Episode 213 | Keeping Your “Floor” High: Maintaining Fitness During ACL Rehab

What is up y’all and welcome back to another episode on the ACL Athlete Podcast. Today, we are talking about keeping your “floor” high or really just regarding our overall conditioning or fitness levels, as we are in this ACL rehab process. Now, the thing here that I want to break down is this road map of the ACL rehab process and really just the series of events. You have an ACL injury, you go through the process of getting an image and seeing if you need surgery or not. A lot of times people will end up having surgery just with the current state of ACL injury we’re in and then you’re on the road to recovery post-op and onwards trying to get back to the things you want to do.

If we look at the two-time point, ACL injury and then ACL surgery right after that, typically most people’s thought is like, I want to rest, I want to let this thing recover and not do anything. It’s almost like from one extreme to the other, you were active and doing stuff, and then all of a sudden this thing just puts you on the sideline or on your bed or your couch. And while I get, of course, you’re going through the acute trauma of this process. It’s important for us to understand that there’s a difference between continuing to do things versus just completely resting. 

Our natural instinct as humans is when we have an injury: One, we just don’t want to move. Our body is protecting us. It’s a protective mechanism to just don’t move that thing and just rest. We also know from just the typical nature of injuries that you are to follow what is an old thing of R.I.C.E. (Rest, Ice, Compression, Elevation) And there’s an old acronyms like that that exists, not the worst thing ever, but at the same time, the RICE piece is the most questionable one. And now there’s been updates to P.O.L.I.C.E. or there’s peace and love as well, which is another acronym that’s used. I’m not going to go through peace and love. It’s a good one. P.O.L.I.C.E. is also really great. It means protection, optimal loading, ice compression, elevation. I like this one much more. It’s very simple. You’re going to protect the joint, but you’re also going to make sure you continue to optimally load or condition yourself, whether that’s a joint itself, the muscle, the tendon, or the area, and then also just maintaining fitness all around. And then of course, making sure you provide a healing environment for the area that is needed to heal.

Now, with that said, what happens is that immediately after the injury and after the surgery that we will just stop doing stuff and just focus solely on the knee joint itself, especially if it’s ACL rehab. But with that said, you are likely doing other things before and what we want to make sure is that we don’t allow that fitness level or what I call the baseline or your floor to drop. And that’s the focus of this episode today that I want to dig into that I think is going to provide some guidance and some understanding around what can happen in this process immediately after we get this injury and then after surgery. We’re naturally constrained to do less, but it doesn’t mean we have to go to the full extreme of doing nothing. There’s always something we can do, whether that is the other arms, whether it is the other leg, whether it is your core. There’s other things that we can do now that doesn’t come at the cost of just doing rehab stuff and resting some. There’s a sweet spot with all of this. What I want to really start off with first is what happens with our physical qualities or training qualities that we as human beings have or have trained to develop and what happens to those if we just rest or what we call decondition, not doing anything whatsoever. If you weren’t doing anything before, then it really doesn’t matter because you’re not doing anything. Again, so really your floor was your current floor. You might just be taking less steps. But if you are active doing stuff and you’re working out, if you’re playing sports, you’re being active doing different activities, then you had a certain conditioning level and fitness level and this ACL injury is likely to impact that.

Now, this chart that I’m going to go through is representative of someone who doesn’t even have an injury. It’s just generally our physiology and how it adapts based on just what’s called residual training effects, which basically means how long can we maintain this biomotor output, which basically means these qualities we have as human beings. Think about like our aerobic system, strength, our ability to be powerful, to be able to sprint, for example, and speed. These are different qualities we can manifest as human beings, and this is coming from Issurin’s book. It’s a Block Periodization, talking through these residual training effects. It shows speed at the very bottom, and oxidative energy system, or our aerobic system at the top. And most of these have some ranges. It’ll say, the retention of speed, for example, is five days plus or minus three days. You can almost look at this as two days up to eight days. Five being the middle or the average of the retention of speed. Let’s say, for example, you’ve been working on a sprinting or a high-level output of sprinting, and then all of a sudden after a week, two weeks, you don’t work on it. You’re going to see that drop a little bit. You’re not going to just naturally be able to pick back up in that same place as you were two weeks before or a week before. 

There’s some variation here, genetics and all of these other pieces that play into this, but in general, when this has been looked at and studied, speed is the first thing to go and we noticed this from a rehab and performance standpoint as well.

