Episode 109 | You’re Multiple Years Post-Op ACL. Is It Too Late to Rehab?

What’s up guys? Coming back at you this week with a new episode, episode 109: You’re Multiple Years Post-op ACL: Is it Too Late to Rehab? This is an interesting question and I am not the one to speak in absolutes. I think that it’s not very good to do that, especially in a space that is very gray. But I’m going to speak into absolute here. It is never too late to rehab. And I know that this may sound cliche (cliches exist for a reason people) but yeah, it’s never too late. And it’s seriously something that is important to understand in this process. You’re never too late to rehab after your ACL injury or after your surgery.

This question came up after a recent conversation with an ACLer. He is four years out from one ACL surgery and six years out from another on the other side. Didn’t do a great rehab process. Did the first three months. Not a hundred percent all in it. A big part of it was the guidance and really just the rehab program itself and what he was getting with it.

And the other part of it was that his life also got busy. And he also admitted that he didn’t follow through on some of the things that he needed to do. And so what happens when life gets busy? We just let things fall by the wayside. It’s good enough. And I know some of you listening to this are probably agreeing with this and shaking your head being like, yeah, that’s me. I did it. Whether it was the rehab wasn’t so great, or maybe you didn’t have the guidance, or maybe you just life got busy. You had a kid, or maybe you started school, a different program, whatever happens. Things fall by the wayside and they just become good enough. 

And I think this headspace of thinking it’s too late in this process, actually comes up more than we think. And it can create a big negative headspace for us. Because if you try to get in front of it and try to tackle it, it keeps creeping in, three months out, six months out. Yeah, sure, you’re still in the meat of it. You’re a year out, sure, you’re still in the meat of it. But then once you start trickling into that one plus year out one, you’re probably exhausted. And then also you’re just starting to get further and further away from that point. And so eventually you’re just like, is this where I’m going to be? And that just depends on what was filled between the time of the injury or the surgery to that current place. And as we know, time flies. Especially if we have something busy coming up or a certain season, it could end up adding up to months and months and years. 

And you guys know that feeling like, oh, I was going to get around to that, or I had intentions for that New Year’s resolution. I’m going to get in front of this. And then what happens? We’re gungho about it for maybe a few weeks, maybe even a month or two, and then all of a sudden it kind of falls by the wayside. This can be a really hard. Place to be in, especially depending on who you’re talking to, and where the information’s coming up. And for this guy, anytime he would try this negative headspace, thought patterns would creep in.

He used to be the super athletic, active guy running, and playing basketball. Now, not so much sedentary told me he hasn’t run in seven years. Let that sink in for a second. Seven years. Seven years in not being able to move your body in the way that you once had been familiar with moving it. And almost walking on eggshells, being fearful of taking a step and doing things, worrying about your knees, your ACL, just your functional ability and ability to just kind of move as a human. That’s hard stuff, and I know it’s not the things that we always want to hear, but it’s the reality of sometimes where people end up. And it’s the reality of some of the conversations we have with athletes all the time where they are not pre-op or three months or six months or even a year or two out. 

We talk with people all the time who are 5 years out, 10 years out, 20 years out. And plus, I’ve worked with them in person. We’ve worked with them as a team remotely. These are real-life scenarios that happen and people get stuck in these spaces because life is just going to happen. And so with ACL rehab, it could be very tough. Especially whenever it’s not a smooth process, you don’t get the guidance, you are not queued up in the best season of life to do it. But hey, like we got to make it happen. And that’s where people start to realize, oh wait, I need to do something about this. Make sure you’re not looking back in 5, 10, 15, 20 years and be like, man, I should have done that.

