Episode 23 | Expectations vs. Reality in ACL Rehab

Welcome back guys to another episode on the ACL Athlete Podcast. Today, my throat is now feeling super hot, but we are going to get this done. But today is an important conversation about expectations versus reality in ACL in rehab. And this is something that comes up a lot, and I see it impacting a lot of people that I work with. And I remember going through it myself. I think this conversation can really help maybe frame things a little differently, especially if you’re going through this process or you’re about to embark on this journey. It can really help to shape the way that you think and also how you navigate this process.

One thing that I want you to picture in front of you, and I think everyone’s probably seen this, it’s the two different images. On the left side is the expectation, and then on the right side is the reality. And so you have a point A at the bottom on the left side and point B, which is the end destination or whatever the result is on the top right. Usually with the expectation, there’s this line that goes straight from A to B in a positive fashion. And the reality picture ends up being this point A and point B, except there are a lot of zigzags. It makes all these different turns. It goes down, it goes up, it goes left, it goes right. And then after all of that, it finally makes its way up to B. And that is typically the journey that this takes, and especially in ACL rehab, you’ll see this all the time.

The expectation is that things are going to go perfect. You have your injury, or maybe you have your surgery and you get out. And once you get out of that surgery, you might be making progress. You go from increasing your flexion range of motion, getting your extension. But then for some reason, your quads aren’t waking up. So that’s something that you’re like, “Wow, this was supposed to happen.” You’re expecting things to go linear. Things will go perfect. The knee’s going to feel good the whole time. This protocol is showing me that I should, by three months be running; by six months, I should be back on the field doing drills. All of these things -and you guys have heard me talk about timelines, and how that will really influence the perspective that you take on these things. And that’s something that I’ll talk about in another episode. But, if I could just do you one thing right now, do yourself a favor and do not stay tied to a timeline because it’s really going to impact this expectation versus reality. Because what I will get a lot of times is athletes who will message me and they will say, “I feel behind, or my PT told me I’m behind.” And this is all based on the protocol. 

And while there can be general buckets that will make you feel this way, every person’s going to be different. You have to think about the surgery that you had. You might have had a meniscus repair versus a meniscectomy; you might have had multiple ligament damage. There might’ve been other things going on. You might have had a bone fracture. All these things are going to play into this. And maybe the way that the surgeon had to drill tunnels and the way that they had to repair the ACL, it might have been just a little different than your buddy. Let’s say, who is on a “faster timeline.” So that would be one thing that I would highly recommend just getting away from. Because it will help you mentally to know, let’s get away from time because time will keep going. Maybe attach yourself to what we call criterion, which is the specific milestones that are subjective to you and objective to you. Your strength and the way that you feel, and the way that you are mentally hitting the box with your ACL RSI. All of these different things that are very specific to you, that is going to be much more helpful and objective, to make sure that you’re making progress. So that’s the expectation. 

The reality is your knee swells up, you’re in pain, and your quads will not wake up when you want them to. It’s taking a little longer for you to get your knee extension. I know the big one is running. A lot of times people will not hit these earlier milestones, and then it takes them longer to start running. I’ll get messages where people say, “I’m eight months out and I’m still not running.” Now, there are a lot of things that could play into that. I typically see that with maybe a poor program, or just not being progressed appropriately, or maybe even too fast. But the list goes on, and that’s the reality of this process, and it’s because it’s so long. If we’re talking about 9 to 12 months, that is a very, very, very long time for things to happen. Especially whenever some of it is out of your control of how your body is going to respond to the rehab and the training and the stress, and not to mention, else outside of that. Those are all things that will be very important to think about as you’re moving forward. And I say this because expectations will 100% drive your mindset, and that’s going to drive your actions following that.

So for example, if we thought we were going to crush a test in school and we end up failing it, that expectation of thinking that you’re going to crush it and then you fail it, it’s going to impact you negatively. And then let’s say for a job interview, if you think that you did really well and you don’t do so hire, you don’t get the job, or maybe you have to wait till the next wave, this is going to impact your mindset, typically in a negative way. These are things that even in the ACL rehab process, if we expect things to go really well and then something, let’s say a setback or a hiccup happens, it’s going to impact your mindset. And now this is not me saying, “Don’t feel bad for this being around because that is totally fair.”

But the thing is, if the expectations are set to know, okay, maybe this is going to happen, then that will really help you to be able to, okay, get over it really fast, and then make sure that you hit the next one better. For example, the test, well, you failed that first one. The next one you’re going to study better, you’re going to prepare better, and make sure that you pass that test—the same thing with the job interview. You’re going to prep as well as you can, you’re going to do your research, you’re going to make sure—you might even seek out some coaching and making sure that you crush that interview to get that job or get that promotion.

