Episode 176 | You Need ACL Surgery – How Timing Impacts Your Success

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today we are diving into the topic: “You need ACL Surgery – How Timing Impacts Your Success.” I’m sure a lot of you listening today is wondering exactly what this podcast is going to dive into. So let’s get into it. You have determined you need ACL surgery that could be in the next few weeks. It could be a plan for maybe a couple months from now, maybe at six months from now. Maybe you’re in a healthcare system where they might just call you up for an opening that’s available, it could be next week, it could be eight months from now. This is something that has been determined. You’ve had the injury, you’ve had the consults with your orthopedic surgeon and they have said you need surgery. You have agreed that is something that is going to take place. 

Now, before I dive into this topic specifically, I want to make sure we take out the time-sensitive people, the people who are going to have surgery rather quickly because of something that is more time sensitive. This might be something, one that could be emergency related. Sometimes with knee injuries, there could be some neurovascular compromises where there needs to be an immediate surgery to the knee. A lot of times this is a very traumatic injury, is not your typical ACL injury through sport or activity. It’s a trauma, maybe a true accident, a collision that is aggressive of some sort. These are situations that are rare, but they can happen, but that can lead to somebody having ACL surgery or knee surgery very quickly. 

And then we think about the people who have some things that are on the line, whether it’s maybe a scholarship where you’re a high school athlete and you have a big time scholarship on the line or maybe it’s some sort of pro debut. Something that is, maybe the Olympics is coming up. Maybe it’s something where you have assess and you’re like, all right, I gotta have this right now in order to make it in time to put myself in the best position. These are typically that one in a lifetime type of opportunity, a dream you are pursuing. But at the end of the day, majority of ACL injuries are not this. They are not time-sensitive to a point where you need to rush into ACL surgery. Yes, you have goals you really care about and want to get back to. But your career or your finances or this one in a lifetime opportunity is usually not hanging in the balance here. So that is something that has to be factored in. It’s mostly out of enjoyment or being a part of something that is a goal for you, but again, not necessarily super, super time sensitive. We’ll get skiers or like I want to make it the next ski season and that is super important and super key to their specific journey and we take that into account and we aim for that. But with that said it’s okay if something does happen and they don’t necessarily make it to the beginning of ski season or maybe to the end or life through some things at them or the knee itself doesn’t progress in the way that was expected and it pushes them beyond that.

But at the end of the day, they’re not going to lose anything from that besides the enjoyment of being able to do the thing they love to do. This is something that is totally fair to be able to try and get back to the thing as quick as we can and that’s always the goal within a safe range. But the thing is that we need to always think about, okay, is this something that is truly time-sensitive? 

What I want to do is kind of take that those people aside, because this is something that majority of people are not dealing with. You have time on your hands to some degree, you can make it a 9-month process, you can make it a 10, 12, even 14 months process and you will be okay. So that will allow you to still get back to the things that you want to do. There’s nothing rushing you to do that besides our sanity, to be completely honest. 

With that said, here’s what I’m getting at with the decision of having surgery, this ACL surgery and how that timing impacts your success. The question that I want you to think about is: Are you in a position to make the recovery a successful recovery? What I mean is you’re looking at ACL surgery, can you put yourself in a position to make the recovery a success? Not just post-op but also mid and late stages. With post-op, honestly, being more of an important emphasis, eery single phase of this process is important, but is especially post-op. The reason I’m saying this is because it is so important, especially in the post-op process to make sure your environment and your schedule and the day-to-day things that you need to do is very well controlled. We want to make sure that we can create, especially the environment for the ability to heal, the ability to rest when we need to, the ability to rehab when we need to, especially because every single day matters because you are trying to recover from it. You’re not trying to overdo it in that period of time, especially acutely. And this is where we are truly building the foundation, range of motion, quads, being able to get the knee to calm down with swelling and pain, getting your gait normalize. All these things that can be overlooked or the basics that will get better with time. But in reality, we’ve got to put in the reps and make sure that we put our life in a place where we can do the best we can during that period of time. 