It just goes, man, you got to have high output, how high strength to be able to go fast. And so that leaves quickly. And then we work our way up towards power that has a 15-day residual or retention plus or minus five. And then if we start looking into strength, that’s about 30 days plus or minus five, as well as the aerobic system 30 days, plus or minus five. So that is something that can maintain for a little bit longer. Of course, there’s specifics within that because strength is very broad and power is very broad. But with that said, as we go from speed and power, it doesn’t stay as long compared to the aerobic system and strength, which makes sense just from an athletic development standpoint, the systems that are consistently operating and that we’re using and the energy demands of this. So that’s really important because that is going to influence essentially when you’re post-injury and post-op. Because think about even not being able to sprint for a while and not being able to do much power work, not being able to do much strength work, especially on that side or in general. And then, of course, our aerobic system which is just like a base system for fitness that we utilize on the day-to-day and helps us with recovery. So that’s going to be super important to maintain as we go through this process versus just putting it on the back burner and then revisiting it six months later.

The reason I’m bringing this up is because it can just show us how quickly we can lose qualities if we do not work to maintain them to some degree. It’s essentially deconditioning. And again, this can happen even if you don’t get injured, you might just stop training. Maybe life gets busy and this is still going to take effect to some degree with your fitness qualities. Now, how can we do something about this? And the big thing I want to point out here is the importance of prehab because that can help us during this process and also not rushing from injury to surgery so fast. And this is where it could be very valuable, but this is going to coincide with not only just that prehab process for injury, and then it’s also going to coincide with the post-op process and that early acute phase of that as well.

So what I want you to imagine, we’re going to use some analogies here, and you have a tall building. And within that building, you have a certain floor. Now you have a certain floor and a ceiling within that. So think about the floor being your minimum output, your baseline and then the ceiling is your max output, the most you can do. Now this changes after an ACL injury and a surgery. The change ends up being more so on how much you can keep these baselines up, both the ceiling and the floor. Now, I just want to focus mainly on the floor because we know the ceiling or that max output is going to drop some after ACL surgery and after injury. But with that said, the floor is the most important thing because that is going to be the thing that is going to really dictate how we are going to rebuild in this process. And our goal, especially in prehab, is to keep our floor high. We use this within the team is just something that we want to make sure that is a focus for us during prehab is keeping the athletes floor high and overall conditioning fitness level while we’re also focusing on the joint itself and restoring things. We also want to keep the overall athlete moving forward, or at least not falling backward, if you will. 

We know that that ceiling drops, as I mentioned, but we do want to try and keep this as high as we can too. But most importantly, we want our floor to stay high. Why? Because think about maybe 10 minutes on the bike or just two flights of stairs that you may walk on a regular basis, we don’t want that to feel like a max output, for example. If your baseline before was 30 minutes and then all of a sudden at 10 minutes on the bike feels like a lot if you’re not doing any type of aerobic work or maybe just not any movement whatsoever. We don’t want these submaximal things to feel like max outputs for ourselves That essentially means that the same thing that we do, it just takes more effort from us. We want it to still feel the same, like the output from the effort standpoint versus feeling much harder to do the same thing again. We just want to make sure that we can maintain that after the injury and after surgery versus it feeling like this significant drop. 

Let’s combine this into one of my favorite analogies going with the building idea. You want to think about your conditioning capacity or your just overall fitness in general, your strength, your aerobic fitness, your power, essentially all these fitness levels to do things as a skyscraper or this tall building. And you visualize your conditioning capabilities as this tall skyscraper. Your baseline capacity or your floor, if you will, before the surgery and before the injury itself was the seventh floor. And so after surgery, your conditioning capacity drops or your baseline floor. This can also apply to after-injury itself. It takes a hit. If you did nothing on the conditioning or prehab front for a while, your baseline might drop all the way down to the second floor, the first floor. As you were being, before the injury, you were on the seventh floor and then as you had the injury, you dropped to the first floor or maybe we can even use this as after you have the surgery, you just dropped to the first floor. Basically, having this detraining effect because you didn’t really do anything in between that time. But if you’re able to engage in some conditioning early on after the injury and after the surgery, your baseline capacity won’t drop as much. Maybe it only drops you from the seventh floor to the fifth floor. This puts you in a much better position to get back to that baseline or back to that previous floor you were at, keeping that floor high and improve upon your prior baseline during these middle and late stages of ACL rehab, for example. It makes the climb back up easier in the long run. 

