Episode 106 | ACL Rehab Principle – KISS

What is up team, and welcome back to another episode on the ACL Athlete Podcast. Today, we are talking ACL rehab principles, and this is a series that we’re going to kickstart and we’re going to drip this out throughout the months to come. And it’s just something that we think can be really helpful for all of you, ACLers, clinicians, coaches, anyone involved in the ACL rehab process. To talk about these principles that create this foundation in this process, the ones that we utilize every day at the ACL Athletes, and just things that can really help to streamline some thinking and navigate some of the complexities that we see in this process.

Today, what we are going to talk about is the KISS principle. I remember when I started my strength and conditioning internship back in 2014 at UGA, my mentor was the one who exposed me to this principle. And it stands for “Keep It Super Simple or Keep It Simple Stupid,” which is the one that he used. And he taught it to all of us who were going through the process and the internship. It was one of the things that seemed so straightforward, it’s so simple if you will, and obvious. You’re like, of course, keep things simple, that’s the goal. But it’s actually something that has helped me a ton and something I’m constantly reminding myself about, whether it’s with life, business, and especially with coaching our ACLers. Because it’s something that in this process, there’s a lot of complexity that can arise. 

Now, we don’t want to be so reductionist, if you will, to a point where we’re like, oh, well, the answer is to strengthen your quads, and that will solve all your problems. Although it will help a lot of problems. We can’t simplify things too much to where it’s like, okay, this is the only answer. What we don’t want to do is make sure that we overly complicate this process as well, which is what I hear from most ACLers. You injure your ACL and then you go down this path of feeling like there’s so much information to take in. What is an ACL, feeling like you’re drinking out of a fire hose, is what I like to say. Because there’s just so much information to process and there’s so much complexity. And when you really do Google just in general ACL rehab or protocols or surgery, you get all these very generic type answers. And then you have to go digging, whether it’s in forums or in groups, or maybe you go on Instagram and start following people. You just go down these rabbit holes and it adds to a lot of the anxiety, the unknown in this, and all the complexity that is to add. And so that’s one of the things that we want to make sure is to navigate what we call the gray here at the ACL Athletes. And that’s basically ACL rehab in a nutshell. There’s no black and white. Well, maybe an ACL tear itself, we know that happens. But this process is nothing but gray. And so that’s where we live and that’s what we have to embrace.

Now, how do we navigate that? The KISS principle helps us to not get too caught up in that complexity or to get lost. And the way we can do this is by making sure we stay rooted in principles, we know are tried and true, especially based on what the science says, what the research says, and what the data shows from it, and keeping it simple. And I think a lot of this applies especially to the program design part of things in ACL rehab. When we have conversations with ACLers, they often have just this laundry list of exercises. And it’s just like, alright, I do all of this and repeat every single day forever. And it might also be just their session that they do where they’re just like just doing exercise after exercise. But honestly, no real rhyme or reason. It is just basically off of this protocol, or maybe it is just the same set of exercises that are easy to give every single patient that they see. 

And now I’m not here to say that every single patient that I’ve seen for ACL rehab needs a completely new exercise or reinvent the wheel. There are certain things that all of our ACLers do, and we know different ways to get there. But that doesn’t necessarily mean that we need to create a super-long laundry list of exercises. We need to make sure it’s based on the goals that we have and reverse engineering to make sure that we provide the structure that is methodical and we provide the movements that are going to help us move the needle and be able to move towards the goals that we need to. And what ends up being difficult is that maybe if you get stuck or maybe you’re not feeling your PT is not doing the right thing or getting the right movements, where will we go? Instagram. And Instagram is a great place to see things, to be able to learn. It’s also a double-edged sword because there are exercises on exercises that you can gain. And without a really solid context, you’re like, oh, that’s really cool, a cool jumping drill or agility drill. And you add it into the mix and it ends up getting a bit fuzzy of like, okay, is that appropriate for you?

And instead of creating this laundry list of exercises and just continuing to make it more and more complex, thinking more is better. Instead, what we actually need to do is focus on keeping things simple and targeted. I want you to really think about it instead of it being like a shotgun approach. If you shoot a shotgun, there are a bunch of little pellets that come out and you’re almost trying to catch this big target. Versus, let’s say a sniper-type approach where it’s very specific, very targeted, and that’s what we need to be focused on with our ACL rehab process in general. Sure, there are some different moving pieces, and hopefully, your PT or the coach you’re working with is helping you to navigate those things.

But all in all, what we need to do is make sure we keep things simple. And that’s where we come back to what’s the goal? What’s the long-term goal? What’s the current milestone that we’re working towards to get there, or the short-term goals that are currently in place? What is that plan to help us get to that and what are the methods and movements to move towards that goal? So that’s going to be the exercises, the structures, the guidance, the way that we balance those things, the way we balance knee-dominant versus hip-dominant days, working on hypertrophy versus strength versus power versus elasticity. There are a lot of different components in this process that we’ll work on. We have to make sure to keep it super simple and not chase too many things at once and keep our goal the goal. And that’s the biggest thing here, is that when you feel like things are starting to get crazy, when you think that things are starting to get complex or it’s hard to kind of figure out, well, what am I supposed to be focusing on? Just think about what if it were simple. What if it were easy, how can we make sure we go about navigating this? And you don’t need seven days a week, 20 different exercises to get you back to where you need to be. It just needs to be thoughtful testing to make sure we are hitting certain milestones. 

And then there needs to be a plan in place and a program designed that is very strategic and very targeted for the goals we have set. And then there needs to be support because the plan is not going to stay on course, and we all know that. We need to make sure it is agile in this process and we need to try and keep it simple. Because when we keep it simple, it allows us to make sure that we are clear on our goals; it allows us to make sure that we are being super targeted with our plan in the program; it allows you to actually be very intent with each and every rep and every movement. If you think about doing 10 or 20 different exercises in a day, you’re likely not going to do all of those very well. It’s likely to be that you’re going to do those to try and get through them versus like, let’s keep it simple and maybe if our goal is to work on quad strength for a certain session, we can even be super effective with three to five movements versus doing 10 to 15 different knees over toes exercises, if you will, to be able to make sure we move the needle.

And that’s actually how we end up working with a lot of our ACLers not by just like, all right, here it is. Here’s the program. Of course, we individualize things, but it’s more so growing intent and making sure that’s the focus with reducing actually how much they need to do. Now, it’s always going to depend on what phase they’re in, and what are their goals. But that’s going to be the main thing, is making sure how can we be as simple and targeted in this process. When you’re feeling lost in that stuff, make sure you come back to the goal of what you’re trying to achieve, and then the plan. And then lastly, when in doubt, keep it super simple. Whereas my coach said, “Keep it simple, stupid.” And it’ll help take you a long way in terms of managing any type of anxiety or anything in this process. And to just help from a mindset standpoint to know, instead of having to navigate all of these different pieces, let’s stay rooted in what we know and keep it super simple. 

I hope that’s really helpful guys. It’s something that I’ve been having conversations with some of our athletes and just our team to make sure that we are keeping things simple and not trying to make things complex just to try and catch everything or just for the sake of sounding cool. Let’s just focus on the goals and what is the simplest way to get there. That’s the main thing. If you have any questions, please reach out. You could send us an email, hit us up on IG ravipatel.dpt, or at the ACL Athletes. But we’re happy to field any questions and when in doubt. Keep it simple, until next time, team.