Episode 42 | Preparing for ACL Surgery – Part 3

What’s up guys, and welcome back to another episode on the ACL Athlete Podcast. Today is episode number 42, and we are rounding out the preparation for ACL surgery’s three-part podcast series. Today is part three. If you have not listened to parts one and two, I highly suggest stopping right now and going to listen to that, as it’ll be really important to put these pieces together of part one, part two, and then part three. It’s getting ready to watch the season three of Ted Lasso, except you haven’t watched seasons one and two. You got to watch it all to understand what’s going on. Go back and do that for me if you haven’t. Also, if you have not seen Ted Lasso, you definitely should. One of my good friends described it as a TV show giving you a hug, which I can confirm. It’s a great show and I can’t even think of a better TV series to watch during an ACL rehab or recovery that is more uplifting than that show. Go and check it out. 

Back to the series, part one, we talked about my own personal experience of my two ACL surgeries. I walked you through what that process looks like through my own eyes. We set the expectations of surgery ahead and what’s to really expect right after. And then we start breaking things down into buckets, starting with part two with movement where we talk about precautions, restrictions, the thought of protocols, goals, the quiet knee, crutches, pain, swelling, you name it, anything related to movement we talked about it. And I also talked about the purpose of equipment and products to help along in this process. And then in part three, we are talking about some of these equipment and products, as well as other buckets including nutrition, sleep, recovery, other completely random things like driving and showering. And stick around to the end because you’ll end up hearing from over 200-plus responses that I’ve put together from ACL athletes within this past week who have gone through this process themselves, their own advice, their own experiences, that I put together and I will share at the very end of this episode. 

This is another jam-packed episode. If you guys can tell, I’m trying to make this one of the go-to resources for any ACL athlete out there who’s going through ACL surgery and rehab. There’s so much unknown about this process and a lot of people will just be like, “Well, it’s just surgery, you’re fine.” But a lot of times this is people’s first major surgery. You don’t know what to expect and if you don’t know what to expect, it can create a lot of anxiety and a lot of fear going into it. My goal with this three-part series is to make you as equipped as possible and educated to know what it is to expect in this process, especially early on. And be able to share real-life experiences, whether that’s me, other ACL athletes, or just my own clinical knowledge of what can be helpful to help you in this process yourself.

Send this to any ACL athlete that you know who is going through this process, especially getting ready for surgery so they can be as educated and best equipped for this process. Also, shout out to you guys who have sent me messages about this series or my podcast in general. The feedback has been so awesome to hear and see. Keep that up and it means a lot to me and is the main reason why I do this podcast. You guys do the MVP. Diving into part three now. And remember, this is for educational purposes only. Each case will be different and unique. You might have to ask your surgeon or your PT or whoever you are working with, specific questions regarding your case. And look, these are all kinds of generalizations regarding the surgery itself and what to expect. Just know that it can be different, depending on your case. 

Let’s set the stage. We are assuming the date is set for ACL surgery. Next is the surgery itself. And now you have had the surgery and you’re at home, groggy, kind of sleepy right after it. We talked in the last episode about movement and those goals that are going to be the foundations and the bulk of this process. It’s a physical issue that you’ve had. Sure, there’s a mental and big emotional component to it, but physical therapy and rehab and movement is going to be the biggest piece of this. And so that’s part two where we set those foundations. And now we’re picking up here in part three with some of those movement, equipment, products, and other buckets that I had talked about earlier. We’re going to go straight into that. With the products, as I had mentioned in part two, one thing that I want you to think about is, instead of buying this laundry list of products, I want you to think about the goal of what you’re trying to accomplish. And then is there something that can help assist to achieve this goal? And what I see a lot of times is people buy this laundry list of things and they end up not using all of it. Or that might be a waste of money and that could have been invested elsewhere.

A quick example of this is, if your goal is to help with the pain that you’re feeling, then maybe it’s something like ice to put on the knee. So then that might be an actual unit, where you could buy to flow ice through, or maybe it’s just a simple ice pack. But you want to think about the goal that you’re trying to achieve, and then what equipment or tool that is going to best get you to achieve that goal. And just know you don’t need very much. You can 100% get by without having 99% of the things that I’ll even mention today. I did it with my surgeries and I know athletes who have done it without much in their own surgeries. And I just ask you to ask yourself: why do I need this product? And if you can justify it, then it might be worth the investment. But this will be for you to decide for your specific situation and just know I don’t have any financial obligations or affiliations with any of these products. These are just my experiences that I wanted to share with you lovely people. 

Product & Equipment for Movement

Jumping into the product/equipment for the movement category. If we are talking about your range of motion, some sort of yoga strap, but you could also just use a belt or a towel, something that you can make sure you anchor your foot to. And that way you can move it around, whether you need to lift it off the ground. A lot of times it’s for knee flexion, so you’re pulling it towards you. You just need something to anchor around your foot so you can bring it with your arms, back and forth. 

