Episode 153 | How to Reduce Overwhelm in Your ACL Rehab – Part 1

What is up team, and welcome back to another episode on the ACL Athlete Podcast. It is 2024, January, our fresh start. Happy New Year to all of you who are listening at the time of early 2024. If you’re not, then this doesn’t apply to you. But anyway, with this particular series, I did want to start by talking about something that I think happens to everybody. 

Overwhelm is something that we deal with as human beings. It’s something that we deal with a lot in ACL rehab, whether we realize it or not. A lot is going on; there’s a lot of moving pieces. The last thing I want you to do is to start this New Year off, or whenever you’re listening to this with overwhelm, or just not satisfied with where you are. And so then therefore the goal with this two-part series is to dig into essentially why you’re feeling this way. And then what are really practical ways to approach this as an ACLer, or if you’re a clinician and coach listening to this, how you can tackle this by working with your ACLer? Just to make sure that we are getting in front of it, because if we’re feeling overwhelmed, then it’s going to lead to a lot of chaos, that uncontrolled feeling, which we hate naturally as human beings. 

Let’s get into it today for part one of this two-part series, we’re just going to tackle how to reduce this overwhelm. But most importantly, talking about the root causes that we work with and are dealing with when it comes to overwhelm. There are certain things that are leading to this feeling or this emotion that we might be having. And yeah, guys, you too, right? Like we all have emotions. And so this is something that we want to make sure that we can understand. Well, what is the reasoning behind this? Ask why? And being able to really reduce down to what are the roots of this. It could be one, or it could be many. And then being able to have some solutions to those or some practical application, which we will dig into some in this episode, but then also, especially in part two, so let’s get into it.

I mentioned this earlier, but let’s be real ACL rehab is a lot. We often say it can feel like a part-time job, especially in those early phases when we’re working on a range of motion. There might be more things that you’re having to do more frequently. It feels like it’s always present. And then slowly over time, it starts to look more like these kinds of training-based blocks or certain times of your day versus multiple times a day. But regardless, you’re just in the ebbs and flows of this process of training of just trying to get back to what you want to do. Ultimately, you’re not here to really rehab, you’re just here to get back to what this thing is standing in the way of. And so, unfortunately, that is what you have to do, right? You have to rehab, you have to train, you have to get your body physically and mentally prepared to get back to what you want to do. 

And so with ACL rehab, this process is long, we know. We’re looking at at least a 9 to 12-month process. It doesn’t operate in a vacuum, unfortunately. So we can just literally do that by itself and isolate it by itself. You still have to do life. And so whether you are in school, you have to deal with the ins and outs of school life. And if you are in work-life, you’re having to deal with those, or maybe it’s a combination of both. But we have to deal with all the life factors, not to mention all the other hats that we wear as humans, whether that is a certain role. If you’re looking at being a husband, a wife, a parent, if you’re looking at being, you know, some sort of supportive role for someone else, if you are leading something in terms of your work or in school, there are a lot of different factors that play into this. And we can’t even touch on the number of different variables that can play into our lives, in terms of what we’re dealing with. So that’s why this can be a little tough. 

And the most important thing I want to talk about is the different seasons that we can have in life. And what I mean by this is essentially just different time periods of the year. For many people, especially since this is a longer journey, if we’re talking about 9 to 12 months, then you’re likely going to go through different seasons within that time period of your personal life. Different seasons can be more overwhelming than others. 

And one thing that I do want to note here is that a lot of times the post-op process can be stressful. But the thing that’s interesting is that usually, we can set our expectations in that particular season, or that certain phase, if you will, to where we try to reduce all the other variables because we know we’re going to be down, we’re going to have a major surgery. And then we are probably going to be immobile for a minute. We’re not going to be normally functioning and we’re going to be dealing with pain. We’re going to be dealing with all the kinds of ebbs and flows with that early process. You might reduce what you’re doing day to day, and that might even mean reducing the hats that you’re wearing. So that might mean less parenting and your significant others helping or someone else in that role. 

It might be not having to go to school as much or to work as much. And maybe you have a hybrid situation with work and you’re just not going to the office as much. Maybe you’re supposed to be on your feet, but you know that you’ve just had ACL surgery so you’re not going to be able to be on your feet as much. And so therefore you can’t necessarily fulfill your job. And so you’ve made accommodations to that. 