You can think about it this way. You start on the 7th floor. The injury or surgery happens. You don’t do much and drop to the first floor, that climb back up to, even baseline, from what was before is a lot harder. You’re going from the first floor to the seventh floor. Now on the flip side, you start on the seventh floor. Injury or surgery happens. You do prehab and are intentional post-op about fitness and conditioning. Now you’re not going crazy with things. It’s not like you’re working out seven days a week and doing all the things. You’re just intentional about fitting some things in to keep these baselines up. Therefore, you only drop to the fifth floor.

That’s only two floors, y’all. That climb back up to the baseline or your old floor is going to be a lot easier. And promise you, more worth it in the long run. And as I mentioned before, this doesn’t necessarily mean that you have to go ham out of the gate and do all the fitness things after your injury and after your surgery. There’s trauma to this, there’s shock about the injury, especially even post-op. We’re not saying, hey, first week, knock it out of the park, don’t lose this. It’s something we may educate depending on the athlete, their prior training age and their history, maybe their training for something. We might tackle this on an individual basis, different for the CrossFit athlete who’s getting back to competition in a certain period of time versus the 13-year-old athlete who’s just like, I want to play volleyball next year. But it’s not super time-sensitive. This is something that we might tailor a little bit individually to each person. But with that said, we still want to make sure we keep that floor as high as we can. We’re going to make sure it’s important to create a plan for this person based on their status, their schedule and time, equipment, season of life, and focusing on the controllables. Some people, they might be out of work for a while and it’s flexible. Some people might not be working. Some people might be in school or it’s summer. So just things to think about based on the timing of all this that will influence potentially what additional things we might give them. If someone’s in a busy season and they had to have ACL surgery, guess what? We might not be working on these things that as much, and it’s just the cost of the time constraint and what they can do to focus on the priorities. We know the fitness will drop and that’s okay. It happens. And some of you listening, it happened to you or it might happen. But let’s say we can find a sweet spot of being able to even just tag in something where you do a circuit for 10 minutes. You might do some incline push-ups. You might do some plank variation or maybe some sort of sit up variation. You might do some sort of seated row. Maybe it’s a bench press. We always say ACL rehab is an opportunity to increase your bench press and get those arms super yoked. This is always an opportunity for that. So with that said, you’re able to maintain some strength, maybe get some conditioning work in.

And then therefore you’re also feeling like you’re working. You don’t feel like you’re just wasting away. I know a lot of people will feel that. And I remember feeling that myself. And a lot of that was mostly just cause I didn’t have any structure or guidance around this. I just sat around, did some exercises, ate some chips ahoy cookies, and played some games when I was in high school, because it was the summer. But had I known all this, I would have done something potentially different with that. But with that said, this is something that is going to be dependent on you as a person, but good to know about. Do you do this at the cost of your specific ACL rehab? I think this is really important. Of course not, because sometimes people say, Oh, I just want to do all the things and then they burn out. We need to find the sweet spot based on where you are in life and all these factors. 

The biggest thing here is that if you’re working with a good rehab provider and coach, they will help you to build this specific to you to keep your floor high during these times while also moving towards your ACL rehab-specific goals and milestones.

I am going to plug in a visual and a blog on our website that will help make this episode and the visual of this really come to life. So definitely check that out in the show notes. But the main takehome here is to keep your floor high. We have these training qualities and some residual effects with these that can lose over time. I shared that you could always Google, the assurance training residual, and that will come up immediately as an image. Check that out. If you’d like to get a more visual on that. But in terms of these training residuals, they’re real. And I know every one of us feels this way, even if we go on vacation and don’t move and it’s a longer vacation, we come back and it feels sluggish, man. And that could be related to some of these training effects and residuals, of course, out of our routine and whatnot. But we definitely feel this after we’ve had the injury and the surgery when we’re not doing as much because we reduce so much activity. I’m going to share this stuff. I want to make sure that you guys can have this available to you, but making sure that we are keeping our floor high.

Another big point here is why taking the time to do prehab is so important. The research shows better outcomes and it also allows us to maintain better fitness throughout this process if we’re really intentional about it. We have good guidance around it and we have a good plan around it. 

I hope that this is helpful y’all. If you have any questions, please feel free to reach out to us. You can look at the show notes for any ways to communicate with us. Otherwise, that’s going to do it for today y’all. I’ll catch you next time. This is your host Ravi Patel, signing off.