Episode 201 | Redefining the Older ACL Athlete: Does Age Matter?

What is up you all? Getting straight into it today. Well, first, if you can hear me right now, it’s about the right time for me to have some sort of sickness and to sound a little nasally, sound like I’ve been smoking for a long time with just some congestion. So that’s what this episode is, but the podcast must go on, here we are. Let’s get into it now. 

This episode I am excited about and it’s one that really stemmed from a question from an “older” athlete, if you will. I will present that question to you here soon. But first, what I want to first dive into is basically what the thought around an ACL injury is. When you think about when this happens, you think about usually a young athlete or maybe college pro athletes; typically around the ages of—youngest could be somewhere like 13, 14, to people in their 30s. It sweet-spot as teenagers and people in their 20s, playing at high-level competitive cutting sports like soccer, football, basketball. There’s lots of jumping, usually involved as well—high speeds—contact can be associated. That’s what we usually think about. And that’s mostly due to the news and research, focusing on these populations, plus is what you hear and see via social media as well. It’s not often that you hear about the 40 year old that tore their ACL skiing, typically. 

For the average Joe, it doesn’t get discussed a lot or covered much in social media or in the news. And of course, a lot of the focus is around younger athletes. And there is just a high amount of volume with these populations because they are essentially driving their bodies into traffic. They are playing sports at a high level, they’re playing with high frequency, especially if you’re doing club level or especially from a competitive collegiate or professional standpoint. All of it’s on the line. Of course, you’re putting your body more at risk driving in a traffic, if you will, than someone who might just play occasionally or go skiing occasionally. So that makes sense with this injury. But there is a group of this ACL or population that doesn’t get hit or that we don’t think of. There are a variety of these and they come in all shapes and sizes and goals. Today, I want to focus on the “older athlete.” And often this group is categorized as maybe around 40 years or older by surgeons. But define that how you’d like, can be from a number of injuries like anyone else playing like soccer or skiing tends to be a very big one for us, especially with older athletes. They’re probably not playing as competitively with fueled or court-based sports, but they’re still doing activities and certain things that could put them at risk and seeing tends to be one of those biggest ones. Maybe they’re doing martial arts, maybe an accident that might have happened. You name it. It comes from our wide range of different sports and activities. But with that said, this is something that I do want to make sure we touch on today. It’s because I got this question from an older athlete. And this question is around them asking, I hope that you would talk about an active older group of people who go through this surgery. They’re struggling physically and mentally because this group isn’t exactly the traditional athlete, but rather a health conscious, active individual who wants the normalcy of their life back and putting in the work. But they may get dismissed because of their age. 

This athlete shared this message and essentially this question and wanted me to touch on this topic. I wanted to dive into this today because it is a population that we see quite often and one that might get underserved. If you’re thinking about the high school collegiate athlete, then there’s this perspective of they’re getting back to sports. And they’re young, they’re mobile, they’re athletic so we need to get them back. But sometimes when people are judged by their age, there is almost this fitting them into this certain box. And nothing fires me up more than people doing that, especially to older athletes or based on someone’s age, maybe as someone’s gender, ethnicity, etc. For some reason, the perception of older people is frail, weak, and sometimes that is even taken on by the athletes themselves. That could be due to the belief in themselves and how they view themselves, or maybe it’s projected on them by providers, such as their surgeons or PTs. We often have people, especially when they go to see their surgeon or ortho, they’re just like, oh, you’ve got the knee of an 80 year old and they’re still 40 years old, 50 years old, whatever age that might be. Or they just categorize them because they’re not a young athlete that they’re just old and they won’t be able to get back to a high performing level. That’s something that they take on themselves, especially someone who might not be as—no, I disagree with you. I’m actually very active, especially someone who is looking for some guidance from a position of authority. This can get very challenging because athletes start to take on those personas of like, yeah, maybe I am old or maybe I just do need to cut back—but screw all of that guys—no freaking way, not here at the ACL athlete and not here with me. We’re here to support you. I want to dive into this topic because it is firing me up. I will talk to ACLers who say I’m older, I’m not an athlete. And when I ask them their age, they’re like, well, sometimes they’re like I’m 28 or 35. And of course that’s funny because they are definitely not old. But even for people who are like, oh, I’m 42, I’m 50, I’m 58, I’m like, you’re not old. You have so much ahead of you. And I think this whole notion of age is just a number. It really is to some degree. We know that there’s something that comes with a by-product of age. 

But with that said, I don’t think that you need to put yourself in this box. They think that their age ages them out of being a “athlete.” Our philosophy at the ACL Athlete is that we view every individual, every person as an athlete. You’re climbing your own Everest, if you will, after your own specific goals. And that’s an athlete to us, it’s relevant to you and your goals. Who cares if it’s not competitive soccer or you’re trying to get to the Olympics, it’s your very own race you’re trying to run. And our goal is to treat you like an athlete because that’s what you deserve. And that leads me to my point here, your rehab team should treat you like an athlete no matter what your age and your goals are. This honestly applies to anyone going through rehab, but it’s no different for our older ACLers. You had an ACL injury, you have goals; why should you be given different care due to your age? We don’t need to treat you as a frail person or a fragile person. If anything, we need to really push you to make sure we can offset any of the aging related changes that typically happen like people losing muscle mass and losing power. We want to make sure that we can almost overcome that stuff by really giving you a solid foundation and building you back up after this ACL injury. 

