Episode 161 | Why the Surgeon’s Post-Op Sheet of Paper Is Failing ACLers

What is up guys and welcome back to another episode on the ACL Athlete Podcast. Today’s episode is perfect for following the three-year anniversary episode of the podcast. And before we get started, I just want to say, if you’re listening to this, I hope you are having a good day wherever you are. Maybe it’s a good night, I hope that you are kicking butt with your ACL rehab, I hope that you are crushing it with your athletes if you’re a clinician or a coach listening to this. I am basically just kind of setting up the stage here because I’m about to go in on this episode because I’m feeling really fired up. I’m going to be really honest today because this is just one of those episodes. I’m just going to call a spade a spade today. There’s no sugarcoating things which I don’t in general, but today is going to be just a full, raw experience. I’m not intending to hurt anyone’s feelings. But if you do have your feelings hurt, I would almost say you better ask yourself why you’re offended if your feelings are hurt based on this episode. 

I’m probably going to get some hate mail, I’m probably going to get some bad reviews from this, but this is just something that I feel very, very passionately about. If you’ve been listening along for a while now, this is something that needs to be said in the space. And the goal is to especially equip ACLers to be prepared for this process. 

And this is something that I want to share because it is very fresh off a conversation with an ACLer on a phone call, just talking to them about what’s going on. It was a consultation to see where they’re at. I just want to share my experience of this because it’s important for you to understand what this process looks like for so many people. And while I might not be your process and it might be very different than your process, I’ve had thousands of calls at this point, and this is more common than it’s not. And so that’s why I want to share this with you guys for the raw experience and basically to make sure that you feel empowered in your process because you have to be your own advocate. 

Let me provide some context for you first. I just had a call with a guy in his thirties. He can’t really speak English super well. You could tell it’s not his first language, but he could speak it. You know, we could have a conversation. He loves to play soccer. And he tore his ACL recently, had ACL surgery almost three weeks ago and was told by his surgeon to wait. Wait for it. I’ll give you a second to guess how long he was told to wait before starting PT —one month. Four weeks from a surgery… a major surgery at that to four weeks later, starting the physical therapy process. And before I kind of like jump to any kind of conclusions here, I’m always like, well, what did they tell you? Why?

And then just to make sure that I have context around this before I just jumped the gun on, I’m like, well, this is bad. This is not good. Always want to ask people why they’re given certain guidance from their surgeon, physical therapist, whatever healthcare professional they’re working with because that’s who we are leaning on to give us guidance. Because let’s be real, this ACL process is brand new for most people, and you’re not well-educated on it. The system doesn’t do a good job to do that. You just kind of get followed along. And so you’re leaning on a healthcare system and these professionals to help kind of set you up for success. You would hope so. 

The thing that I want to talk about first was just kind of his tone of voice. I could tell based on his voice, that he was just panicked, he was worried, he was upset, he was anxious. It was all the things that you just don’t want to hear on a phone call—and it sucks. This is quite common to hear because people are always trying to navigate their own way through this with the information that they have available to them at that point. 

He told me he had an isolated ACL. There was no other procedure done in his knee and there was no other trauma in his knee. It was literally just an ACL reconstruction where they took a graft, put it in there. There’s no reason for him to be four weeks without physical therapy. And as we dig into the details of this, it will start to make more sense. It was just poor guidance. But as we talk about this, this is the thing where he brought up. I have other friends who have had this surgery before, so I was talking to them and they were in physical therapy two to three days after their surgery. And so he said, I’m so lost as to why I’ve been told one month. I got some stretches on a sheet of paper. Feel like it’s not enough. I started having some sharp pain last week and I don’t have another visit with anyone until another two weeks. Because he was in his second week going into his third technically and so he was basically limited to the fourth week, he’ll have a surgeon followup. And then after that, they will let him know if he’s good to start scheduling PT. 

He has a followup with the surgeon one month after, and then he is able to schedule physical therapy. There’s so much wrong with this from the amount of time delayed here between the surgery and physical therapy. Honestly, even the post-surgical follow-up is kind of weird. And while this might seem like an outlier-type situation, it’s way more common than you would expect in this scenario, which is why I do want to talk about even the title of this episode. That will be really important to help set you guys up for success. 