Now let’s go a little bit deeper here. And the reason why I’m bringing this up. And so what happens is we get people from all walks of life coming in. They’re young, they are active adults, older adults.I’m talking literally 12, 13 years old, all the way to we’ve had people in their 60’s coming back from an ACL injury who have had surgery. You talk about that entire span of people and then we talk about the different sports and activities and life circumstances that they’re in, whether it is school, work, combo, both potentially, think about a college student who’s working in school, maybe it’s a grad student, maybe it’s a high level sport athlete to a recreational athlete to. Just something leisure lead like that you like to do, maybe it’s just hiking or maybe it is something where you just want to run around and chase your kids. But you don’t even trust your knee, of course, that is still something that is a goal that we have a lot of parents, believe it or not, they injured their knee. Maybe they go skiing and then they’re like, I just honestly want to run around with my three-year-old. And they can’t do that because of a knee that they don’t trust. 

Also because to be able to run around and the unpredictability of a little child is very difficult. And so you might have to cut, you might have to like catch them, do all kinds of crazy stuff and they don’t feel confident on that. You get what I’m saying is that there is such a variety of humans who walk into this injury, unfortunately, that have to navigate the circumstances of their life from age to activity and sport, to even just the circumstances of work and school and all these different pieces that play into it. Basically, you are having the surgery, it’’s plan and you want to make sure that you can set up your rehab and the time that is to come. That process is to be successful, meaning the time and the environment you put yourself in. 

Now, let’s talk about some examples here, so I can give you some thoughts around the timing of this because I really want, especially if you are someone who is approaching ACL surgery to think about this.You might have this surgery date planned, or you might be thinking at some point here soon. But I want you to think about this in terms of, can you make this a success? And now let’s talk about these examples. 

Example one, the freshmen high school athlete that has a lot of summer travel plans. It is currently summer. And I will tell you that the high school athletes that I work with, it’s crazy. They’re busier than the people who have jobs, to be completely honest. And is because they are going to the beach, they have camps, they have so much going on that it is so difficult to even schedule consistent sessions in the summer. And so then therefore, that can be very disruptive for this athlete. Now, of course, like there are certain people who prioritize that and there’s some people who are like, ah, you know, like I’d rather go on this beach trip or go to the lake with my friends. Instead of prioritizing the rehab they need to do. 

Then therefore, it can make it a little messy. If this person is having surgery at the end of the school year, let’s say May. And then they’re leaning into the summer time to be able to do their rehab. Well, in theory, they’re like, oh yeah, I’m off and that’s great. I have all the time in the world. But then they’ve got all these plans for travel and all these plans for these different places they’re going to go, whether it is the beach or they’re going to these camps that they had planned and they had signed up for a year in advance or this like particular opportunity. All that plays a factor into it. Then therefore that is something that needs to be accounted for, as small as this may seem and in theory.

Okay, yeah, the summer’s open. It might not necessarily be. Then therefore, this is something to consider for this high school athlete, especially the freshmen. This might be something that maybe we have this conversation with this athlete and refocus the priorities of rehab and some of these plans. But then maybe it’s also thinking about the timing because they are freshmen. Sure, it’d be awesome to get them into the next year, being able to play at some point. But maybe it’s something that they actually get to the end of summer, enjoy the summer things, and then maybe be able to have the surgery right before school starts, get them in a place where they can potentially walk a good bit, use their assistive device and then gradually kind of get into school mode and their rehab mode. This is something to just think about for the freshmen high school athlete, for example, but it could be any year. But this is something that I have noticed with working with athletes here in Atlanta and even for our remote athletes where we have younger athletes, This is something where we see plans kind of get in the way. 

Example number two, the skier that works as a teacher and is January. The skier tore their ACL. Let’s say it’s December and they are now in January and they’re trying to figure out, do they have surgery? they’re a teacher. They don’t get a lot of time off, their work might not be as flexible because of their position that they hold, maybe they get two weeks, maybe three. That’s great. But with that said, a teacher walks a lot. My wife is a teacher. We work with a lot of different teachers who injure their ACL, doing one activity or another, maybe it is skiing. And the thing is, is that you take a lot of steps whenever you are in a school system; ttherefore you’re on your feet a lot. Are you in a position to set yourself up with the spring semester coming up to be able to have surgery, especially post-op? Do you think that you’re going to flare your knee up with a lot of steps that you have to take because you only get two weeks off and then you have to just kind of get back into it. You manage a fourth grade classroom, for example, or maybe even younger kids. This is something that you don’t have as much flexibility, you have to move around, get to kid to kid, you don’t have as much help in your school system. These types of athletes have existed for athletes we’ve worked with. Therefore, it’s a conversation around the timing of the surgery and can that be successful. Maybe that is someone who does push it to the summer because there’s no time sensitivity. I know you want to get it over with, but with that said, maybe that sets you up for such a good foundation to be built because the summer, while you’re offered the summer, and you’re going to have flexibility to be able to do your rehab then, and give it a really good shot. 

