Episode 26 | The Most Important Principle in ACL Rehab

What is up guys, and welcome back to another episode on the ACL Athlete Podcast. I’m super pumped today because of this topic, and I think it’s something that is going to be very valuable for you, I think it’s very valuable for life. And it’s something that I am continuously trying to apply for myself and also how you can apply it to ACL rehab. And what is that exact principle that we are going to be talking about today? The most important principle in ACL rehab, I would argue, getting 1% better every single day, 1% better. And today’s topic is going to focus on this because I think that there are a lot of takeaways from just having this mindset, especially when we look at the frame of ACL rehab and being able to apply it and being able to look toward the end goal, but also making each day count.

This all stems from the book, “Atomic Habits” by James Clear, which I highly recommend for anyone who is trying to change habits, bring some awareness about it, have a system to be able to set up, to know good ones and bad ones, and what you can do about them. But there’s a lot of life lessons in this book that you can just take and apply today to be a better person.

James Clear starts this book off with a little bit of his background. He was a baseball player in high school. He almost lost his life after one of his friends was slinging a baseball bat. It accidentally slipped out of his hands and basically hit him right dead in the forehead between the eyes and ensued a cascade of, he had to go to the hospital, his brain started swelling. They had to induce him into a coma. He lost vision. He had a ton of issues. It took him a very, very long time to recover, to get himself back to who he was, the great baseball player, and he actually got cut the next year trying to get back to baseball. He almost hit like a low, and then he kicked things into high gear. He started taking what were small habits every single day, trying to see what would make him better, those one percents that are going to make him better every single day to get him to that end goal, which he wanted to be an amazing baseball player. He wanted to be good in school.

All these things were really important to him. He ended up becoming an All-American. There’s so many things that he attributes to this. But it’s even just as little as getting to sleep earlier and getting seven to eight hours of sleep as opposed to five or six, working out consistently putting on muscle mass. His mindset of how he approached things even into just the minor details, which relates to his getting 1% better every single day.

Now, we’re going to pivot to a story about British cycling. I hope you guys are in for some stories and some analogies today. But we’re pivoting towards British cycling where there was some history about their cycling and the Olympics, which is super timely with the Olympics going on, but they were bad for a very long time. They won one gold medal at the Olympics from 1908 to 2003, so almost a hundred years and only one gold in the Olympics, in any cycling events. The recycling brands in Great Britain who didn’t even want them to rock the jerseys or the branding because they were embarrassed. They didn’t want a bad team rocking their gear. And it’s crazy because it’s the native country. That tells you how bad they were. 

And then enter Dave Brailsford. He became the performance director around 2003, 2004, and he came up with this philosophy that James Clear talks about, which is called “The Aggregation of Marginal Gains.” And this is searching for a tiny margin of improvement in everything that you do. How did they apply this to British cycling? Well, they went a little crazy, but it’s not too crazy if you’re thinking about the Olympics and winning championships. But they went from redesigning bike seats to rubbing alcohol for better tire traction, and heated shorts to keep ideal muscle temperatures. Even the degree of hiring a surgeon to teach them how to wash their hands to prevent cuts, and the list goes on. It’s really crazy how far they went to be able to optimize every single aspect of training and health and even nutrition and things of that nature, to be able to make sure how can they get as best as possible. And they were very relentless in this pursuit, especially because of Brialsford’s guidance on this. 

What was the result? Five years after he came in to start implementing all of these ideas of getting 1% better in all these different areas of training, they won 60% of the cycling events in the Beijing 2008 Olympics. From 2007 to 2017, they won 178 World Championships, 66 gold medals, and five Tour de France winners. Why do I tell you all of this? Because I’m super obsessed with British cycling. Not really. I’m just super fascinated by how can we optimize and how can we get better as human beings. And whether that starts from a mindset to habits, to actions, all of these things are super important. I want this to translate over to ACL rehab. If we think about this in ACL rehab, we have this injury, or we have this ACL reconstruction or repair, and you’re essentially kind of starting over with the basics, getting your range back, the strength, the activation, trying to get things under control. Not too much different from James Clear, except he almost lost his life. With the ACL, it’s a little different, but it’s a long recovery process, right? This is where this 1% better every single day is so important because it’s going to help set you up to hit that end goal that you are striving for and that you’re looking for. Whether that’s getting back on the field, whether that’s getting on the slopes, running again, playing with your kids, anything that’s going to make you feel like you and to feel like an athlete. 

Now, let’s dive into the concept of getting 1% better every day. What happens is there’s an overestimation of the importance of one defining moment. Let’s take, for example, you can bend your knee all the way to get that full knee flexion, or maybe you get that heel pop where you straighten out your leg to get an extension. Your quad can contract really strong, and you get that little gap under your heel. You know what I’m talking about. It’s almost like there’s this one defining moment, and that’s a little overestimated. It’s exciting, but there’s an underestimation in the value of making small improvements on a daily basis, that essentially leads up to that one big defining moment.

