hopefully, you’re getting tested so you didn’t hit enough to start running, for example. Or maybe it is doing a movement that you’re just not ready for, like you try to do a jump, for example, whatever variation that you have been given. And it didn’t feel great. 

And yeah, there are times where maybe the body is getting used to it. But a lot of times, if it didn’t feel great and it doesn’t look really good, then it’s probably something you’re not necessarily ready for just yet. There should always be progressions towards building up to, especially more complicated movement or things that are a little bit more demanding. It could be challenging in this ACL rehab process because it could be due to some symptoms flaring up, or it could be because we’re just not strong enough, we don’t have the range of motion yet. The body’s qualities or specific attributes, such as those range of motion pieces, strength, being able to be explosive, and being able to be very dynamic. You’re just not there yet. We’re still rebuilding this process, and maybe there has been a movement that you’re just not ready for. And stuff like this happens more than we like to admit. And maybe things aren’t just evaluated well enough to be able to make adjustments like we need to. But I think what we need to do in this process, especially with dealing with setbacks or maybe someone not being ready for this next milestone or phase, or this movement, it’s something that we need to normalize a little bit more versus these linear, non-setback-based expectations. This perfect linear line, as time progresses, your progress linearly increases each day progresses. And life doesn’t happen this way, and ACL rehab doesn’t happen this way. 

As you guys know, it’s the crazy zigzag lines where it might go up a little bit, it goes down, it goes backwards, it goes forward. You might have a spike up, a spike down, because the thing is that this is something that we don’t have full control over—it’s biological healing. There are some weird body changes, like the nervous system is also going through a change because of this, the brain is, and then also the body. When you look down, your quads are shot after an ACL injury and then after surgery. This is something that’s pretty normal. And you’re also doing this with life, which means it doesn’t happen in a vacuum. You don’t get to control all the variables, and then your life just exists to do ACL rehab. There are other things that are going on, whether you are in school, whether you are working, whether you’re a parent, or whether you have other people you’re taking care of. There are so many other factors that exist that you have to continue with life, which makes this process in and of itself very non-linear to begin with. 

And the other thing too is that it might be a little bit different than what Instagram. But it isn’t the reality for the majority of ACLers. I want to normalize this a bit to know, hey, it’s pretty normal for you to not hit that thing yet, or to have a setback. It’s not supposed to be this perfect process, or you hit all these things early. If you do, then awesome. But with the state of ACL rehab and with different graft types and with expectations, and with the way that the body just breaks down and needs to build back up. It’s easy to get caught up in hitting these things, especially whenever you look at most resources and what’s communicated out there based on protocols and time. These types of things tend to set us up for feeling like a disappointment or failure because we’re not there yet. 

A classic example of this is that at 12 weeks, a lot of protocols will say, start running, and guess what? I would venture to guess that 90% of ACLers are not ready to run at 12 weeks. I can feel pretty confident in that, given just where this is and working with different graft types and just how long it takes to rebuild. They’re, of course, people who can get there in certain situations. But for the most part, most are not. 

That’s the thing that is important in this is I want to talk about today, is that I want to share this quote, and this post that I saw by ALTIS is a very well-known program for track development and speed development. Dan Pfaff is someone who is a legend in the space. He’s the founder of ALTIS, and he’s just an OG coach in the space of strength and conditioning performance, especially track and field. And this quote is “When an athlete isn’t ready for a given task, regression isn’t a punishment. It’s progression done right.” I’m going to read that again. When an athlete isn’t ready for a given task, regression isn’t punishment, it’s progression done right.”

Y’all, this is so freaking good and such a helpful perspective. It is flipping the script on when you’re just not ready for something yet, and I’m saying, yet it’s not. You’re just not ready for anything. It’s just not yet. We still have work to do. But instead of viewing it as a failure, which is often what we do in this process, is that we have failed to make this deadline. We have failed to meet this particular time or this particular movement. It’s a progression done right whenever there’s a regression done. I know that might feel backward. But when I read this, I was like, man, if this doesn’t align so much with ACL rehab, and I’ve taken ALTIS mentorship programs and learned a lot from Dan Pfaff and Stu and the others within the ALTIS program over the years. And they’re one of the leaders in track and speed development, but also for performance education, working with some of the most elite of elite athletes and Olympians. And Dan is just someone who I’d argue has the ability to look at human movement as one of the best in the world. You watch this guy and you watch his videos and see him break things down, the man is brilliant. And this quote is so helpful for us, especially as rehab professionals and coaches, and as ACLers, as you’re listening to this, navigating the ups and downs of this process for ACLers.

I want to repeat this because I think it’s important to really hit this home. When an athlete isn’t ready for a given task, regression isn’t punishment; it’s progression done right. It’s not taking a step back, but more so a progression because it’s exactly what the athletes, or in this case, use the ACLer as you’re listening. Maybe that’s what you need right now, or an athlete you’re working with, if you’re a clinician or coach, needs this right now, at this moment. We encounter this nonstop in ACL rehab.. You guys know the one step back, two steps forward. I’m sure some of you have sometimes felt one step forward and then five steps back. Sometimes it is that tug of war. Yes, one step back, one forward, two back, one forward through this process. It just depends on where you are, the type of injury, the surgery, life circumstances, and how the body’s responding, and then also the rehab process itself. There are a lot of factors in this, and it’s a never-ending rollercoaster, and adapting the plan given how volatile some ACL rehabs may be.

