Episode 233 | Stuck, Lost, and Piecing It Together: The ACL Rehab No One Talks About

What is up team? And welcome back to another episode on the ACL Athlete Podcast. I’ve been having conversations with ACLers about where they might be, either three months out or six months out. They have been discharged from physical therapy, they have been cleared by their surgeon, maybe cleared by their physical therapist, but they are not there. They know they’re not there, especially if they have been released from physical therapy. It’s just due to typical visits, or maybe they have exhausted how much they can help them. It’s crazy. 

I talked to somebody the other day, and they joined our remote team, working with us, and they shared that their physical therapist literally said, “We cannot offer you any more assistance.” But she was having pain with stairs, with jumping. She’s not running yet, but she was discharged. And it makes me sad. The same thing can happen with a lot of you, where you’re told you are finished. And again, it could be from a number of these reasons, or you feel like your physical therapy is not enough. You are not getting enough of the exercises, or you feel like you need to add more into the mix. But usually what I find is that when I’m talking to these ACLers, they are feeling like they’re piecing these things together. They’re structuring their rehab sessions, their workouts, and they’re planning their things. And that is just very hard.

I asked them where they’re getting things from, and they’re like I’m pulling some things from Instagram and from YouTube. I saw this influencer on TikTok who is like do this and it’ll help your knee pain. It is really hard in this space of movement with rehab and especially with so many educational resources, if you will. It’s hard for me to say educational because it’s just information that we take in, and a lot of times it is via social media. I’m not here to throw any shade across any of it. I know that there is a lot of value to it, but it is also a little challenging because we don’t necessarily have the best filters to know, okay, what is good, what is bad, and people can sound convincing. 

My point of today’s episode is you should not be structuring your own workouts and planning your own ACL rehab, ever. I feel very strongly about this, and this is something that I have spent a lot of time thinking about, especially over the years, talking to ACLers who are in positions like this. And it’s something that I think to myself, I’m like, okay, why are people in these positions? And a lot of times it is due to several different things. I get that there are factors in play. It could be finances, it could be just a lack of local resources, like a good in-person physical therapist. Maybe you tried a bunch of different people, maybe it could be the time available for you, maybe it’s insurance visits or the healthcare system that you are in. With other countries that athletes we work with, people are sometimes seeing their physio two times a month, or one time a month. Sometimes it is like they don’t have a PT visit for four weeks, and they are fresh post-op. It’s wild, y’all. If y’all could just be in my mind of the different conversations I’ve had with ACLers, with just different cases and just different situations where either things fall through the gaps or the way the systems are designed. There are a lot of things in play. I don’t want to overlook these things. I understand that people are trying to do their best. I know people don’t just do this intentionally just to be in these situations. There are usually a number of factors in play. 

The other thing is that with health and wellness, including movement and nutrition, so exercising, thinking about the things we take into our body, it is the wild west. Especially nowadays, there’s a little bit more proactive health taking on the scene with supplements, biohacking, and being very health conscious. With that, there has been the opportunity for more of the space to get flooded with people who share their opinion. It is challenging because no one has clear ownership of this space—I’m not here to say one person should or one group should. Sure, there are registered dieticians who go to school and get a license to be able to prescribe meal plans and work with people with different diseases and to be able to help them get the proper nutrients based on research and the education of the foundational pillars of what our body takes in and is able to prescribe things for people. And then there are physical therapists, of course, who deal with musculoskeletal-related issues. It could be neurological issues, it could be cardiopulmonary issues, it could be skin-related issues. Did you guys know that there are physical therapists who specialize in wound care? Yeah.  These are things that we go to school for, we get our doctorate for. And it’s something that we focus primarily on the movement piece, how these systems integrate, but especially when you’re thinking about the orthopedic realm, which is where ACL falls into. That is something that is the realm of physios or physical therapists, who are managing these types of injuries and rehabs. 

And of course, there are performance and strength and conditioning coaches, there are personal trainers, there are fitness coaches and other professionals in this space. Now, the barrier to entry is challenging because some of these, yes, they require bachelor’s degrees, they require master’s degrees, doctorate degrees. Some of these, you can become a nutritionist after taking an online course. Or you can become a personal trainer by taking an online course or a two-day course. I’ve done it myself when I was in college before I became a physical therapist and a strength conditioning coach. I took a personal training certification that was a three-day event, I took a test, I passed it, and now I can train people. And there’s nothing wrong with this, but the challenge is that if you’re just good at taking in information and taking a test, then that makes you qualified. That’s what makes this challenging in this space. I think the thing that I typically see, and I’m seeing more of, is that it’s just with social media, if we take essentially the thought of movement and with nutrition. There are a lot of influencers and just people out there who are like, these supplements can do X, and these supplements are great for that, and then this movement is great for all your knee pain or to bulletproof it. 

