Episode 198 | Changing Seasons, Changing Goals: How to Adapt in ACL Rehab

Welcome back everyone to the ACL Athlete Podcast. We are close to approaching 200 episodes—not fully there yet, but this is just wild to think. We have been at this for almost 200. This is 198 and we’re getting into it. This is all about seasons in life and just talking about this ACL process and how it aligns with that. This topic has come up after talking with our team, talking with some athletes recently, and just knowing that the holidays are approaching, which brings up this important topic: seasons. How’s seasons will influence your ACL rehab and just the different phases you’re in. Let’s talk about this a few different ways. 

The first way I want to talk about this is the “timeline.” As we kind of typically visualize this process, you have the injury and then maybe you go on to have surgery and then you have the early stages of this process, post-injury and post-op. You have the mid stages and then the late stages, just to keep it super clean. We talk about this being a nine to 12 month-plus process, of doing this recovery and getting back to the thing. This is going to help us to think about this in the sense of the timeline, however long you want to extend it in these phases. But just take it as just these three different phases through this process. 

Now with that said, we’re going to break this down. The way that we want to look at it is the early stages: post-injury and post-op. The thing about this is that people will have more time and not dealing with things like school and work and other typical responsibilities and roles that they have for a period of time. Now, some people don’t get the luxury of this and some people have to hop right back into it. But a lot of people, I would say have some sort of change in that. Whether it’s some time off from school, even if it’s in that first week, two weeks. There’s some people we have where they don’t have to go back until they are good to go. Some people like maybe military base, they can go onto like a modified version of it. It really depends. What we do know is that if you’re especially going to have the surgery, and even for post-injury for that matter, you’re going to be impacted by the way you can move, walk, do your daily stuff. You’re typically going to have some sort of off time, whether it is a few days to weeks and months.So that means you’re not dealing with school; you’re not dealing with work. 

People think is that they can keep up the same amount of, let’s say frequency and intensity as when it’s not there. Meaning, you’ve finished with this early phase of it where maybe the work in school isn’t there and then you have to jump right back into it. But they think that they can maintain the exact same amount as they did before. But you have so much time available whenever those responsibilities weren’t there, your mental capacity was a little bit better. Your earlier in this process as well, I will say. You’re noticing more changes day to day so that helps with the mental piece because you’re noticing the milestones. You had increasing flexion, extension, being able to start walking, getting off crutches, being able to take stairs, driving a car, all of these things start to feel like, all right, I’m making progress, I’m hitting this. It starts to slow a little bit once we get out of what I call this honeymoon phase of ACL rehab. Because then it’s harder to notice the progress of the results as much. This is just something important to consider with early stages because life does start to feel blocked off a little bit, and you can operate in this vacuum if you will, of focusing on ACL rehab versus work or school, or maybe other responsibilities, like even parenting, for example. Maybe your partner or someone else who is helping to support with the kids is able to come in and help assist. You aren’t even worrying about that as much. 

Now let’s talk about mid and late stages. I’m going to combine these two because now you’re back at it. You’re having to get back to work, back to school. Maybe it is responsibility as a parent. But there’s less flexibility like the earlier stages and you’re having a more balanced these things out, understanding how all of this kind of fits together. The other thing too, is that maybe your ACL rehab tends to not be as daily, but it’s something where maybe you might be working on range of motion still in this process. We’ve had people who still have to work on extension or flexion or some other things they’re dealing with. Those things they might be tackling a little bit more frequency of daily, and then you’re going to have your structured strength or your rehab days and maybe some dynamic on-field type days or on-court days. So that’s going to be a little bit more regimented and structured because you’re not going to be hitting strength every single day like you do maybe in the early post-op process where you’re doing a little bit more frequency and repetition. Then you can balance that out a little bit more, ideally, more demanding, of course, in those phases. But you’re trying to push really hard to get strong and more explosive, more dynamic and feeling like an athlete again. That’s the mid and late stages that you’re working towards and you have to balance all these roles and responsibilities because you can’t necessarily leave those out anymore like you did in the early stages. Think about that as different seasons, if you will, of the different stages of the ACL rehab process.