A good example that I want to highlight here is our guy Tyler. And we talked about him in our Athlete Wins episode. He tore his ACL when he was young. Back in 2005, that was roughly 18 years ago. Never really rehabbed it and carried on with life. And so he got busy and started his own business. All these different pieces where he was just like, “Ah, this is kind of good enough.” And he always lacked in that area. He realized his strength wasn’t there. He wasn’t feeling athletic like he used to be. He was kind of scared. He thought he would tear his ACL again if he did anything dynamic. And he’s around a bunch of family members who are super active, super athletic, wanting to do stuff, and he saw himself always sitting out and that’s the worst feeling. Nothing feels worse than just sitting out, especially when, you know, you could be at that place where you could be participating, but you’re not there. And so that’s always a hard pill to swallow. Tyler was sick of it. He reached out to us last year and I was actually the one who worked with him one-on-one remotely. And we worked for six hard months. And I told him, “Hey man, like we got to put in the work. You’ve got a long history. There’s some things that you’ve been dealing with for years and years that are a bit chronic. We’re going to have to put in some good work. Create a plan, test, consistently do that, and meet these certain criteria and benchmarks we have set to make sure that we are moving things forward.

And while things were not perfect, after that six months, Tyler was a completely different dude. He worked super hard. Even on the days when his business was up to his neck and things, he still showed up and did the work. In times when we weren’t able to necessarily do that, we pivoted the plan. And the guy absolutely crushed it and it was awesome to see it. And he is 18 years plus, out of surgery and he was able to still do that and make the. progress that he needed to, which was awesome. And so he just really needed someone to really talk to, to be able to understand his goals, to understand where he’s coming from and to really create a roadmap. We talk about roadmaps a lot in this process. And he needed someone to be able to build that for him specific to him. But not only the roadmap itself but the GPS along this path. So that’s the biggest thing that I think I see is really an issue with this process. 

The roadmap in most people’s cases ends up being a protocol and then hopefully your physical therapist is your GPS. The problem becomes is whenever the GPS and the roadmap are the exact same thing. What really needs to happen is that when you think about using your GPS, you have your map that is just based on roads and all these different routes, and guess what? Your GPS is going to calculate the most appropriate way for you to get there. And there’s a bunch of different routes to get there. The saying goes, “Many roads lead to Rome.” I actually saw that spot in Rome, which was pretty sweet, where they had actually come up and coined that phrase. But there are so many different ways to truly do this.

The biggest thing is figuring out what’s the most efficient, and sometimes that needs to be pivoted based on traffic or some detours that need to be taken. And that’s what the GPS system is. Your coach and the person who is going to be helping to guide you and being able to take in your own personal factors. Things that come along in the path. And there are plenty of providers and plenty of PTs and coaches in this space that can do that. The biggest thing is that you need someone else to help externally do that for you. Don’t leave it up to yourself because we will fall into the natural habits and patterns of behavior as before. We’ll use the motivation kickstart and be like, yeah, this is the year, this is the time. And then it’ll just kind of dwindle down once that energy goes down, or maybe you had a setback or life gets busy. You need that accountability piece, but also the GPS and the roadmap. 

And one of the big things I want to come back around to is something important and realistic to consider in this process. If you’re listening and you’re multiple years out from your ACL injury or your surgery and you never really got back to where you wanted to be, and you’re still stuck in this limbo phase. One of the things that I think is important to be transparent is to understand the further out you are from that initial time, whether it’s the injury or the surgery, the harder it can be to get something like your range bag. If you are someone who is three or four weeks post-op, we can help get your range back much faster and much more efficiently. Versus someone who is three years, five years, 10 years out, that doesn’t mean you can’t, it’s just a little harder. Your body has realized it’s new, normal. It’s something that has laid down tissue and has adapted to the new positions. If you did not get your end range extension, you’re probably still feeling that if you’re years out. And so that’s why we always stress getting that as soon as possible, especially your extension, immediately post-op and post-injury, because the further away you get, the harder it is to get back.

That’s not to say, like I had mentioned, that you can’t, it just makes it harder. If you’re listening to this and you’re early in the process, then you should take the initiative and make sure you iron that out. But just know that it is still possible. I think part of my job here as a physical therapist, a coach, and an ACLer, is to give you guys these transparencies of, what is it like if you are someone who has multiple years post-op. And we’ve seen it before where people do get their end range flexion back or do get some of that extension where they can kick on the quads and they just never had the strategies to do so. But it does make it harder once you’re further out. 

