Episode 173 | Can You Accelerate the ACL Rehab Process? – Part 1

What is up team and welcome back to another episode on the ACL Athlete Podcast. I’m excited for today’s episode, we are doing a two-part series where we are tackling the question: Can you accelerate the ACL rehab process? And along these lines, thinking about, can I basically get back to what I want to do faster? And that’s what I mean by this question: Can you accelerate this process? And get back to doing something in five months, for example. 

Adrian Peterson is always the example that comes up with this. He returned back to NFL football in five months after an ACL tear, I believe. And so a lot of times people will be like, well, he could do it. Why can’t I do it? Well, he’s also Adrian Peterson and he is also a 0.01% of the 0.0001% of human beings that walk this earth. We can apply what he does to most people on average. I want to make sure we tackle this topic because it’s something that comes up all the time. I’ll get DMs about this, I’ll get emails about this. I will see people who are marketing about this and saying, we can accelerate this process.

This is something that I do want to make sure we have clarity around it and understand the expectations around “accelerating” this process. And so let’s make sure we tackle this question as best as we can. In part one here, I just want to share some background on this and some assumptions coming in with it. And then in part two, we are going to tackle this more holistically of like, okay, why is it that we think about this in a certain way and answering this question in more detail with some more data, to be able to support that. 

Let’s go ahead and dive straight into it and do the thing. Now I’m going to speak to what the norm is in terms of ACL rehab and accelerating if you will in this topic in mind. Because usually what happens is that people have an ACL injury and majority of the time, as we currently stand today, people are going to have an ACL reconstruction versus any other route possible. There are outs non-operative where you just manage it that way, you go and get a repair. There’s the BEAR procedure, there’s all these new things, there’s cross bracing, which is the healing process and doing non-op seeing if they’ll heal again. There’s all these things that are continuing to come out and exist through this ACL rehab process. I’m going to be talking about specifically ACL reconstruction, because that is what majority of folks will go through after having an ACL injury. And it sets up for the context and the situation that we’re going to talk about today in terms of accelerating this process. And most importantly, can you get back to sport faster or your activity faster? 

With accelerating ACL rehab, I often see two things related to this topic. Number one is the ACLer, or maybe it’s the supporting role, like a parent, maybe a coach, maybe it’s an agent, someone else who is kind of have some stake in this, if you will, whether it is just vicariously living through their kid, or maybe there is some sort of monetary or some other asset alongside this, like an outcome of a championship or whatever that might be. But basically they’re asking to accelerate or speed up their process. Can they get back to practice faster? Can they start doing this thing faster? Can they return back to game play faster? And then obviously doing the actual thing in a sped up process. And then there’s the other side of this, where there are companies, surgeons, physical therapists, coaches, just the entity who kind of take care of their rehab or the management side of things who claim they can get you back to sport “faster” or have an accelerated program or protocol, or this surgical technique can get you back faster. These are where we see these things in terms of with accelerating the ACL rehab process. 

Now let’s break this topic down because I think it’s so important to address this in terms of expectations. Let’s tackle number one first. ACLer or their supporting roles, as I mentioned, parents, coaches, maybe as an agent, whoever it is. A lot of times it’s parents that are truly vicariously living through their child, a little too much sometimes. And they’re thinking that their kid is going to be the next LeBron James or Alex Morgan. They think that they’re going to go on to be the best of the best and that one person who is going to make it. And I’m all for believing in your child and then doing the thing, but I think we need to just understand the context of where they are, especially if they’re on the younger end and not putting so much pressure on kids and not sucking the phone out of sports, to be honest. This is something that I’ve seen over the years so much. But anyways, with that said, this can be a lot of times perpetuated by the parents because they’re looking to get their kid back to the sport. Therefore, this conversation can come up. The thing is like, I get this thinking, you know, you hope that someone can give you this expedited route. Maybe there’s this like magic pill, this cheat code. something that someone knows. They’re an expert if you will. And they’re able to get you access to something that can speed up the process and get you there. 

They’re even willing to invest more, to get this faster route back to doing the thing. This comes from the place that no one wants to really hear a 9-month to a yearlong recovery process. No one likes that’s a long time. It keeps them away from what they love doing. And when we think about people’s goals and dreams, it might also be passing up on certain accomplishments or getting a college scholarship, for example, or to that higher level of school versus going to maybe a lower tier school, if you will, to play. All these things factor in to this process, and this could be coming from the ACL themselves or as I had mentioned, the supporting roles of parents, coachesbwhoever that might be who is wanting to make sure that that athlete is getting back to the thing. And of course this kind of spreads the whole spectrum of youth athletes, all the way to athletes who are 20s, 30s, 40s, 50s and so on. And of course, maybe they’re not trying to get a college scholarship, but they might be competing in something or maybe they are just really, really, anxious to get back to doing the thing again. And so then therefore they’re like looking for any type of way to speed up this process. And so time is of the essence. Things are on the line. So we want to rush it in order to get back faster so we can do what we love and achieve those goals. Right. I get it. I want to do the same thing in my first ACL injury. I was like, why not try and speed this process up. I can get back to playing football. I could play baseball. Maybe I could jump into wrestling season and do a little bit of that. So anyways, that is something that we are wanting to do because why would we just wait? We just want to have fun and enjoy the thing.