Now, here’s where it’s going to be more of the important part of this. Let’s consider life seasons. Maybe you are in school, maybe you’re working, maybe you’re a parent or you’re expecting, you can wear one of these hats or you can wear all of them. Maybe life events happen, maybe there are certain seasons that are approaching that are busy for you with your lifestyle and traditions. We have Thanksgiving and Christmas coming up and I know everyone’s got their thing and looking forward to the holidays, looking forward to time off, and that can influence essentially this process. I know a lot of people end up having surgery during this time because they know there’s going to be more downtime. But you also have to recognize there are going to be other moving pieces because your lifestyle might be a little different compared to April and may, for example. This is also something to consider. You have all this stuff happening or one of these things happening. And then, oh, you’re going through this ACL surgery, this process, maybe it’s just post-injury and you have to rehab it now. 

I want to take these one by one, because I think it’s important to break this down and for you guys to really understand this and to have this message really hit home. Because I think it will help you so much as you’re approaching the coming weeks and months, and depending on where you are in this ACL rehab process and life in general. This is just something that I noticed so much with our athletes and as our team talks about this that it really does influence so much without us noticing it. I think it’s good to help share this and also for you to be able to take a second to stop and analyze it for yourself. 

Let’s take this one by one, let’s break down school for a second. We have athletes who are approaching finals and some breaks that are coming up. Now can we expect them to achieve the same level as when it’s like a normal week for them, especially with finals. Everyone knows like with school and whenever you’re sprinting they finish things up, projects, practicals, different tests, especially if they are very important things that are going to determine like a future fate, getting into college or getting a certain job, or maybe going to grad school or medical school, whatever it might be. There’s going to be more stress- associated, there’s going to be more time-intensive focus for those things. We can’t necessarily always expect our athletes to achieve this—and we see this pretty consistently. There might be the small percentage that can keep things rolling. But for the most part, we have to adjust because of the season that has athlete is in. They’re in finals, they’re studying a lot, they’re stressed, not probably eating the normal and not sleeping the normal. Can we expect them to have the same results as normal? No. We need to adapt a plan and know that it’s important to know this because of the season that they’re in.

Work. We have athletes who have high-stress jobs. We have athletes who have high-stress jobs in certain seasons only, and then it lays low. We have athletes who have remote jobs, ones who travel for work, ones who work hard with physical labor jobs. We have ones who take 10, 15, 20,000 steps in a day for work, if not more. Do we think these factors will impact their ACL recovery? Depending on what phase they’re in, their programming that they’re going to be doing and just overall process—1000%. It’s important to know these seasons for these athletes and the demands of their work. Is it going to be a high stress? Is it just in the seasons? Are they able to just chill on a computer most of the time? Do they have to take a lot of steps? Is it a hard physical labor job where they’re moving people or are they moving a physical items? We’ve got people who work in package stores or people who are nurses or teachers. PTs for example, having to transfer a patient. A lot of considerations in this process that I think often gets overlooked and we’re trying to fit everyone to this perfect square peg, whenever it’s this round hole that we’re trying to actually fit them in. I think the thing is that really everyone’s kind of got their own shapes. They need their own shape hole to fit in if that makes a sense because we need to make sure we individualize this process. And that’s basically what I’m getting at here is that the seasons will impact things.

From a parent’s standpoint, we have parents who are expecting kids, or they have multiple young ones, or maybe it’s a variety of some older ones and some younger ones. If you’re a pregnant mom who tore her ACL, do you expect the same recovery as the high school athlete who’s just chilling over the summer while they’re out of school. We just had a mom in this exact same situation reach out for help. She has surgery weeks after giving birth because she tore her ACL weeks before she actually gave birth. Six weeks after she ended up having ACL surgery and so that was just their situation. She came and connected with us after. But with that said, we don’t know what situation people are going to be in when they tear their ACL and how they do it. It could be sport-based and activity-based, it could be accident-based, which happens a lot where people fall from something, they might step off of something, some sort of freak accident happens. You just never know the situation of how someone tears their ACL and gets injured. We have to make sure we account for all these factors and variables that play into this. And the thing is with this mom who has a newborn now, first kid, newborn life is hard. And having a young one is really hard work. 

