Episode 125 | ACL Surgery Essential – Planning your PT Early

What is up team? The goal today is short and sweet, trying to not be long-winded. I’m sure you guys have listened to previous episodes and been like, wow, they’ve gotten longer. I’m going to try and keep it short. I’m thinking of you guys and I know you don’t want to be here very long, so let’s get into it – ACL Surgery Essential Planning Your PT Early. And this comes from recently being on a kick where I’ve just been thinking about planning ahead for ACL rehab, having these conversations. ACL is going through this process, with lots of education going on, and the biggest thing is to plan ahead. The one advice I can give you: plan ahead.

I have this conversation every single week with ACLers where they feel like they didn’t know or got stuck in the system and just relied on it to help guide them through it. The more we can become educated in this process, the easier it could be for us to know what’s ahead and when to pivot if we need to and to constantly reflect and audit the process. That’s probably the biggest thing here, is to not let it just push you down this assembly line or just assume that, all right, I’m being taken care of. Continue to audit it, ask questions, and make sure that you are in check. 

Today, I want to really focus on the physical therapy, the physio, PT side of it, and planning ahead, especially for that first post-op or post-injury visit. Usually, the process goes something like this: ACL injury happens, goes to either an urgent care or ortho, gets an x-ray, MRI, ACL tear diagnosis, maybe some additional things, then discussion of next route. This will be dependent on your injury, limitations, age, goals, and the professional you’re getting advice from. It depends on the lens they’re looking from. And maybe their background, their experience, and how educated they are in the ACL rehab process and surgery process. And if they are aware of there’s non-operative situations, if there is ACL healing, or if they only see numbers because they get the outcomes and are paid to do the thing.

These are all things to factor in and consider the lens that the person is looking through. In most cases, when you look around the world, more people are having surgery than they’re not. It’s the surgical route that is the go-to. And typically when you see a surgeon, they do surgery, so they’re going to potentially propose a surgical route. It’s just the way that it goes. And so while non-operative has gained that traction to some degree, it’s still a super small percent. And it doesn’t account for the youth athletes who are trying to get back to higher level cutting and pivoting a sports like soccer or football or basketball, things like that, where ACL is such a major player in that. And they want to do still and they’re healing and they’re growing. And it’s something that when you’re a youth athlete, your chances of having ACL surgery skyrocket compared to someone who might be older, who’s not getting back to a higher level cutting or pivoting sport. 

Then surgery has been decided and it’s on deck. PT is recommended post-op, and this is where I want to emphasize things. This is where I see the gap or maybe a lack of emphasis. And we’re going to play the role of thirds here because they tend to be fairly accurate with most situations. A third of the ortho offices or professionals, praise PT there are a third of ortho offices, take it or leave it. The PT is there, do it. It’s a part of it. Then there’s a third of the ortho offices think it’s super secondary or don’t think that there’s as much merit or weight to it. It’s like the surgery’s done, do a little bit of rehab and you’re good to roll. This operates in those rolls of thirds, of course not. But this is a lot of times what I see also with talking with ACLers. 

And when I asked about when did they recommend physical therapy? Did they put weight into it? Is there a certain PT they recommended? What was that process? Or was there any testing? All these things. This is the vibe that I get with most of these conversations of, well, some are super proactive, like, yes, PT is awesome. Some are like, yeah, you should do it. And then there’s some that’s like, it’s not that big of a deal, like especially depending on your goals. But I would disagree because physical therapy is where you are going to make the physical changes that you need in order to get back to the thing, especially with the weakness, the lack of range of motion, the pain, all those things. 

You’re going to need to do a lot of gym-based work and field, court-based work, or open-field work in order to get back to getting used to the stressors you need. Your physical therapy is going to be key. And basically, there can be variants of the recommendations of when to do post-op physical therapy and getting that set up. And in my professional opinion to really tackle this topic and subject with planning ahead is to try and do that within the first three days post-op. I want to see you. I want to be able to get you started on the post-op movements. Sure, you might get a sheet of paper with exercises post-op from your surgery, and that’s okay to start. But if you’re not given guidance, whether that’s remote, in-person, basically being able to make sure you have a specific plan and the guidance around it, the execution of the movements can impact the outcome, given that you’re in pain, fearful of moving the knee, the quad shuts off, nerve blocks, pain pills, anesthesia, you name it. Your body feels pretty foreign to you post-op. For you to assume that you’re just going to be rocking it with post-op exercises is a different story. You’re going to be super out of it and trying to kick on the quads and bend the knee. 

The biggest thing that I have athletes worry about is if they’re going to mess something up from the surgery. Because after surgery you’re locked in that brace typically, or your knee’s straight, and bending that knee just feels fearful. You feel pain and you’re just like, am I going to pull the ACL out? No, you’re not, and you’re going to be fine, I promise. But the thing is being able to make sure you see your physical therapist or have that game plan in place to start moving, is going to be so vital which is why PT as soon as possible is going to be key. 

