Episode 170 | Embracing “The Stall” in ACL Rehab

Show Notes:

In this episode, we discuss embracing the stall during the ACL rehab process. We cover what the stall is, the early ACL process, plateaus, and how ice, brisket, and ACL rehab all related. A big mindset episode for my ACLers, so if you’re feeling stuck, definitely the one for you to check out.

Picture of the brisket cooking graph and how it relates to ACL rehab:

What is up guys and welcome back to another episode on the ACL Athlete Podcast. Today’s episode is a little different. We’re diving into a mindset one for you guys. It’s called Embracing “The Stall” in ACL Rehab. This is something that is coming off of just a random thought that I had this past weekend. I was cooking a brisket and when you cook a brisket, I have a Traeger so we were smoking it for a very long time. It was a very long cook because I just decided that I needed to cook a 19-pound brisket for some of my family coming over. And so that’s what happened. But I want to back up a second because I want to talk about the first time that I actually did this, because this is all going to kind of play into the episode so work with me here. 

The first time I cooked a brisket, I thought I really, really messed it up. I was cooking it for the longest time. I was a little nervous because I was trying to do it overnight. Briskets take a long time to cook. It can be anywhere from like 10 hours to 18-20 hours. It’s a long process, especially when you think about teeing it up for maybe a lunch or for a dinner. And so anyways, I was a rookie at this and I’m going to go cook my first brisket. I saw that the temperature itself stalled at a certain point, which was around like 150 degrees. And I started kind of freaking out a little bit because we had a certain time that we need the food to be ready for and it hung out there for hours and hours. I didn’t know anything about this term called “the stall,” which is something that is actually normal with cooking bigger pieces of meat, especially a brisket. And so that was something that I had learned about afterwards. 

This weekend, luckily I was prepared for this, even though I had decided to cook a very large brisket. And this was something that did take me 20 hours, way too long, but I was able to use my meter probe to be able to track the internal temperature. It was pretty cool because it graphed it for me. I was able to watch the temperature over the 20-hour period of time and essentially see, where was the temperature? What did it look like? And the cool thing is, is that I actually got to see the stall. I was also ready for it, but I was also able to see it from a graph standpoint. As soon as I saw it, I was like, man, this really relates to ACL rehab because my brain is always thinking ACL rehab. 

I want to share today a little bit about this and how this relates. So just stick with me here. I promise you, there is something to take away from this, especially if you are someone who is in the throws of ACL rehab right now, maybe you’re in mid and late stages and you’re just kind of dealing with the ebbs and flows of it. Stick around. Listen to this. See if this helps at all. Maybe not. Maybe it will encourage you to go cook a brisket. Maybe just go and get some food. But anyways, let’s do this. 

Basically, you can see the image of this graph, so you can check it out in the show notes to reference. I’m going to attach it there. But basically imagine you have that graph and this is where there’s essentially on the vertical axis is the actual temperature and then on the X axis is the time. So over time and over this 20-hour period, the temperature is rising, starting at 50 degrees and there’s a big spike in the temperature. It actually gets up to 150-ish degrees fairly quickly in a few hours, especially when you think about this relative to 20 hours. It gets up to that and then it flattens out for hours after that. It just stays at this 150 degree-ish temperature. I think for me, technically it was around 140-ish. And then it kind of hung out there for up until 160, 170 degrees for hours. And then it eventually makes its way out and gets to the temp in a reasonable amount of time after that, where it’s not so plateaued and it has more of a positive curve. So imagine this spike in the curve, and then it kind of flat lines a little bit. It has a little bit of a positive angle, but you can’t really tell because it’s such a long period of time. It gets out of that period and then it kind of spikes back up positively. So that middle part is what I want to talk about, which is called the stall. It’s the plateau part (as people will call it). This is the main focus for the conversation today and embracing this stall, if you will. 

Let me share what this is in cooking first and so then we can relate this to ACL rehab. I said the stall itself, as I had mentioned, is the plateau or kind of that zone where it kind of flatlines a little bit. It occurs when smoking or cooking larger cuts of meat at low temperatures for an extended periods of time. It’s when the interior temperature of the meat reaches around that range. As I had mentioned around 150 to 170 and stops going up. It just kind of like stays there for a hot minute. It can last for hours and that’s what happens in this case. The stall itself has caused, if you want to know, by the evaporation of liquid on the meat surface. This evaporative cooling effect works just like when you sweat, while you’re working hard. The stall can get pretty frustrating because it can last for hours. And it’s because of that heating rate of the meat and the temperature of the smoker matches that of the rate of evaporative cooling. Well, I kind of science pieces there. I know that they’re still trying to 100% figure out what it is that is causing all of this. I just wanted to share that process because it relates to ACL rehab. 

