Episode 215 | The 0-100% Assessment: A Simple Tool for Addressing Gaps + Confidence in ACL Rehab

What’s up, team? First off, I just want to say I hope you’re having a good day, that is all. Now onto the actual episode, as a performance PT who works solely with ACLers, I always want to know where my athletes are in the process. And now I have my own analysis of where they are throughout the process. This is through profiling through their subjective and objective responses; specifically with subjective, being always able to check in on them and just see how they’re doing up-to-date on where they are at and how they perceive their rehab to be going. And then there’s the objective pieces, the numbers related to their physical and psychological qualities. The buckets that we are assessing or the areas that we are really trying to focus on. And of course, the physical qualities are the biggest focus within the rehab process, and that might be range of motion; it might be monitoring symptoms and handling those; it might be different movements and positions; it might be strength profiles; looking at power dynamic components of people moving, whether it’s decelerating, accelerating sprinting, cutting, jumping abilities is going to be a big component of this.

We are assessing a lot of things objectively in this process. This allows me to have a good idea of where the athlete is, from my own perspective, as I’m looking at this information, both subjectively and objectively. And this allows us to anchor these things to the criteria, whether that is the end goal, or maybe it is them getting back to running, for example. Looking at this from the short- and long-term goals perspective. I am always trying to keep in tune with where they are in this 4R roadmap that I’ve created, starting from post-op all the way to returning to performance. 

Now, within that, that’s where we are trying to see, are they essentially in these early phases? Are they in the mid-phases? Are they in the late phases? And what does their performance overall look like and where do they feel like they’re at? Now, going a little bit deeper here, one thing that’s really important is to get an idea of where the athlete sees themselves in their own journey. I want to know what the ACLer is thinking, where they currently are at, getting inside their head, and their perception of where they are.

While post-op seems a bit more obvious, obviously they have just had surgery or maybe not having surgery, and they’re just going non-operative. But with that said, they’re in the early stages. We have a good idea of their perception. They’re like, all right, I’m just getting started. I’m getting things rolling, starting to move the needle on a few things. And of course, their day-to-day lives are a little bit more impacted. This is a little bit more obvious to know, okay, they’re in the post-op phase or the earlier stages. They know they have a long way to go if we’ve set the frame for the expectations of the process; looking at 9 to 12 months in theory, maybe beyond that. This is where we just want to really have some value around getting into the mid and especially the late stages of ACL rehab. This is where it can be a little bit more gray plus more time has evolved in this process, and we’re trying to get a pulse on where the ACLer thinks they are at. 

One of my go-to assessments here is asking my athletes on a scale of 0 to a 100%t, with 0 being a potato on the couch. You’re just sitting there, you feel like a potato. And then 100% is where you were pre-injury at your best. Where do you feel like you currently are at? And then just give them a second. And I may even go into a more specific context of this. If there was a full soccer game going on right here in front of us and they asked you to jump in and play your position, how do you feel you would do 0-100%? And typically, there is some sort of percentage that they give you. If you had your best powder day, snow day, and you had your skis with you, how ready do you feel to put them on and hit a green right now? What about blue? What about a black? And let’s see if we can anchor that to 0 to 100% and get some sort of number there.

And then you can connect this more specifically to shorter and long-term goals as well as they come up. If you have someone who is going on a hike or maybe there’s a trip coming up, but you just want to gauge where they’re at right now. What if that hiker trip is happening tomorrow? How ready do you feel for it 0-100%? And then they give the number relative to the question that you ask. It might be an overall, I feel like I am 70% out of 100% there to my pre-injury level, or maybe it is anchored a little bit more specifically to an activity, an event coming up, a sport. And maybe they say it’s 85%, or maybe it’s even as low as 50%, maybe someone who wants to run soon. You are trying to get a gauge of, “Hey, like where do you feel like you’re at in terms of being ready to run?” Because this is always like a vague area within ACL rehab, so it’s good to connect. All right, well this is where their quad strength is, This is where their jumping profile is, This is where their symptoms and range of motion looks. Overall, their rehab programming compared to where they perceive that they’re at. And if they say, yeah, I’m ready to run, or maybe I’m 75% there, or 50% there, that provides some context. Whatever it is, this answer gives us a starting point to get inside the ACLer’s brain and understand this context.But I don’t just stop here. 

