Episode 184 | Do You Feel Behind In Your ACL Rehab? – Part 2

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today we are diving into part two of this two-part podcast series answering the question: do you feel behind in your ACL rehab? Now, I’m going to try and bring the energy from part one, because I did allow a lot of passion and just feelings into that episode. Because as I was speaking and talking about these different points, it really just made me fired up, in terms of some of these things that can kind of bleed into this thought process of feeling behind. It just struck a chord personally, because I dealt with this so much through this process and I can not tell you the number of times that I have hopped on a call with an ACLer, a parent, whoever it is, I hear the phrase “feeling behind.” I talked to somebody literally yesterday and they said, I feel behind. 

I just want to really tackle this head on because it’s something that I do think it’s just this negative cloud that is looming over this process. I want this podcast series to tackle this because I think that is something that is not productive and I think it’s something that we need to kind of peel back a little bit to understand where is this coming from. As you know, I talked about a system-wide issues. This is something that I want to make sure we are kind of dissecting a little bit and figuring out, okay, is this coming from this person? Or is it coming from this thing that I read? Is this something from a group?Tthere are different places where information is coming in and it starts to mold our perception of this process. A lot of it comes down to expectations and reality of it. This is something that I want to make sure we do discuss in today’s episode. 

But before I do that, make sure that you check out part one before tuning into today’s episode. It really sets the stage and I think it will help share some perspective for those of you who might feel this way, which is most ACLers, so definitely go and check that out if you haven’t yet. Because it really will set the stage for this. In part two today, I want to share some perspective. Since part one did cover a lot of how this feeling can sneak into our mindset and process. 

Timelines play a big role in this, again, whether this is based on the protocol, your surgeon, PT, coach, maybe it is in that Facebook group or Reddit group, maybe it’s a friend that you were talking to and they had a different procedure, or maybe their protocol is different or maybe their surgeon or PT told them something different.That kind of enters into your headspace and it could be positive and it could also be very negative. Especially if you are the person who is potentially “not on track.” This is where it can be really challenging and it can also lead to just you also putting pressure on yourself. And look, I get it. Timelines are helpful. We use the calendar to really plan things. That is very normal, a human behavior where we’re looking at certain dates, certain days available, weeks available, months available, even years. If we’re aiming towards something, that’s how we’re looking at these things. 

Let’s say for example, school, it’s all conditioned based on a school year. You’re going to have this period of time where you do this grade or this particular year in college or whatever that might be, but it’s all based on timelines. Our brains are normally processing it in that fashion. The thing is that’s difficult with this is that there is biology that we can’t always control. And that’s what makes this so challenging is because we put this thing on a timeline and assume that it’s going to be this perfect process, or it’s going to pan out in these 3, 6, 9-month timeframes. When in reality, there’s just so much variance to this. 

But look, I get it, which is why we also use timelines with our rehab and with our ACLers. It helps us to anchor knowing, all right, well, these are where goals are and this is where the athlete is and that’s where our testing. We have a good idea of where the athlete is and being able to make sure that we know, okay, this is roughly that timeframe that we can see these results in. This is just through working with a lot of athletes, reading the research, our experience, and we’ve been fortunate to do this. This is something that we want to make sure we just don’t say, ah, third time out. Just get there when you get there, because that’s not helpful either. We want to make sure we still use them, but the most important thing about this is how do we communicate them. This is so important. I had to come down to the base of all this, is just really good communication. Even, some well-intentioned medical professionals—my actually be just poor communicators and they know their stuff, but they just communicated poorly. Therefore, it sets their athletes up for failure or putting them into this negative headspace. 

When in reality, if we could communicate better a lot of times, things could probably not fall through the cracks. It wouldn’t lead to these feelings of maybe feeling behind right. Communication is such a big foundation. It’s such a big piece of what we do, and we make sure that we are doing that to our best abilities, because words matter in this process. You talk about medicine, you talk about things related to our bodies, things that we can and can’t do, I repeat words matter so much. In healthcare, it can feel kind of more transactional versus being intentional about the words we use. This is something that is so important to us as a team I care so deeply, we care so deeply to make sure that we are building you up versus tearing you down, which is what it kind of feels like sometimes in this process. We might set timeframes like we want to achieve a full extension in four weeks. Or we want your quad stregth to be at 70% or 80% symmetry around four to five months. But these goals and criteria are set on a sliding scale. There’s going to be some variants and there’s a lot of factors that play into this. 