The thing is that the body is so much more complex that yes, there can be benefits to maybe some of these things that they suggest, but we got to look at things as a whole. Brock, who has 150,000 followers, can’t necessarily explain the mechanism of why creatine is beneficial, but therefore he is jacked. So you’re going to buy a creatine from him because it’s awesome. Or Melinda, who has the anti-inflammatory keto diet with 500,000 followers, has worked for her, but she has no education or background on this. But it worked, and it seemed legit. And I get it y’all like movement and nutrition. It’s a part of people’s lives. It’s a part of our everyday lives. We are doing things like this every day. We’re putting things in our bodies. We are moving. Everyone feels like they have a little bit more of an opinion about what that looks like and what might be the right thing, and what works for them. This is where it can get a little challenging in this particular space. 

The thing that I find always comical, is that sometimes I’ll have people, especially more recently, telling me what the right exercises are they need to be doing, the problems that they’re having, and that they already have the solutions for their goals, the supplements, the nutrition, and they don’t have a background in any of it. I’m not saying to discredit any of it, but at the same time, it’s them being able to feel confident about saying these things because of X influencer said it, or an ACL guru that said it’s legit. I know I’m getting on a little bit of a tangent here, so I’m going to digress a little bit. But here I’m always wanting to share just the transparency of it all because I think it’s really important, because of conversations that I feel like I’ve been having more recently.

While the planning piece has flowed through this ever since I started the company and have been having these conversations, it’s been a consistent problem. But I think recently I was just trying to, like, break down why it is that we feel like we are okay to plan things. I know the healthcare system doesn’t do a good job of allowing us to know, all right, are we there yet or not? Because it’s a little not great, in terms of just the way the process is, because it could be based on insurance, or the quality of the physical therapy you’re getting. As we know, testing is not very common. We know that individualization is not very common because it is volume-driven. Surgeons are clearing people at six months. Surgeons are saying you should be running at three months. So there’s a lot of noise within this, so it makes it very challenging. I don’t want to fault anybody for this, but movement, rehab, nutrition, these things can be a little bit challenging in this space. As you guys know, I’m all for empowering you guys, wanting to make sure people feel empowered in their journey and process. It’s why this entire podcast exists. But it’s really important to know where to draw the line on where it makes sense.

And I truly do believe that no one should be managing their own ACL rehab or any complex rehab for that matter, especially when the stakes are high. When we are talking about 20% to 30% go on to have a re-injury. When we talk about people having a lot of challenges with mental health, people not getting back to what they want to do, and then also the earlier onset of osteoarthritis because they didn’t get themselves to a better place. But that is a little bit harder for people to see because when you’re going through this process, the arthritis thing might not be for another, maybe 10 years, 20 years, 30 years, 40 years, or maybe it doesn’t set in as much because of the proper combination of just the way your knee tolerated things, and you’ve done a good job of keeping yourself strong and mobile. Those are things that are important in terms of this process to take into account. But when we are connecting the dots here, when you’re thinking about, all right, doing things ang planning things in ACL rehab yourself, especially planning your workouts, your schedule, structuring things yourself, and piecing it all together. I’m gonna give you some examples here, guys. It is like you’re trying to build a house without knowing how to read a blueprint. You might know what a house should look like, but without the structure, the tools, and the experience, you’re likely to build something unstable or maybe unsafe. You don’t want me to build you a house. I know how to build things. I’m fairly handy because of my dad, and I learned a lot. But I promise you, you do not want me to build you a house. It could be like hiking through the mountain without a map or a compass. You might eventually get your way there, or you might get lost, take the long way, or eventually end up getting hurt because you just didn’t know your route or, being able to have any guidance through that. It’s like writing your legal contract after reading some blog posts about it.