The biggest follow-up is for me to ask: What do you feel will close that gap? What do you need to get to 100%? Or what do you need to get to that thing to feel like you’re fully there? This is where the real magic happens. While this might be more addressed to clinicians and coaches who are working with ACLeRs, this works so perfectly if you’re an ACLer listening to this, which I know a lot of you do, so then therefore this is something to ask yourself. You’re like, all right, cool. Well, this is what I want to get to. Where do I see myself 0-100? You can also anchor yourself and see where you are. This is super helpful to be able to just say, okay, well, what do you feel will close that gap? What do you feel you need to get to that 100%? Or to get back to that short-term goal, for example? And now sometimes they’ll tell me it’s confidence. They don’t fully trust their knees yet. Other times, they might feel like they need more strength in their knee, in their quads, for example, or more practice reps on the ball. Or maybe it’s even just reassurance from myself, other people on their team. Maybe it’s the surgeon, their sports coach, and maybe it’s someone else that is close to them that they just need reassurance from in order to know they’re gonna be okay. 

This question isn’t just about the number. It’s about uncovering barriers and knowing what they think is going on and what they might need most importantly. If they say they’re at 85%. But can’t really articulate what the last 15% is, that tells me we need to dig in deeper. If they say they need more game speed drills or maybe a little bit more pop in their single-leg jumping and ability to sprint, then we have some direction there. They’re feeling like they’re lacking some of that ability to express themselves, or maybe it is just more sport-specific stuff they need to build up to. And that is something you’ll see that is very common in this process is that maybe they get through the physical preparation side of things and as they start the sports side of things or activity, there’s this fear that starts to creep back in, and hesitation because they haven’t had exposure as much to it yet, especially with high-level sports like football or basketball, soccer. Those are things where you are going to need some exposure back to it, especially given that there’s contact with high levels of decelerating and change of direction, jumping and things like that. You’re really expressing that body and you’re expressing your knee a lot, so it makes sense. We need to make sure we build that back up and that could be something that we need to make sure that we are creating a plan around. 

This is also a good opportunity to address expectations versus reality or check in with the athlete, if you will, with where they are. Sometimes ACLers forget the earlier education side of the process because they’ve been in it for a minute. Sometimes they’re not having day-to-day issues and they’re maybe five months in, they’re running, the strength training is going on and they think they’re close to being done because they’re feeling good. They’re not really perceiving any problems, especially in their day-to-day life. But their goal is to get back to playing soccer, maybe it is basketball, maybe it’s being on skates, roller derby, maybe it is skiing, rock climbing. This allows us to anchor where they are and the work that still needs to be done. A lot of times they just haven’t test driven the car enough to notice issues and their daily lives aren’t impacted as much. They think they’re fine or doing better than they are. I find this helpful when I need to have that honest conversation to really reset things of where they are and what still needs to be accomplished to put them back at 100% and beyond. Most importantly, we do not want you to have another ACL injury, and that’s where this is super important.