What I’m saying here is that when you are post-op, sometimes there is this almost a by-product of adapting your lifestyle and that season to allow for the time to focus initially on your ACL rehab. And then slowly that normalizes back to your normal lifestyle, especially once you regain normal function, walking stairs, off your crutches, and operating day to day, normally. You start to get back to the normal thin. Life tends to increase if you will, or it’s just going to get busier because you’re no longer in that acute post-op phase where things might have been dampened down. 

But here’s the other thing too, is that sometimes this post-op or recovery process can take longer. Therefore, this bleeds into the time when you didn’t necessarily have all the time available. Initially, post-op you took some reduced time and then over time you started to get back to normal. You got to go back to work school, whatever you do. And the thing is, is that you’re still not back to full function for your day-to-day. So then that’s going to be a struggle in and of itself. We have to account for just different seasons and certain things that we are expecting in this process and may be unexpected. And just know that different seasons are going to demand different things. 

And to go on this a little bit further, when we think about certain business executives, let’s say they tear their ACL. Well, maybe they’re coming up on a very busy season. And so then therefore the biggest thing that’s going to be a limiter here is going to be time and secondary to that is going to be energy. And that’s the thing that we are always trying to figure out in this process because we need both of those things to be able to dedicate, to moving towards the goal, but we only have a limited amount every single day. 

It’s like a battery, you start the battery on full and then you slowly wind down the battery each day and then you try to recover and then you have a full battery the next day. But the hard thing is whenever that battery doesn’t get all the way full again, and then you start the next day with a half-full battery. 

This applies to literally any different person in different roles or where you are in this process. This is where the seasons are going to have such a pivotal role in your planning and your life. And that’s why it can play into the overwhelm. This is one of the things that we want to just take a step back and account for these different seasons in life and know maybe it’s a busier one. You also have all these 2,000 different things you need to do for your rehab. Therefore, you need to be able to take that step back and understand, well, what season of life am I currently in. What am I expecting as we move forward in the coming weeks and months? And maybe in the mid-year or late year. And what time do I have available? This is one of our first root problems if you will. It’s just being able to see what season of life you’re in and your time. 

Am I in a busy season right now? Am I normal? Am I in lighter? Maybe it’s kind of a hodgepodge of these. Maybe it just kind of comes out of nowhere. But this is something that we need to know, and then that way it allows us to adjust for our time and our energy during that period of time. That you can truly dedicate towards your ACL rehab. Because if you don’t have it available and you’re in that busy season, but you’re also expecting to hit the gym maybe five days a week or hitting hour-plus sessions, three times a week, you’re setting yourself up for failure because you don’t have that available and maybe you don’t have the energy available as well. Let’s get real with this, understand your season of life and know that things might need to be adjusted because it’s just demanding more right now. And that’s okay. That’s the biggest thing to take away is just knowing that you might not always give as much as you could at certain parts of this because of what life demands of you. 

The next thing that I want to talk about is you need to have full clarity around your ACL rehab process. I can’t tell you how much this plays into just the overwhelm and uneasiness that people will feel as they navigate this journey. And what I mean by this is we need to know what is our direction, and what is our game plan. And when we don’t have clarity around this, we feel lost and we feel unorganized. It’s a crappy feeling to feel as human. And this naturally leads to overwhelm because we feel like things are out of control. And humans don’t like feeling out of control. This is where we have to figure out what the direction is, what does that plan create clarity around this? And I think that that can help us to know, okay, we are in control and we know where we are heading and that’s going to be able to help us feel a little bit more in the driver’s seat. 

This is where I usually come back to our A-B-Z framework. And so when you look at this. A-B-Z framework the biggest thing is to be able to just really take that step back and zoom out. Where you currently are, is going to be such a key factor, that’s going to be your point A. This is done via assessments and testing with your rehab provider in this ACL rehab process. So that needs to be fairly consistent throughout. But if you don’t know where you are, then that’s going to be a hard thing to understand where you need to go. Figuring out that point A, where you currently are, what’s the end goal and what’s the aim for that time point within reason. If you’re trying to get back to sport in five months, well, that’s not reasonable. But if you’re aiming for 9 to 12 months and you are progressing along, then that’s fair. That’s the point Z that you are aiming for. Maybe it’s the ski season that’s coming up next. Maybe it’s a pickup soccer game and league that you’re trying to get into that is coming around the corner. So what is that end goal? And what does that time roughly look like? 

And then from there, what we’re going to look at is, well, what’s our next small step, your point B, if you will. This is your next target to aim toward getting you closer to being you, and ultimately towards that end goal, we talked about. You got your A, B, and Z. Your Z is what you’re setting your sights on. But the most important thing is your next point point B. Because then that’s going to help you move the needle toward getting to that bigger picture and end goal. 

