Episode 142 | Athlete Wins 8.0

What is up team, and welcome back to another episode on the ACL Athlete Podcast. Today, I’m pumped. We have been hard at work, trying to get each and every podcast episode transcribed and uploaded to the website as their own blog post. Well, now, it is there and you guys can check it out for yourself. We started to realize — and this actually stems from an initial conversation from one of my ACLers where she has a hearing impairment. I have to speak very loudly with her and communicate via words, texting, and writing things down because it’s better communication for her. These are some of the things that we have talked about. And then she also mentioned she’s not able to listen to the podcast because of her hearing impairment.

And so I started to think, well, man, how many people might not be able to tune in because this is just an audio podcast, right? I decided that we wanted to make every single episode from episode one all the way to, this is episode 142. You guys are getting 142 podcasts on our website, transcribed, being able to follow through with whatever you would like, and resources associated with every single post and every single episode. We have been working on this and I hope you guys do enjoy this. 

If you could just do me one favor, I had some people who reached out and be like, how can I support you? Honestly, if you could just share this with people. And the other thing too, is that if you guys can just go in and just give us a review, a five-star review, maybe an experience you’ve had, how this podcast has helped you, whether you’re on Apple Podcast, on Spotify, it helps us a ton. It helps to create reach with this podcast. It allows us to really extend how many ACLers we can impact. When they type in the ACL podcast, this one comes up, and they have over 140-plus episodes to tune into. It’s a game-changer. And the way that we can reach that more is by sharing it, but then also being able to have better ratings in order for people to see it more.

That’s all we care about, guys. We just want to expand this reach as much as possible. Thank you to those who have supported us. And we are pumped because the goal is always value. And that’s why we made these podcasts into transcriptions, just to make sure that we can continue to provide as much possible value. You guys can catch any of those episodes in our show notes on the website. You should be able to go to any single podcast blog and be able to check it out. 

Now, on to today’s episode, Athlete Wins 8.0. And if you’re new to this podcast, the athlete wins episodes are focused on sharing wins, especially given the ups and downs of this process. And sometimes feeling like there’s no end in sight; no light at the end of the tunnel. The goal of these episodes is to encourage you, to show you that ACLers do get there. And I promise you there is light at the end of the tunnel. 

Today, I’m going to share one specific ACLer. He’s a college athlete, a soccer player, going into his second year. He’s well within a second year now, as it is technically October with this recording. And so he has kickstarted the season with his team. He had a very tough start with his ACL surgery. If we back this up, about a year ago, he injured it, and then he had surgery in December. And so this has been quite a rollercoaster of a journey for him. He ended up having the surgery, a hamstring graft, with that surgery in December, and then we started working together a month after it.

It was basically in January when we started working together and we have now spent pretty much the past eight months working together. It has been an absolute fun ride. This kid freaking works. I say kid but he can kick my butt. I probably shouldn’t say that if you’re listening. We worked together for 90 percent of our time remotely, I might add.

He wasn’t necessarily here in person. We saw him a few times, but 90 percent of our time it was remote. I want to walk you guys through the process of his journey. And then how we got to where he is now. Postop, he was locked in that brace for a long time, with lots of pain, swelling, poor range of motion. The surgeon actually restricted him from movement and weight-bearing for the first six weeks with an isolated ACL injury. I don’t see this often guys and I didn’t really understand fully why that happened. But you know, surgeons have their own training and their own preferences for some reason. But for some reason, this isolated ACL injury was a six-week restriction of locked in a brace and non-weightbearing. That’s going to atrophy and really make that leg go downhill because there’s so much immobilized.