We have an eight month old now, and it has been a challenge in different seasons of his life and us as parents to navigate this. And not to mention newborn, you’re sleep deprived and you’re lugging around this human and this blob for a little bit and they can’t walk.They’re still not walking until they’re at least maybe a year and still they’re not independently walking. You got to account for lifting awkward positions and also again, sleep deprived, maybe not in the best energy place to be able to push rehab. It’s a lot to account for and important again, to know the season you’re in. Whether it is school, work, parenting, these are usually the main responsibilities people will deal with that will occupy a lot of their weekly time and attention. 

The other thing that I want to mention is actual calendar seasons and holidays. This is the thing where, as I had mentioned before Christmas and Thanksgiving is approaching. People are going to be traveling. There’s going to be eating, drinking, change of essentially your normal routine. It’s a season. You have to be intentional about this. And we do this with all of our athletes of asking, “Hey, how are the holidays going to look different for you?” Then that way we can go ahead and plan in advance. Whether it’s a different gym, maybe they won’t have access to equipment because sometimes they’re only gone for a few days and it doesn’t make sense for them to go to a gym or get a membership. We’re trying to account for this maybe it is a person who is nearing kind of like, I need just a break for a second. Maybe we give them a week where it’s like, Hey, go enjoy. Let’s come back, fueled up and ready to go.But this is all about knowing our athletes and knowing what they need and all about communication and where they are in this ACL rehab process. 

The last thing that I do want to mention is life events. We’ve had athletes recently, actually, who have lost a family member have gone through some pretty big breakups. They’ve lost their jobs. So it’s a season that’s really difficult for them and understanding where they are as important.  Again, this comes back to knowing the seasons that these athletes are in and the life events that you’re having, or any of these other roles and responsibilities. 

What is consistent is that through your nine to 12 months plus of this process for ACL rehab, this doesn’t just operate in a vacuum. I think this is something that often people think is that like, as long as they go to their PT visits, as long as they continue to keep doing the program, that things will move along in a linear fashion as we know this is a non-linear process. But most importantly, it does not happen in a vacuum and neither do the other hats you wear, or the roles and responsibilities that you have as a human being is going to stop. You might have it for a second during certain periods and you might be able to catch a break. But with that said, they just don’t stop. It all kind of combines together. Life continues to happen. And my point here is to give yourself most importantly, grace for this and understand life has its seasons. We need to have a plan and adjust for it versus thinking we have to have the exact same output throughout this entire ACL process. If I’m being honest, it’s just not realistic. It puts you at a disadvantage to assume you can just maintain this through the process. You will hit certain moments of potential burnout, or you just might be like, man, like I just need a break. Because it’s just one of those things when you’re doing something for so long, it is hard to stay as steady as possible. And think about it from any other scenario you’re in, whether you are in school, whether you are at work, whether you are a parent or any other things that you do. There’s nothing that exists where you’re just like, nope, I never get tired of it. I need a break. As human beings, we need a break. With ACL rehab it’s difficult because it is the gap or it is the barrier standing in the way from us being able to do what we love. We’re trying to stay as steady as possible, stay the course, do the thing. But with that said, it’s not just like three weeks or four weeks where you could just sprint it out and just get it done, get it knocked out and you’re good to go from there. You’re talking about such a long process that is physically draining and also mentally very draining. Therefore, we need to understand that as you go through pretty much a year of your life, that you are going to have ebbs and flows through that based on other variables that happen in life. With that said, we just want to make sure our athletes are taking care of, and that we know about this and we also ask them to let us know when they expect something like this to happen. 

Of course, there are certain things like losing a family member or losing your job, life events that happen that you just can’t control or know when they happen. Maybe some but like not most of them and that’s where we do have to make some changes, whether it is work or whether it is school or whatever that might be. You got to make some quick changes and that’s okay. We just got to be reactive to those situations. But there are certain other situations where we could be proactive. Especially when I was talking about school and work and even parenting, for example. There are ways for us to be more proactive about this understanding the season you’re in. 