Quads, NMES, I’ve told you, guys, about this one. There’s a specific podcast episode about it. But if you’re looking for an NMES device, which is something that I would recommend. There’s a really cheap one called Balego NMES off Amazon for about 50 bucks. What you want to do is actually get two-by-four-inch rectangular electric pads for about 5 to 10 bucks. The reason for that is because the Balego NMES comes with smaller square pads, I think they’re two by two. It does not cover enough surface area for you to get the most out of it. And I’ve even had athletes who have switched over to these squares. They went from square to rectangular pads, and it made a huge difference in the input and the muscle activation that they got. 

Bands

Next up is bands. That is something that can be really helpful to provide resistance. Mini bands, you’ll see that a lot where people are doing more hip and glute work. And then there are those pull-up thicker bands in different variations for you to be able to do terminal knee extensions, isometrics. And the beauty of it is, is that they have multi-purpose use and you’ll use them for a ton of other things. And even, if you want to get in some rows or bicep curls, stuff like that, bands end up being really great because then you can anchor them to something and then you’re in business. 

Ankle Weights

Next up is ankle weights and you can kind of pick the weight here, anywhere from 1 to 10 pounds to kickstart some knee extension work based on your specific rehab. I have athletes pick these up because we end up doing a lot of knee extension work. And they start with isometrics and then build into a may be reduced range from 90 to 45. And then we build up with the full arc. You’ll often hear short-arc quads and then into long-arc quads, which is essentially a full knee extension. I get athletes to pick this up because we will work the quads. But this will be guided specific to your case. And this can be a very hot topic itself, which will be another episode. Always just use your brain and use the guidance of your PT to make sure you use these appropriately. But I would suggest athletes to get this, so you could start training the quads early in the process. I can list a bunch of things here in terms of strengthening, but these are the essentials right after post-op. 

And then I’m going to assume that you are in some sort of setup that you can go and utilize equipment and weights of some sort, whether that’s a gym, hopefully, your physical therapy clinic. If you are not moving towards weights pretty soon, or if you feel like the clinic only has weights up to 20 pounds, then I would suggest start looking for another place at some point very soon because you’re going to reach that threshold pretty quickly. And in order for you to get back to a full return to sport, return to performance, you need to have an environment that’s going to set you up for that. And a lot of times what I will hear is that people love their PT. They’re so nice and it’s so great and that’s awesome. But if your environment is not going to facilitate you being able to get stronger and better, then you need to find an environment that’s going to do that for you. And that might have to be you leaving the physical therapy clinic and going to another, or finding another option, or buying your own weight and being guided remotely—tons of options out there. And for us to just say, oh, the clinic down the road is the best thing, it’s convenient. But I’m going to push back against that because this is your health and this is your knee, and this is the only knee that you will ever get. 

And to really send this home, because I like to talk about homes and buildings and foundations. If you’re going to build a home and you don’t have any of the equipment that you need to be able to build the home. The home’s going to like crap. And that’s the same thing here. If you don’t have the things that are going to facilitate your recovery, then you got to look elsewhere to make sure you have the home, if you will, that’s going to be built like you want it. Sorry for my little rant, but not really, because this is really important. Let’s get back to products and why you’re here.

Ice Application

If we’re talking about pain now, we are talking about a big topic, which is icing. And this is something that you’ll hear random people say, “Oh, ice is good, bad, it helps with the healing, pain, all of these things.” Right now for where the researchers, the main thing we know about icing is that it helps with pain more than anything. And we all know this, you put ice on something and it kind of numbs the area. We just have a decrease in sensory to that area. And so then that helps to ” numb” the pain, if you will, or change the sensation that we’re feeling. Talking about the products themselves for icing, there’s Freeze Sleeves, there’s ice packs themselves, there’s an ice machine pumps. An ice machine pump is probably the most popular if you will. Those are also the most costly, you’ll see things like the Polar Cube or Game Ready. There’s all these different ones out there, and everyone’s got their own preference. Here’s just something to consider. These things can be pretty expensive. I personally had a water cooler with a pump in it, and luckily I had my old one for my second surgery so that’s what I used. It was fine. I liked it. It was a pain to change. Luckily, I had people with me to help change the water and the ice. 

Side note: If you try to get an ice pump, you probably want one that’s motorized, instead of using gravity because that is such a pain. Because then you’re going to always have to be below where the ice pump is in order for it to kind of do its job. One with a motor in it is definitely better. With that said, those also come at a price. Evaluate that for what it’s worth. I think ice packs are just as good. Another quick little tip is that instead of using a bunch of ice cubes, maybe you could just freeze a bunch of water bottles to put, instead of a bunch of ice trays or buying these big ice packs. These are just some tips that I’ve learned from other athletes as well as my own process. And just know you don’t have to have it. I know a lot of people rave about these things. I’m sure they can be great and helpful, but it is not a must in this process. And if you’re about to drop a pretty penny on this, one thing to possibly consider that has more value in the long term is maybe just using some ice packs and then investing in a blood flow restriction cuff or unit. And as of today, if I had to pick between the two, I would get some ice packs that I can use that are much cheaper, and then use that money towards buying a blood flow restriction cuff. And that’s because of just the long-term benefit that I see with this as opposed to the ice. 