But two things come to mind here when I do mention this. Think about the athlete who has a meniscus repair with ACL reconstruction versus maybe they have a meniscectomy or no meniscus issue. It’s just the isolated ACL. Do you think that these people, the meniscus repair with ACL versus ACL by itself, do you think that they are going to operate on the same exact timeline? Well, you’re automatically on a different timeline, in most cases, because the surgeon has put more restrictions on your weight bearing in most of these meniscus repair cases. We often see you four weeks, it could be six weeks. We’ve seen as much as eight weeks, which is wild. But the thing is that there’s a lot of variance. It could be just maybe one week non-weightbearing. Maybe you progressively are able to start putting weight on it versus it could be four weeks. So that’s probably the average timeframe that we will see versus someone who has a non-meniscus or  meniscectomy-type situation with their surgery. You think about this case and they’re going to be a four-week difference, especially if you are non-weightbearing, that is four weeks of deconditioning on that leg. Not putting load through it, not getting it used to being able to walk, not being able to probably bend it beyond 90 degrees, which is a common restriction we see with a meniscus repair. 

The thing is that when you look at these protocols that are listed, the expectation of the timeline is exactly the same. It’s almost like these athletes are supposed to play catch up to the athletes who had an isolated ACL; not to mention also what type of graft did they get. Because guess what? The allograft who had an isolated ACL is going to do way better in terms of pain, their strength, all those pieces versus let’s say the meniscus repair with a quad autograft. Your quads are going to be impacted and  you’re going to be restricted with range of motion, and you’re going to probably be non-weightbearing. The lanes of these two athletes are going to be completely different. But if you look across a lot of protocols, man, they all look the same. They’re like, okay, well, if it’s non-weightbearing cool. But then they’re supposed to get back up to speed, almost the athlete who had just an isolated ACL or a meniscectomy associated with it. 

This is the thing that I want you to think about, well, where are we pulling this information from? And it’s not a lot of physical therapists are thinking through these nuances with ACL rehab. I wish that that was the case. But guys,  we did not cover all this stuff in physical therapy school. When you go to a general orthopedic clinic, we did not go through the ins and outs of  quad graft, hamstring graft and the patellar graft and allografts. We didn’t think about, all right, well, meniscus repair versus meniscectomy. I hate to say it, but we didn’t learn all these nuances. Unless you’re really dialing in the experience, you’re doing continuing education afterwards that is more specific to this and working with this population, then a lot of times, because of the volume and the nature of the system, it’s going to be something where it’s treated “the same.” I’m not saying that there needs to be these drastic differences in programs and everything that each one of these athletes do. It’s just more so of how is it communicated? What is that timeline looking lights and what are the criteria that you’re aiming for? The nuances that are going to be determined with different graft types, different surgical procedures, repair versus not. These all play into that feeling of behind. It might not be used as the ACLer, being all right, thinking through all these different details. But it is being communicated in one form or another from your physical therapist or from your surgeon based on these things. 

This is one of the things I want to mention is that the surgical differences will impact your timeline to some degree. Now, can an athlete with a meniscus repair catch-up? Sure. But there’s so many differences within that, that you can’t say the athlete is going to catch up compared to maybe the isolated allograft. You can see all kinds of different variations of people and their outcomes. But this is something that I do want you to think about in terms of that feeling of behind. Let’s say if you’re someone who had a meniscus repair, because you’re going to be doing a little differently than someone who had a meniscectomy. Just point blank you will be because of those restrictions that a surgeon puts on an athlete post-op. 

The other thing I want to mention here that comes to mind is the athletes who develop a cyclops lesion. Especially those who work so freaking hard on it. And often there’s nothing that you could have done. A lot of times people will say, well, maybe, this could have been done. You could have worked on range of motion more. But look, we don’t know a lot about cyclops lesions at the end of the day. We don’t even know exactly where they come from and we know that they develop and they could develop maybe early. A lot of times it takes a little bit of time for them to develop. Is it the root that’s leftover? Is it scar tissue that develops? Is it like a narrow intercondylar notch? Are there all these different factors that could play into why does the cyclops develop? But the thing is, it happens. I’ve had it happen to athletes who literally are type A, do everything and anything, they listen and is still developed. What can we do? That’s the thing that is always so challenging. The thing that I want you to think about is that if you develop a cyclops lesion, you’re probably going to have a little bit of a difference in a timeline and of those expectations. Because think about it,