The one thing here that’s frustrating is that the post-op visit itself is kind of serving as a gatekeeper in a sense for being able to start physical therapy. When patients are told certain instructions a lot of times because this process is so new, it’s scary, it’s daunting, you just kind of follow in command. You don’t just say like, oh, that seems weird. I’m just going to go start PT. You’re kind of like, I just had a major surgery. Maybe I need to rest. The surgeon knows best. And while I’m pointing out the surgeon here, it could be any professional involved in this process. There’s poor information given out across all domains.

But usually the surgeon and their office and any of those people involved within that domain are the people who are helping to provide a lot of guidance, especially post-op. Because the surgeon is done the surgery. Therefore, we’re going to listen to them because they got into the knee. They’re the ones who are helping be a part of this team. We want to be respectful and listen to them. There’s also this kind of like hierarchy feel or this person who is in a position of authority to what we need to listen to essentially. Bsically, they know best, they did the education, we’re going to listen to them. They’re educated. And so with that said, this is where there’s kind of this problem with this particular space, because we almost follow two blindly. And so what happens is, is that that post-op appointment can serve as a gate for you to be able to start your physical therapy, which of course I’m a little biased towards physical therapy because I’m a physical therapist, but in that sense, it should be a team-based approach. 

While there are situations where a surgeon will have a physical therapy clinic connected to them, within their own practice.Usually, there is a more synergistic approach of like, all right, they have surgery. They come in at this point. But there’s also a lot of situations where surgical offices, they operate independently and they say where you do physical therapy doesn’t matter. Or maybe they have reliable places that they recommend you to go or people you work with. 

It kind of runs the whole kind of spectrum of those experiences. And there’s also the surgeons who…. for one reason or another, whether it’s training, whether it is there may be experiences with people post-op going to physical therapy that they’ve maybe had a negative experience. 

And so they take that into account and then they’re like, well, maybe they don’t need to start physical therapy so early, or maybe their belief is I just did a major surgery. They don’t need any rehab for a bit. They’re fine to just do some things here or there. And so there are a lot of things that kind of factor into this whole decision making process. But the thing that I think I’m trying to hammer home here is that I don’t like the whole fact of like there being a post-op follow up and then you’re okay to go start physical therapy. Because at the end of the day, the post-op follow-up, depending on the timing, especially this closest surgery, it’s just a check-in it’s literally just make sure you’re fine. The wounds look okay. And they’re just making sure that you’re not kind of falling off the edge of the surgery, in terms of mentally and also physically. But it’s a very short visit. Oftentimes it’s not even with the surgeon, it’s within an assistant of some sort at this point worth where we stand in 2024. 

And so with that said, the other point of this that I want to make is that, you have the post-op follow-up. And then you are scheduling physical therapy or go do physical therapy. Now in a good situation, you’ve already got that scheduled and handled. And a lot of situations, people are told to start physical therapy after. So they’re just like, they take it almost like in a sequence. They’re like, all right, the surgery is done, I got my post-op follow-up dental opened the door or have this green light to start physical therapy. Therefore, people are like, oh, well now I’ll schedule my PT. This is where the other misnomer is, is that assuming that physical therapy, whichever clinic or people you’re working with have spots available, especially to get you in immediately post-op. 

Now, you might say you should have scheduled it ahead of time. This guy was not told to schedule it ahead of time. You would be so surprised how many of these calls I’ve had, where people have been told to wait X amount of time and then schedule the physical therapy. Don’t start it till then. So then you almost kind of block this in your brain inherently as a human that you’re just like, okay, I’ll do this process first. Then I’ll step into this next process, take a step by step. And people follow that to a T, again, coming back to someone who is in a position of authority, maybe the instructions aren’t as explicit as they should have been and you’ve been directed to do that by the guide in your current situation with a very unfamiliar territory. 

So that’s what this guy did. And this is such a myopic lens and operating within a silo, which is a lot of what healthcare is. It’s so busy. It’s volume driven, money is the thing—that’s the biggest driver at the end of the day. I wish I could say it was human beings. Well, intention, but at the end of the day, sure, at the core of it, people want to do good, but it’s a system. And so then therefore we have to step back and also understand how the system operates, whether it’s the U.S., whether it is the UK, whether it’s in Australia. We’ve had athletes all over the world. While some are better than others, there is no perfect system that exists. That’s the thing that’s so hard. But this is where the silo cares and it kind of like the myopic lens of what we view—is really tough. And then people can fall through the cracks because it’s not this like continuous process and it’s not all dialed in and put together because people do operate independently a lot of the times. We got to think about the drivers behind it as well. 

