Episode 152 | Revisiting Expectations in ACL Rehab

Welcome back to another episode on the ACL Athlete Podcast. Today, we are diving into revisiting expectations in ACL rehab. So today’s episode is short and sweet, all about expectations, the name of the game with ACL rehab. Let’s be real. It’s the name of the game for life. So I just wanted to talk about this for an episode today because we have an episode from before that I’ve done, which is setting expectations in ACL rehab. If you haven’t listened to that, please go back and do that because that is really helpful to essentially set the tone for this particular episode. 

It’s almost like an A and then B. So this is the B. So if you are someone who is going through the day-to-day with ACL rehab, if you are just on the three months, six months, nine months and beyond, maybe you’re starting off early. And it hasn’t been a great start. So, this is where it’s important to come back and revisit our expectations, not only setting them, but revisiting those expectations. Why? Because life itself doesn’t operate in a vacuum, especially for anything, but especially when we’re dealing with ACL rehab. We can’t control how our bodies respond sometimes to the rehab we’re doing to the surgical process. We might be doing anything and everything that we can to get our extension better or improve our quad activation or that donor site issue. And our body might not be responding. Maybe you’re monitoring your steps, or maybe you’re in your crutches and you’re taking your time to wean off of them. And your knee will just not stop swelling. These are things that we can’t always control fully as humans because our bodies do have their own way of healing and regulating. While we do have a normal course of understanding that, there are certain things that we just can’t explain all the time. And so then that’s why we also need to make sure we can understand what our expectations are for this process and make sure that we know what to do if things don’t go as expected. 

And the thing about ACL injuries is that it’s arguably the most complex musculoskeletal injury and recovery. I’ve dealt with a wide host of different injuries myself, but then also worked with athletes in the CrossFit world to professional sports, football, baseball, jujitsu athletes, to just everyday recreational athletes, you name it. And the thing is,  I’ve seen a lot of different injuries from ankle to the hip to lower back to even concussions and things of that nature. When we are talking about the world of sports and injuries, outside of things that are so kind of life-changing, if you will, from the degree of like a spinal cord injury.

When we talk about true musculoskeletal injuries, I do believe that ACL injuries are the most complex. If not one of the most complex injuries that exist in our space in the human body itself. It is a tough recovery. Just speaking to all those different experiences personally and professionally talking with other professionals in the space and just seeing what can exist. And so that’s what makes this really tough. And then on top of that, you tack on that. It is one of the longest recoveries that can happen in the musculoskeletal space in terms of injuries, which makes it even harder. You can talk about a shoulder issue, you can talk about Tommy John recovery, you could talk about an Achilles-related injury. And then anything else underneath that. A muscle strain, even like a ligament sprain of some degree. 

A lot of times we can kind of bounce back from a lot of these things and the reinjury rates aren’t nearly as high as something like an ACL injury and recovery. So this is where it makes it really hard. And the thing is is that if it wasn’t so hard, it wouldn’t be one of the most research in the world. And if it wasn’t so hard, we would have incredibly low reinjury rates and high success and all the numbers, including a return to sport. But we don’t, which makes this complex. And so what I’m trying to share here and get the point across is that this injury is a lot. And so then therefore you might have the best expectations from the start. And then as you go, those might get changed a little bit and you might be thinking, Hey, I’m going to hit it in six months. I’m going to hit it in nine months and get to a certain point. And you have your sight set on this particular competition. You might have your sights set on this trip. Maybe getting on your skis again, or maybe being able to just go and play with your kids, whatever that might be.

This is something that can make it really hard because we’re not just working with this four-week timeframe, we’re working with a timeframe that is usually upwards of nine months, if not longer. So there’s a lot of things, not only from your own rehab and injury side of things that you’re recovering from, but also life. There are so many variables that can take place and a time span of 9 months to 12 months. And so therefore there’s a lot of things that have to be adjusted along the way. And some of this could be related to the criteria that you’re trying to hit for getting back to something like running.

There are plenty of athletes we work with who are able to get to that point in a reasonable time. And there’s some athletes where there might be some delays in certain areas. Maybe their quad strength is taking a lot more time. So then we can’t necessarily clear them until they have a certain threshold of string for us to feel comfortable, to make sure that they can get back to running appropriately. 