Let’s dive into that and why you’re probably here. The stall is where, honestly, when you think about the ACL rehab process, you’re past that initial post-op gain. Let’s say you’ve torn your ACL. Maybe you decide to go the non-surgical route or maybe you decide to have surgery. I know a lot of people relate to both of this. But imagine you’re at the initial part of your journey and you’re about to start the road ahead. And so you have those initial post-op gains. Your knee is calming down from the injury or surgery. You’re getting the swelling down. You’re getting the pain down, especially post-op. And then you are making progress day after day, typically. Your quads are starting to fire more. You’re getting that extension. You’re getting more flexion. You’re going from 60 degrees to 75 to 80 to 90 to 105. And this is not over the period of months, maybe for some of you, but this is literally over the period of days and even weeks. You’re noticing positive gain after positive gain for the most part in that early post-op phase or post-injury phase along with all kinds of other things. You’re maybe getting that first revolution on your bike. You’re able to ditch the crutches, ditch the brace. You’re able to take the stairs. You don’t have to take two steps up the stairs. You don’t have to take two steps down the stairs. You could actually alternate steps. You could drive your car. You can walk for more than just in your house. You could use the bathroom comfortably. You can go and get in the shower. All these things that happen in the early post-op phases and post-injury phases that we recognize that our lives are very much impacted by it. And so then therefore, it just feels more and more meaningful plus you’re seeing the progress day after day. Typically, there’s a lot of hype behind it. And plus you’re in the early part of this process. So you probably have a little bit more energy, a little bit more of like, all right, I’ve got this kind of honeymoon effect. And then all of a sudden you kind of work your way out of it. And so that’s the thing that we’re talking about that’s the initial post-op gain, or even in this cook process, the initial spike of the positive progress that you’re getting— those milestones and seeing that day after day, for the most part, the small wins. But then you finish that phase. 

And you enter the mid stages. This is something where you are starting to notice that it looks a little different and it feels a little different. This is where it can be that drag for a lot of people. They don’t have those day-to-day wins as much. You’re not seeing your progress nearly as much. They might still be there, but it’s just much less noticeable. You might have more gym sessions where you’re like, all right, you might be at the same weight or you might be a little bit better. But it’s not as easily measurable if you will and noticeable, especially in your day to day, like getting rid of crutches or getting rid of a brace, being able to drive, all those things that really have a meaningful change to your day to day life. There can be a lag in the strength during this process as well. It doesn’t feel like it’s coming back nearly as quickly as it was. Initially, there could be a lag in getting back to jumping, to running, to other activities you want to do in these mid stages. This feels like the plateau phase or that stall phase that I’m talking about whenever it’s cooking the brisket. It’s where it feels like it’s just kind of lingering and you’re just not noticing as much. Are you even making progress or are you just plateauing? And a lot of times what you’ll feel is that it kind of goes up and down. It’s not this steady plateau. It might be for some people, but it might also be this kind of like two steps forward, one step back; one step forward, two steps back. It’s this up and down non-linear process. But it feels like it’s in this kind of window of time where you just don’t notice it nearly as much. And often this is where the results are just not quick. It gets hard and where people will also quit. And whether that’s because of the rehab, the skills they’re getting from that rehab and the professional, or maybe it’s just because they’re just kind of tired of it. They’ve been in it for a hot second. Maybe it’s been 2, 3, 4-plus months, 6 months and they’re still not where they want to be. I said, this is where a lot of people will quit. They’ll just be like fine, it’s good enough even though they know internally, it’s not. And this is something too where we see the quad has its own stall effect if you will, where it’s just the muscle we are tackling in this process more than anything, because it’s the biggest thing that atrophies gets weak. It’s inhibiting a lot of the things to move forward. So we are trying to tackle this as much as we can, and it can follow this curve pretty, fairly too. And that’s something that, especially if you’re dealing with a quad graft or AMI (arthrogenic muscle inhibition) where there’s weird neural brain/spinal cord connection and connection to the battery, if you will, is not there or maybe it’s both. It’s dealing with it being a quad graft, and it’s also AMI. 