Sure, it feels good. But in terms of getting the quads back and getting stronger, that’s just such a big focus for ACL rehab, and you can kickstart blood flow restriction pretty early. It’s going to be much more worth it, as well as the cost, can be pretty similar to what some of these ice machines can cost. Just something to consider. But as this episode comes out, this is my own personal opinion, get a cheaper ice pack. And then maybe put that money towards investing in a blood restriction cuff because of the reward and the gain that you get from it. To finish up this ice conversation, some of the things you can also think about in terms of guiding the on and off. Sometimes people are like, I keep it on 24/7. Again, it will be specific to what you’re using and the contact and how cold it gets, how your knee responds. But a good rule of thumb is 15 minutes on, 45 minutes off, and you can do that multiple times a day. And then just make sure that you don’t put it directly on the incisions or on the knee itself, especially if it’s a very cold surface. You want to make sure you have at least a pillowcase or some sort of pad in between where you can feel it. But not necessarily direct contact because that can also not be good for the skin sensation. So that is ice for you regarding pain. 

Medications

Now, if we jump into pain and medications, again, this is going to be based on your case and the surgeon and what they prescribe. But pain relievers and NSAIDs are often prescribed after, something to consider. As I had mentioned before, with the advice, if you start to feel the pain really set in, there’s going to be a cost and benefit to all of this. And I know most people’s goals are to get off of these things. But if you can’t sleep, or if you need to take the edge off, do not just feel scared to take it. Make sure you do it in advance and don’t let it get to the peak of your pain before you’re like, all right, now it’s time to do it. I know many ACL athletes out there would agree with me on this notion of just timing it appropriately and then obviously tapering off as soon as you can. 

The other thing in terms of medication is stool softeners. The pain medication that you get can make you constipated and it’s a real thing. I remember my first time I was like, I’ll be good. And it really did back me up. Stool softeners can be super helpful. Obviously, you consult with the medications you’re taking. But I think most surgeons and pharmacists will agree with this. So consider that in your ACL rehab process and surgery. Maybe some anti-nausea because the pain medication can make you feel nauseous. These are all the things that typically can come with this, consider those. TENS unit can help with pain as well. TENS is essentially taking this electrical stimulation and provides pain relief. It can also give some input to the quads. So, hey, guess what? If you get an NMES device, that is going to be good for activating the quads, then a lot of these units have the capacity to be set up as TENS units as well. So that is a pain for you and some things that you can potentially utilize to help with the pain. 

Swelling is probably the band of existence for any ACL athlete or physical therapist, surgeon, whoever. Swelling is just tough and it’ll be there. In terms of products, the thing that I recommend is a compression sleeve. As soon as you are able to put it on and then making sure that you wash it and keep it clean. We’ll talk about wound care in a little bit, but this is going to be one that’s really important. Make sure that you wash and just be clean people, and that’ll really help to prevent infection. But also with the swelling, a compression sleeve or stocking, you could buy a really cheap one on Amazon or find one at a local medical store to be able to use, and that’s going to make a huge difference with the swelling.

Use of Crutches

Now, if we’re talking about your gait, you want crutches. You might want crutch pads if you’ll be on them for a while. Let’s say you’re non-weight-bearing for six weeks. It might be good to have some crutch pads to create a little extra cushioning, and it doesn’t irritate the underarms. Crutch pouches are something that they sell. And if you’re… let’s say independent, for my second ACL surgery, my friends went off to Christmas break and I had to hang out at my house by myself for a while on crutches. I didn’t know these exist. It wasn’t like Amazon was delivering directly all the time. This is something that I’ve come to know from other athletes with crutch pouches. So that way you can put things in these pouches for you to carry as you are on your crutches. The other trick to this is that you can also just use a good bag or a backpack, and you probably want one anyways to make sure that you can transport things that you want to use. If you’re going from the bed to the couch or the kitchen or on the toilet, whatever it is, a handy backpack can easily do the job as well.

Wound Care & Management

And then if we’re talking about wound management, you want to make sure you’re on top of this and looking at the wound and the scarring of it over time and making sure that it’s kind of doing its process like it should. And so then you might have stitches or staples or glue and a dressing over top, and then a potential ACE wrap. Just keep it clean, guys. Watch out for any signs of potential infection. It can happen. And I’ve had some athletes who have done it because they weren’t keeping it clean or keeping an eye on it, or maybe there was something that had happened and they had to go and get it taken care of. Be clean.