My point in saying this is I always want people to have good expectations and fair expectations of their own process. And to also get started as soon as you can. And that will help to be able to maximize the outcomes. And the biggest takeaway here is that it is never too late to start. And I’m comfortable saying that absolute because we have done it with so many other people. My recommendation, if you are in this category to find guidance and guidance from an ACL expert. You want to work with someone who knows the ins and outs of this process, who’s seen people across the entire spectrum, who has dealt with the good, the bad, and the ugly, and who knows the rehab side of it. But also knows the strength and conditioning and performance side.

I can’t stress that enough because that is so key in this space. You want to make sure that they can be the person to help you build out a specific plan for you. You have testing in place, you have the support in place, and allow them to be that GPS that I talked about on this path because it is not going to be straightforward no matter what program you sign up for. There are so many ones that exist. You can Google and find a hundred ACL protocols. But how do you know where you need to start and where you need to go specific to you, especially if you had a quad graft, a hamstring graft, or an allograft? Maybe you had a meniscus-type injury that you had repaired. Maybe you had a lateral extra-articular tenodesis. So many factors in this process that is just going to be crucial to have someone who is familiar with and can guide you through it. 

And I’m sure if you’ve listened to any podcast in the past, that is one of the things that I cannot stress enough. Don’t do it alone. And if I did it again, I tore my ACL twice in the past, so I have the personal experience twice. We have worked with countless and countless of other ACLers, hundreds of people I have worked with in terms of ACL rehab. And I wouldn’t do it again by myself. I would outsource it to someone on our team, someone I trust. And making sure that I’m not doing it on my own because even the best coaches have coaches. It’s good to be external to yourself in this process. It’s healthy. It allows you to be able to separate from having to plan things out, and it allows others to look at it objectively and guide you for what’s best for you and all the factors within your life and making sure that you’re along this right roadmap and GPS versus you having to figure it all by yourself. And we don’t want to do that. 

If you are one year, two years, five years, 15 years, or even 30 years out, seriously, it’s never too late. We’ve seen this with many different athletes we’ve worked with just like Tyler. You are no different. I promise you, it is never too late. And most importantly, do not let this injury define you. I have these conversations all the time with ACLs and they get on the phone and they’re like, man, I’m just too far gone. And they get into this like negative headspace and this feedback loop of like, anytime they try, they almost feel deflated because they’re too far gone. It is never too far gone. This is not something where it’s permanent, you’ll never be able to get back to it.

Will you make maybe different choices? Possibly. But with that said, you’re still able to train, you’re still able to build things back up. It’s not like the knee or the muscle has lost the ability to function. It’s just more so of like, we need to make sure we create the best plan. And train it up like it needs to be for your specific goals to do that. And I think what happens is, is that we let this injury define us for the negative. When you can actually let it define you for the positive and be that person who says, “Man, I didn’t let time consume me. I didn’t let it be 15, 20, 30 years.” And even if you are, that’s okay. It’s all about taking initiative as Tyler did 18 years later and making sure that whenever you have kids, or maybe even in the future, that you want to be able to play around with grandkids or just function as a human being.

You want to make sure you do everything you can in this process to maximize the outcomes. And part of that is sometimes taking initiative much later than you thought. If you’re listening to this, you guys know I’m big on call to action, so take action here. If you’ve been thinking about it, if you’re someone who’s like, man, it’s been years, I, I don’t know. Just take the first step. You may explore it and be like, you know what? I can’t do that right now. And that’s okay. But at least you’re taking the next step and really trying to invest in yourself. If you’re multiple years out from post-op ACL or injury, is it too late to rehab? Never. 

Until next time, team, thank you guys so much for listening. This is your host, Ravi Patel, signing off.