I’ve worked with some badass clients and older athletes over the years. Literally, people who had kicked my butt in a number of different sports. And just honestly, if we were to sprint, they’d outrun me and I’d probably pull my hamstring and they would keep running. I’m not talking about someone who’s like in their 40s or 50s, I’m talking about people even in their 60s and 70s, too. Human beings are incredible. And in reality, we’re probably limiting ourselves mostly on self-belief more than anything. We currently have a 67-year-old athlete who is on our remote roster currently. He is absolutely crushing it. Getting back to so much now, super athletic, skiing downhill, cross-country snowshoeing, running three miles consistently, a big hiker, trout stream fishing. These are the things that he had set out to do. He reached out to us after he had gone through just normal insurance-based PT. 

I was like, I’m getting the same thing as everyone else. They’re kind of treating me as like this elderly patient. I don’t have any direction. I don’t have any structure and I’m leaning on you guys. Can you guys help me? And we were like, heck yeah, we can. We love working with athletes who are dedicated. We love working with our older athletes, if you will. But people put these limits on themselves. Or as I mentioned, have it projected on them and it sucks. And sometimes, athletes just feel like, oh, well maybe I just need to accept this. This is where I am in life and my age and I should probably be careful. And it’s like, no. So that’s why if you find yourself in this older athlete or ACLer category, there needs to be a shift if you’re feeling like you’re not being served well.

Number one: Your mindset. Belief in being an athlete and rehabbing like one. Your treatment and attention to detail should be no different than the 17-year-old football athlete getting recruited by that top D one school or the collegiate skier trying to make the Olympic team. To be completely honest, you should have a professional or collegiate-like experience, just like any of these other athletes because it’s your body, it’s your care. You shouldn’t be treated like a number and you need to be treated like an athlete and an individual person.

This leads me to my second point: Your rehab. You need a team who supports you as an athlete and not someone that is old. You should have a surgeon in your corner who supports you, believes you’re an athlete versus this frail, older, you need to quit doing that activity-type person. You should also have a PT and a coach in your corner who meets you where you are in terms of your goals and as an athlete. That means pushing you, lifting heavy, getting powerful, learning how to run, jump, cut, sprint; of course, specific to your goals. We’re not just going to throw all this stuff at you. We’re going to prepare you for life. You never know when a worst case scenario is going to hit you, so you need to be prepared for this. Sometimes people are like, well, I just want to go back to yoga and walking. And it’s like, fine, that’s great. But do you have kids? Do you need to be ready to run in the rain? Do you need to be able to handle certain situations that you never know you’re going to be in. And that’s why we want to make sure we build you back to being an athlete and of course, fitting that to each person appropriately. But your PT should be there to push you to do these things because you need to get back to where you were and use this as an opportunity to be better than you were before. What happens here is that there is a decline of muscle mass as we age. But a lot of this ends up being due to inactivity more than anything. We want to avoid that and not let you be this statistic within this older age group. We prefer outliers here at ACL athlete and that’s our goal here. We don’t want to be re-injury statistic. We don’t want to be this aging sarcopenia or osteoporosis statistic as we age. We want you to be those outliers that throw the research off and to be able to come back and perform, and also get the most out of the later years of your life. It’s not just this younger years you maximize it. And Peter & Tia has this very interesting image of essentially when people get free to be active, as they get older, they retire. The thing is their health declines that they can’t really maximize the retirement funds that they have to go travel or be active because they didn’t necessarily take care of their health. And so then therefore they’re just more sedentary. And then those last years of their lives, it’s just kind of really declines. This is something that we want to make sure, well, you know, let’s kind of undo that or prevent that from happening by making sure we build you back. 

Now with that said, with this population, is very rare that we have super sedentary or people who are inactive, who are coming to us or who get these injuries in general. You might have the mishaps here or there where people slip and fall and it’s an accident like that. But usually this injury happens from being active and doing something active. Very rarely are we trying to get our athletes off the couch, if you will. It’s more so of holding them back. But we do want to make sure that we are able to get them back to a level of high performance. That way they can continue to build muscle, be strong, be powerful, and be able to do the things that they want to do. You need a team that supports you, visualizing and treating yourself as an athlete. 