And especially if you’re not weight-bearing on it. So that initial restriction did impact his recovery. Especially because we couldn’t even connect for the first month, we ended up connecting in month two. We had a lot to catch up on and work towards. The biggest problem that he had was getting his heel pop and that extension. We had to hammer extension really hard and it wasn’t something that just came automatically as we worked on it. It took months. He didn’t get his complete heel pop until months of work and low-load, long-duration stretching, some contraction-antagonist type muscle relaxation techniques, and things of that nature that he was doing on his own to be able to really promote that last little bit of extension. Because we think about the need for that extension from the quadricep contraction to being able to sprint triple extension into acceleration positions, sprinting, jumping, and being able to just access that position is key for any ACL, especially a soccer player.

We had to work on that a good bit on the front end. He dealt with a good bit of pain and swelling, and he was also one of those people who thought more was better, so we had to be on top of how he was doing and overall training volume. So that meant plenty of setbacks also happened along the way, or just having to adjust that game plan because of how his knee was responding. It was pretty sensitive postop. Even leading into that early to mid-phase, we still had to work around a lot of pain and even some effusion within the joint because it just wasn’t handling the load really well. We had to work around it. But luckily, we were able to get things rocking. We were able to get him out of the brace, we were able to get his range going, a lot of strength work. The biggest difference here is that he got into the gym early and we started working on things as much as tolerable.

We implemented blood flow restriction training which is an absolute game changer and one of our non-negotiables which helped a ton. He was super dialed in. We ended up making it towards the mid stages, which went, I would say overall pretty well, once we got his symptom profile decreased a good bit. And then that way he was tolerating things and we were actually building towards some strength and some power work. But he did end up going through this strength plateau for one small phase.

For some reason, his quad didn’t want to keep getting stronger, even though we were using all the resistance-based training principles, progressive overload, and making sure that we were able to keep nudging the needle. It would just have a little bit more fluctuations and it would be harder to break into that plateau that he was feeling. But we’re able to do this with more right-of-force development work alongside overloaded eccentrics. It was great to really get them over that hump.

One side note I want to add here is that some people keep building and some people have these undulations. It’s normal with someone who’s not even injured. You go and ask really well-trained athletes how often they make jumps in strength or improvements in their numbers all the time — it’s a long game process. It’s even more normal for an ACL injury where there’s not only a lot of local muscle and joint changes, but also a lot of nervous system changes from the brain to the spinal cord to the motor neurons that are affecting it, the sensory neurons that are affecting it. All these things affect this whole process, which is why it’s so complex. So that was something we had to really work through in that mid-stage for him. And then that helped us get towards the late stages. And so these are more of the recent months and this is where our people if they’re in the late stage, they’re usually in our return block, which means they are following the return-to-performance framework that we built out where they continue to build on top-end strength and power. Most importantly, build up on their on-field or on-court related exposure through the phases of return to practice, return to sport, and return to performance. 

This is making sure top-end speed, deceleration, acceleration, and change of direction ability are rock solid, then reintegrating back into the athlete’s sport. We progress through the controlled chaos continuum alongside this. We are balancing the amount of volume and intensity of play, as well as the contact and number of bodies around. While he’s doing many components of this in the early and mid stages, this is where the scale slides towards keeping the strength and the power ceilings high, but with more emphasis on the dynamic aspects like reactive and elastic abilities. Those qualities truly make athletes feel and move more like an athlete.

This guy worked really hard. There’s been a lot of collaboration between the surgeon, which even had to change to his training staff, to medical staff, to coaching staff, to parents, and all stakeholders involved with him at the center of this, all on the same page. We all agreed upon specific criteria and reintegration to get him fully back and fully cleared.