And at the very end of this call, he said, I’m worried, I feel like I’m losing time. And it’s just weird because it’s just an ACL reconstruction. And after talking to some of my friends, it just doesn’t make sense that I need to be waiting this long. And to top this all off, he said he was with one of the best recommended surgeons around—Wolfe. Could you imagine how different this could have looked if he could have gotten into physical therapy right after surgery. Let’s even say he didn’t have a ton of changes in his exercise during this period of time. Do you think seeing a trained healthcare professional in physical therapy, physio and in movement would have helped someone in that mental department at the minimum? The hardest part of the immediate post-op process is the mental aspects. Sure there’s pain, there’s limited mobility, but it’s more about having a surety, everything is okay, to be honest. That’s one of the biggest things that I was striving for after my first surgery is just knowing that it’s okay. You are so unfamiliar with something like this. It’s peoples’ typical first major surgery. 

There’s no clear roadmap. They don’t give you this very clear… like here’s what to expect next, here are the things that you should look out for. Sure, there’s a sheet of paper and small things here they’re medically. But in terms of really knowing a detailed road map, it’s not there. And how it’s supposed to be. You just kind of followed along in the process and hoping that these people you’re leaning on is going to take care of you. 

The thing that I wanted to mention here is that I think that there was just kind of this false kind of like hope or believe in thinking that a sheet of paper, which is what this guy had gotten of some stretches and a few exercises would have done the job for four weeks. That’s the thing that was kind of like this a misnomer, if you will. And how is he supposed to know about this? The surgeon’s office, you know, post-op, they’ll give them a sheet of paper. Here’s a few exercises and stretches to do, be on your way and we’ll follow up in four weeks. And for this to be one of the best surgeons mentioned in the area—this is just bizarre to me. 

Let’s talk about this a little bit more. If you are someone who is post-op ACL, don’t wait to get into physical therapy. I don’t care if your surgeon is the pro-team surgeon of the best team around, did surgery on Taylor Swift, or works with Michael Jordan, Tom Brady and Messi—I don’t really care. Because guess what, any of these people would have been doing great rehab the day of surgery. I promise you these people, if they had the best care, the best equipped team, they would be having that person doing stuff the day of surgery, and immediately the day, after multiple times per day already. 

This is your call to action. If you are someone awaiting surgery, schedule your physical therapy ASAP after surgery. I love seeing my athletes literally the day after if I can. Your goal should be to try and get in within 72 hours within three days, post-op at the minimum. Let’s say the weekend hits, you have a surgery on Friday. Try to get in on Monday. Of course, you got to let the weekend roll and you’re okay with that. That’s fine. But there’s a certain window of time and I say three to four, five days maximum before you need to really get into physical therapy. And when you schedule your surgery, schedule your PT. This is your rule of thumb. I wish that this was the thing that was screamed across all surgeries in general, especially with the ACL reconstruction. When you schedule your surgery, schedule your PT. Don’t think of it is, A then B; think of it as a plus B. You have to do that in order to complete. The 50/50 of it versus l00% and then 100%. And that’s the way we need to go about thinking about this, because it is going to set you up for success as you move forward in this process. 

Now, a month here is extreme. I will say it. It seems like an outlier a little bit, but it’s not the first time I’ve heard this. I’ve heard this before. I’m with multiple athletes where they are told to wait four weeks. Don’t know why, no reasons given when we have this conversation breakdown, there’s no details in the surgery that makes any sense to wait four weeks. Could you imagine how much atrophy and how much of a downside it is to just not do anything for four weeks? It’s crazy. And it’s probably going to drive you crazy. So therefore this doesn’t make any sense. And this is even something. When we think about the most major, major surgeries, cardiac surgery, anything related to a surgery where outside of maybe a bone repair or something that is, let’s say a neurosurgery of some sort. Most of the time we’re getting people up. 

I remember being in the hospital, we are trying to get people up ASAP. You have a total knee replacement, you have a hip replacement, we’re getting you up and moving ASAP. This ACL reconstruction, for some reason, there’s this reason to protect it. I feel like there’s this, irrational belief that the graft is in there and a sudden movement is going to just rip that thing out. When you think about it, they have anchored that thing down with, screws and with buttons. And they’re anchored in there that surgeon takes that knee through flexion and extension. They do a Lachman test on it. If you could see what they do, post-surgery to check and make sure the knee is okay, you’d be like, I could do anything after surgery. But of course, we want to be mindful because the knee is responding to such a major reconstructive surgery that we don’t want to just go ham on things and plus you’re feeling pain and swelling, which is going to slow you down anyways. 