This is one of those things that are hard to tackle, and it has its own stall period where you feel like you’re doing everything possible and it’s not gaining strength. We’ve had plenty of ACLers who have gone through this, where we throw everything at it in a normal neuromuscular system quad connected. You should be able to make progress in 4 to 6 to 8 weeks reasonably. But with ACL rehab, for some reason, there’s all of these weird mechanisms going on and things that we got to play against and it’s not everybody. Don’t go out and think you guys have AMI. But it is for many people we work with, especially the ones where it just doesn’t add up. And so this is a little bit of a caveat of how this same example plays for the quad itself, but even for the bigger picture process, which is what we’re mainly tackling. 

And so with that said, you are continuing to chip away. You’re in the stall and you continue to chip away and then you stay consistent and then you realize the stall actually is no more. You break through that plateau, you stay the course, you see the quad gain, you see the rest of the body gaining and you’re able to move in the right direction. You’re like, oh wow, I’m actually like getting closer to the thing versus a being something where I feel like I’m stuck in this plateau forever. It’s just this kind of purgatory feel where you’re like, all right, I had just got to kind of work through it. The thing that this reminds me of that I did a podcast episode a long time ago. If you’re an early listener, or if you’ve gone through all of this series, this is going to sound familiar, but I want to bring this back around because of this mindset episode, because I just loved James Clear’s work. But it reminds me of that 1% better principle. He talks about this ice analogy and how it relates to progress. And so I want to talk about this, bring it to light, especially because it’s just so helpful to serve as a reminder. But basically imagine this cube sitting on the table in front of you. The room is cold. You can see your breath. Currently, it’s 25 degrees Fahrenheit. If you are on the metric system, I apologize. And I don’t know what that is, but is that zero? I think so. Anyways, imagine that this is something really, really cold. Slowly room begins to heat up 26 degrees, 27 degrees, 28 degrees, 29 degrees, 30 degrees, 31 degrees, still nothing has happened. You’re just hanging out there and it’s fricking cold. But then 32 degrees, the ice begins to melt. One degree shift, no different from the temperature increases before has unlocked a huge change, breakthrough moments. It’s the results of many previous actions, which build up the potential required to unlock a major change. And it happens everywhere. Some of the examples given right cancer, 80% of its life undetectable then takes over in months. Bamboo rarely seen, for the first, you five years as it’s building roots underground before growing 90 feet tall, within six weeks. 

This is something that he relates, of course, to habits, if you have read atomic habits and read James Clear’s work. But he basically relates it to habits and really making no difference until you cross a critical threshold. And this is where I want to kind of talk about there’s this graph he uses. It’s called this “valley of disappointment.” And a lot of times this can be during certain stages of the ACL rehab process. You expect to make progress in that linear fashion. And it’s frustrating because even over these days, weeks and months, you feel like you’re not going anywhere. Kind of sounds like the stall, right? Or he kind of calls it as like the valley of disappointment, which can honestly be relatable because you’re not making progress. And it’s a lot why people give up as I had mentioned, but these things need to persist long enough to break through this plateau. 

And this is where he talks about this term “plateau of latent potential.” And basically he’s saying, complaining about not achieving results or success despite working hard is like complaining about that ice cube not melting when you heated it from 25 degrees to 31 degrees. Your work isn’t wasted. It’s not. It’s just being stored. You’re building up for something and you’re being consistent about it. All the action happens at 32 degrees. And when you think about this is not an overnight success. It’s the build up to that point and the work done over time. That’s the 25 to 26 up to all the way to 31 that people might not see, but it’s literally compounding benefits that led to the breakthrough. Then, once you hit that breakthrough, just like the stall and the ice cube, you’re nearing the finish line. And its insight getting closer to feeling more like yourself. 

Most importantly, and this is what I want to really stress here is like you stayed the course and work consistently hard through the stall and it paid off because now you’re getting back to the things you love to do and feel like you write more like yourself, you’re doing the thing of getting there. And you broke through that plateau, hell yeah. So what’s the take home here? Watch out for that quick initial post-op gain. That’s one thing that I do want to make you guys aware of, is it makes you feel like you’re just making nonstop progress. I remember that in my two ACL rehabs, I was crushing it. I’m off my crutches within a week. Doing really well. Quads were firing, flexion was great, all these things, but then you do hit that stall. It’s just this period where you just don’t have those initial quick post-op gains. 

