Episode 194 | Should You Go to Your Surgeon’s Recommended Physical Therapy Clinic for ACL Rehab?

What is up team and welcome back to another episode on the ACL Athlete Podcast. Today, I am talking all about, do you have to do PT, physical therapy, physio at the surgeon’s physical therapy clinic, or one that they recommend? This is a topic that I run into quite often actually, where people just don’t know which is fair in this situation. The ACLer has met with the surgeon and surgery has been planned. And then they’ll discuss when to start physical therapy. And usually there’s a prescription given for it. At least here in the United States, you’re given a prescription of somewhat where it’s like, all right, you’re going to do rehab for 12 weeks, two to three times a week. I’ll potentially put on there the different modalities, if you will, exercise, heat, ice, steam, whatever it is. And so you’re given this sheet of paper and don’t really look too much at the detail. It’s basically the same thing as you would give when you get a prescription drug but you’re giving it to your physical therapy clinic. And usually this is the way for insurance to see, you went to the medical doctor, now you have been prescribed physical therapy for your rehab, and then go from there. 

What’s interesting with this situation like this is that I hear from these athletes, in terms of the choices that are offered from this standpoint. What I will typically hear is that some surgeons and their offices will advise, go where it is convenient or close to you. That’s fair. They might give you a sheet of paper with a list of possible PT clinics in the area. That’s fair.They’re just kind of giving you options or they recommend a clinic or two, they have a good relationship with, which is fair as well. They have a good relationship. And they might say, “Hey, like they do really good work. They might be a sports-based physical therapy clinic,” which is awesome. These options all exist. 

Another route that often can happen is the surgeons will have physical therapy clinics that are associated with their medical practice, and not always giving the patient an option. And that’s where I really want to dig in here with this episode, is that they’re told to work with their associated PT or clinic with their office. And the ACLer thinks it’s what they have to do. It kind of makes sense when you think about it logically. Yeah, I’ll have my surgery here and then I will do physical therapy here, all in one house. You might also just not be given the option to go outside of that. Now don’t get me wrong. There are amazing surgeons and amazing physical therapists and offices that are connected under the same umbrella. There are some here in Atlanta that are awesome. There’s also some that are not awesome. And the thing is you’re hoping for really good dialogue between the surgeon and the PT to keep updates between each other and knowing how you’re progressing. There’s this scenarios where you have a really good surgeon and a bad physical therapist. The surgeon isn’t controlling all the physical therapists that come through the practice itself. And so then that’s the responsibility of the physical therapy practice and the way that it is built and the philosophy and the way that it’s model is. And so that exists. Then, it’s also possible just a surgeon’s practice by itself without a physical therapy clinic associated, which is also very common. This is something that I want you to know how this can all look because this exists and also the options will impact potentially your rehab. 

Now, sometimes in these scenarios, especially with a surgeon and their medical office and the physical therapy clinics associated, they could be incentivized to refer internally, to stay within the company umbrella. Now, this is not in all cases and of course, we want to seek the best in everyone. But it exists. My goal with this podcast and with this episode is to share awareness of this. I know not everyone is just trying to make a quick buck and there’s people who are doing incredible work out there. But just kind of know what exists in this space. We know, especially in the medical system, there’s a lot of siloed-based care, even though they’re under the same company umbrella. Man, it could still be so siloed based. I know plenty of physical therapists who work in systems like this and they don’t really communicate with the surgeon. Or they might send over a note, the assistant gets it and then the surgeon never hears about it. There’s all these kinds of hoops to jump through. I think when we think about the surgeon and the physical therapy being under one umbrella, it could be great. It could also not serve any benefit and almost be at the detriment, especially the physical therapy is not really good. Just onsider these factors with a situation like this. 

What I do want to most importantly shared that in probably 99% of cases here in, especially the United States, if we’re talking about using insurance, you can go anywhere you want for physical therapy in your ACL rehab. Of course, you have to consult your in-network benefits, out-of-network benefits, all these things, in terms if you are using insurance. But with that said, you are not supposed to be told where you have to go. Or say, “hey, this is the place that you have to do rehab.” Because even here in Atlanta, it is crazy the number of athletes I will get and they were told by their surgeon, okay, go work with our PT clinic. They weren’t even given options. And it’s just crazy to me and then they come in and if they’re not looking really great. It’s just a challenge because this is something that I would hope people would know. But at the end of the day, they don’t. And why would you, I don’t want to assume this is super obvious because it’s not as much as you think it would be to know you can go anywhere. 

The medical system is very confusing. You have to deal with insurance. And often this is someone’s first time experience with a major surgery with physical therapy itself. I know it was my first experience overall. And you do what you’re told without thinking twice, plus it’s less work for you. You’re just like, cool, they’re under the same umbrella. Why should I worry about this? The thing that I want to bring up with this is that it can also have some downsides to it. I talked about some of the plus sides, especially with a good PT and good surgeon combo, but there can also be downsides to it. It ends up coming back to the same problems that we have with just any clinic in general. It’s the generic cookie cutter type clinics the surgeons connected or not. There’s lots of volume where people are seeing, anywhere from two to four people in an hour. And there’s not really a sports emphasis like you’re doing the same exercises through this whole process. As Bertha in the corner who’s 75 with a total knee replacement. And you’re just like what gives. You’ve been promised there, the sports clinic, the sports medicine clinic and there’s nothing to be shown that it’s sports-based. It’s still the beige carpet and walls; the weight’s only go up to 30 pounds; you’re doing the same exact exercises as every single other person with the same injury and probably any knee issue that they’re dealing with. And so that’s the thing that we have to always create a litmus test for it, if you will. 