To dive deeper here, we’re going to evaluate a common route of the overwhelm that goes alongside this: your plan and guidance. Or really the lack thereof. It’s more common for me to hear from ACLers, literally on a weekly basis, that they don’t know where they are, their next goals they’re aiming for, or their structure. There’s no clarity whatsoever. They feel lost. They feel just really that they’re not being taken care of, which sucks. But I know some of you listening to this probably can relate to it. And so this is common in this space, unfortunately, just with the nature of healthcare and insurance, and just knowing that it’s just the limitations of the system. 

And while I say this is common, it’s not okay. And that’s one thing that I want to make sure it’s clear. What is typically that happens or is common or that feeling doesn’t mean that it’s okay. So that’s where I want to make sure that you understand. Okay, well, if I’m feeling this, well, let’s kind of take that step back and figure out what is playing into it. 

And now I want you to imagine this, you get in your car and you’re aiming to get to a city you know that is roughly three hours away from you. You’ve never been to it and you have to start driving to get there. Oh, and by the way, you don’t have a map, you don’t have a GPS, you can’t just get on your iPhone and you can just type in the city and have these three alternate routes based on scenic or traffic or certain stops. You don’t have any of that. You literally just have your car and you know the name of the city. And you know it’s three hours away. You also don’t know where you are in terms of where your car is. So you’re also in another random city. You don’t really know the location of your current starting point. Do you think that you would be overwhelmed? You freaking right, you would be. 

While this seems like it’s something that is very exaggerated, this is literally a combo I have all the time with ACLers on how they’re feeling. They feel like they’re just going through the motions. They don’t really know because they haven’t been tested to know where they are and they don’t really have a plan. Their PTs follow a protocol that is probably dated back to 1995 from their surgeon. They don’t want to necessarily go out on their own to kind of critically think about their process or don’t have the experience. And then there’s no short-term goals and there’s really no long-term goals. And insurance is dictating all of this. This is something that many folks feel whether they know it or not. And maybe that initial post-op period, you don’t really notice it because you’re just constrained to the post-op like you’re just working on a range of motion. You’re making some progress here and there. But as you start to get out of those initial phases, you start to realize, is this really clicking with what I’m getting? Do I know what are my next steps? PTs can be really good with those initial first few weeks. But then once you start to go outside of that, where strength training and all these other pieces play into it, it’s not necessarily our strong suit, unfortunately. And this is something that we almost lean into protocols or these kind of cookie-cutter approaches which is what can happen. Therefore, we need to make sure that we understand what it is that is guiding us and what it is that we’re getting our information from. And this can all lead to that overwhelming feeling that I’m talking about. 

My suggestion is to talk with your guide, your GPS. If you don’t have clarity around where you are, where you’re heading, or the plan to get you there, then in my opinion, it’s not going to improve. You need to find someone else or another option who can clearly answer those questions for you. And if you need help, we surveyed ACLers all over the world remotely. Check out our website where you can find out more about our one-on-one remote coaching. And in all honesty, I don’t care if you work with us directly or with someone else. I just care that you get served in the way that you need to, and that you get the answers and the solutions, and that you don’t deal with overwhelm.

I went through this twice and I felt like this was my journey overall of just feeling the unknown, that overwhelm, no clarity around where I’m heading. And this is something that I will always wonder whether that second ACL injury was because of a poor lack of testing and process in that first time. I’ll never know the answer to that. On the other side of this, it’s a blessing to be able to serve you guys and share my experiences, and lead me down this route to be able to work with ACLers and the clinicians and coaches who do this. But in hindsight, it’s just a very interesting thought of like, well, what if I did have that GPS and that guide? Would that have happened the second time? So that’s something that’s very interesting to me. And something that I think, ultimately, is really important for you to be able to evaluate. Is just being able to see if this person I’m working with and this team going to get me there. And there just needs to be a change, if not, because if you stay with the current setup, it is going to get difficult to get rid of that overwhelmed you’re feeling because you need that GPS to help navigate the chaos of ACL rehab. 

The other point that I want to mention here is expectations and setbacks. If you didn’t catch last week’s episode, I highly suggest checking that out, as we discuss revisiting expectations. We talked a lot about setting expectations in ACL rehab – early, mid, and late. But one of the things that I think is important is revisiting it, so go and check out that episode. Because I think what can happen is that we have expectations potentially set in the initial phases as we get ready for surgery and what to expect, but we don’t update these based on conversations. We don’t update these based on the information that’s coming in. Therefore, we still have this expectation to be at a certain time point doing X movement or running or whatever it is, and that can impact everything we do, including our actions in terms of our expectations. Therefore, that can also lead to an overwhelming feeling. So we need to revisit them. Are we expecting too much out of ourselves? Or is our guidance not matching up appropriately? Or think we are at a certain point and we’re not there yet? 