This can be a lot of things like crossing the finish line. In a race. Well, that’s a huge defining moment and it’s very valuable and impactful. But then there’s all the training and all the rehab and all the things beforehand that had happened that led up to this one defining moment. If you think about most outcomes, it was because of those small moments that led to those bigger defining moments. If you improve just with a concept of 1% better every day, you’ll get a significant increase when you put them all together. It’s like compounding interest for money, except it’s for self-improvement. James Clear actually says, “Habits are the compound interest of self-improvement,” which I love so much.

Let’s dive into a little math here. Keep it really simple. But there’s a really cool graph that does a great job on representing this. If you take 1% better every day for one year, let’s say 365 days, that is equated to 37 times better by the time you’re done. One percent better every day for one year, 37 times better by the time you are done. On the flip side though, is that if you get 1% worse every day for one year, you decline nearly to zero. This is really important to take because you could be either, at the end of one year, and let’s just even say from today, you could be a year from now and you could either be 37 times better, or you could be pretty much close to zero and not have gained anything and actually getting worse as a human, which we don’t want. And let’s be clear here. Sure, we can get 1% better every day, and that’s the goal. But this also doesn’t mean that every single day is just going to be perfect and you’re going to get 1% better. Let’s be realistic about life and all the things that it can throw at us. If you really lean in towards just this simple concept, it can really be a huge change for you as you’re going through the ACL rehab process or even life in general.

And if we’re taking the concept of the compound interest, the small wins or even the setbacks accumulate into something much more over time. So skipping, doing your program one day might be okay. But then if you start doing that for two to three days and then that starts to turn into weeks and then into maybe a few weeks and then into months, that starts to compound on each other. And that’s where you start getting closer to that zero. But if we flip that and you start doing stuff every day, and you do what you’re supposed to be doing and guided to, and you’re following your program, and you’re building on this small 1 % wins every single day in getting better, you’re inevitably going to be at a better outcome. You just are.

How does this specifically relate to ACL rehab you asked? And this is something that I think can be so valuable and it’s something that I talk with with all of my athletes. And instead of trying to sprint and think that one day you’re just going to do a lot, and then the next day don’t do anything. Or maybe for this one hour, we’re going to push really hard and then back off. It’s kind of like you are sleep-deprived during the week and then you try to catch up on the weekend. It still doesn’t work. It has to be something where you have to have good habits in order to make sure that you are well rested, you get that sleep that you need, and then you hit the next day. And then sometimes the ebbs and flows, but as long as it isn’t these concentrated amounts that you’re trying to catch up on.

Now, let’s apply this to ACL rehab. Let’s say you are early in rehab and this really actually is beneficial for the early stuff and the boring stuff, if you will. Where you’re trying to get your range back or maybe you’re doing stuff to try and wake your quads up, gait where you’re trying to learn how to walk. Those are all things that can get so repetitive, so redundant, and it almost makes you want to be like, “Okay, this is good enough. Let’s move on.” But if there is anything that I have learned myself going through the process or working with so many other people with this is that if you don’t do the early stuff well then you can’t do the later stuff and it ends up setting you back.

If we’re talking about the range of motion, whether that’s extension or flexion, instead of this being something where maybe you go to physical therapy and you’re just only doing stuff there. Or maybe you are at home and you only block off maybe an hour or something like that every other day to do your exercises.Let’s spread this stuff out. When it’s talking about these earlier things like gait and range of motion, maybe you hit morning, lunch, afternoon, or maybe you hit 10 every single hour. Something of this nature where you’re consistently getting in the work.

But then there’s a sweet spot of not doing too much and not doing too little. This can really help for that 1% better every day. Because if we add this up and you’re hitting your extension work and your flexion work and you’re doing these every single day with some breaks here or there, then that’s going to help you so much to be able to make the gains that you’re trying to get. Now, this is also going to vary based on the phase you’re in and what you’re working on. But we’re specifically talking about the early phases of rehab where getting that range of motion back is going to be something that you need to chip away consistently day after day with the right program.

And the same thing can be said about quad activation or gait training. Things like that is going to be something that you’re going to do most days, and then as you get into more of the specific strengthening work, that’s going to be something where you might need some more rest and recovery to be able to build back up.

But with that said, you’re still chipping away at it, 1% better every single day, and that includes the recovery days. Let’s say you have a hard training session for strengthening and some power work, then the next day you might have a recovery day, if you will, or a rest day that’s still 1% better. Because you’re choosing not to do things or overdo things, and then you’re allowing your body to repair and rebuild and recover to be able to hit that next training session.