Example number three, the soccer athlete consultant that travels every week. We’re talking about someone in their 20’s, maybe 30’s. There are recreational soccer athletes, but they travel every week. Usually these jobs can be flexible but with that said, maybe it is a high pressure situation. I’ve got friends who work in these consulting firms and it can be cut throat. The thing is they want you to get back to traveling and getting to their clients as quick as possible. And so then therefore you are needing to travel, you got to go to the airport, you got to get on a plane, you got to walk, you got to stay in this place and this hotel gym, if that’s even there and then you have to come back and do the thing all over again, every single week. And so then therefore, your work going to set you up for success and that’s something that you need to consider. 

Example number four, this is the final one I’m going to give you here — a curve ball, for you guys. The athlete who has terrible insurance deductible and out-of-pocket max, and then switching jobs with a better insurance in six months. This is something to consider, of course, the constraints aren’t necessarily their job, maybe they are switching jobs. But with that said, it’s not the job itself. The constraints aren’t necessarily the timing of the year is just more so of they’re switching jobs and they’re going to have a better scenario over all, by being able to wait and allow that insurance to kick in. Because it’s going to give them a better coverage is going to give them maybe less of a deductible that they need to pay and maybe better insurance visits for PT, who knows. But this is someone who is in a unique position where they probably want to get the surgery over with, or they’re told by their surgeon, “Hey, have the surgery next week or whatever,” that might be without factoring in their circumstances or context of their insurance situation. This is something that could also play into the timing of the surgery and making it a success.

Other scenarios I want you to think about is the college rec athlete, mid-fall semester, the couple that’s trying to get pregnant, I’m sure many of you listening are walking in these particular shoes, not maybe very, very specifically one of these. But you’re in a circumstance of some sort where you’re like, oh, I got work on my mind or, I’ve got school or you’ve got some sort of plans that are coming up that you don’t want to give up. But then you’re like, “Man, I need to have this surgery. It sounds like it’s really important.” To be honest, it’s never an easy time. There’s no “perfect time” to do this surgery. But it has to happen if it is something that has been well thought out with your surgical team and you are on board with that and with your goals. Then of course, we need to make it happen. Finding the right time is what’s really important. But you do need to make sure you are set up best in terms of timing to make sure it is a success. 

And how can it not be a success? Well, let’s talk about some factors I’ve seen play into this. And some of this is some themes that I had mentioned from basically the examples. But one is being your work isn’t super flexible. It’s not a desk job and you potentially need that income. We’ve had athletes where they didn’t really get time off. They’re not salaried. And so then therefore they’re an hourly worker. They might’ve gotten hurt off the job. And so then therefore they are stuck in a position where they still need to work and maybe it is a physical labor job, or they just have to be active with the job and moving. Let’s say as a waiter, for example, what are you going to do? Therefore that is something that can really impact your ability to have a successful surgery and have successful outcomes on the other side. But this is something that does play into it so that’s why the circumstance is very important. 

Another thing that can play into it not being successful is you’re in the middle of a school year and you don’t potentially also have a lot of support. Being in the middle of the school year, it can be a little dicey because you have to potentially take a lot of steps. Let’s say a college student, I remember being at UGA. Sure, there’s accommodating services which can be helpful. But you still end up taking a lot of steps and you’re kind of in this kind of gray area sometimes where you’re off the crutches, but you don’t necessarily need help getting to class. It just takes you a long time, it’s still a lot of steps, there are stairs. You’ve got to take a lot of steps in your day. So then that could still play into that whole process. And we’ve had college athletes who have their knee flare up all the time because they’re trying to get back to classes, they’re trying to go out, they’re trying to do all this stuff. And while it’s easy to say, well, just don’t do all that stuff.