This leads me to setbacks. These are pure momentum crushers. I get it. I had setbacks in my ACL rehab. I’ve dealt with a number of these with many of my athletes, our team deals with them constantly — because there’s just not all the things that we can control in ACL rehab and our human bodies. Setbacks can happen. People can push too much. The human body can react funky. And there could be no rhyme or reason, and that’s no one’s fault necessarily. But these things are liable to happen. And the thing is that we need to understand potentially expecting those and also how we’re going to react to those. 

The thing that makes these even harder is mostly just the derailed ones or the ones that really take longer than they should. And so then that can really crush the momentum, especially if you’re on this kind of upswing and really progressing along. And so then that’s the thing that is going to be really key. So this comes back to expectations. Were you expecting this entire ACL rehab to go smoothly without a hiccup? That could be a big problem there because even with conversations we have with our ACL, we let them know. Hey, we’re progressing along, we’re collecting data where you’re going to implement and test and we’re going to continue to reiterate this. But we also let them know that we can’t control every single thing that occurs, but we can also make sure that we put in place these principles for you to operate, to prevent this as much as possible. But with that said, we also have full transparency because of the nature of this process, that setbacks can happen. Therefore, we need to know that that can be expected. 

The next thing to tackle alongside this is the plan of attack. The setbacks themselves can be deflating and overwhelming because they throw off your expected timeline. And then you’re adjusting what you’re doing. Honestly, just the natural discomfort of typically a setback. There’s usually some pain or swelling the company is at. So you’re not just dealing with a change of plans, but you’re also physically feeling symptoms to some degree that would require it to be changed. So that’s where it is going to be important. We come back to those expectations and more importantly, to the guidance around how to navigate the ACL injury, your GPS, and the rehab professional, who is being that guide. 

As you can see, all of these variables will overlap and factor into one another. The season of life, the time, the expectations, clarity around everything, the planning, the guidance. These are all players with that overwhelming feeling. And the one thing that we have to know is that is going to be somewhat of a dance with trying to be able to navigate all these different pieces. Otherwise, overwhelm will really set in and it’ll paralyze us, which I’m sure some of us are familiar with. I know that I’ve experienced that, leading to using energy in the wrong areas or being spread too thin. Definitely, I can attest to that, or worst case just giving up. That’s something that can happen. And you think that it’s just one of those things where it’s like, don’t give up. Sure, that is a cliche, which is very true. Don’t give up. But with this, you would be surprised by certain conversations I have with ACLers who have given up. They were just overwhelmed or they’re like dealing with setbacks or whatnot. And we have a call and they tell me about their history and what they’ve been doing and they’re just like I’ve given up. I don’t think that there is any reason to keep going. I’ve changed my goals, all of these things, which is really depressing. And so that’s the thing that we want to make sure we get in front of and make sure that we can reduce all of these kinds of negative feelings that we start to feel in this process — get in front of those and be able to attack them. 

And it’s often due to a number of these different factors that I had mentioned. And so this is not going to be you, you’re not going to give up. But this is something that if you are feeling this in this process currently right now, no matter what time point you’re at — it’s normal. But the thing is, is that we’re going to make sure that you have a plan of attack and practical strategies to implement in order to make sure that this doesn’t consume you that you don’t get paralyzed, and that you don’t give up. So that’s what we’re going to talk about in a little bit more detail in part two: how can we attack this head-on? 

I hope that this was helpful today, guys. This is one of the things that I know I can be guilty of in other areas of life, in terms of just allowing things to get busy, and that’s what we naturally do as human beings. But this is one of the things that I want to make sure as you kickstart this year, or whenever you listen to this, that you are able to take that step back to reflect, and to be able to really just take control of it. And that’s the thing that can be really hard because there’s so many variables. You’re not supposed to be the person who is figuring this all out for you. That’s where your rehab providers should serve you— your coach, your team that you have formed to support you and help be your GPS. But if you’re having to be your GPS, then that’s where a big problem of this is. So that’s where we got to take this step back, address what are some of these problems or root causes that we are starting to recognize, and then be able to have a plan of attack. 

So until next time team, this is your host Ravi Patel, signing off.