There’s a lack of communication between the surgeon and the PT. That’s the things that we have to look out for, with this situation, and especially with it being super busy with a clinic like this and working with physical therapists like this. So just something to be aware of. In these situations, my suggestion as always that I share with you, is to see if you can get in pre-op to see how it is. If you like it, does your gut tell you I need to stick it out here or maybe go somewhere else. This is the part where you’re going to be interviewing your surgeon, but also your physical therapist. Whenever I’m consulting with an athlete, they’re asking me questions and I encourage it. Ask me all the questions. I’m an open book. I’ll tell you what I don’t know. And it’s important to be able to share this and to be able to interview your physical therapist in a sense. The challenge is that you’re typically post-op in many situations and the first time meeting your physical therapist and that can make it a little challenging because you’re already there your post-op. The last thing you want to do is switch PTs. But you still need to do your due diligence. Get out of that first week and then just continue to see how it goes. Be careful of the honeymoon phase because anyone is going to make progress with even poor physical therapy because you’re really starting from ground zero. You have a knee that is post-op. You’re going to start bending the knee. You’re starting going to start straightening it. You’re probably going to start putting weight on it. You’re probably going to be able to start doing more stuff with your daily life. You’re going to be making progress. 

Once you get out of those early phases, that honeymoon period of ACL rehab, that’s when the true PT shows and the quality and the care that you’re getting. This is where it’s going to be important and where you can vet this physical therapist early on is asking them good questions that I have covered in previous episodes. Go back and look in those episodes to be able to find those questions, but you’re essentially trying to understand what is their process look like? What does testing look like? What is their experience with ACLs. At the end of the day, you want everyone to be able to get good at ACLs, but you never want to be a new grads first ACL coming out of PT school. Someone’s got start somewhere but you don’t want to be that person, specially with an ACL injury. 

Let me get someone who’s a little bit more experienced and understands ACLs and has more volume underneath their belt. So then that way we can adjust with all the ups and downs this process has that comes with it. Something to consider in this. Do your due diligence with the physical therapist that you are going to be working with, whether that’s connected to the surgeon’s office, or maybe it’s just independent of that, which I have shared before, and make sure you follow your gut on it. If it feels like you’re just not getting what you need—pivot! Don’t wait. Have a plan—pivot, and I promise you it will make a huge difference and it could be the difference in you walking normal at two weeks versus six weeks. You might be running at four months versus seven months. And you’re having issues at seven months and no issues at four months. It could be the difference in returning back to your sport in eight, nine, 10 months. Or it could be the difference in you returning back a year and a half, two years later. 

What’s the opportunity costs in this?This is the thing that a very good physical therapist versus a not so good physical therapist can save you. Can we accelerate getting you back to sport? No. Can we accelerate you within the rehab process? Yeah, in all honesty. And that’s the difference between good and bad physical therapy is that we can make sure that we are checking their appropriate boxes and making sure that you’re progressing and there’s feedback within that. And you know where you’re at and where you’re heading. And therefore, we can adjust things faster versus doing the same exercises on repetition for a month, two months, three months, four months, six months. We’ve seen it all, literally. Someone was doing straight leg raises at six months post-op. And you’re like, come on. 

With that said, this is going to be really important in terms of a situation like this, and  I’ve seen it in terms of just athletes being really kind of stuck in these places. Sometimes they feel like they just need to stay with their physical therapist, or maybe it’s in the surgeon’s office where the physical therapist is there. And it’s like, no, you got to do you. And it’s important for ACLers to know you have options. You don’t have to be forced into working with someone ever, to be completely honest, but especially with yourACL rehab, it’s such an important rehab. The thing that I’ve kind of started asking people whenever they start to think about these things and know there’s an issue, what is the cost of a second ACL injury? Instead of thinking about this pivot or this hard decision right now, what is the cost of another ACL injury? And I promise you will move a little bit faster because the last thing you want to do is endure this injury again, go through the surgical process, go through rehab again, and just endured the length of it. It sucks. So that’s where we can make these decisions faster, especially when we know it’s not going to work out. 

And ultimately, the biggest thing about this podcast and what I care most is that you take away is that you have to be in control of your own journey. There is no one that’s going to look out in this process for you, the way that you do. It’s going to be important for you to take control of it. Don’t allow yourself to just passively be passed through the system. And make sure that you are able to help make these decisions. And most importantly, feel educated to make informed decisions. And that’s why this podcast exists. And that’s why I do it every single week for 194 weeks at this point, straight, to make sure that you guys are equipped as best as possible. You don’t make the mistakes that I did. Don’t have a second reinjury or a third reinjury. 

These are things that I am hoping that we can just shift what is happening, reduce reinjury rates, be able to most importantly get you back to the thing that you love to do. That’s why we’re here. Make sure you have good quality life; not only short-term but long-term, too. If we can put off a total knee for 40 years versus 20 years, maybe never having to have one. Whatever that we can help facilitate through this podcast and through what we do as a team in a company we’re here for. 

I hope that this is helpful. Take control of your process. If you need any help, if you’re like, I’m not getting really good physical therapy, I need some direction, you know where to find us. You can hit the show notes for our remote coaching. We work with people all over the world. This is a good opportunity to get in before we hit our capacity here soon. This is something that I want to make sure you guys just have direction. And whether that’s just kind of helping you find someone, even your local area to be able to use as more of a resource or a solid PT, then that way you can get back to doing the thing. So until next time team, this is your host, Ravi Patel, signing off.