With that said, that graft is anchored in there and you’re fine. The thing is, is like you just need someone to help guide you and make sure that you know what you need to do, and that you have assurance knowing that I’m not going to do anything “bad” for the knee. And I get that, it’s a brand new surgery, it’s something that doesn’t feel comfortable to just kind of force through, because you’re just like, this is all brand new. Now, as I mentioned, the month seems a little extreme. But the thing that we will hear very often actually is 10 days to two weeks. It happens more than you think with people who are told to kind of just delay. Or the same people are the ones that… what’s sad is that they’re the ones who are dealing with the increased pain, swelling. They have a range of motion issues, atrophy, they’re limping, they’re fearful, there’s anxiety. The list goes on, seriously. 

This is the thing where we see that because they just don’t have that guidance afterwards, or what’s worse is that they are relying on a sheet of paper. That is that false hope that you feel like is going to give you some sort of 10-day to two-week window of support. And that’s what the title of this episode is, is that I think that that sheet of paper that they give you postop is actually failing people. The surgeon’s office and the staff, they give it to you. It’s kind of this false illusion that you’ll be fine for whatever duration they tell you to wait for physical therapy. But the way that I want you to think about this is that it is your 1 to 3 day placeholder, is just a placeholder until you actually get into your physical therapy. 

I know what the outdated sheet of paper has on it. More than likely I can guess it, 90% to 95% of the times. It’s ankle ponds, quad sets, straight-leg raises, glute sets, heel slides. It might be some hip four way. But that’s really it. Maybe there’s some mini squats on there, if they’re being really aggressive. But the thing is, these aren’t bad exercises. We use them. They’re basic exercises. They’re things that are helpful. But the problem is, is that thinking that this will address everything that you will need immediately post-op, especially two weeks and four weeks. It’s a massive opportunity costs if that is the only thing you are given during that duration. You carry on in this kind of unguided path for two to four weeks. Assuming it’s a normal protocol because you’ve been told, hey, wait this long, do these exercises, and this is what everyone else gets. 

So you’re assuming you’re a part of the common thing that’s being done, or that they’re a surgeon, so we should follow blindly. We should trust them without questioning anything, whatsoever. It’s so interesting. And I’m going to go off on a tangent here. 

My wife is at this time, almost 39 weeks pregnant. This is something that is super fresh. And we have had such a crazy journey through medicine. For the past two plus years of some health stuff. That has been just awful, to be honest. This is the thing that’s bizarre is that I’m in the healthcare space, I’m a physical therapist, I’m very well-educated about this stuff. My wife has a good job and she’s very well-educated. She’s a special needs teacher. We are fortunate to be in a place to set ourselves up to handle situations like this, where we understand insurance, where we understand the healthcare marketplace and the way the system operates.

 When we go to these appointments, it’s so interesting. We still go there and we’re like, what do we take away from this? Like what, what is helpful about this? And the amount of negative input that’s come into our lives that has been hard for us has been crazy. And this is two people who really know this stuff and especially myself, and then we have to also navigate insurance by the way, there have been so many missed charges with our insurance. We had to call the offices. We had to talk to the insurance. It’s crazy. 

My number one thing is like, I question everything and it’s probably coming back to something from my childhood and also being with a family where my parents immigrated.  We had to kind of take out for ourselves very early. But the one thing I encourage you to not do in this process is just follow blindly. Ask questions, ask why, make sure you understand the reasoning behind the guidance that’s given. Don’t feel like you’re being too overbearing. If they’re rushing, you tell them to chill. It is your rightful duty as a human being, healthcare to make sure you have the time and your answers for your questions. And it’s so freaking key to do that. 

The thing is that there’s good and bad in all professions. There’s terrible physical therapists, there’s terrible surgeons, there’s bad in everything. But there’s also good in everything. There’s great physical therapists, great surgeons, great special needs teachers. Although, I would say most special needs teachers are amazing. But with that said, it just exists. We just live in a world where this happens, right? Healthcare has a lot of gaps. There’s cracks and people fall through them all the damn time, all the time. And I was one of those people. This guy was one of those humans and he is panicked. He was upset and it could have just been averted if he would’ve just been empowered by the office to ask questions, if he would have had better guidance post-op and even pre-surgery when this was all planned. This is an episode to let you know that no matter who your surgeon is, you should get into physical therapy ASAP. I don’t care what was done in your surgery. 