In terms of some of the stuff that you’ll need, you want to make sure you have dressing and gauze and maybe some other different aspects. A lot of surgeons’ office will give you kits or little bags where it has things for you to be able to change it. Just make sure you have that stuff in order to make sure that you are able to aid the healing of the incision site and the scarring. And then one thing to consider is that a lot of people, you get scars after this. I’ve got scars and they’re great. They show obviously the process and the work that’s been put in. But you want to make sure that these scars are mobile and maybe they heal appropriately. I know they make lotions out there. Not the one here to talk about lotions. Make sure that you are able to mobilize that area as soon as it starts scarring down pretty good. And some healing lotion can kind of help with either that skin area or just kind of moving it around and things of that nature. So that’s wound management and scar management itself. 

Getting into some of these other buckets, if you will. Showering is one that comes up, shower the night before or maybe even the morning of. And then your night shower is really going to depend on the procedure, as well as the surgeon and their post-op recommendations. I would suggest following them. Usually, you won’t shower for at least a day or two after. And then you can cover it up the wound site to make sure water doesn’t make the scabs wet. You want to keep the scabs nice and dry to allow the healing process to go on. You just want to make sure that you keep an eye on those things. When you’re showering, you want to plan through your shower. Maybe the first day you get some clean wipes in case you can’t. Maybe a shower chair—people are in two camps. Some people really like the shower chair. Some people are like, it was a waste. So I’ll leave that up to you in terms of what you need. It might just be based on the setup of your own shower. Consider that. And then I know that they make these waterproof leg cast bags and you could use a trash bag. You could do all kinds of certain things. You could even let your leg hang out of the tub if you will, and sit on the edge. There are a lot of different options. Maybe you want a shower head that you can use with your hand to be able to specifically guide it. 

My suggestion is to plan through this process beforehand and just know that you don’t want to get the wound area wet for the first week or two. So you just want to be kind of careful with that until the scabs really do fall off and are further after the procedure. Plan through it. Make sure that you kind of walk yourself through it to know even crutches all the way to the shower, and make sure that you don’t slip as you get out of the shower if you’re using crutches, rubber mats, towels, just be safe, guys, because I’ve seen some dumb things happen from people and not planning through this, and then, it’s not fun. But that will not be you, so you’re good to go.

Transport & Driving

Next up is transport and driving. Again, planning through this definitely has helped the first one to two weeks after your surgery. In terms of getting ready to drive, that is really going to depend and vary based on individuals, especially if it’s going to be the left or right, knee being operated. Obviously, if your right leg is operated on, you just got to be more cautious because that’s the driving leg. You want to make sure your quads are there, your range is there, and you got to prepare for a worst-case scenario in case you need to slam on brakes, to be able to activate those muscles and to be able to adjust quickly on the fly. 

And then obviously medication comes into this. Do not drive if you’re on any type of medication that can impact your ability to make decisions. We all know that. But sometimes we just need to be told that and reminded. So here you are. Really, if you can just plan through this as best as you can to have support. Luckily there are Ubers now and Lyfts that you can use to be able to help with this process. But when in doubt, always go conservative and be safe as you don’t want to risk anything. 

Another tip here about this is to account for time in terms of if you need to get to certain places or for your physical therapy appointment. It’s going to take you longer than you think, so add at least another extra 10 to 15 minutes to whatever leave time you have for your appointment. It’s inevitable that you will take much longer because you’re not necessarily thinking about, I got to pull myself into the back seat, or I need to gather some things, or getting down some stairs, or whatever it is. Be respectful about where you’re going and just know you just need to add a little extra time to whatever it is that you’re getting towards. Highly suggest planning for that. 

Work & School

And then we’re talking about work and school. This is always another question that comes up just like with any of these different topics, it’s really going to depend. For the first week, I recommend doing as little as possible, especially for the first three to five days. Because you’re going to be tired, especially if you’re feeling that pain or maybe you’re limited in your mobility. Then, that is going to be something that you just want to make sure you plan for. And I always tell athletes to make sure that they plan for at least the first week to two, play worst case scenario in this situation. And say, “Well, I’m not mobile or I can’t get to this certain place,” what would that look like, as opposed to saying, I can get back to work or school within two to three days. Just play that worst-case scenario and then in that way, if anything, it’s going to be of good benefit to know you can start earlier and you can kickstart the process. If you have a remote, non-physical job, then you might be able to start working sooner. 

I just had an ACL athlete that had surgery on a Friday, and she started work on Monday. But she also is an IT, and so her job is pretty laidback in terms of the demand. She also told her work that she might not be able to make every meeting, or might not be able to be fully there that first week. As long as they knew on the front end, then that also gave her peace of mind knowing that she can have some days where it might be a little harder. And she even said that Tuesday was tough, so she had to back off of some things that she was doing and rest a little bit more.