People are still going to kind of live their lives. We have to make sure people are set up for success. If they do go on to have this surgery and then making sure that that doesn’t disrupt, especially that post-op process, even mid and late stages. But it really is stressing this post-op process because your life is truly constrained because of the surgery itself and the limitations of your knee and what you can handle. And so then therefore, this is something that is going to be really key. You have a job that requires a lot of steps or reacting to unknown scenarios. Teacher, nurse, as I mentioned, construction worker, a parent, for example, has managed their two year old. You think your two year old is going to be able to understand like, “Hey, like I can’t take a lot of steps today.” They’re just going to kind of run around and you got to make sure that they don’t fall off the couch or something. This is something that is so true in life. It doesn’t get talked about a lot, but  the surgery itself doesn’t happen in a vacuum as much as we want. And so then therefore we have to make sure we account for these life factors that will play into this ACL surgery and this process overall. 

Another one that plays into this, you have three little ones and are the primary caretaker. I had mentioned the parent running around and chasing their kid. Now imagine there’s three little ones and they are all under the age of five. Good luck! Therefore, this might be really tough. Maybe you don’t have help right this second, or maybe your partner’s in a busy season or maybe the help that you can have won’t be here for another three months. This is something to consider with this versus just rushing the surgery and getting it over with. This is something that I see all the time is that people just want to kind of get it over with and I get it. Trust me. I had a delay with my first ACL surgery because of insurance, not intentionally. I wish I could have gotten it earlier. My second ACL surgery, I had a little bit of a delay with insurance, but at the time it up with school, because it was Thanksgiving break, this was college. And I was trying to make sure that again, I wasn’t navigating UGA campuses and stuff like that with an ACL that I couldn’t walk around with. I was trying to time it up where I was going into Thanksgiving break and then into finals so that way I could tee it up for a good solid end of November into December, to really focus on my rehab with school coming down, knowing finals was the only real thing I had to worry about. This is something that we got to make sure that we factor into. 

The last thing that I do want to mention is maybe you have a lot of work stress, and they can overtake your schedule. You’re a workaholic, or you have a high stress job and you’re demanded to be there. Your attention is focused there. You can work long hours. This is something that we see with the high performers and kind of CEO-type people where they are ones who will kick the surgery and the recovery itself by the wayside a little bit, and all this work stuff will take priority. And they might do stuff here, there, but it’s not prioritized as much. We got to make sure that that work is in a place that could set them up for success, in order to make sure that, especially post-op and even into the early stages they have the boundaries, if you will, and decrease stress to prioritize their health and their ACL recovery. It’s okay not to rush into ACL surgery. 

If you’re approaching the surgery and needing to make the decision on timing, you need to ask yourself this questions: Are you in a place to make it as success? Can you dial in your rehab show up, put in the work or as live crazy, or you have other priorities, you’re going to let take the precedence over this ACL rehab? It happens all the time and sometimes it’s not the person to blame, 

it’s honestly the timing. Often something that wasn’t considered with an open conversation with the athlete and the surgeon. It’s something that a lot of times it comes down to, if they’re a candidate and there is a spot open for surgery. 

I’ve literally seen this happen for an athlete, who I was consulting. And basically they had a very major knee injury after a skiing accident. Knee was blown up. She was so apprehensive to move it. It was just really locked up. And she saw the surgeon and the surgeon was like, yeah, let’s have, sir, I’ve got a spot open on Thursday. You just want to go ahead and get in then? And she didn’t have any time sensitivity, no specific goals that were really on the horizon that she needed to get to. Even life herself like her work, she had flexibility with that and the surgeon was just like, yeah, I’ve got a spot. What happens when we are kind of leaning into our medical professionals is that we’re leaning on them to guide us. And the thing is that sometimes we could be led in the wrong direction because of maybe biases of what they believe, or maybe it could be financial. At the end of the day, we make money from surgery. And so then therefore, why not just get this person in. We could lose them as a client. And while I would love to say for the good of the people, no one ever thinks that, we are humans and humans behave very differently, especially whenever money can be attached to things or power or status, whatever that might be. And so that could be with anything, it’s not just surgeons, it could be with rehab professionals, with coaches, anybody. With that said, this is something that I see where athletes can get in this position where they go do the consult. 