And oftentimes what happens is, is that we are just not educated or informed about this process. We think that better care will speed it up and you’re getting back to it faster. And specifically talking about the context of returning to cutting and pivoting sports, most field and court sports is going to take a long time and I’ll share why in the next episode in the part two series. So this is something that I do want to make sure we hit home on, but this is something that takes a minute. But in all honesty, better care, more than anything is going to help create clarity, is going to create a specific plan for you, adjustments when things don’t go as planned, because guess what? 

With ACL rehab and with a knee that is healing and going through a process that is so long, there are going to be ups and downs. So there needs to be rerouting or quick adjustments that can be made and adaptable. And to avoid making this longer than it needs to be based on your situation. And in all honesty, when you get really good care, they can reduce how long this process can be, because they are tackling things from a data-driven standpoint, the research, there is more individualization. So then therefore you are, let’s say, for example, you’re trying to lose weight and you’re a part of this group that is also trying to lose weight. And they’re all getting the same thing, right? They’re all getting the same exercise plan, the same diet plan, the same everything. Their schedules are all the same. 

But then think about this other group where every single person is getting a very individualized attention. It’s all based on their specific lifestyle. They are able to individualize their training, their nutrition, be able to account for let’s say work and schedule and equipment, all those things. There’s one where it’s a little bit more general and then there’s one that is more specific. Who do you think is going to be the person that is going to get the best outcomes related to that? The one where it’s more specific because you are going to have things that are more built around your lifestyle versus the other thing. It doesn’t account for just the individual variation of human beings in general. This is something that is very important with ACL rehab is that you have someone there that can help to account for these differences and individualized things in order to make sure that you don’t have to take the long way to be able to get back to walking, for example.

There are some situations where I see athletes where they’re on crutches for way too long. And it’s because the protocol says they need to be on crutches for six weeks because they have meniscus repair. But then there’s no questioning of like, okay, well what type of meniscus repair was it? What does the surgeon say? How are they doing functionally? There’s no questioning of all right, well, is this actually holding this person back? We’re talking about accelerating the process, there are things that can be done to make sure you’re moving along in a steady progression where it’s not too fast, but especially not too slow as well. It’s finding that sweet spot. We always use the porridge and Goldilocks and the bears. You’re trying to get the one that’s not too hot, not too cold, but the one that’s just right. So that’s ACL rehab in a nutshell. We’re always trying to adjust for this to make sure that it could be meeting you where you are versus feeling like it’s too slow or too fast. And it’s adaptable.

With this, that’s where really good care can come into play and really be helpful as that guide and to be able to provide, what you need for this ACL rehab throughout the different steps of the journey. The thing that is tough here is that, even with the best or most perfect program, are you going to be able to just get back to sport faster? Hard to say. I would venture to say no. But this is something that we will tackle as we continue on with the episode in the series. But this is something where I think people assume because I’m getting better care I’ll get to the things faster. I think it basically helps us to make sure that you can feel confident knowing your plan, what you’re doing is guiding you in the right direction and it’s not delaying things, especially. Sure, in some unique cases, “speeding it up” but after a certain point. We’re not talking five months returning here. Again, coming back to goals if it’s hiking, skiing, or maybe playing easy pickle ball where you’re not really running around, but staying in place. You might have some wiggle room in terms of the timing of this, especially higher level unpredictable sports. And especially if you’re on the younger side, for things that are really demanding the ACL like soccer, football, lacrosse, basketball. When you think about things like that, you’re high-level cutting and pivoting.

This is where we are going to be harder on the criteria and the timing of things versus maybe there’s some flexibility depending on the activity or even the sport that you’re trying to do. Depending on the demands of the body and the ACL. And of course, timing, it’s all carrying different weights. Some have more weight than others depending on the goal and also just considerations for you as the athlete and the person and everyone else involved. And it’s interesting. 

I’ve had conversations with parents of ACLers who are looking for that accelerated route. It’s happened many times, to be honest. I tell them we have a criteria and one thing that’s very important for me and us as a team is setting expectations. Part of this is the timing of this process. If I tell you that it’s only four months. but then we go into nine months. Well, that’s a mismanagement and it’s a miscommunication and it’s setting poor expectations. If you do a job and you were told, you’re getting $100 and you only get $20, you’re going to be really mad. But that’s where we got to have clear communication and understand. With these conversations, letting them know that nine months is our return of performance criteria in terms of timing, because of what the research shows is reduction. in the rates of re-injury. But we are dealing with a lot of ACL re-injuries and I think where we can do our due diligence is making sure that we follow what the research shows and. Appropriate criteria to make sure athletes are fully ready. 