To give you an example of this, one of my athletes, she does contracting work as a florist and she has a pretty sensitive knee, a very unique situation. With that said, can accumulate a lot of steps, especially on the weekends which is currently the busy season for weddings and basically the work that she does. We have to know that this is currently a sprint work season for her. She told me that this is going to be coming to an end soon. But for right now, she can’t not work. There’s no reason for us to assume we’re just going to go hard on her ACL rehab during this time. When each weekend, the knee is super sensitive. It’s beat up from all the steps she can take. And so that’s something that can be challenging. So are we just going to go into Monday and push super hard just because we need to push our ACL rehab. No, because we have to understand that her work is also a big barrier for her knee to physically progress and for her to put in the work she needs to. But that’s okay, because it’s a season and we’ve talked about this and created a game plan around adjusting day to day and week to week. 

Also, once this season comes to an end, we can normalize a few things and know, okay, maybe we can start to really hit it hard once she’s out of this season. I think here what’s important is knowing who you’re working with knows this, whether it’s your physical therapist, your coach or trainer, whoever you’re working with. They need to know about this stuff. It’s easy to just get caught up in this, well, here’s your next program, here are your next exercises, go and do it. But really this needs to look like a very individualized and structured process because again, it’s not just a three week thing that you’re bouncing back from. It’s a very long-term thing and you’re rebuilding from the ground up again. I think it’s very important to consider this as you are entering certain seasons and making sure that your guide or the person you are working with is going to help adjust for this. It’s your responsibility to let them know. For us, sometimes we do not know about some of these things that happen. And it’s something where we start to notice some differences with like maybe responses or maybe just like the knee is starting to get bugged out a little bit. We start to ask this athlete. And we’re like, oh, they’re in a busy season with work. They’re having to do a lot more on their feet. , or it’s a high stress. Situation with school or whatever it might be. Sometimes we do have to dig in to understand more and maybe the athlete doesn’t even know it. But this is something also that if we can be proactive, being able to communicate with your guide and your coach will be so key here. Especially during the season, so most importantly, you don’t have this mismatch on your goals and especially the expectations of you’re trying to get back to running and you need a little bit more quad strength, but your knee is also very sensitive given the season that you’re in. Maybe let’s reroute a little bit of the expectations of like, maybe we can’t get there in the next two to three weeks, but this is going to end and maybe we can get this. Calm down. Push hard after that and maybe in six to eight weeks maybe we get there. But that helps us set both you and your physical therapist or coach up for success as a win-win versus especially for you as the ACLer to feel very disappointed by the outcomes. 

One of the helpful heuristics for me when talking with my athletes goes back to actually an episode I did a while back episode 75 of hitting the gas, the brakes and coasting. I shared basically these modes of driving a car: gas, brakes, or, you’re on cruise control or coasting.  With gas or accelerating or moving forward breaks, you’re slowing down or stopping and with coasting, you’re kind of just staying at the same speed. You’re not moving forward or accelerating or hitting the gas. And you’re also not hitting the brakes you’re slowing down. You’re just keeping the momentum going and not hitting zero. With that said, it’s knowing the season that you’re in, life wise to know what mode you need to hit. And you might hit different ones in a specific season. But that’s all depending on these factors and what needs to be worked on. My ACLers hate it when we have to hit the brakes. Or just potentially coast because they’re wanting to push, push, push. But we know they’re not in a season to do that. And I think that’s what’s important to recognize

My favorite way to think about this is one step back to go two steps forward. And what ends up happening is that if you’re in a crazy season, you might end up feeling like you might take two steps forward, but it might be three steps back or it’s two steps forward, two steps back. You make some progress, you go backwards. I think what we want to make sure we can have happen is a net positive, that’s the most important thing. Honestly, if you’re in the same place and if you’re in a tough season, that’s okay. I would say more than anything we just don’t want to net negative. We don’t want the two steps forward and then three steps back. That’s the main thing we don’t want. But more than anything, if we can be proactive on this, then it usually does feel like “a step back.” But really it is to launch you forward two steps or more, more steps forward. I know this is all abstract in theory, but it really is something that translates so well to this process. I see it time and time and time again with our ACLers and our team talks about this so much of athletes who go through different seasons and we just have such a variety of a caseload. We have people high school, college, we have someone who’s 67 years old, retired all the time in the world, wants to get back to doing the thing with ACL rehab and getting back to skiing and all the things. It’s just so many different seasons of life responsibilities. That’s something that’s really important in this process. 