And again, this is specific to you, whether or not you are a traditional athlete, going back to play a sport like soccer, for example, or maybe you’re not. And you’re more health conscious as the initial person who had reached out I had mentioned and just wants to feel healthy and normal. You may want to get back to just something simple like hiking. Maybe it is skiing, maybe as high level skiing, maybe you just want to go travel and be able to hike and maybe doing Ironman’s. Maybe it’s just being freaking fit as you age and being independent. Or maybe it’s being able to keep up with your grandkids and your kids and being able to not feel limited like, oh, I have a bad knee. You don’t deserve to be dismissed or overlooked by your team due to your age. If you are, you have the power to change that that’s in your control, your surgeon, your PT, your coach, whoever is on your team, you have the power to change that. Make those changes if you feel like you are not feeling empowered, if you’re not educated, if you feel like communication lines aren’t open, if you feel like you can’t share with your PT, like, Hey, you know, I feel like some of this stuff is pretty easy for me. I understand there is hopefully a plan, but is there any way for this to meet me where I’m at? Because I feel like I’m much more capable than what I’m currently getting. Or just open up the dialogue around it and if they don’t want to listen to it, maybe they’re hitting some fixed protocol. Maybe it is just an insurance-based or a PT clinic that is just high-volume driven. They don’t have the bandwidth to individualize things. It exists all over the place. 

I’d love to say everyone can get individualized care, but it’s just not the way the healthcare landscape is. But at the end of the day, you have to make a change if this is something that you want. What people will typically say, well, I like my PT. They’re nice. Or I don’t want to change surgeons or PTs. I’ve been with them for a while and they know my history. I’ll be honest, any good PT, any good surgeon, any good coach will be able to easily see where you are and pick up from there. If not, then they’re honestly not a good PT, surgeon and coach. They should be able to pick up no matter the complexity of your history, where you are on the spectrum. This is something that any good professional can pick up where you are and take you where you need to go. You can either stay with that team or provider that doesn’t treat you like an athlete, or you can make the switch and make a huge shift and not only your physical rehab outcomes, but mentally as well. 

I can’t tell you how much this just shifts people from not only feeling like they have a plan, they have structure, but mentally, they feel like they’re being challenged and they’re being heard. And they know they’re getting back to what they want to do. And it just almost shift this identity. I talk a lot about James Clear’s work and his Atomic Habits book, but it’s not just like, hey, we need to change the plan. We need to shift the identity here. And for a lot of my older athletes, sometimes they have been told these things of like, oh, you have bad discs or you have bad knees or you have arthritis of an 80 or 90-yea- old, and you’ll never be able to run, jump or go play sports again or ski again. If you name it, I have heard it. 

And the thing is just so frustrating because they look at an image, they look at the person, they may spend five minutes with them, if that, and then they’re like, oh yeah, here’s this treatment move on. And it’s frustrating because it’s like, let’s not put these limits on people and we don’t know how much this affects their identity or the words that we say as rehab professionals mean so much because we are in positions of authority and I don’t take that for granted or lighthearted. That’s the thing that is so important because the words that I say to someone who I work with is going to have such a huge impact. I think we don’t watch that enough in healthcare and I see this impacting a lot of different people. But this population of older athletes, this is one that we see all the time where they just feel like they need to reserve themselves. 

Now, especially they’ve had an ACL injury and it’s like, nope, not today. We’re getting you back to the thing and we’re getting you back to a better level than that. No one is handcuffing you to say that you have to stay. And there’s a ton of incredible providers in ACL rehab world both in-person and remotely. We work with people all over the world. If you need any help, if you need any guidance, we’re here for you. There are other resources out there available, but you just got to do your diligence. It might take more work to find them and likely to invest more in it. But I promise you, if you look back a year from now, and you’re like, man, I made that shift. It’s going to be something that’s going to be so impactful versus feeling like in the same place you were a year later.

I promise you, the hardship now is the hard shift that you want versus that six or 12 months down the road, still frustrated, as I had mentioned, because your team isn’t taking you seriously or treating you like an athlete. They need to bridge the gap between where you are and where you ultimately want to be. They need to have a plan for that, they need to have structure, they need to have objective measures, they need to make it specific to you. That’s what’s so important here, we can’t have a general plan for every single older adult or youth athlete or every single sport, every skier gets the same thing or every soccer athlete gets the same thing because every human is so different. Our DNAs are different, our fingerprints are different. Even the lines in between our fingerprints are different. Our game plan needs to be different in this process. It’s not knee pain; it is not a back issue; it is not something where it’ll go away in four weeks. This is something that shifts a lot of people’s lives. Sometimes for the positive, but a lot of times we see from our end, the negative, if they don’t course correct. 

My goal here is to make sure for our older athletes define that however you want. I’m not putting an age on it. Of course, you’re not a youth athlete, but let’s say beyond the 20s and 30s, maybe. But you put the number on it and whatever you define that as. But in reality, it’s just a number, it’s just more so of like the considerations of what the world probably views that as, and also making sure you don’t fit yourself in a box. There are options, and most importantly, you need to be treated like an athlete equal to any other athlete. No matter the age, sport, gender, whatever that might be. 

I hope this helps team. If you have any questions or if you need any support, reach out to us. We are here to help. Until next time, this is your host, Ravi Patel signing off.