Episode 138 | ACL Rehab Principle – Addition By Subtraction

What is up guys, and welcome back to another episode. We’re getting straight into it today — ACL rehab principle addition by subtraction, or I said a different way that maybe some of you have heard is less is more. Man, I love this concept and I think it is really awesome. And I think that it comes at a very valuable time when maybe just our worlds can feel like we need to constantly add to it, especially in this ACL rehab process. But honestly, just in life in general. 

Let’s get straight into it. In a broader sense, addition by subtraction can be applied to kind of decluttering like one’s life or business. In this case, we’re applying it to ACL rehab, of course. But I do want to kind of zoom out and talk about this in the sense of what it looks like in general, and it is eliminating unnecessary tasks or processes, individuals, maybe organizations that can create more space for you and focus on what truly matters, leading to an increase in efficiency and productivity. Addition by subtraction highlights the idea that sometimes simplifying or streamlining can be more effective than just kind of adding things or resources to try and progress forward.

Let me give you some examples. Let’s start broad. Let’s say you’re on a team in a sport or like a work team. Instead of adding more people, it might actually be helpful to eliminate the ones who are not doing as much or creating a lot of problems for you guys. You’re adding to your team by subtracting actually. Let’s say you have a friend or a person in your life who speaks very negatively or doesn’t build you up. This means getting that person out of your inner circle maybe or potentially out of your life. You’re adding to your life by subtracting. 

I mean to think about this even, would you rather go to a restaurant with 100 options to eat or one with just 5? Decision fatigue is real. And my follow-up question to that is, do you think that the restaurant with 100 items on their menu is amazing at all 100 of those items? Very unlikely. Or do you think that one with five different entrees is amazing at those five dishes? More likely. Of course, there’s a bell curve here. But with that said, you know when you reduce it down or do the less is more reducing how much it is that it is you might need to focus on or kind of trimming the fat if you will. This can be very valuable in this process, especially with ACL rehab.

Let’s dive into the meat and potatoes of this episode applying it to ACL rehab. The number one thing people will often ask is: what exercise can I do or add to improve X? Whether that is an extension, flexion, maybe quad strength, hamstring strength, swelling, pain, running, jumping, etc. Most athletes we get who are coming from other places usually have this laundry list of exercises with no specific order or guidance on intensity or weight to use. I’m talking about 20 to 30 exercises we have seen guys. How can we be effective from a time or even a stimulus and physiology standpoint if we have 20 to 30 exercises to do in a session or a day? That’s a lot. And a lot of times we start by subtracting, not adding. Well, in theory, we are adding, but again, it comes back to this concept of addition by subtraction.

By subtracting, we get so much from this. We are more efficient with our time, we have less to worry about, we don’t burn out from exercise purgatory, and we can build and put more intent behind each and every single movement. Intent is so key. It can really be the driver of really getting the output that we want. We can put more intent behind each movement, each rep, each set, and the intensity of things that you’re doing. Versus if you have 20 or 30 exercises, man, you’re just going to kind of roll through the motions and get it done, check the box. Versus the intent and really driving the stimulus and the adaptations we want from movement, man, you can really get into that and really do those five to eight things well, versus 20 to 30 things.

And so the other thing that is cool about this is that you can measure progress easier because you just have less to manage. But this is only valuable if the things you’re doing are bridging the gap between where you are and where you need to be. That’s going to be short-term and long-term.

Let’s take someone who might have started running and whose knee is getting painful or swollen. Well, this is a mixed bag of potential why, which is why an assessment and conversation needs to happen around this. Usually, there needs to be an audit of the programming and things they’re doing that are active variables. And then obviously, the rehab and training variables that play into their daily life. 

For example, a teacher is on their feet a lot. They’re accumulating a lot of steps. So that’s going to be a factor that plays into how we adjust the game plan. The other thing with this is, instead of thinking, I need to add X exercise to improve this. Well, we might just need to remove some of the provocative movements and reduce some of that load and volume and reduce or potentially eliminate for a second you’re running.

In general, your knee can start to get swollen with some running. But if you’ve had the proper preparation and training, that shouldn’t be a problem. And you’ve had the clearance and the testing to make sure that you are good to go with this. But as we know, this process is not perfect, but what are our heuristics and our game plan if we are going to go down that route, right? Addition by subtraction. 