When I talk about the one step back to go two steps forward, I know it was hard at first. It can be for sure, but we want to work on maybe hitting the brakes a little bit to allow ourselves to find a different route or maybe just like continue to coast. And it’s just for a period of time. It’s not for the whole time. And I know it eats you up, especially if you want to keep rolling forward and making progress. I do find it helps my athletes and our ACLers mentally so much to understand this season and what the game plan is. I think when you feel lost, that’s where it’s challenging or you’re just kind of like feeling like it’s discombobulated. This allows you to feel less guilt whenever you can give yourself grace in this season. Keep the game plan dialed in and continue to move the needle and do the thing, that’s, what’s most important. It’s just the season. And we’re going to get past this thing, whether that’s a week, whether that’s two weeks or whether that’s a month, maybe, or multiple months. This happens and we’ve seen it happen across the board with our ACLers. It’s just something that we can’t always control certain things like school/work. And then being a parent, especially you can’t just get rid of your kids on. I’m sure parents want to be able to take a break, but you just can’t do it. There are certain variables that you just have to account for. Especially if a kid gets sick, I just shared our kid got sick in the previous episode and it was brutal for us for two going on three weeks to be completely honest. Our entire lives daily got derailed significantly. We got less sleep than we did as a newborn. And it’s just wild, but the thing is you can’t plan for that, but it happens. 

If I was going through ACL rehab over the past three weeks, there’s no freaking way I would have sustained it the way I could have, if I wasn’t in that period of time. This all comes back to basically, if you are an ACLer who might find yourself in this purgatory or you’re in certain seasons, think about your hats that you wear and the roles and responsibilities. And see if one of these might be really affecting your progress and you’re putting pressure on yourself to make it. And so that’s something that I want you to just kind of step back and evaluate and see, and also give yourself permission to take that step back if you need it, to be able to give yourself some grace and understand this is a season. And if anything, what we call is hid the MVP, which is the minimum viable product for us. We go into this mode for our athletes where it’s like, what is the bare minimum we can do to keep at least the, the ceiling where it is, or like where you have worked so hard to do. What is the bare minimum you need to hit in this week or this season in order to coast, or maybe to just kind of keep the needle slowly moving during this process. That doesn’t look, need to look like seven days a week. Itt could look like two days a week and we’ve had it and we’ve done it before with certain athletes during certain seasons. And just know that’s what it is. It’s a season and this can always be adapted and changed. This always ends up coming back, guys, to who you are working with. I cannot stress this enough of like, it shouldn’t be on the ACLer  to guide this process to be completely honest. 

I think leaning on your guidance, your physical therapist, your coach to be the people to help guide you is going to be so key, especially if they know this process, they know you and they have the time availability and the individualization to do that. I know that’s not always fortunate for a lot of places based on the way healthcare is and insurance. And we know that. It’s what you deserve. If you feel like that is selling you short or just shortchanging you on your results and especially mentally, then just no other options exist. 

We work with people remotely, all over the world. There are other people who do incredible work in this space as well. Maybe it’s someone that you need to change to locally that is in your geographical area, maybe we can point you to in that direction, but we have an incredible network of people, that we work with. 

This is something that I would encourage you just to reach out to us, , and we can help point you in the right direction. It is something that I really do think makes or breaks this process is who you’re working with. And also can they help guide you and be that GPS. Because that is the difference in you struggling through some of these seasons or not. Making progress or just kind of being in this kind of like purgatory where you feel like you’re kind of making progress, kind of not, but you’re not back to doing what you love and you don’t feel like you have direction. 

So that’s going to be super important. I want you to know that it is just a season, be proactive about it. Do not be reactive. And when you have to be reactive, lean on your help to help guide you in this process. 

All right team, that’s going to do it for today. I hope that this helps with any of you who are listening, who are getting into a busy season , whether it’s the holidays or work or parenting school, whatever it might be. And allows you to kind of take that step back and reevaluate where you are and also the direction you need to go in. Until next time, this is your host, Ravi Patel signing off.