You need that reassurance and the guidance as you navigate a very dark and unknown path. And I guarantee you, any of you who are listening to this who are in the throws of ACL rehab, especially if you’re in the mid and late stages, or maybe you’re on multiple ACL’s, you know this path can get dark, so you gotta have a GPS, you gotta have that light and you gotta make sure you know who you’re working with and you can lean on them. 

This episode is to tell you to schedule that physical therapy visit. When you schedule your surgery, don’t wait places, fill up, get that locked in. This episode is to tell you that you should never wait two to four weeks for rehab after post-op. This episode is to tell you that that sheet of paper you get post-op is a placeholder for maybe a few days post-op, that’s it. Otherwise, you’re losing out big time. So something needs to change. I don’t care if your surgeon says you’re good for 10 days. Only maybe one to three days, max, get into physical therapy, whether that’s remotely, in-person, whatever that is, you got to find someone to lean on immediately post-op. 

And finally this episode is to let you know, you have to be your own advocate. Blind trust and healthcare system will get you into trouble people. I’ve seen this on countless occasions. As I had mentioned, I’ve navigated two of my own ACL surgeries with immigrant parents and poor healthcare. A $10,000 of out-of-pocket max as a college student from watching my dad almost loses fricking life from just a terrible healthcare management. From watching my wife and holding her while she’s crying on countless times because of poor advice and mismanagement from even trusted healthcare professionals. And saying she’d have miscarriages that have kids and we’re about to have our kid. 

From talking at this point to thousands of ACLers who have had negative experiences. And I’ve had to deal with poor aftermath after reinjury, pain and suffering. And that dramatically impacted their physical and mental health. 

This episode is raw, it’s honest and it’s the real deal. I’m sick of these calls, honestly, you guys, and we have to do better. And if you wait for healthcare to catch up, you’re going to be on this list. Which is why you have to be your own advocate. Be in the driver’s seat, question every freaking thing, seek multiple opinions, don’t blindly trust and educate yourself. It’s why I care so much about this podcast. It’s why I show up every single week to make sure that you guys have an episode and that you can take this and put it into play versus just this random junk of information to equip you so you can do just that. You can educate yourself. And so you feel like you could actually be in the driver’s seat and have an opinion on the GPS, what road we’re taking. And not just be forced down this one path, because it’s just what your surgeon or physical therapist, or whoever says that, it is a team-based approach you at the center of it. And this is your life we’re talking about. 

This is your health, there’s nothing more important. And when in doubt, we’re here. They, so athletes here, we are a team here to support people. We answer emails and questions all the time. And there’s not a single email, any message we do not answer as a team. I get messages all the time, I get emails all the time from any of you who are listening. So we’re here as a beacon, as a resource for you guys to help make sure you’re navigating this process as best as you can. I could keep going here, but I’m going to sign off for now because I probably need to just go into it and let out some steam here. 

Anyway, I hope you guys enjoyed this episode. This is the raw thing. I try to bring this as much as I can. I was not expecting to get choked up on this, but it just is what it is. It means so much to me. And this is something that I just want to make sure that you are set up as best as possible. So then that way you can get back to the thing that means the most to you. Because no one chooses this ACL injury. It just happens to us. But then we do have a choice to make sure that we can come back from this a better human. Itt all starts with making sure that we are educated and then that way we can make informed decisions about our care, our process, knowing when to pivot, knowing when we need to find better options for us at certain points in this process and also to make sure maybe like dump something, maybe we need to get rid of the surgeon or a physical therapist or performance coach, when is the right timing, because it’s not serving you anymore, but you wouldn’t know that until you are more informed about this process and knowing where you should be or knowing what you’re aiming towards. 

This is so important to me guys, as you can tell. I can’t say thank you enough for all the support, all the messages, all the emails for the ACL athlete, for myself, for my family, it’s crazy to me. There’s one thing you can do that would mean the absolute most to me is if you can just leave a five star review, a review on podcast, Apple or whether it’s on Spotify or whatever platform you’re listening on. Leave us a review. The goal is literally… I don’t care about money. I just want to reach as many people as we can. And I just want to make sure that people are equipped because this thing can really change the trajectory of your life. It really can. Support is out there.

If you are listening, and if we can do anything for you, please reach out. We’re here for you. Until next time team, this is your host, Ravi Patel, signing off.