Episode 255 | ACL Injuries Happen – Re-Injuries Don’t Have To: Where Your Focus Actually Matters

What is up team? We’re getting straight into it today. If you’ve noticed in the sports news, Patrick Mahomes and Micah Parsons both tore their ACLs this past Sunday. It wasn’t the best Sunday for ACL with two pretty premier athletes in the NFL tearing their ACLs. Michael Parsons was non-contact. If you look at it, it is a very common mechanism of ACL tear. And then with Patrick Mahomes, his was a little bit more of a hyperextended injury. You would categorize it as more of an indirect contact injury. 

I would say it wasn’t like someone tackled the side of his knee and, of course, made that ACL tear or that knee do it. He had someone in the process of tackling him on the other side of his body, and his other knee hyperextended as he was going to get rid of the ball. This is very interesting with just coming later in the year with the NFL. Of course, every year we hear about, especially in preseason, we get hit with the ACL and the Achilles injuries. And then over the course of the season, you’ll see athletes get hit by these as well. Malik Neighbors is another notable. Zach Ertz, who was injured recently. Michael Pennix who has had a history of knee-related issues. This is all something that I know a lot of people are like, what’s happening?

I know people wish that there was one specific answer to this, but I’m not going to sit here and act like I know exactly why, because no one will know best besides their medical team, and even then, y’all. That’s something that is just pure speculation. People might have some lingering issues that are not necessarily discussed, that could lead to maybe some compensations. There are things where people could be doing less strength training or building asymmetries over injury histories, and that leads to things. There are also just within-day type scenarios that can play into it. Yes, there’s the turf versus grass argument, but that’s been pretty kaboshed, if you will, because you can see a pretty split, if not more, on grass fields for injuries recently.

It’s just something that I think we have to take in stride, especially for an ACL injury. It’s one of those things where we can continue to speculate, but I want to focus more on the point of why I’m sharing this today, which is that these pro athletes have torn their ACLs. I’ve had conversations with ACLers where they have this ACL injury for the first time, and they start to look hindsight and blame themselves for it.

And again, mostly talking about non-contact here. When you’re talking about contact, it’s like you get in your car, the car is perfectly fine, and someone just hits you. You can’t do anything about it. You couldn’t have done anything to prevent it. It just happens, it’s an accident. The same thing with a contact injury. No matter how much training you do, how perfect you are, it happens because someone hit you in the side of the knee, or somehow there was some sort of contact. Someone tackles you, whatever it is that is not necessarily the forces that you can control with your own body. 

Now we are talking about non-contact (indirect contact), where there is maybe a little bit more at play in how that happened. But that’s the thing that’s going to be really important here, is that with these ACLers, they look in hindsight and they start to blame themselves. And this is normal, right? You have an injury, and then you’re like, man, what could I have done? Any type of negative outcome. If you don’t get the job, if you don’t get into this school, you might reflect and be like, What did I do wrong? What could I do better? These are things that are very normal in this process. I did the same thing after my ACL injuries. I started looking for answers. But to be completely honest with y’all, it’s really hard to find. Some are more obvious, but there are also some that it could chop it up to… it was going to happen anyway, no matter what. There have been some gaps; maybe you can assess or identify areas that have nagging issues or aches. I know I have athletes who, when I talk about asking them, when they had the injury, what they were feeling leading up to it and they were like, I had this lingering hamstring issue, or I noticed my knee was having some buggy issues and it wasn’t that knee that had the issue, it was actually the other knee that tore the ACL.

There could be some contributing factors, but I can’t necessarily say, and I don’t think any true professional, if you’re looking at this in isolation, could say that was 100%. And if they do, eh, that would be a little weary of any absolutes, especially with ACL. But you could also say, there are too many load management issues, like too much practicing or playing a sport without proper recovery. We’ve got club sport athletes who are practicing every day, going to play, multiple games on a weekend. And they have no breaks, no off-seasons. They go into school ball, and it just rinses and repeats, especially with the way that club-level play is picking up now and has been for quite a long time. Little to no strength training. This one tends to be a big one. I see ACLers blame themselves, and it looks like there can be merit to it. But with that said, I think that we have to take this all within context.