This is something that you’d probably want an attorney for. You’d want a lawyer to help write something up, or at least proofread it to make sure, like you’re not making some sort of mistakes, especially with situations where there may be liability or high stakes in place. And especially with the complexity, because on paper, yes, it might look like, all right, it sounds legit. But until someone goes through it with a fine-toothed comb who has this experience and background, that’s when you can be like, all right, I’ve got the stamp of approval. These are things that we wouldn’t just necessarily navigate and do ourselves. Maybe the hiking piece, depending on your experience and background. But again, these are things that we would want professional help with to help plan these things, to make sure that we take it step by step and do it the right way. We would invest in these situations. 

The same thing comes down to my hip rehab. I’ve shared earlier that I’m going through a hip resurfacing process, and going through my rehab process, and I could do it myself. I could. But the thing is that I don’t know my blind spots. I am going to be biased towards certain things I want to do. I also want someone who’s an expert at this particular thing. I have hired my remote coach who is giving me my programming that’s individualized week to week. We’re communicating week to week. We have these different testing processes that I go through to make sure things are moving along. The thing is that even for myself, with my background as a physical therapist, having a strength and conditioning background, understanding performance pretty well, I didn’t want to do my own hip rehab. I’ve worked with a lot of hip rehabs before y’all. And the thing is I think it’s important for me not to coach myself, but to have a coach and to guide me through this. 

The tough love that I want to share with y’all is that I think social media allows people to think that they can get by with doing it themselves, finding the five best exercises for X, or using this template program for return to sport. But the thing that’s always so challenging is how do we know it’s right for you? And do you have the background to put it together to be able to understand, like how to test and assess? Is this right for you? I’ve had people who have been doing programs for months and months. They’re like, I feel great. When we do the testing on their knee and look at the different movements, they’ve been compensating with their glutes and hamstrings for months and months that they’ve been doing it. They’ve been only doing compound lifts, where they do squats, deadlifts, split squats, step-ups. There are things that our body is good at doing, and that is compensating, especially when an injury happens. And especially with the ACL, whenever it’s a long process and there’s a lot going on. This is something that we want to make sure is right for you based on your history, your graft type, and other procedures.

The thing that is even just so crazy is that I evaluated someone this morning who has a complex ACL case. She tried the knees over toes program here recently before we connected, and it made her knee worse. Am I here to throw shade on the knees over toes program? No. But the thing is that it has to be for the right person. I know people have had success with that. But we have also had a lot of people who have come to us after and have not had success with it. And the thing is that it’s not individualized. It’s not accounting for your specific case, your specific needs, your specific gaps or deficits. That’s the thing that is challenging with something more templated or pieced together.

ACL rehab is complicated. Eighty percent of physical therapists don’t know how to navigate it themselves, if I’m completely honest. We have mentees in our mentorship who want to get better at it. When we are talking through a lot of this, the biggest hiccups are that we didn’t get educated on this. And we only know how to handle maybe the first 8 weeks to 12 weeks.n And even then, it’s a big challenge. And then after that, from 3 to 9 months to 12 months, they’re like, we don’t know. It’s the wild west. There are so many different ways to go about doing this. The thing is that it’s challenging for us. We have a three-year doctorate studying the human body and movement, and it still is challenging. This is something just to provide some context around. If you feel like you have been doing that, then I want you to just take a step back. Especially if you feel like you’ve just been spinning your wheels, things have not been progressing in the right direction, to be able to find a different signal within all this noise and to see, all right, what other alternatives do I have? Trying to piece these things together yourself. 

And lastly, I don’t want to overlook this one important point. And that is maybe there are some of you who can’t necessarily afford additional help or don’t have the resources nearby. That is something that I know is hard, and I get it. I was in debt really badly after my second ACL surgery, having $10,000 worth of deductibles and out-of-pocket maxes for my surgery, and it’s just sad. I do get it. Sometimes you do need to tackle it yourself for a minute. Maybe you’ve been with somebody for six months, and you just feel like you need a break just to be yourself. I understand that. But I do think that even with the lower socioeconomic and with people with lack of resources, with the way that technology has evolved, there are other opportunities now. And maybe it is just like these one-off consults, or maybe it’s connecting with somebody locally and saving up and then just figuring out like, all right, can I at least find a starting point? Can I even borrow or find out if there is some sort of scholarship? Some sort of opportunity that is something that we have done in the past and do. That is something that is important because we want to make sure that we can also help people who don’t necessarily have the resources or the means. That is something that I think is important to consider within all this. I don’t want to overlook that because I know that not everyone can just go and throw out investments and finances towards just a bunch of different resources and different, maybe remote options or in-person options. And I know sometimes the out-of-network or cash-based options can get pricey; therefore, I think that it’s an important consideration with this.