The other caveat here that has nothing related to this that I want to say is that, it can also mask thinking you have really good physical therapy whenever it’s just the natural process of your post-op that your ACL rehab would have been done as long as you just had the basic rehab there. Don’t let that mask what good rehab is and more so the communication, the testing that you get, the checkpoints that you’re working towards, those are pieces to really help vet your physical therapist or the rehab provider you’re working with. Not just because you’re making great post-op gains. Because I’ve seen the worst clinicians possible make progress in the early post-op because at the end of the day, the surgery is constraining you or the injuries constraining you for what you can do. So then therefore you’re working on extension, you’re working on flexion, you’re working on gait. You’re trying to get the knee to calm down. It helps to reduce some of the noise, to be honest, until that resolves. And then therefore, once you do get into the phases where there’s more complexities, balancing schedules, strength, and conditioning, getting your body actually stronger and dealing with setbacks and things of that nature, that’s the nuances that really do pay off, especially in the long run. So watch out for those initial post-op gains. And then also don’t credit that to just amazing physical therapy. I think there are certain other things that you can vet to be able to know if you have a credible provider or not.

The other take homes, don’t cook a 19-pound brisket because it takes forever. And then the other thing here is to literally embrace the stall. This is where you truly learn a lot about yourself. I’ll learn so much about myself through that stall period, where it’s like, all right, I can do this. I can work hard. I can keep at this. And if you have a good guide with you, then you’re going to be able to work through it. Even if it feels like you’re just kind of staying in the same place. What you don’t realize is that you’re just at ice cube that’s literally just paying your deposits,  literally warming up slowly from 26, 27, 28, 29, 30 31. And all of a sudden, you hit that breakthrough, that plateau of latent potential that you’re trying to bust through in order to get there. And that’s kind of like getting through this doll period, if you will. And you’re able to really get towards the goals that you’re aiming for, because we know this process is not linear, it’s non-linear. But this, I think it’s crazy how much it does make me think about the ACL rehab process. And knowing that there will be ups and downs. There will be plateaus where you just kind of feel stuck, but stay with it because you might just be that one degree away from that breakthrough. Some of you might think this is cheesy listening to this and that’s totally fine. I get it. It’s a little weird, but at the same time, I love this stuff. You guys know me, this entire process is just as much mental if not more than physical. 

Our mindset literally directs and impacts our actions. And this is where we see the ACLers who truly get to the end, who are able to stay persistent through that stall. They’re able to embrace a mindset like this. They’re able to understand that if I keep chipping away, even though I don’t see this positive gain day after day after day, then I know that I’m paying my deposits, it’ll compound. If I can get through this plateau or if I can get through this phase that I’m in, and I know that it’s the stall, then therefore I can make it through and be able to see things on the other side. There’s so many ACLers we know who embrace this and do quite well. 

If you’re maybe kind of feeling like you’re in this like stall period, or you feel like you’re plateaued a little bit, keep rolling. I would do an audit first to make sure that all the other things feel right. If you’re with a good provider, if you have a good guide who is very grounded in testing, who provides a very clear plan and program with a certain objectives that you’re aiming for, you feel like you have a roadmap and you don’t feel confused about the process or where your direction is and you have support. They can communicate with you. They’re not so busy. I know that this is the nature of care and healthcare in general, but with that said, ACL is different. You got to make sure you have the things in place. If you audit that and you know that, and you’re doing the thing you’re putting in the work, then just stay consistent. 

Maybe you are in this stall and you’re in this little plateau of the middle phases and just keep with it and you will get there and it might just be the ice cube. Always think back to the ice cube and be like, maybe I’m just literally at 29 degrees and I just need to a few degrees more. So stick with it. You guys know if you need anything whatsoever. We, as a team are here, the ACL Athlete. Reach out to us. You can go to the website, you can send me an email, a message on Instagram, whatever it is to just start the conversation. We’re here for you. And if you want to catch the picture of what I had posted and get a digital of this to see, you can check out the show notes. While you’re there, if you will leave us a 5-star review, that would be clutch because that helps us to reach more and more ACL just like you. Until next time team. This is your host, Ravi Patel, signing off.

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