Nutrition, sleep, all the big rocks that we’re trying to focus on in terms of making sure athlete performance and health are really good, and the things that move the needle, truly, not a TheraGun massage or some red light therapy. It’s the big rocks of movement, nutrition, sleep, stress management, and having a community around you. Those are pillars of performance and for recovery. Then it’s all the other stuff that is the small filling in the cracks. And so yes, we can argue about these different things that contribute to it. The thing is that we even see people who are doing these things really well, and guess what? They still have an ACL entry. Now, that doesn’t necessarily mean you don’t work on these things. There are controllable factors that contribute to this. And then there’s also just uncontrollable factors. And every ACL injury is going to be different. 

I think that there are a lot of things we could always point the finger at of why it possibly happened, but in reality, in the majority of cases, we won’t know. And I don’t think it’s super productive to be completely honest, to do that because while I do think there’s some value in reflecting, there’s also just in situations like this, sometimes stuff happens. Or, if you have a kid, close their ears, shit happens. This is just the reality of ACL injuries. 

And that’s why I bring these players up, especially these pro players. You can, yes, play through some stuff, but in reality, these players have the best genetics. People who are playing professional sports, we would argue they have the best genetics. They have been gifted to be able to perform at a high level in terms of performance. They have the best training, they have the best resources, and the best finances. Some of these guys spend hundreds of thousands, if not millions of dollars every year on their health and just recovery, and this is their full-time job. They get paid to do that. Guess what still happens to them? They’re not ignoring this stuff. It’s just something that no one is immune to. And so that’s the main thing that I want to get across here is that no pro athlete, no college athlete, no high school athlete, no middle school athlete, no older athlete, if you will, is immune to an ACL injury, especially pro athletes, even though they’re considered the best in all areas.

My point is that it’s healthy to reflect on this, but don’t dwell on what if I did X or blame something else. Maybe this could have been different. I think that it’s something where you could do everything perfectly, and it could have still happened. First, ACLs, in my personal opinion, are harder to prevent because we just don’t have many predictors for a first ACL tear for someone. They even did a study where they looked at the typical knee valgus, and they looked at people who had knee valgus during movements of a jump, and they tried to predict will this person would tear an ACL, guess what? There’s no correlation between what the naked eye could see of what we would assume would be someone who could go on and tear their ACL. Guess what? They didn’t; they couldn’t find any relationship. I think we can try and assume, okay, yeah, we can figure out who is going to be that person. Now, there are certain genders, there are certain categories of sports that you’re automatically increasing your risk for. Yes, that is the case. We just can’t necessarily point the finger at one specific thing. If you can, then you have solved all the problems. But with that said, it’s very multifactorial because you can throw a lot of things at it, from, yes, gender, age, and sport. You can also talk about, yes, if you want to talk about things related to female athletes, menstrual cycles, which I think is not nearly as prevalent as what the overall news and media portrays. Even though that’s where a lot of funding is going, pushed towards FIFA. 

I actually think it’s more of a culture-based issue that female athletes are focused, or more so told to basically jump into sports a lot faster, and they don’t have as much development over a period of time. And then all of a sudden, they’re playing sports year-round,  especially if you talk about soccer, which has a high re-injury rate. And guess what? They’re the ones who also have a higher re-injury risk. There are a lot of layers to this. And then also just no exposure to strength training, which is one of the biggest players for reducing the risk of any injury. Strength training, heavy strength training, athletic development, not just playing your sport, but building a really good athletic base and strength profile—massively huge. 