Well, he recently hit the 9-month mark. And I’m pumped to say he has been cleared with all return-to-performance testing, crushing all of his KPIs. I’m going to share some of those KPIs and return-to-performance criteria with you guys. He got a full range of motion matching the other side. His quadriceps, isometric peak torque, LSI, and his symmetry was 109%. He’s 9 percent stronger on his ACL side than his uninjured side. Same thing with the hamstrings, he’s at 99 percent. And keep in mind, he had a hamstring graft so that makes it harder to come back to that symmetry because you’re lacking a hamstring muscle group essentially in that side. We equated all of this to torque to body weight, especially for the quads where he was 3.9 on involved and 3.7 on uninvolved trap bar deadlift, 295 for three reps. Single-leg leg press for three reps on each side was 365 pounds. Holy crap, that’s a lot of weight. Dropjump RSI was 2.5. His 5-0-5 and penultimate foot contact quality was rock solid. We worked on this a lot because there were some compensations that he was seeing sometimes and we were seeing, so we fixed that up with him with some drilling and making sure his positions looked great. His ACL RSI: is 97.8; usually, we want greater than 77 based on research for higher return to sport rates. The one-mile test, I usually don’t give this to people, but he wanted to do it because it’s what his coaches usually test their athletes on. And he was able to hit this at six minutes flat, which I will say is pretty darn solid.

I just wanted to share all this because you guys are probably wondering like, well, what is it that this process looks like? What did he go through? What were some of the tests that he did? And there were other pieces, too. But these were the main buckets we looked at to make sure his criteria from clinical to performance to sports-specific were all there. We didn’t even mention his progression back into soccer with the minutes and the intensity and the contact points and whatnot, but he did the whole process like that over the past three months. These are killer results. 

How did he get here? I’ll be honest, tons of factors play into how he got to this place in nine months. And I always tell you guys, it’s 9 to 12 months, it might be longer, or it might be a little less based on your unique situation. Nine months is my cutoff, our team’s cutoff, because the research supports it. But what are these factors? He had an incredible support system, finding good help, his parents didn’t settle after realizing the first month of PT was not great. Let me remind you, he did 90 percent of this remote. Over the summer, he’d go to crunch with his brother and hit the weights, and whatever else was planned and programmed for him. He was often recording videos when there was no one else in the gym, at school, or at crunch. His consistency was incredible. He always showed up and put in the work. Even if there were setbacks that happened, he showed up, he communicated. He had a singular-focused goal. He wanted to get back to college soccer. And so that helped him to make sure he shifted his priorities in a sense to make sure he can get back to that this season with it being one of the most important ones for his life right now.

He communicated really freaking well and provided feedback as I had mentioned. He was patient even with the ups and downs. We tested, and we found gaps and deficits that existed along the way. We planned and programmed around his goals and his schedule, supporting him week in and week out. And we just did that on repeat. That’s it. Till he got to this point, no secrets guys, no special equipment, nothing like that. He could have done it without BFR. But what we did anchored to his principles, science, research, and just good, old-fashioned basics to get him to this point. It’s just hard work, consistency, playing the long game.

The best part is he finally got back in his first game this past weekend. I got this message from his mom: “He got some time in tonight’s game. He did great. He was nervous to start but then settled in. He had a couple of big runs and a slide tackle. He almost scored a goal. Thank you, Ravi.”

Man, I love messages like this from athletes, from parents. And it’s a big reason why we do this. This is the thing that I wish I had whenever I was going through this ACL process. And it’s just something that I want to share with you guys about this journey, the realistic journey. And most people don’t get this in nine months, but he did. And there are a lot of things that worked his way, a lot of things that didn’t necessarily, but he stayed consistent and he just did the thing.

If you’re listening to this and you’re like, well, I don’t know if I’m going to get there. This kid had setbacks and everything and it still was a possibility for him to get there and put in the work and be able to see the other side of this. I hope that this helps encourage you guys. I think the biggest thing here is knowing like what it is that he did that set him apart from people who might not get there. I hope that this helps you to be able to audit your own process, see where you’re at, and also give you some encouragement because this process is long and we are here to lean on each other. I hope that this was helpful for you guys. 

And like I said, check out the podcast on the blog. The link is in the show notes. If you’re wanting to support us, please leave a review, a five-star review for us helps us a ton and helps us reach more ACLers. It just keeps pushing the mission forward, and you are a part of that. Thank you guys so much for listening. This is your host, Ravi Patel, signing off.