if you have to get that thing removed, that’s another procedure. And then therefore you got to work on extension. The focus of your rehab starts to be very targeted towards extension because we’re really aggressive after that clean-up procedure. And then of course, you’re going to start continuing your rehab. You’re not going to be set back nearly as much as that initial reconstruction. But with that said, there is going to be some disruption within the knee. It’s going to swell up a little bit. It’s going to be painful. You got to protect the incisions and you got to focus a little bit more on range of motion. So that is going to impact the results that you might be getting in other places, So these are the things that I want you to think about. From a biological standpoint, there’s not a lot of control over. For us to assume that these athletes are going to get back to, let’s even say nine months post-op, I think it’s a bit of a stretch because there’s still a lot that needs to be done. And they’ve had some disruptions in that process. Nine months, 12 months could be 15 months, could be two years but with that said, that’s where working with a very good physical therapist, coach that is going to guide you, will give you better perspective on this because they have the experience to say, hey, we’ve seen this before. This is what we’re aiming for. This is where you currently are, this is where we need to be, and this is the gap that exists. This is how we’re going to create this roadmap to get there. Sokey in order to make sure we dial in that process. But the thing is, you know what, this is the strict four weeks, you’ll get there in three months, X, Y, and Z. And then six months here, sure, in general plan, we can map that out. If anyone say 100% , I’d run the other way because there’s a lot of variation in this process. The main point that I want to share here is that there’s going to be a lot of variants. I think in different surgical situations or maybe something biological happens like a cyclops lesion where you can’t control it. Therefore, this feeling of behind sneaks in and is fair because then you’re like, okay, well, this process does feel like it’s been prolonged because of this situation happening. 

I think what needs to happen is a reset of  all right, cool, I’ve had this road bump in a sense, but what can we do to reframe this? All right, this is my reset. Maybe instead of thinking on a timeline, I’m four months out. Maybe you kind of backed that up a little bit and know basically based on your criteria. That is what you’re going to be dictated by in terms of, all right, this is where I actually am. Instead of the timeline at chronologically of all right, I had my surgery at this point. This is where I am right now. How do you present physically is more of an accurate estimation, if you will, of what the road ahead looks like. 

One of the things that I want to share is about this book by Dan Sullivan and Benjamin Hardy. It’s called The Gap Versus The Gain. This helps a lot with feeling behind and just this whole idea of ACL rehab. Because it is just this weird mindset thing that you’re trying to work through. It’s this tug of war dance that I tell a lot of my athletes. I want to talk about this gap and gain concept because it’s a very brilliant concept that I think will be very helpful for you ACLers who are going through this process to be able to look at this whole journey and be able to pull some different things from it.

The concept is the gap is the distance between where you are and where you want to be. This can lead to this feeling of being inadequate, some frustration versus the gain shifts the focus to how far you’ve come, highlighting progress and creating a sense of accomplishment and positivity. The focus on where you’ve come versus the moving goalpost, which I’ve talked about that gap. The constantly striving for more versus getting more fulfillment this way and building confidence via self-image. You’re trying to find happiness and peace now with where you are versus this kind of like anxious, constantly stressful pursuit. I love this concept and I’ll probably do a bigger episode on this because I think it’s so valuable from a mindset piece and it’s just a good life concept. A lot of times what we’re focusing on, especially the way we’ve been conditioned in life, is we’re looking for where we are and what’s next. What is that gap? We’re always onto the next thing, trying to attain the next thing and especially in today’s society. But what we haven’t been able to look at, what’s the gain, man? How did we get here? That’s the thing that I think is more appreciating of this process and looking at this process as a whole and being like, all right, cool. I can appreciate this because of what I’ve gained from where I have come from to now. So that’s the gain versus the gap.

I hope that’s helpful because I think that this is great in business in all honesty. Because I could always be forward focused and onto the next thing versus realizing, wow, we’ve come a long ways. We’ve worked with hundreds of ACLers, we’ve been able to build a mentorship and have multiple cohorts come through this. and be able to make a big impact with what we’ve been able to do with this podcast, with you guys listening. I’m so appreciative, but that’s the gain, man. It’s easy to look at the gap and be well onto the next thing. And that’s the same thing that we can do in this ACL process where we feel like we’re behind. Because we are looking at this gap versus looking at the gain, which is the main focus of this concept.