In general, this might be subtracting exercises or certain movements for a period of time, or maybe it’s even taking out a training or rehab day. People don’t realize sometimes that this can be beneficial because they’re just hitting so much volume. We actually had an athlete come to us earlier this year who is still working with us. And she had been working with a pretty renowned ACL specialist. And it was very interesting when she was sharing what she was doing. Man, she was doing five days of one-and-a-half hours of gym work. It’s a long time, man. And her knee was constantly grumpy. Don’t get me wrong. They did great work and it was awesome. But we thought that the stimulus and the volume were definitely a lot, based on even what we know of research in this ACL rehab process. Especially for a very sensitive knee, we have to be very mindful about the volume and how much we’re having athletes do. Because if we’re just constantly triggering the knee because we just don’t give it enough recovery with where they’re at, then that could just be the problem in and of itself. It’s just too much. 

In reality, we didn’t do anything magical. We just reduced some things and put more emphasis on a few other items, especially because she had this goal of trying to hit within a certain period of time. Of course, there are going to be balance and minimums to everything, but that’s where your ACL guide is going to come in here. And they’re going to help direct and manage the right and wrong stressors in your body, ideally.

And I like to think a lot of times is this is like a slingshot method. You’re kind of being pulled back, and it sucks at the moment, but it’s going to help to launch you forward. In this kind of example, maybe we do have to reduce things, but that’s going to help to be able to move forward, it’s that addition by subtraction. You’re subtracting or doing less, which means that step back or counterproductive. But in reality, it is going to add more to your outcomes and the goals that we’re aiming for. 

Lastly, I’m going to share some other thoughts about this concept that might seem unconventional, but it’s my podcast and I don’t care. I just want you guys to do what’s best for you. Let’s say you’ve got someone on your ACL care team who’s not helpful. It could be your surgeon, it could be your physical therapist, it could be your strength coach, it could be your sports coach, supporting roles, friends, etc. Guess what, your medical team? You can fire any of them at any moment. Sure, there might be some caveats with certain people with legal things or maybe with teams and stuff like that. But honestly, in most cases, you can just get rid of that person or find a second opinion. Find someone else that is helpful to you. But if they are not helpful, not being a guide, not empowering you in this process, then dump them. Find someone new. There’s an opportunity cost for waiting. And if they’re nice, guess what, you can go and grab a coffee. You can call them up. You can text them. But we do like nice plus also being valuable and really good at guiding you in this process. So that’s what’s going to be key here. This is addition by subtraction at its finest. Maybe it’s your coach supporting role like a mom, dad, or other humans that are involved, maybe your friends in your life and they’re giving you some negative vibes. First, I suggest talking to them and addressing it, having that conversation. And then let’s just say it’s just someone who just is who they are. If they don’t stop, then you create some sort of boundary around that. You subtract that in order to add to your life and your process. 

The other thing I’m going to talk about here is social media. This is one that sneaks in without you knowing it. You’re seeing a friend who tore their ACL, at the same time as you progress faster or back to X. Reflect on that and check in on why you’re feeling that. Likely feel some comparison here. Maybe you’re in a group or a forum seeing other people share their experiences. I would suggest really checking yourself with these because that could be a very not-so-great rabbit hole in my opinion. Usually, people will share more negative experiences than positive experiences. And the people who have this flawless recovery are usually not searching for answers. So that’s where you’ll probably end up seeing more of the not-so-great experiences than the positive. Just check that. It’s something we have to be careful of because social media can easily become a comparison trap. This might be, in addition by subtraction, at its finest. Mute them, unfriend them, exit the group, reduce the time on the app, and delete the freaking app. Don’t let it affect you in a way that is going to be counterproductive in your process. Ask yourself what value you’re getting from it and how it makes you feel.

Seriously, this happens to a majority of ACLers. It happened to me during my process. It’s a mindset game. You have to use strategies to protect yourself and focus on running your own race. I’ve said this before. My wife always says, guard your gates. Watch what you let in and protect that and how that impacts your thoughts. Most importantly, how it makes you feel. Addition by subtraction, less is more, this concept and approach can be an absolute game changer in ACL rehab, in school, in work, in life, and simplifying things. And instead of asking what you can add, focus on seeing what you might be able to subtract first.

And let me end with this question: what do you feel you can subtract from your current ACL rehab that could actually add to your process and help your mindset? Think about taking away, simplify, and see if it doesn’t add to your life. All right, team, that’s going to do it for today. Until next time, this is your host, Ravi Patel, signing off.