If you have a physical or have to drive to a job, those are things that need to be factored in and you might need to ask for time off. I’ve had some athletes who have a physically demanding job or have to walk around a lot, and then that might be something where you just kind of work it out with work, whichever way is going to be best. But one of my big suggestions here and notes for all of you out there who are getting ready for this process, I know that each situation is different. You might have something coming up that’s really important, or maybe it’s a financial thing, and I know that all of these things will play a factor in the decisions that you make.

Do Not Rush

One thing to just think about is to make sure you do not rush back. Because I’ve seen people do this and it really derails their progress, very early. What happens is that people go back to work or school and they forget to prioritize rehab. And then is too far out and further out from surgery you are, the harder it is to get things back, like your extension and your flexion, your quad size, getting that normal gait pattern, all of these first phase goals that we’ve talked about. It is going to be harder to get the further away from surgery you are. It doesn’t mean you can’t, you’re just going to have to work harder. And that’s where I emphasize this consistency and the frequency. So then don’t let those things get in the way of you getting your knee back to the way that you want it to. And it’s going to be super important to, as I’ve said before, set these foundations because otherwise, you are going to have to work backward a little bit to catch up on this. That is just one piece of advice here from someone who has gone through the process and seen other people do this before. And then they get frustrated later because they’re like, “Man, I wish I would’ve done more in the beginning.” This is your early tip to not rush back too soon.

Nutrition

Now, let’s jump into these other buckets that are really important in this process that I’ve wanted to talk about. The first one’s going to be nutrition. This is going to be a big bucket here. You want to make sure you get adequate amounts of carbohydrates, proteins, and fats from good whole foods, especially protein is going to be big here. One for muscle building, but to preserve muscle loss and healing. So that’s going to be one of the big things. And protein is a big foundation of this. A good rule of thumb here is 1.5 to 2 grams per kilogram of body weight. If you weigh 150 pounds, that’s 68 kilograms. If we take the number 1.8 times 68 kilograms, that equals 122 grams of protein. You want to make sure you are getting adequate amounts of protein. 

And if you want specific guidance, then find and consult a dietician who can help give you a specific macronutrient breakdown for your specific case. But just to make sure you need enough protein, guys, that could be in the sense of protein shakes or meat or other protein alternatives. There’s a ton out there. So that’s something that I would highly suggest. Stay hydrated. Make sure you’re drinking electrolytes and water throughout the day. Plan ahead. Pre-made meals and easy cook and access things, especially if you’re not going to have as much help. Maybe you want to free some foods, some soups, maybe you want to order some pre-made meals, whatever that looks like for you. Make sure you plan ahead for that. So then that way that’s not a stressor to you. And then you just start binging on chips instead. And I feel you guys here, I had these Chips Ahoy chocolate peanut butter cookies that I ate a lot of and too many that I can’t say.

During my first surgery, I noticed that, and one of the things that were in front of mine for me was, I was trying to get back to my senior year of football. But also I had a previous experience of a lot of weight gain in the past when I was younger. So that was something that was definitely in front of mine. For those of you who are thinking about this, just know that I hear you and I know that it can definitely be a stressful thought. With that said, allow yourself to enjoy this process. If you can stick to 80% to 90% of you really eating well, then just indulge in some of the things that you want but don’t over-indulge. One extreme or the other of not doing anything, or not eating anything that you like, or eating too much of it is never good. It’s always somewhere in the middle. My recommendation, especially from personal experience as a chubby little Indian kid, is that you just want to be able to enjoy and be happy. And sure, you want those snacks that you like, but also just be in the middle with it. Don’t do too much, don’t do too little. 

Sleep & Recovery

This is the next bucket and this one is tough. There’s really no way around it because pain is going to be there. It’s a limiter early. And I just want you all to be prepared for it. Are you going to be an excruciating pain? Not necessarily. But it’s going to ebb and flow based on your surgery, the medication, how your body is coping, the graft itself, and the graft site. There are a lot of factors that play into this. One thing is to get into a comfortable sleep position. A lot of times you’ll have to sleep on your back, initially. Just because you need to keep the knee straight and you also want to limit as much movement because that can kickstart some pain. One thing that I am going to stress and highly recommend is nothing under the knee because one of our main goals in this early process is to get our extension back.

Sometimes I’ve seen where athletes will put a pillow under the knee because it just makes it feel comfortable and secure. And while that can be helpful at times, you ideally do not want anything underneath your knee. Majority of the time, if we’re talking about the majority 90% to 95% of the time because we want to get that extension back and that’s going to be so important. And people who end up putting a lot of stuff under their knee, especially when they sleep and maybe their knees in a bent position for too long, then that can kind of impact their ability to get to that end range knee extension that we want. It can also make the muscles tighten up a little bit back there, as that might be a “normal” position for them. I’ve seen people get contractures here, too. Don’t worry about that. Just don’t put anything underneath your knee for longer than a few minutes, or even just keep it at the 90% to 95% range of nothing underneath, and you’ll be good. And then you’ll ideally be on your back with your heel and leg elevated into extension. You want the leg elevated above the heart to help with the swelling. 