And I was guilty of this. I remember during my ACL rehab, I thought things would go perfect. I was three to four months out and my knee got swollen. I think I was trying to do too much and I didn’t realize it. As everyone, you’re just like, this is going to make me better, this is going to make me get back on the field faster, all these things. But it ended up set me back. And some of this was an expectation versus reality. I thought things were going to go fine. I thought rehabbing more would lead to more success, but that was just not the case. I actually just had an athlete this past week, where she has been steadily cruising for about seven months; no issues, had been going really well, and out of nowhere her knee swelled up, for no reason. She knew this could happen. She is also a PT herself which helps and it’s also her third ACL surgery. These are all things that have shaped her experiences, which have helped her to manage her expectations. This didn’t mean that she didn’t get down about it because it still bummed her out. When you’re seven months out, you’re like, “Okay, maybe I’m actually at the end of this” But then it happens and it set her back. We’ve had to regress her program. But what was awesome about this is that she had her little pity party and she was bummed about it for a second. But she is back on track and she’s getting after it. We’ve set some things in place to make sure that she’s going to continue to make strides toward and she’s good to go.

A lot of that comes back to knowing that this could be a part of the process from her experiences and our conversations and knowing that this could happen. This is important as you go through this process. No one is immune to a setback or any type of issue that can come up in ACL rehab. Professional athletes have this happened all the time. If it happens to them, it’s going to happen to anyone. Just take this and think about it, especially if you’re someone who feels like this is really impacting your mindset of having a setback, or maybe you’re not running yet, or maybe you don’t have a full range of motion and you’re not walking like you want to yet. But this is really important that you make sure that this will drive your mindset and how you approach this whole process. 

The expectation of knowing it’s going to be nine months and even possibly 12 months before you’re fully yourself again. Because it even took me that long, especially for my first one. To start to feel more like myself and confident. If you think you’re going to be there in five or six months, that might be setting you yourself up for failure, and thinking, “Okay, well, now, this is way too long.” It’s delayed and it’s impacting you negatively. Even the expectation of time will help you a lot. Knowing that you’ll have bumps along the way, pain is going to come up. You’re going to see some increased swelling. I don’t know any ACL athlete at this point, who hasn’t had some sort of episode of their knee getting swollen at some point a little bit later down the road, or increased pain in their kneecap, joint, or maybe their graft donor site. May be harder to get their knee flexion back. That takes a little bit of time longer than people think. So keep working at it. But just knowing that. And I think that that’ll be really helpful. Some clicks, pops (here and there), some weird pains, that’s probably one of the things I get questions about the most. And that is something that you know if it’ll be there and it’s not functionally limiting you, then you’re probably going to be okay. But make sure you check with the physical therapist you’re working with, to make sure that all things are going okay. And that you can put these thoughts or these feelings to bed, and it will not impact you in a negative way. And it will not build up anxiety, which I know a lot of these things can do. 

Another example, I know a lot of people see is, maybe looking down in their quads aren’t as big as they want them to be, or they’ve atrophied, or they’re not getting as strong as they’d like. That is something that I notice a lot with athletes that I will see, is that it doesn’t pick up as quickly as we want it to. And that is something if you just know the process that you have a plan in place and you have a coach in place, then that is going to be really important. That is something that I cannot stress enough, is the guide and the program that you have for this, whether that’s your physical therapist or coach and someone to provide assurance during this process, to manage these expectations versus reality. Because sometimes if it’s your first experience, you might not know any better, right? So that’s where trusting the person that you are working with and trusting the plan that you guys are using, would really help to create that confidence and reassurance, and knowing that you are on the right path. And that these things will happen and that you’ll be able to overcome them with the right approach and especially with the right mindset of these expectations.

These just need to be quick course corrects, nothing that needs to be something to dwell on. But something that you quickly course correct, and then you’re back on the path. And that’s the way that this should look. So that’s it for today, guys. I just wanted to come on and talk about managing the reality versus expectations in ACL rehab because it can really impact your mindset, and it can really drive your actions behind that. So that is something to think about. And just a reminder, each month I’m picking one person to do a free strategy call. All you have to do is sign up for our newsletter which is in the show notes below, and leave us a review. Give us some feedback. Allow other people to see this podcast more, so they can get more information out of this and become better in tune with this process as well.

Thank you all so much for listening to the ACL Athlete Podcast. This is your host, Ravi Patel, signing off.