If you’re a parent listening to this, if you want to prevent ACL injuries, that is going to be the number one thing. Allow your athletes to be able to take breaks from their sports. Don’t specialize in a sport. Focus on movement, nutrition, and good sleep. I know it’s typically younger athletes and teenagers who focus and have a struggle with this. But with that said, this is something that’s going to be super valuable, especially if we’re talking about what we can control in this process. But this is where the predictors are a little challenging from that first ACL standpoint, where the weight and focus need to go. In my personal opinion, it is going to be on re-injury. You have had the first ACL tear. Maybe it’s the second or third, and this is something where we’re trying to reduce the risk of that second, third, or fourth ACL, depending on who you are and where you’re at. But whatever the next ACL is, we’re trying to reduce the risk of that. This is where we have the most impact and control over is the re-injuries, and this is where we have to leave no stone left unturned. Starting from day one, proper movement, nutrition, sleep, stress management, and the big buckets of health. And most importantly, using research-guided criterion-based progressions, using data to drive this process, and testing and making sure that the programming and guidance are individualized. And if you could say you feel 10/10 here, then amazing. If not, then you need to figure out what you need to change in order to make sure you reduce your risk as much as possible for another ACL injury.

And the thing is that I find a lot of people who are looking for cost-effective options and trying to try and shortcut some of these things. Or, trying to gain the system a little bit, thinking that they can figure it out on their own, and watch videos. And y’all, this is hard. You wouldn’t go out and build a house. Unless you’re a contractor who can build a house and is very educated on it. This is no different, to be completely honest, like I wish that it was just something so different that people almost had no choice but to give it to somebody. But since it’s in our own human body, we have a little bit more control over the training of it, the choices we make, of course. It makes it just really challenging in this particular area because the cost of another ACL injury is so high, and I think people don’t weigh that enough. And they think that once I go through this and they just work through the process, that they’ll get there. But it needs to be done right. And that’s where it’s so important to focus our energy here is because the previous ACL injury, especially if it was your first, isn’t worth the energy or mental stress fight over. 

If you’re listening to this, that’s the one thing that I want to tell you is that the first ACL injury, don’t sweat it. It happens to these pro athletes; it happens to everyone. No one’s immune to it. Yes, be reflective on it, but put your energy towards making sure that you make this your last one. And that’s what I always tell people. Use it as an opportunity to come back stronger and a better human, a better athlete. You can do that. It’s an opportunity to rebuild yourself from the ground up. I think that wholeheartedly, as an ACL athlete myself and working with tons of ACLers. It’s just something that we have to lean into and make sure that we make the most of. I think sometimes it can be looked at as okay, let’s let time progress, let the ACL heal, and it’ll be back to where it is in 9 to 12 months. And people just use that as like the timeframe of okay, then I’m good. 

But in reality, the ACL biological healing is only one part of the pie. To be honest, it’s the easiest part. The hardest part is rebuilding athletic qualities to get you back to the sport you want to play or the activities. And to be able to make sure that you are at a certain point that you’re super resilient, you’re more injury proof, if you will, and making sure you’re not compensating and you’re moving very fluidly, as an athlete and as a person. I think that’s super important in this. And so that’s where I think we need to put all of our focus on how to reduce the risk of another ACL injury. That’s where PT, medicine, that’s where coaching, like all this is going to take place, and what we can really lean into and focus on. And what I would suggest for you as well, because that is where you’ll be able to say, okay, I stepped on the field, I got on my skis, I went onto this court. I test it out where all the criteria show are proper, and making sure that I’ve been training consistently, my legs, expressing myself in a bunch of different athletic ways from like sprinting, cutting, and being able to jump. And so there are a bunch of different aspects of athletic development that we want to rebuild.

And so that’s where we want to put our focus on, is what we can do to reduce the risk of that, and also making sure we hit the benchmark criteria that is so key that the research shows that reduces the risk of an ACL injury. Then we can start putting numbers to it, of course, through this process, and making sure we dial that in as best as possible, and earning the right to get back to it. Not leaving it to chance, not leaving it to just a timeline of even 12 months, because face it, there are a lot of ACLers who might have to go beyond that. But I promise you guys, it is not worth trying to do this again. It is not. Make sure you do it right, do it only time, make it your last one, and use this as an opportunity to come back stronger and a better human.

Until next time, this is your host, Ravi Patel, signing off.