Episode 203 | How to Design Effective ACL Programs Using the 80/20 Rule

What is up team and welcome back to another episode on the ACL Athlete Podcast. I’m excited to talk about the concept that we are going to jump into today, that is the 80/20 rule, also can be known as the Pareto principle. But imagine there is the number 80/20 rule. This is a concept that suggests roughly 80% of the effects come from 20% of the causes. 

Now, let me break this down a little bit more. This concept originated from an economist Vilfredo Pareto (aka the Pareto principle). What he observed is that 80% of Italy’s land was owned by 20% of the population. Now, if we translate this over to more modern day, how this 80/20 rule, this Pareto principle plays in. We can look at business where 80% of sales often come from 20% of its customers. Productivity—and everyone knows this—think about this. If you are someone, whether it’s at work or at school, 80% of the results stem from 20% of the effort or the tasks. We know this right. There’s a lot of procrastination and not as much productivity, just in general for human nature. But this is saying that 80% of those results really come from 20% of the effort or tasks that are done. Wealth in a sense, 80% of wealth tends to be owned by 20% of the people in many of societies. Software specifically, 80% of the users complaints are often related to around 20% of the software bugs. 

Now, is this principle strict and hard and fast? No. It is something that is a heuristic, however, and is used in many different domains. You can see these percentages really line up with a lot of different areas in life. But, it’s basically the idea of an uneven distribution and helping to really prioritize high impact efforts. That is the main concept and main takeaway from here, is that we are trying to prioritize high impact efforts with using this 80/20 rule or the Pareto principle. 

What really sparked this particular episode was something I overheard from Eric Mira, where he was talking about this 80/20 role. And then I was thinking, okay, let’s apply this in ACL rehab. That is looking at your ACL program, your exercises, even your day. If you had to cut out 80% of it, what would you cut out? And then what’s the 20% left that you’d keep. This really helps us to tease out the big rocks of our program and cut out the fluff or the extra stuff, if you will, all the time back to help prioritize our high-impact efforts.

And the reason I bring this up is because it is a valuable heuristic for us as rehab professionals and coaches, and even ACLers listening to this, can apply this concept as well. It’s such a brilliant concept and so simple. It’s very easy in this process to get inundated by so much. There’s so many moving pieces, so many different phases of it. So many things that you’re trying to keep track of, whether it’s different symptoms like swelling or pain or joint limitations, flexion, extension. It could be  particular areas that athletes are dealing with certain positions, maybe it’s certain strength deficits, actual ability to produce force quickly, being able to be very bouncy, all the things that we’re thinking about, as well as the mindset side of things. There’s a lot of moving pieces in ACL rehab. Therefore, as we’re working through this process, how do we account for all of these things? It’s not just a calf strain, if you will, where it’s like, all right, cool. We’ll let it heal and load it up and then it’ll get back to it. This is such a major injury that happens to the knee and surrounding muscles and the brain, all things are impacted and it’s a long recovery, long healing process to get that graft back in there and to turn into a ligament.

And also it just shoots down the quad and all the surrounding musculature, joint range of motion, all you guys know what I’m talking about. It’s a long recovery and there’s so many things to account for, especially because people who this happens to, aren’t just trying to get back to walking every day. Sure, that’s the thing. But that’s 1% of the things they want to do. They want to get back to running, jumping, cutting, getting on their skis again, doing all kinds of stuff with their body athletically, and that takes time to rebuild. And so that’s where we have to account for building the athlete back up from this process and making sure they’re ready for what’s ahead. There are a lot of different buckets, a lot of different goals as we move through this and it can get super overwhelming. 

Now, as a company, this is something that we use and talk about all the time, this 80/20 rule, and this Pareto principle because it’s a big-time concept and heuristic. We hit on with also our ACL mentorship who are physical therapists, assistants, athletic trainers, strength and conditioning coaches, people who are working with ACLers who want to learn how to do that better. We talk through that, through this mentorship and we go through cases and there’s assignments. The goal is to potentially build out an ACL program for this specific athlete or case of four different phases or maybe different blocks, maybe it’s just a very particular day that we’re focused on. They had to get specific on exercises, the reps, sets, intensity, being able to create some wire around it. And we’ll often bring in this concept of the 80/20 role as a way to analyze, connecting the goals of the program to the movements and exercise prescription. 

What we might do is we’ll take a look at the program or maybe even a specific day and then we asked them to cut out essentially 80% of it and only keep 20%. Maybe that is five exercises listed and you can only do one of the exercises in the session. Or maybe it’s 10 exercises listed and then you have to pick two. What are you picking whenever it is looking like you have five exercises? What’s that one exercise? Practically, let’s say an athlete has only maybe 10, 15 minutes on that day and they come into you in the clinic and they’re super late. Or maybe they’re going off to do their own thing at the gym and they only have 10 or 15 minutes. Maybe they have something at home that they can just get in really quickly and they need to do one specific thing. They can’t do the whole workout. You got to kind of pick and choose and you can only do one thing. What is it? Why do you choose it? This allows us to get really focused on a few things. 