It might be at the cost of this scholarship or this opportunity, but I would rather do my due diligence to make sure you’re set up for success versus putting you out there just because this thing is on the line. Now again, there is always going to be an open conversation around this of like, all right, well, are you at the eighth-month mark, are you at the seven-and-a-half month, are you close to nine months? But not all the way there yet. There’s grey area that does exist for each specific situation. But as a general rule of thumb, nine months is something that we stick pretty hard to, especially for these higher level sports and younger athletes, because the research consistently shows us is very important to stick to that. Otherwise, we are setting athletes up for failure. So what happens though in these conversations is that depending on the athlete and depending especially on the parents and maybe the culture they’re in or their general expectations. They don’t like to hear what I have to say. They want to return faster and they’re like, I’ve heard there’s accelerated protocols and ways to get people back. And I’ll never hear from them again. Then, they’ll likely go off and find someone who will say yes, we could do that. But I am not about people pleasing here or hearing what you want to hear to be completely honest. My job is to do no harm to you. And as a team, that is our number one goal. And it’s the set you up for success. 

I went through two ACL injuries and I’ve walked hundreds of athletes through this process. This is not something that I want to put you in a position where you’re just going to go out and wreck your life again for the next 9 to 12 months because you decided to accelerate this process. I’m not going to do that. And that’s not something that any good clinician or provider is going to do based on where we currently stand in the landscape of ACL rehab. And I won’t budge on this as our philosophy, no matter what that cost is, if they’re, Hey, like I’ll pay you X amount. If you help my son do this, or who they are to be completely honest. 

This is something that is a very, very firm philosophy for us as a team because it’s very important to make sure that we are doing our due diligence. And not contributing to the problem that exists in this space. This is something that is really important to tackle from the ACLer kind of supporting roles who are coming into this, asking for these accelerator protocols, or just ways to speed up, getting them back to sport. 

Now, let’s tackle number two companies, surgeons, PTs, coaches, any person involved in management, who claim they can get you back to sport, “faster.” Or have that accelerated program or protocol. To be completely honest, I think this is a bunch of BS, that’s how I really feel about this. I think it’s more business and marketing related than it is truly understanding the space of ACL rehab and returning to sport and the care. Going back to the point of the parent who didn’t like, what they heard and sought out someone else who, would move things along faster, whether it’s surgery or turning the sport. There are surgeons out there who brag or who tout that they can get you back to return to activity and their return to sport rates. 

They’ll say you can return back in six months. That’s one thing that I still consistently hear from athletes where they’re like, yeah, six months. You’ll be good to go. You can do this, you’ll be cleared. And then you’ll be able to go play your sport. Excuse me. Are you Houdini? Can magically expedite this process with some secret sauce you have? Please let me in on this secret.  Because I literally don’t know this and this is all I live, breathe and do day in and day out. And if anything comes out about this, I know. And so this is just something where I’m like, you know, what is it that you can do in six months? And honestly it’s just marketing. They can’t necessarily promise it. Sure, they can say yeah, six months and they might get lucky and some athletes can get back. and they’re fine. Or maybe they just don’t get back to playing the sport anymore and they’re “cleared.” so yeah, six months worked. But it’s just marketing. And often when these athletes do return and there’s another ACL reinjury. One in four athletes going to re-injured their ACL based on current statistics today. It wasn’t the surgeon’s fault. It was a fluke accident or maybe they rehab wasn’t grades. It’s chopped up to something else and my surgery was great.  Maybe it was these other things, there was a fluke accident. But there’s very rarely any responsibility taken. And this isn’t just surgeons, it’s also rehab providers who “that they can do the same thing” or companies, coaches, um, with this accelerator process. 

I honestly just don’t understand because there is just mountains and mountains of research data and just the human body and knowing the physiology and the biology of it and healing that goes against this accelerated approach. Can you guys tell where I’m coming from here and how I feel about this? So my suggestion for anyone who says they can do this accelerated process and get you back faster. And you’re going to be back on the field, in six months or four months or whatever it might be. be skeptical, super skeptical, ask questions in my opinion, go the other way. there’s nothing good there because they are just going to shortcut and shortchange you. I just don’t know how it’s even possible based on my experience and knowing what this space involves. So when it’s too good to be true, it probably is. Trust your gut.

Now, if you haven’t gotten my answer yet, based on what we’ve been talking about, let me just say, as we currently stand, can we accelerate ACL rehab? And most importantly, returning to sport faster. This is something that we are going to answer in part two of this two-part podcast series. It’s something that I want to dive into some of the data, some of the information around ligamentization for the ACL itself and some other important factors that play into answering this question. And I think after you listen to this, it will be very helpful to help anchor this process. It will help to set expectations and to have a bit more of an understanding around why. And so that’s what I want to do. 

Make sure that you guys tune in for the episode releasing next week, part two, where we will tackle this question and basically unfold all of these different things that we are talking about to help create clarity around the answer to this question. Until next time team, this is your host, Ravi Patel, signing off.