And then from a comfort standpoint, just make sure you have some blankets and pillows around you. There are some people who like the wedge pillow off of Amazon or this pure comfort pillow. It doesn’t necessarily put anything directly under the knee, but it allows you to just kind of sit your leg in this elevated position. You can also just stack up pillow cushions, which is essentially what I did. Making sure that it’s elevated, but nothing directly under the knee, especially while you’re sleeping. Be ready to take random naps of different duration all throughout the first few days to a week, especially because you’re just going to be balancing the recovery and the fatigue. Focus on getting a solid eight to nine hours of sleep each night. I know a lot of you are probably laughing if you’ve gone through this process because it’s unlikely that you’ll get that in the first few days. But your goal is to get there because healing is going to be so important during this process. And a lot of this goes down during our sleep. That’s when we recover, that’s when we rebuild all of these different components of the knee and the body. These are things to just think about as we’re prepping for our sleep and to have the best sleep that you can optimize your recovery. 

What to wear

Just dress comfortably, you’ll likely change into scrubs for your surgery. And then you’ll get back into the clothes that you wore to get there. And then make sure things fit over a knee bandage or a brace for the first week, in case you do have that or even longer. And then stuff that’s just easy to take on and off. The last thing I’ll mention here is socks. People will all the time say, get some really comfy socks because your feet will get cold. Get you some socks, get some good socks. Ask for it as a Christmas present or whatever it is. But get some nice socks for your surgery. 

Stress Bucket

Now, we’re going into the stress bucket. And this is a big one. And this is one where we’re going to talk about planning ahead and again, being able to be educated and know about this process. But planning ahead, knowing what to expect and having a plan in place, especially for any of the worst case scenarios, can really help. Let’s say you can’t necessarily get to work back in the next week, or maybe it’s a driving-type situation or transportation. It’s just going to help ease a lot of the stress and worry. I want you to be able to plan through all of these things.

And then let’s just talk about some of the things you’re going to start thinking about. I can’t move as much; I’m losing my fitness; my quad muscle looks like a hotdog; not with your friends as much; relying on help from other people, especially if you’re someone who’s very independent and doesn’t like help; even the whole driving, work, school; your sports teams or rec teams; travel, if you love to travel; all of these things can be impacted. And we know this. It’s normal to feel that anxiety, the worry, the what if, all of these different thoughts that go through our heads, as we are getting into surgery and even days and even months after. But it’s normal for this stuff to especially kick in those first few days because the surgery is fresh. It’s happened.

Now, we’re on the road and then a lot of things just really quickly change and that’s okay. And just know that it’s okay to not feel okay or have these feelings. I think that needs to be very clear in mental health and in this area, is that you don’t have to just shove this stuff down and that you need to be able to talk to somebody or to be able to have these feelings. Make sure that you’re working on a plan to be able to not let these stay around for too long.

One thing I recommend for all my athletes is to journal. And it’s really important and it’s something that can be very helpful, especially from a stress standpoint. And even something just as simple as a brain dump of all the things that are running through your mind, whether it’s I can’t be with my team; I can’t go on this trip my friends are going on; I can’t ski next season; I won’t be back for my senior year. All of these things are probably running through your head. It can be a list of different things. It can be helpful to write this out and have a journal to track it and just kind of see where you’re at. 

And then one thing I’ve talked about is focusing on that A-B-Z framework. A is where you’re currently at, and then Z is that end goal. But we need to focus on what is the next small step, which is your B. And it might just be making it tomorrow with less pain. But figure out what that B is for your next day, instead of thinking, “Man, it’s going to be a while before I’m running and jumping, and all of these things. Think about your next goal and make those very accomplishable goals to get to the next day, whether that’s even a few degrees of knee extension or flexion, or maybe it’s seeing your quads more. But celebrate those little wins and utilize this A-B-Z framework to be able to continue on the path that you want to be on. Staying busy is really important, whether that’s books or articles, podcasts, movies, shows, documentaries, video games, other hobbies, hanging out with friends. Just stay busy. And this is also a cool opportunity, if there’s something you’ve always wanted to do but never had the time, hello, you might have some time to do it now.

Think about these different areas and just stay busy. And then that way you can focus on the time you need to with your knee, and then other times you’re just utilizing your time the best that you can and not thinking about maybe all of these negative things that can really set in if we’re just kind of spaced out and not having things to do.