Here’s what I’m going to ask you to do: Reflect on where you’ve been. I know that whenever you think about reflection and you’re like, I don’t need to do that. But really, if you are listening to this podcast episode and you’re feeling behind and this idea or this phrase is snuck its way into your head. And you’re like, I relate to a lot of this stuff, then let’s just have a reflection moment. Set your phone timer to five minutes. It could even be a few minutes, whatever works best for you. But think about where you’ve been, instead of thinking about where you want to go, which is where we are always focused on and we are always forward-thinking people. Think about where you’ve been, because this is something that will help so much with this feeling behind feeling that we do have. And when you sit down and reflect. Look and see, are you having fun? Can you say that? ?Now, trust me I know that. This ACL rehab is not fun per se. But how can you make it fun and how can you enjoy the process? Because you’ve got to do it anyways. I guess you can quit. But if you’re listening to this podcast and this episode, that’s not you, you’re not a quitter. This is something that you’re going to have to do. You’re going to have to go through this ACL process and since you have to do it, why not make it fun, enjoyable and enjoy the process. There’s always this comparison of the product or the outcome or the process. And really when you think about it, when you achieve that thing, it’s cool. It ends up being more momentary than you think, whether it’s the race, getting on the mountain, being able to climb and do bouldering, for example. Be in that fight, being able to get back on the soccer field, all that stuff, being able to win the championship. All that stuff means a lot. Don’t get me wrong at all. That stuff has its moments. But a lot of times what’s funny is that when we get to those moments, we’re always onto the next thing, or it might not always feel that fulfillment that we thought it would. It’s just almost more of a target that we’re aiming for. What we end up noticing is that the process is where a lot of this is. 

That is why I’m coming back to the process versus that product, because this is where I want you to reflect and I want you to reflect on where you’ve been. Think about where you are now, and of course, if you’re super early post-op or post-injury, then this is something that I want you to set a reminder and come back to later. But this is something that even if you are in that early stage, you could still see where you have come. But if you are especially into the later pieces of this, you’ve been in it for a few weeks, months, then sit and look at where you’ve been. You’ll notice all the small wins that have probably accumulated along the way that you probably forgotten about, especially if you’re in mid and late stages. Because you don’t have as many of those wins or those noticeable improvements as you did post-op. The range of motion, extension, flexion was gaining. You got off your crutches. You’re able to start walking and using stairs and being able to drive your car and being able to navigate to different activities and your day-to-day was less impacted. Instead of that first week, post-op you’re like, how do I get on the toilet? How do I take a shower? How do I get down the stairs? You’re out of breath using crutches for like more than 50 yards. I felt all this stuff. But then now you’re in the mid and late stages and maybe you had some setbacks, or it didn’t go as planned, if you will, therefore it’s hard to see that. What I want you to be able to do is reflect on how far you have come and list out those wins, list out all that you’ve done and what you’ve been able to accomplish in this process. 

This could be physical. It could be the emotional pieces. It could be also the mental pieces of the hurdles that you’ve had to get past. Every single win counts and allow that to build momentum. But focus on that gain versus the gap, that’s basically what I’m asking you to do here. And then therefore, you can put that towards this feeling of behind and being able to dissect this and make sure that you use that as momentum as you move forward. 

As we bring this series to a close, I want to share some reminders here. If you’re struggling with this feeling of behind, I encourage you to write this stuff out. Literally, grab a sheet of paper and put your phone on airplane mode or do not disturb, set that timer. Make sure it is on 5 to 10 minutes, whatever you need in terms of timing to do this and gets her riding right. And be able to reflect on this and look at what that gain is in this process. And I promise you, you’ll be able to see, wow, I’ve come a long ways. I’ve also had to battle through a lot, whether it is the setbacks, a cyclops lesion. Maybe it’s just some life stressors that you’ve had to work through that has derailed your ACL rehab. We’ve had athletes who have had things come up, whether it is financial issues in their life. They’ve had to literally pivot jobs and so that could be a struggle. Maybe it is something related to a kid and you’re having some type of surgery for your kid. Therefore, you’re out of commission being able to focus on it. Maybe it is some other life thing that came up outside of maybe just the rehab itself. And so then therefore you made it through it. Now, it’s time to move forward and hopefully be able to set that back up. But with that said, you’re able to reflect not only on the ACL rehab and where you’ve come, but also other life pieces that can play into this. 

Another reminder here is check your expectations where are they coming from, check those voices. A lot of times, I will say, finding the signal within the noise. There’s a lot of noise these days, guys, so much noise. If you hop on social media, Instagram or Facebook, or get on YouTube, you may get on Reddit or Facebook groups, whatever it is, there’s a lot of noise out there. That’s in addition to just general life, whether you’re with teammates who have torn their ACL, you’re in the clinic where there’s a lot of ACLs, maybe it’s surgeon, PT, coach,  parent, all these different voices that can kind of come into this. Some of those are signal, some of those are noise. It’s up to you to be able to decipher that and it’s not easy. But the thing is that I would recommend you doing is just check what those are, if there’s comparison creeping in, if it’s a professionalist putting maybe some negative thoughts into your mindset or a supporting role, whoever it might be, check what that is. Being able to redirect and it might mean firing that person. I don’t have any problem with people firing whoever it is that’s putting it negative voices into your process or poor guidance, then that person needs to go and you need someone who is going to uplift you, support you, guide you, make you feel like you’re in control of this process and they’re there to help be your GPS. They’re there for your guide.