There are a lot of things during this process I want you to think about. One of the things that stick out the most to me that can be very beneficial in those early phases because people want to just get back to the strengthening and get back to the running and jumping, all the fun stuff. But if you do the early stuff and you do it consistently, it’ll be done quickly, bearing no setbacks and it will really help you to set the foundation for moving forward. Some of these things can be getting that terminal knee extension, which is so essential, not just getting it straight, but getting that hyperextension to 5 to 10 degrees similar to that other knee. Same thing with the flexion. And then we need to start normalizing some walking. We needed to make sure that there aren’t compensations, and that you can straighten out the knee while you’re going. It feels fluid and very comfortable for you. 

I’ll leave you with this one analogy that I really liked, and it was the ice analogy from this book. What I want you to do is imagine an ice cube sitting on the table in front of you. The room is cold. You can see your breath. Currently, it’s 25 degrees Fahrenheit, and the room slowly begins to heat up, starts to get to 26 degrees Fahrenheit, 27, 28, 29, 30, 31 degrees of Fahrenheit, and still nothing has happened. And then it hits 32 degrees of Fahrenheit and the ice begins to melt. Here, we’re talking about a one-degree shift. No different from the temperature increases before has unlocked a huge, huge change where the ice was solid and then it started to melt into liquid. And these are called breakthrough moments, which are a result of many previous actions, which built up the potential required to unlock a major change. And this happens everywhere. He alludes to cancer, 80% of his life is undetectable and then it takes over in months. Bamboo is barely seen for the first five years as it’s building its roots underground before growing 90 feet within six weeks. And these habits appear to make no difference until you cross a critical threshold. You have what he calls the “Valley of Disappointment,” where this can be related to maybe those early and mid-stages. You expect to make a ton of progress in a linear fashion, and it’s frustrating because even over days or weeks or months, you feel like you’re really not going anywhere.

I mean, how many ACL athletes can relate to this where you’re just kind of chipping away? You’re like, is my range getting better? Is my knee flexion getting better? Can I really wake up my quads? All these different things that you’re working on, and you’re like, is it really getting anywhere? Even if you’re doing stuff day after day. And that’s where a lot of people will give up. They’ll be like, “Well, I don’t see any changes. Things are not working. Clearly it’s not, but we might just need to break through this plateau with these habits. And that’s where he comes in with a “plateau of latent potential,” (aka that heel pop) where you get a full extension, quad activation. Maybe you’re able to pull your ankle up, where you can touch your heel to your butt, which is always a huge breakthrough and a good feeling for a lot of ACL athletes.

And so that is the plateau of latent potential. And what happens is you might get down because you’re like, well, I’ve been working on this and working on this. But maybe you’re just in that valley of disappointment in those early to middle stages, especially when you’re starting to feel that plateau. And then all of a sudden you have that breakthrough moment. But it’s not just that one moment, it’s all of the moments that led up to it. And one of the lines that I love that he uses in the book is “Complaining about not achieving results or success despite working hard is like complaining about an ice cube not melting when you heated it from 25 to 31 degrees.” 

Just remember that your work is not wasted and that is just being stored. All the action happens at 32, but it’s not going to be an overnight success. It’s the buildup of that work that is done over time. So that 25, 26, all the way up to 31 that people might not see. And that compounding benefit that led to that one breakthrough. Relate this back to your ACL rehab, especially if you’re continuing to work on the range or you’re working on your gait or your walking. Maybe it’s trying to mitigate some of this swelling and pain that you have, and then building some strength, getting some power, getting into the running and jumping, and then back towards the actual sport and cutting and pivoting and all the things that you want to do. It’s not an overnight success. Just remember that, it’s not just this one breakthrough moment and that it’s all related to getting that 1% better. Every single day. And if that can be above getting worse every single day, then you will eventually hit that plateau of latent potential and you’ll have that breakthrough moment. You’ll get that full extension, you’ll get that flexion back, and you’ll be able to start jumping and start to move like you used to. 

This is your encouragement to get 1% better every single day as much as you can. And I’m here with you and I’ll be trying to get 1% better of myself. I’ll keep you guys accountable, you’ll keep me accountable. I hope that this was helpful for you to be able to see a little bit of insight into why that’s important and why this mindset can really make or break the difference in your ACL rehab, your recovery, and getting back to sport, which is why I think this is the most important principle ACL rehab. 

So that’s it for today, guys. The big review or takeaway from this: get 1% better every day. You’ll be 37 times better in 365 days from now. As a reminder, each month I’m picking one person to have a free strategy call. All you have to do is sign up for our newsletter in the show notes below. Leave us a review. Please just go and do that because you’re a nice human and you want other nice humans to see this podcast so they can know more about their own ACL journey and be more informed about this process.

So that wraps things up for today, guys. This is your host, Ravi Patel, with the ACL Athlete Podcast, signing off.