And piggybacking off of this whole mental health piece because I don’t think it gets talked about enough, in terms of the emotional and the mental piece. I’m going to just put it out there. I think the mental piece is harder than the physical. Sure, there’s pain and there might be swelling, and training is hard, but the mental piece is the thing that people battle with the most. And it’s something that I think is really important to make sure you’re ahead of. At any point in this process, if you’re before it, about to go into it, maybe you’re years out and it’s still something that is there and very present in this huge mental battle you’re having. Make sure you have support. So that’s where, even speaking with a sports psychologist and therapists, I have so many athletes who do this, maybe it’s mindset training. And this is something my athletes go through and we talk about. And it’s something to make sure that you address. And even though you’re doing a lot of physical therapy, there needs to be some degree of some sort of, if you will mental therapy to make sure that you’re addressing these things. 

And I will say that people who have a more positive outlook on their recovery are the ones who get back to the sport and the things and life and more confident and have the best outcomes in general. I’m going to put that out there. It’s okay to fuel these things. But at some point, this needs to get shifted towards, okay, like what is my plan, what is my next step? And that’s where we’re working with someone who’s professional like a sports psychologist or a therapist can really help with this. Start this before surgery and day 1 after.

Brain dump everything as I had mentioned before, especially if you’re fighting against a lot. And then track your progress and those little wins that we talked about on a daily basis. Literally, anything you can think of like you can squat to your chair without as much help or you got rid of one crutch. These are all wins and they’re all steps in the right direction. Just make me a promise guys celebrate every single little win, and write them down. If you want to create a note section and just write down wins, you should do it. It’s something to continue to keep pushing the needle forward.

Support System

As we are nearing the end somewhat, we’re going to talk about support as the next bucket. Your support system and community is so huge, so big. And this goes into the stress component that I talked about before. But some of them might not know how best to support you with this process, with you tearing your ACL helping you recover with being in your corner during this process. And sometimes you just need to let them know. This is not the time for you to be independent; it’s really not. Lean on your people, lean on your team, those people who are in your corner and they want to help. Every single person if you ask them they want to help and they want to be there. Sometimes that might mean you have to tell them how to be there for you. And that can really help to make it really clear, whether that is texting, phone calls, whatever it is, or just coming to hang out with you. That can really make a huge difference because they might be thinking, “Oh, let me leave them alone for their recovery” while you’re like, “I need as many people around me to be able to take my mind off things.”

Let them know. Maybe you’re someone listening to this and you’re trying to figure out ideas and understand the process yourself. Maybe you’re a mom, dad, wife, husband, teammate. Something you can kind of think about for this person who’s going through this surgery is to ask friends and family to make a video for this person right after they get out of surgery. If you’re in this supporting role, that could be something really cool. There’s something else, I think called cameo.com where you can pay a fee for some celebrity to record a message directly to the person who’s having the surgery. Maybe if someone who has an obsession with some particular celebrity, then that would be a really cool treat for them to get a video to help kickstart this process. But I think the video of friends and family with technology the way it is now. It’s a really easy way to do it. A few friends, family members, send in your best video of, “Hey, good luck for this particular athlete.” Or maybe it’s for you. You’re like, “Hey, I’m gonna really need this. I’m having a hard time.”

And then people will voluntarily do it. Make that happen. And then just make sure you have friends scheduled phone calls. Have some friends lined up to come by. I can’t stress this enough of how helpful that can really be, to be able to facilitate the process and that connection and support is so big and just as big as any of these other buckets that I’ve talked about. My support system was incredibly huge for me. And I 100% would not have had the recovery had I not had the people in my corner to support me. Really please consider this, and this is not the time to be independent. Lean on your people. Let them know how to be there for you, and that’ll make a huge difference in your own recovery.

Other pieces of random advice, stay off of Facebook and Reddit threads. A lot of times there could be a lot of negative talk, so you just want to be really careful here. You can hear a lot of honestly bad stories of people’s experiences, and you just don’t want to fill your head with all kinds of different things that could possibly happen. Stay the course, if you can. I highly suggest staying away from those, as those can be filled with a lot of people with just some like, pretty terrible situations. Most people I know end up becoming scared in the process. It’s kind of like when you Google random symptoms, it probably ends with cancer.

This is kind of along those similar lines of, well, if you go to these Facebook threads. You’re probably going to think that you have to amputate your leg. When in reality, probably not. In terms of graft, you might feel less pain with an allograft than an autograph. So that might be why you might have an easier process after because you didn’t have a donor site taken for graft. Just some caution and your experience is going to be different from maybe someone else’s. It’s not uncommon to have some things not go fully to plan after this surgery. Setbacks are normal. You’re going to have some along this process. Your knee might swell up, you might get an infection. I hope none of these things on you. Just know that this process is 9 to 12 plus months. If you expect things to go perfect during this, then that’s going to make it really hard for you to be able to navigate this in case there is something that comes up. 