One error is that they only get one consult with one surgeon. Get multiple opinions in my experience and my preferences. That’s why I recommend for all our athletes just get different opinions, see the surgeons that you want to vibe with, make sure they’re the right fit. They’ve had the reps. But then also in terms of the timing, this is something that is also really key is that can we have enough time to be able to get this knee to calm down and do maybe even four weeks of rehab prehab to be able to get this knee ready for surgery? And I am a super, super strong advocate of this because even the research itself shows that if you do prehab, your outcomes are better than rushing into surgery. Of course, outside of those time-sensitive people. This is something that we want to calm down the initial insult, that initial injury and this is something that we want to get them ready for surgery, which is going to be essentially a second trauma to the knee. And so then therefore, if we could do that, people are in a better place to come out of surgery and have a better recovery process. You have a choice. The only person that doesn’t have a choice as someone who has a live compromising thing whereas a neurovascular issue, which I had mentioned earlier, which is probably 0.00001% of ACL injuries in the injuries. So that probably doesn’t apply to you. And so then in this situation, you have full authority to make that choice. If you have some sort of rehab professional, you have surgeon, whoever it is saying like, Hey, you need to have at this time. You need to ask questions and then also ask, you know, what if I do kind of delay this or, you know, my life right now is a little crazy. What if I rehab it for a little bit and then therefore find the right opportunity to make sure that you can make the rehab a success. And so make sure you can say yes to this question if you are an ACLer lining up your surgery. Being able to say, I am having ACL surgery and then therefore, can I make it a success? Is the timing going to allow me to do that? And then therefore, if your answer is no, then you need to really think about this and say, all right, well, when can that be successful for me? 

Especially post-op, as I had mentioned. Because throughout this whole process, you are building a solid foundation, but especially in the post-op, when you’re trying to get your range of motion back, trying to get the knee to calm down, your quads active, trying to get just your gait normalize, all the things that can be skipped over. This is something that I see a lot of times because of busy lives and maybe people not prioritizing it, maybe poor rehab. There’s a lot of factors that play into it. But one thing that’s not mentioned is the timing of that person’s life and it’s a conducive for them to make that post-op process a success. The thing is, is that the further and further people get away from their ACL surgery, they’re like, oh, you know, it’ll work itself out. I’ll be able to kind of work on it as time goes on. We have worked with so many ACLers, the further out from surgery you get, the harder it is to get your range of motion back, especially your extension. And so this is something that you want to dial in and get back as quick as possible because it’s going to really help you in the mid to late stages. People often we’ll make this process a lot longer because they don’t take the post-op process seriously and they’re not set up for success, like I had mentioned.

This is one thing that I did want to share with you guys today because it’s something that I’ve been thinking a lot about, and it’s something that we’ll have athletes come in and ask our opinion about this. And this is something that I’ll ask them. I’ll be like, well, do you feel like you can make this a successful process if you do go into surgery at this time? And we potentially talk about their life circumstances and their goals, we always do that, but especially for someone approaching surgery. We want to make sure that they’re set up for success. Because you could be needing surgery, but your life is upside down right now that you would not even be able to commit to going to rehab because of so many different factors. We need to reconsider, is this something that needs to be pushed off for a little bit or scheduled, during a time where you can make sure that this thing takes priority and you can focus 100% on it. And it’s an absolute game changer when you can. And we see it day after day with athletes who are very prioritized in this process and have the life built around this to know, all right, I’ve got my surgery coming up. I’m not going to travel. I’m not going to do this. I’m going to focus on this while still trying to live my life within that window. But knowing in that first, especially week, two weeks, I would say even the first month, four to six weeks, you want to really dial in and make sure that life is really controlled. You can give yourself the best shot. So at the end of the day, if you are facing surgery and you know, you need it and it’s planned. Then, therefore you need to ask yourself, am I in a place to make this successful? And how that timing will impact your success? I hope this was helpful, team. If you have any questions as always reach out. Until next time, this is your host, Ravi Patel, signing off.