Next up is, are you doing everything in your control? The controllables. Make sure you are doing everything that you can within that. If it’s uncontrollable like your cyclops lesion, man, I hate that for you, but I promise you we’ll get through it. The controllables are, you might need to have surgery and you need to really focus really hard on your rehab and your extension afterwards. But those are controllables. In terms of the human body and biology, you can’t always control that stuff. So that’s what’s going to be really important here. Do you have expert PT guidance? If not, then it’s time to find some. This will help clear a lot of this as this is probably the number one issue that I see. The professional advice, especially when you’re looking at your surgeon, when you’re looking at your PT, your coach, that people who are on your ACL team, especially who are giving you the guidance of recovery. This is going to have such an influence on the way that you navigate it, clearly, because they’re hopefully the ones who are navigating it for you. But with that said, it can feel siloed, it can feel not very humanized in a sense, it can feel very transactional. This is where I want to make sure that you have people in your corner that are supporting you and who are up-to-date with these things. And you have really good guidance. 

To me, that is the number one thing, more than anything in this process. If you’re looking for help, we’re here. You could reach out to us. We work with people remotely, all over the world. We love to do that and we literally talked to athletes every single week and we have people joining the team. It is fun to be able to do this because then we see the light switch. We see that moment where people are like, oh man, there is hope in this process. I don’t have to just be stuck in this purgatory. Therefore, this is something where we can reframe this feeling of behind to being like, all right, cool, this is where you’re at. This is where we need to go. This is what this is going to look like in terms of this roadmap. We’re going to build it specific to you, and then we’re going to make sure you have a GPS along this path. Let’s say there’s a road bump that comes up because not everything is predictable that we’re going to adjust and make it as efficient as possible. Therefore, you’re not set back 1, 2, 3 months at a time and instead is a quick redirection back onto the path. Your guidance is going to be so key in this process. 

Next up is focusing on the gain versus the gap. Focus on the small wins, the milestones you’ve achieved. Sure, you can focus on the things that are ahead. But what I suggest, especially if you’re feeling behind is make sure to revisit the gain here and the wins that you have collected along the way. So that’s going to be really key and just reflect. It’s one of those things that we don’t do enough as humans. I try to slow myself down to reflect. And especially be thankful for the things that I’ve been given and the things we worked hard for and the accomplishments and the wins and these milestones. This is something that I encourage you to do, and I promise you will find some victories in this and it might even help to reframe this process for you. 

Last, but not least, run your own race. This is no one else’s race but yours. Run your own race. It’s so huge. Comparison is a thief of joy. This is something that really does bleed through this process so make sure that you’re running your own race. You’re not running Bertha’s race, you’re not running Randy’s race, you’re not running your surgeon’s race or your PT’s race. It’s your own race. You have some input and help and guidance through that. But don’t let that comparison sneak in and make sure that you’re competing against yourself because that’s what we can ask of ourselves. We’re not trying to compete against that next person at rehab or whoever it might be. It’s about making yourself better. And that’s what this process is in a nutshell and it’s going to be at different rates because of the human nature and human biology of our bodies and how this process is. 

Whenever someone’s like, this is where you need to be on this timeline. There are some times where that could be helpful and healthy to have that conversation. But if it is based on protocols or just general timelines, and it’s not considering the nuances of your specific procedure and your ACL journey, and this person doesn’t really know ACL is really well, then I don’t really put a lot of weight and merit to that. I think that in most situations, if you’re doing everything that you can within your control and you have good guidance, then therefore you’re doing the thing and you’re focusing on the controllables. Focus on running your own race, because that is going to be so key in ACL rehab. 

I hope this series was helpful for you guys.  I know I rambled on a lot, but I enjoyed it. I was happy to talk about it, and I felt very passionate about this subject because it just hit near and dear to me. I hope that it was beneficial for you. If it was, then send me over a message. You can do that in the show notes. There’s a way to send me a one-way message. I don’t see your number, so I will not text you back. Don’t sweat it. But there are so many other ways from Instagram to email, anything that you can send a message through. You can send it over to me. I would love to hear back from you. If you got any value from this episode, this series, this podcast, I would appreciate it so much if you would leave us a review, five stars on Spotify. It literally takes five seconds to just click over and leave a quick review. Please share with us anything that is helpful for you. If you want any other topics covered questions, you can send us a message that way through the show notes and I will be happy to tackle them. 

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