This leads me to the point of the episode plan ahead on when that session is and what your physical therapy is going to look like, especially post-injury or post-op. And I’ll be honest if the surgeon or professional you’re working with says to wait two weeks until after the surgery, Don’t do it. Get in there as soon as possible, even if it’s a single session, or maybe they say to schedule it once you’re post-surgery. You get to the surgery, you have the surgery, and then you’re kind of reliant on like, okay, maybe I should go ahead and schedule my physical therapy since they said within the first two weeks, depending on the clinic, they might be booked out. Or maybe there’s a particular physical therapist or a place you want to go to. And that’s something that you have to get ahead of because especially if they’re specialized in ACL, they are probably going to be busy. So you want to make sure that they’re not booked out. And this is something that has even happened at popular hospitals that I know of.

Athletes and parents weren’t given guidance on getting into the PT, or maybe they’re like, hey, schedule it whenever. Thinking of resting post-op, and this is something that a lot of people think. It’s like, all right, I’ve just had a major surgery. I probably just need to chill and let it just heal. But ACL is different. You need to let it move and you need to get it rolling and going because you’ll deconditioned. The knee will start to freeze up a little bit and you don’t want to be that person. I want you to start moving the knee, get into rehab, get your quads going, and make sure that you can still train and not decondition too much. And this is the natural thinking is, I’ll just rest and then eventually get to my PT. And then they realized most places around them were booked up for a couple of weeks once they did try to reach out. And then the kid has a heck of a time post-op with pain and getting range back because now it’s three to four weeks post-op. And this could have been different if they had solid guidance on day one. 

Of course, prehab is ideal in this process for planning ahead. Prehab is preoperative rehab. So let’s say you injure your ACL and you’re planning for surgery, then do prehab people here all across the board. Prehab is great. It shows better outcomes post-op ACL and to returning to sport. Definitely, do the prehab if you can. Not everyone has either recommended it or has the time. There are a lot of different nuances with each case. But if you can, great. And if you do prehab, then this could potentially impact your post-op timing. If you have a solid understanding of what you need to be doing, and maybe you have limited coverage of visits, so you’re trying to stretch things out, that’s okay. 

But in most cases, most people don’t do prehab. And if you don’t do prehab, you should have even more importance of getting into physical therapy as soon as possible. My recommendation is within the first five days, ideally, the next day, which is when I love to see people. So many advantages to being able to get that going and whether that’s in-person or remotely, it is just having that specific guidance. On the flip side of this, you have so much to lose by not going early. Really, you do. And the first six to eight weeks of this ACL rehab process, the post-op process are game changers, absolute game changers of how your mid to late stages can go. And it can impact how long you might be in this process. If you don’t lay that foundation, work on those pieces, and a lot of that is going to be dictated by making sure you’re doing things right and that you have the proper guidance and planning. And the goals you want to be able to get after. 

Do not rely on the system that you are in the healthcare system, wherever you are to take care of you. It is designed for volume, not for individualized care. And I don’t say this in a negative way whatsoever. It’s just the way it’s been built. They see many, they see lots of people. You see one, you’re an n equals one. And so you’re going to be thinking about your own process while a surgeon’s office or even a big physical therapy clinic is thinking about the volume, the amount of people that are in there. Sure, they want to care for you and help you, but things can fall through their cracks, especially the details of like, hey, maybe you should do your post-op appointment ahead of time, or maybe you should have done this post-op, or hey, you could do these exercises, but they forgot to give you the paper. There are a lot of details that I see all the time that fall through the cracks because of the way the system is built.

Think about this from your own perspective when you have a lot going on or you’re stressed or you’re juggling a lot. Do you feel like you remember everything and you’re able to work on all of it to improve it? Sometimes it’s really just surviving in life and doing just enough, and this is a lot of how this can be. You have to be proactive, ask questions, educate yourself, and take control of this process. This is not some shoulder pain or a hamstring strain injury that you can recover from within a few weeks. It is a major injury that can have honestly, life-altering implications. I’ve seen it, I’ve experienced it, I know what it looks like with ACLers, and I talk with them every single week about this.

It seems dramatic, I know. But that’s why this podcast exists. It’s not just because it’s this easy injury to recover from. It’s because speaking with these ACLs and going through this process myself and knowing this, we need help to be able to tackle these problems. And this is something that I want to make sure is very clear. Take control of this ACL rehab process yourself. Don’t rely on the system. Plan ahead and get into your physical therapy immediately. Post-op bonuses if you get there for prehab. If you are looking at ACL surgery right now, a good rule of thumb, with the exception of some situations, is to get in there within the first few days, a maximum of five days. I want you to set that as your rule and make sure to adhere to it and do it ahead of time. I like to see athletes literally the day after surgery if possible. Get out your calendar, whatever you’re going to track. Look at the timeline, look at where your surgery is, if you’re having surgery, if you can get in for prehab for even one session, do it.

Then schedule your first post-op session or two within the first week, within the first five days. If it’s two to three days post-op, awesome. If your PT is like, hey, we don’t need to do that this soon. Well, just say like, hey, I’d rather just be sure can I come in, get the feel of it, and make sure I’m doing everything correctly, and I promise you, you will not regret it. I promise it might not seem like much, but man, it can just be a huge game-changer in this ACL rehab process. Make sure to plan ahead, audit your process and the system, and reflect to make sure it’s consistently meeting your goals. You’re feeling like you’re in the know and not feeling lost. 

And if you are feeling lost, as always reach out. Until next time, team. This is your host, Ravi Patel, signing off.