But this is where shifting this mindset is so important for us as ACLers and as rehab professionals. We sometimes feel pressured for the sake of time. And I know I have felt this before as not only as an ACLer but as a professional working with ACLers.  When I have a young athlete who is seven months post-op and she’s still not running yet. And she came from somewhere else, and she had a very terrible extension. She had a cyclops lesion. She didn’t have but 50% quadricep strength symmetry. And so yes, they’re further along in the process, but that doesn’t mean anything in terms of their readiness. This person is not ready to run. They’re not ready to do dynamic things. We sometimes feel that pressure because they’ve been in this long enough because for the sake of time, and maybe for psychological wellbeing and other factors. Or maybe there are other stakeholders like parents or coaches, or other people on their care team, surgeons, other performance people, or PTs who are also contributing or making these types of recommendations to make decisions on moving this ACLer forward. And it can be challenging. 

But when we look at it through this lens, it helps us to stay anchored to what’s important while still accounting for all of these variables. And we’re not just going to progress somebody just for the sake of time. And that’s what gets us into trouble in this ACL rehab process, is that we’re progressing people based on time because it feels right or they’re good enough. We just can’t do that. Good enough is why we are leading to re-injury rates that are so high right now. We need to make sure that we are testing appropriately, we are progressing, and programming appropriately. That we are also regressing appropriately when needed. And every athlete at some point will need a regression where they have to take a step back, or maybe the movement is too challenging. Maybe their need just bugged out with a certain movement so we got to regress it. That is not failure, that is progression done right.

The other thing too here is that as a good coach and as a good physical therapist, knowing that we can be adaptive with programming to be able to regress a movement, progress it when we need to and what we call lateralize, which is also changing the movement itself. Maybe it’s the same stimulus, but we are changing the movement to get a similar stimulus. Any good professional can do that. And so that’s something that we want to make sure we can do. And with any movement, there’s always a safe starting point and an entry point for us to utilize, to be able to get this stimulus to some degree. And yeah, sometimes there is a no-go with certain things. If you’re early in the process, jumping is probably a no-go. But with that said, there are going to be buildup progressions, block by block, face by face, to make sure that you feel ready and you look ready. And we’re going to test those things out. That’s where it’s going to be important.

If you are someone who is dealing with just a challenging ACL rehab, which is probably most of you, and you also feel like you’re just stuck. You feel like you’re doing the same exercises, maybe there’s no answer. And the classic thing that I will hear from ACLers is that their rehab professionals will say, or maybe the surgeon, it’ll get better with time. And that answer honestly makes me so mad because that is not an appropriate answer. Yes, there are things that we may not have full answers about. Yes, we could say it’ll get better with time, but let’s be detectives and figure out what’s going on. I just talked to somebody. She’s gone to multiple physical therapists and surgeons, and she’s been having this extension-based issue, and it’s crazy. We talked on the phone. All we did was talk on the phone about her case, and we were able to just nail down what it was. And it is just because she was doing the same stuff. No one was looking into what was going on. I didn’t even evaluate her, whether it was remotely or in person. We talked on the phone, and we’re like, this is it. And we were able to get to it because it was just carving out the details of her case, listening to her story, listening to what works and what doesn’t work. And it is just something that we need to make sure that our ACLers are heard, that we are able to make a specific plan for them, and to be able to make changes, not just it gets better with time. Just know regression isn’t a step back, it’s progression, and it allows us to build momentum for what’s ahead. If you’re having an ACL or dealing with this, or you’re an ACL or listening, feeling like you always have to take a step back, know that it’s progression done right. 

Now, let me also be clear here. If you’re constantly taking a step back, then maybe the programming and the guidance aren’t getting you where you need to go. But just know that there are times when you have to take that step back because maybe you pushed a little bit too hard. Maybe the knee is just still a little sensitive. Maybe it was just a movement that wasn’t something that you’re ready for. But just know that step back is okay and it’s progression done right. 

And the other thing I want to share in addition to this is that it’s normal to have the knee be a little sensitive when you’re pushing its boundaries. I think sometimes we almost want to stay in the safe zone. And of course, with a more sensitive knee, we do want to be a little bit more, as we say, undercook it versus overcook it. But with that said, we also want to push the boundaries a little bit. And when you’re trying to stress your body and push the boundaries, it’s normal for the knee to respond to that and feel a little sore. But we also want to make sure we have certain feedback loops and certain guiding parameters, and a place to make sure that this is done right and that it’s not too many steps back repeatedly over time. And that’s what a good coach is going to do. They’re going to make those adjustments and adapt versus trying to force it or progressing because it’s been long enough. It’s for the sake of time. They’re at this certain point, and they should be doing this by now. But you’ve got to earn the right to do that. I don’t care what timeframe you are out of surgery, you have to earn the right to progress. And so that’s where testing is going to be helpful, that’s where having a very adaptable program is going to be helpful, and having expert guidance. 

If you need any help guys, please reach out to us. We work with people all over. And if you have any questions, we are here to help. Otherwise, I hope that this is helpful for you to reframe things, whether it’s the ACLer you’re working with or ACLer listening: Regression isn’t a punishment, just know it’s progression done right. So that’s something to help flip that script, change the mindset, and know there’s still momentum in the right direction, and you’ll get back to doing the thing as long as you are following these particular principles. Until next time team. This is your host, Ravi Patel, signing off.