We will adjust the plan and continue to keep rolling. Maybe there is a donor site that is creating a lot of issue in terms of pain. So then therefore we can’t move forward with being able to load the knee as much as we want to. And there are a ton of things that can come up – a knee flared up, cyclops lesion, flexion, isn’t coming along. There’s so many different things and hurdles that we have to navigate in this process in order to make sure that we can continue to progress forward. And make sure that that expectation and reality are actually matching up. The thing that is tough is whenever that doesn’t match up.

This is where we’re kind of coming back to understanding, okay, well, why don’t those match up? Well, first off setting expectations from the front end of this process is so crucial, which is why I mentioned that previous episode to make sure that that is set, having a conversation with your physical therapist, your rehab provider, your coach everyone who is a stakeholder who has a kind of piece in this puzzle to help you get to where you want to be. Having a conversation with them and understanding what are the expectations from a sports standpoint, from a rehab standpoint, from a training standpoint, from a psychological standpoint. How does all of this kind of play into your expectations, especially the procedure that you have and when is it that you’re trying to get back to a certain activity or a sport? And what that timeline looks like roughly. And what criteria are needed to meet certain milestones? 

That’s going to really help to manage the expectations and understand, okay, here’s how close I am or here’s maybe how far I am. And so then therefore, you know, that that is something that you can kind of connect with time in order to make sure that that expectation and that reality is both connected. What’s tough is when those don’t match up, especially whenever you are not on the positive side of that.

And then that can put you into a negative mindset. You’re just like, all right, well, this didn’t meet my expectations. So then especially if that is repeated multiple times or dragged out for a long period of time, then that starts to lose motivation. And really the mindset leading to inaction of not feeling like it’s a meeting up to the right standard for you or what you’re doing is not leading to the outcome you want. So then that’s where it can be really tough with your expectations and understanding. Well, okay, if I was planning to run in three months, for example, and maybe your professional edge, you astray. And you’re at four months and five months, and you’re still not there. Or maybe you did start running and you’re just not running like you were hoping, like you’re limping, your knees swollen and you’re in pain. So those are all things that are tough to navigate through. And this is where you’re hoping. 

I’ve got a professional who knows ACL’s who are experts in ACL’s, who understands how to provide a plan, who can communicate with me,  and to be able to adjust the plan as needed and to communicate around expectations and to understand what is that looking like from a criteria standpoint, but then also from a time standpoint. A

The thing here that’s really important is that we want to make sure we escape this negative mindset whenever it really does kick in, especially if you’ve been grinding in and out for a long time because you’re just going to lead yourself to burnout. And so that’s where those conversations. Taking place will be really key. 

And to give you guys an example, I’ve got an athlete right now who has been crushing it. She had a really rough go at it for her first three to four months. She was elsewhere. And then she decided to work with us. And so her and I started working together. And this is something where she was wanting to get back to running. And so then we had been making awesome progress and trying to work through some issues that she had had a little bit of a complex ACL injury. And surgery. And so then we were doing well, gaining strength, doing all these different dynamic tasks, getting some plyometrics going. 

There was just one session where her knee just flared up a little bit. Nothing out of the ordinary. It wasn’t like it was something where we added a ton to the session. Her knee just did not get happy after the session. And so then therefore it just got a little bit swollen and it wasn’t responding normally to the course of action, which could also be related to the complexity of our history. But with that said, we ended up having a conversation around this and it took a minute to get back on track. 

And so then she was riding high and then her knee brought her kind of back to earth, if you will, after such a tough initial go. We started making progress. And then there was one session where the knee was like, ah, I don’t know. And so there is nothing that we could track it back to directly. It was just something where the knee was just like, Hey, I’m just going to freak out on you guys for a second. And so then it has taken a minute to get back on track, but we have gotten her back on track. And it’s good, but we had conversations around this and it was frustrating. She was cruising expectations were there. And then all of a sudden the knee kind of came out of nowhere. 

But the thing that was important here was that we had a game plan. We revisited it. We talked about what was going on. And we talked about the way that we were going to intervene to make sure that we get her right back on track. Always use the example of like, if we are in the car, we’ve got the GPS going and let’s say, we just got to take a detour. The road comes up. There’s a little bit of a roadblock. Well, we got to get off the interstate for a second and we gotta take a little bit of a detour. 