Number one, what’s our goal or the adaptation or stimulus we’re looking to gain out of this particular program exercise specifically. Number two, what’s our method or the exercise to provide that said adaptation or stimulus, ultimately connecting it to the goal of what we’re trying to get out of this. Number three, helps us remove the fluff that often we’ll see an exercise handouts or lists people get in rehab. You guys know the whole laundry list of things that people will get. I kid you not, people will come in and working with us and they might have 30 exercises to do in a day. We’ve seen this on multiple occasions and this is wild. Sometimes people will say, yeah, this takes me two, three hours in a day. And sometimes they might be even doing it twice a day, for example. And we’re just like mind blown or like, there’s no way that you’re getting any efficiency out of doing 20-30 exercises in all honesty. Sometimes even 10 is way too much, depending on the day, what the person has to do and also what are the specific exercises and where are the goals of the program. 

With that said, if you are an ACLer and you have a laundry list of exercises, this allows you to apply this rule and say, okay, what are my current goals? You should know what these goals are if you’re an ACLer rehabbing in this process. There’s not a single point that you are in, where you should not know what your short-term goals are, what you’re working towards in your exercises and your programming. And if you don’t know, ask, if they don’t have anything to say, besides that’s what the protocol says, you need to make a change. But the important thing is coming back to what are my current goals, knowing what these are, and then looking at what’s the 80/20. You can ask your physical therapist this: Hey, if I only have 10 minutes in my day, or let’s say, if I have to cut out 80% of this and I only have 20% left, what would I need to hit? And that allows you to find your big rocks in the program and also connect that to your goals. 

If you’re a clinician or a coach listening to this, make it simple and practical. That’s huge in this process, especially with so much going on, whether that’s you giving an athlete exercises from the session, doing them at home for their home exercise program or building out a program for the day or the week, the month, whatever that might be and the way that you do things. Ask yourself once you have this built out, what’s my 80/20. Even look at it through a lens as you’re designing the program and say, all right, what’s my 80/20. And be able to look and be like, all right, this is what I’m going to focus as my big rocks, my 20% and then 80%. It could be the pebbles, the sand, whatever that might be. With that said, you have to ask yourself at the end. If I had to cut out 80% of this, what would I keep? What’s the 20% I would leave in that are my big rocks? And then ask yourself why. Why are these my big rocks? These are ways for us to help simplify and also audit our ACL programs and the designing of this and how we plan these things. Most importantly, connecting the dots on how this relates to the athletes’ current and long-term goals.

It also might cut out on things you may not need or wasting time on, especially if it’s not moving the needle on the things that matter most, or it could be overwhelming the athlete. Athletes sometimes depending on what’s going on and the timing in their day, and it’s relative to each person, of course, there’s a certain amount where you’re like, all right, this is too much. But for us, we’re also trying to take notice of our athletes and what they can handle, the amount of time they have, what they have access to. And let’s say, for example, as we’re getting to the holidays, some of my athletes while I would love for them to complete certain number of things, they’re just going to be busy. Christmas is coming up. They have moving pieces. They have access to same equipment. Guess what? We are creating an MVP. And we’re making sure they’re getting the minimum viable necessary to hit the minimum effective dose. And that’s what’s going to be important. We’re literally coming down to this and being like, all right, cool, what is our 20%? Can you hit this 20%. And even if this is 10, 20 minutes, sweet, we’re still continuing to move the needle on the things that are important to us. Instead of just being like, all right, we’ll take this break and then we’ll pick back up. We keep the momentum going. 

This also helps to not overwhelm the athlete whenever their schedule changes or maybe life is just throwing stuff at them, we can reduce it down and be like, all right, this is the big rock that we want to focus on, this is our 20% and we should be good to go. This comes back to our MIT (the most important thing) that principle of being focused on our top priorities. And that’s what it should always come back to your number one important thing, your top three priorities within each part of this process, phase by phase, block by block, you should have some focuses and some main priorities that you’re looking at. And then connecting how our exercise prescription and the program design connects with that with the 80/20 rule. This is ultimately going to help us to be more efficient, more personalized to the ACLer or the athlete in front of us, and keeping the main thing, the main thing. 

I hopethis is helpful team, this 80/20 rule is something so simple. You can put into play today and look at your program, look at what you’re giving your athletes. If you’re an ACLer you can look at what you have and be like, all right, cool, what’s my 20% that is really going to move the needle and really account for 80% of the results. And that’s where we can really put a lot of our focus towards, and then therefore it reduces that overwhelm. Massive game changer. Go put it in play. Send it to me if you guys have like programs and you’re just like, hey, what would be the 80/20 here? Or share it with me? I would love to see it. And if you have any questions, you know exactly where to find us. I hope that this was helpful y’all. Until next time, this is your host, Ravi Patel, signing off.