And sometimes people will come in and they’ll be like, you know what? I’m good. I’m there and I feel like I’m good. I can take it the rest of the way. And you can only lead people to water, but you can’t make them drink it. The thing is that we want to try and educate and be prepared for this along the journey. But with that said, it’s also so important to be very transparent, do our due diligence, and be able to share things like, “Hey, I don’t think you’re ready. I think that there’s still more work to be done.” And sometimes we have to almost ask the ACLer, “Hey, why do you think this?” And allow them to sit and think with it a little bit. And maybe because they’re burned out, man. I know I burned out in both of my ACL rehabs. It’s a long process. You’re constantly grinding with it and you’re trying to deal with the ebbs and flows and the setbacks. You’re just wanting to get back to doing the thing and you’re just frustrated by it. You might just be like, “Hey, I’m gonna peace out.” And so thinking that you’re done because you’re doing okay, but in reality what needs to happen is that there needs to be a reset conversation where your guide, your coach needs to make sure that they’re letting you know, “Hey, this is where you are.” If this is where you want to go, this is what needs to happen. These are the risks associated in a very tactful way, not in a fearful way, to just understand like, “Hey, you put in this work, let’s get the rest of the way there.” Let’s not half-bake this thing. So that’s really important and there are conversations I have to have, our team has to have with ACLers where we need to be transparent and being able to use this helps to anchor that a little bit. 

If an ACLer says 90% and they just need to have a little bit more exposure with a taekwondo class, for example, then maybe that is something that they can do with their sports coach. But the thing is that like if an ACLer comes to us and they’re saying 60%, 70%, and they’re like, I got this, let’s finish up or I’ll figure it out. It’s like there’s still a lot of work to be done. I think the biggest thing here is with that gap, making sure that we can figure out a prescriptive way to tackle that. Making sure that we anchor it, but then also be tactical about approaching that and making sure we can close in on that gap.

This has been super helpful for me to know what my athletes are thinking they need to work on—address any barriers and help anchor reality when there may be a mismatch in those expectations after some time. It’s huge and often you’ll find that there’s some things they may not have shared or maybe something new has come up that would’ve been good to incorporate. Now you get to do that, and guess what? It helps them to continue to trust you and build buy-in because you’re caring like you’re asking important questions. You’re taking the time to listen to your athletes, and that’s so freaking important to us at the ACL Athlete. We’re not here to just funnel people along and give everyone the same exercises, we want to make sure you are cared for. We want to make sure you know where you are and where you’re going, and what that plan specifically looks like for you. It’s so important. I cannot stress this enough because this injury will change your life.

Here’s where we can just be able to do something about it by helping to address this gap that they are still sensing. It’s likely that there’s an alignment between what percentage they say and where you say that they’re at in terms of the rehab process and being “done or cleared.” So that’s often what I find is sometimes the athletes will say 70%, and I will ask them, okay, what is left to be able to get to 100%? I’ll say like, I just feel like I really need to build up that single-leg ability to just pop and jump and express myself and to slow myself down. And then also getting more sports exposure, being on the ball more, being able to get some contact drills going. And so that starts to integrate or control chaos continuum and being able to expose them back to sport, through our process. And so that is something that can be really helpful, and it allows me to see like, okay, yeah, they’re actually from a gym and performance standpoint, they’re checking out at roughly 70%. So then therefore there’s an alignment in that and there’s a conversation around it versus it just being assumed like, all right, cool. Check this criteria and move forward. We want to get the subjective pieces to know where our athletes are and where they’re trying to go. But most importantly, what is that gap and how do we bridge that gap? How do we create a plan for our athletes to make sure that is addressed and they can have confidence in the plan?

If you’re a coach, PT, rehab specialist, I challenge you to start using this question with your ACL athletes. It’s simple, it’s super effective, and it gets them involved in their own return to performance process, their ACL rehab process. It allows you guys to connect and maybe touch on some things that they didn’t necessarily share at the get-go. So that can be super helpful as we navigate the ACL rehab process. If you’re an ACLer, I encourage you to ask yourself these same questions and be able to see. All right, cool, how can I maybe bring this to my physical therapist and share this with them and see what kind of plan we can get in place? And if you need help with this or if you feel lost with this, please reach out because we are here to help. We are really wanting to help as many ACLers as we can, as many clinicians and coaches as we can, which is why we are doing what we do through education and through our remote ACL coaching and in-person services. Please reach out because we are here for all of our ACL community. Until next time team, this is your host, Ravi Patel, signing off.