But with that said, if you are listening to this and you’re like, I do have the means, and you’re scheduling and creating your own workouts and your own ACL rehab, then I would highly recommend you reconsider. Especially if you haven’t had any testing, especially if you don’t know what your next steps are, in terms of what you need to do, what metrics you’re working towards. If you find yourself showing up in the gym, and you’re like, I don’t know what to do, or I feel like I’m just throwing stuff together. The rep schemes are all random, and especially if you don’t feel like things are moving in the right direction, getting you closer to what you want to do, then I would strongly consider finding some additional help. Someone who is an ACL expert, someone who knows this stuff well, and I promise you guys that this is something that I’ve seen where it has added a year, two years for people’s ACL rehab when it could have been cut down to three to six months. I kid you not, I see it all the time. Talk to people all the time who just spin their wheels. I know that this is more than just them. It’s just more of a system, and just like a healthcare-based issue that we face. But now with technology and with the resources that you don’t have to be tied to just where you are geographically, especially with remote ACL coaching, that is something that can be done from anywhere.

We have people all over that we work with, and that is something that I do think will be a very strong force for years to come because I think there are many people who can benefit from this. And we have worked with hundreds and hundreds of ACLers all over the world, never seen them in person, and it’s something that we are able to get them back to what they love to do. And it’s fun. This is something that I would suggest if you find yourself struggling with this feeling lost, feeling like you don’t have structure, feeling like there’s no plan, or what are the next steps, then finding someone local to you who is an expert in this or finding someone who remotely does this.

And the thing I want to share is like, how should this look, and how we do it with our ACLers so you have a reference? You provide your work, school, life schedule of what that looks like, your days you have available, the time, your equipment access, and what is most feasible to you. We’re not just trying to max this schedule out, we’re trying to figure out what is the minimum needed for you to be able to move the needle with these particular priorities and goals. This is where the testing pieces come into play. Being able to break down your profile, your history, and your background, your case, and being able to assess and see, all right, these are the gaps that we see with Patricia. And Patricia, we got you. This is what the game plan is going to look like, and this is where we’re going to build out specific to Patricia and her life to fit it around her. We’re not having her fit our mold; we fit the mold of her life. That’s our job as physical therapists, performance coaches is to build it for you so that way it disrupts your life as least as possible as needed, and you get the minimum outcome you need to be able to do that. Therefore, we’re going to build it to that. And yeah, we could always add more; we could always do less.  There is always a lot of variety in the way that we do things, but that is left to us. We are the ones who can help in terms of deciding those priorities, the exercises, and what to do. This is something that needs to be built into you because life is going to have things come up, and it needs to be adaptable. You might get sick, you might have a family member that something happens to, you have work, travel. There are so many things that I can’t even explain that people have come up that they have to have adapted programs.

I have an athlete right now, she’s at a camp for three weeks. We had to adapt things. She didn’t get technology or wasn’t supposed to have technology. We were supposed to find a middle ground for this, in order for her to be able to access what she needs to do, especially with the phase that she’s in. But we have to adapt things and make sure that we move things forward for you. And it’s not just set in stone like a set-and-forget-it program. It’s continuously getting updated to meet you where you are. 

If I could leave you with anything, if you feel like you’re building your own programs, structuring your own rehab, or feeling lost in this, and don’t have any structure, please find a trusted source who knows ACL rehab, who can back it up that they have worked with ACLers who have worked with cases similar to yours, and just make sure that you are not the one left to do it yourself. No one should ever do their own ACL rehab. And I believe that firmly. I may change that in the future, but honestly, I probably will not because I feel that. We don’t need to be our own coaches during this process. It’s already enough having to drive the car. Let’s find someone else to be the GPS for us. That’s our goal here at the ACL Athlete is we want to be the GPS. We’re here to help.

If you do need help or if we need to point you in a different direction to someone local or some other resource, we’re happy to do. I just want to make sure that you feel like you have a little bit more than just feeling like you’re left to your own devices to navigate this process by yourself, because it is already enough to deal with on our own y’all. Until next time, this is your host, Ravi Patel, signing off.