The goal is to make that detour as short as possible to get back on the dedicated route. And that’s what we try to do here. Instead of getting lost on this detour, you know, the signs are really not obvious. And then we’re making all these random turns. We got to make a U-turn. Get back on. And so our goal is to make that as minimal as possible. And that’s where connecting the communication with expectation is going to be so key. And so what I want to most importantly communicate here, Is that it’s important to always revisit our expectations, especially even if things are going well. Awesome. 

Let’s make sure that we have a clear game plan on that. I think what’s important as someone who’s gone through this twice and worked with so many others with this now… there’s no one’s immune to a setback in this process. No matter how good you are, no matter how much you do your plan and are dialed in. It can still happen even in the mid to late stages when you think you’re cruising and you’re good, the knee can still kind of bug out a little bit because let’s be honest, the ACL and this injury is already complex in of itself. And so it’s not always explainable what’s going on. 

But with that said, I think that is always important to be able to know what are your long-term goals and short-term goals? What are you working towards? And then also just evaluating if you are someone currently listening to this and you’re finding yourself in this cycle, maybe this frustrated cycle or state and feeling disappointed. I encourage you to review your expectations. 

So our responses themselves are simply just a result of our expectations. So, if we’re feeling this type of way, we need to revisit what those expectations are. And managing those expectations. We have a better chance of managing our responses to those outcomes. So if we have better expectations, then therefore like, you know, you might be less disappointed or frustrated with the outcomes and your response to that. This is something that is really key and I think really important to revisit very often in ACL rehab. It’s not just this, like you do it on the front end and hopefully that’s kinda kind of get you sat through the whole process. Hopefully, with your rehab professional and with your team, you’re able to have these conversations and to be able to just really dial in and look at your expectations at periodic time points. Especially if something let’s say on the negative side does come up because that’s where I noticed sometimes even let’s take this outside of ACL rehab. 

If we notice ourselves in a consistent state of frustration or disappointment or feeling these things, maybe we need to kind of take a step back. I’d be like, well, what are my expectations? Why am I feeling frustrated? Why am I getting disappointed? Well, maybe it’s because I’m with a provider that’s not really fulfilling on what they need to be helping me with. 

Maybe it’s because I don’t have enough time in my day and I can’t get to all my workouts. And so maybe I need to communicate with my provider and let them know, Hey, I can’t do these sessions or I don’t have the equipment always available, the gym’s always busy. You’re trying to fight through a lot of pain and you’re not really communicating that. And then you’re not sleeping really well. And that’s leading to some just poor recovery and just poor moods in a sense. So maybe we need to backtrack that and understand what the root of all that issue is. 

There are a lot of things that can lead to failed expectations. And I think the most important is that we revisit these often, especially in a process like this because there are a lot of variables that are moving. And so then we want to make sure that we can control what we can control. And then obviously there are certain aspects. We can’t always control the human body and with life. And so then therefore we just do what we can with those expectations. And manage those and then that’s going to help us to have a better response to those outcomes. And this will dramatically help with our mindset and this will also lead to better actions. A huge huge believer in your mindset will dictate your actions, both positive and negative. 

So we just want to make sure we revisit these and these will help to move the needle forward. And just know, I think sometimes people think you’re either taking steps backward or you’re taking steps forward. And so just know that there are times where you’re also maybe in place for a minute and that’s okay. 

But just know that that’s probably something that’s going to help slingshot you forward, whether you believe it or not. But that’s where you got to know. Maybe it’s just showing up one day, but it’s all about making those 1% changes day after day, doing that compound interest.

Just like a stock market does over time. You take a step back and you’re like, oh wow. Look at all this progress. I’m sure those of you who are in the mid to late stages, or even further out from surgery, you’re like, okay, I’m a lot further out from where I used to be, of course, not where you want to be yet. But this is where coming back to revisiting your expectations is going to be so, so key. 

Something we talk about with every single one of our athletes. And we revisit as much as we can. So then that way we can make sure we set ourselves up for our game plan, and any changes we need to make. And most importantly, our mindset, which is going to be dictating our actions both now and for the time to come. So 

I hope this was helpful team. If you have any questions at all, reach out to us, you know where to find us until next time, this is your host, Ravi Patel signing off.