Planning Ahead

Another thing that we had talked about is just planning ahead. That is a huge principle for these series and episodes whether it’s meals, cooking, cleaning, access to things nearby, shower, or transport. I have a dog, we consider feeding, getting the dog outside, working, walking, all these different things to think about. And then finally, I want to touch on the athletes who have the best outcomes. They really are focused on all these things, right? They focus on their own recovery and they don’t compare it to others. They have a positive mindset for the most part. Sure, things can creep in, but a positive mindset makes a huge difference in the outcome in the recovery. They’re very determined. They have a good PT or coach by their side throughout the entire process. I kid you not, if you look at most people who do well in this process and get back to the things they love, they typically have someone in their corner who knows what they’re doing and is specialized in this area to be able to get them to the end. And it’s planned out.

It’s not just, here’s my three months of physical therapy visits and that’s it. There needs to be someone good by your side who knows what they’re doing. Athletes who are consistent with movement from day one with their rehab and balance the move often and recovery aspect do really well. They eat well. They have good quality sleep and recovery. They manage their stress well. They have an incredible support system. And notice I didn’t say anything about any products or you need this or otherwise you’re not going to have a good one. These are all the foundations or the base of the entire process and pyramid, that you want to make sure that you are checking the boxes on. And that’s why these are most important, and that’s why these athletes who really do their best in these areas, have the best outcomes and recovery. 

Let’s cap this off with responses from athletes where I asked them, if you have gone through the ACL surgical process, what is one thing you wish you would have known prior to surgery? I’m just going to go down a list of things that they had mentioned. One of the things is prehab, prehab, prehab. I can’t tell you how many people were like, I wish I would’ve done some sort of prehab or physical therapy or something like that before to build up my leg. Another thing someone had said is, to get a good physio. Having a sports physio with a special interest in ACL is key to a smooth recovery. Not all physical therapists are trained in ACL rehab. Mental health from not being able to be active and playing sports for a bit. So that’s something that we have talked about and consider, listen to when the doc tells you to take a stool softener. Recovery is slow, early and celebrate every small victory. Eating enough calories is important for your recovery. We talked about that. Making sure that you are eating enough in good food. Mental preparation for post-op pain. Guys, this is real. It’s gonna hurt. I don’t want you to think that it’s going to be the most excruciating thing, and you’re going to be in that 24 /7 for weeks and weeks. It’s not the reality, but it is going to hurt right after surgery. Someone who’s gone through it twice talked to a bunch of athletes, those first few days are brutal. So you just need to expect that and know that. You need to have patience in the process might be one of the hardest things you do in life.

Consider life training. Learn different coping and resilient skills to be able to help you with it. Surgery is not a quick fix. It will take months to potentially years of quality rehab and good programming to get back to your goals. Use a doc who knows what prehab is and agrees with it. Prehab actually matters. Instead of I’ll just wait and get my quads stronger until I have surgery. I need to do prehab and I should have done prehab. Physical rehab was easy, but mentally I was not prepared for it. Some people can get by without ACL surgery. You can have a normal life. So that’s going to be specific to your case and depending on your goals and the way your knee is acting. So that is very much true. You just got to be able to decide for yourself and have the right people to guide you on that. 

Do not focus on timelines; focus on criteria and your strengths. This is one of my athletes, obviously. They mentioned it, and it’s something that’s really important that you don’t focus on time or these protocols based on time because they can really mess with you mentally in terms if you do not meet those criteria early enough. Focus on the strengths, focus on the specific objective criteria other than time. And then if we get into more prehab, get as strong as you can before, especially in your quads and hamstrings. In the mental aspect, be prepared for your leg to get smaller. Backpacks are really helpful. Everyone recovers at different rates.

Be prepared for lower energy because of the early days. You’ll need help from others for your support. And it’s okay to ask. Understand your specific graft type as it’ll be helpful to know why there might be pain in the specific area. I highly recommend that as well. That is a really good point here. Know that flexion will come with time. And you need to get your extension as quickly as possible. Not every crack or pain means that you’ve messed something up. I’ve talked about this before. You’re going to feel a lot of these things and feel like you did a lot of weird things to it, or you might have messed up the surgery. And again, it’s going to be on an individual basis. But just know that if you haven’t had something super traumatic and your knee doesn’t look like it’s dramatically more swollen or unstable, or things like that, you’re probably okay. When in doubt, ask your surgeon or your physical therapist. 

And last but not least, I love this one. Remember that this is your own story that you’re writing. You won’t have the same complications or even successes as you’ll read on different groups or Facebook threads or Reddits. Again, stay away from those. But this is your story you’re writing. Don’t compare to other people that you see. You’ll see a lot of things on Instagram where people might be like, back to running in eight weeks. Guess what? They’re probably going to have some issues if they’re running at eight weeks. With that said, compare yourself to yourself and run your own race and write your own story. Really beautifully said here.

In summary, set your expectations, plan ahead, set up your environment as best as possible, and focus on these different buckets that we discussed, whether it was movement, nutrition, stress, sleep recovery, your support system, or any of these other areas. Remember, you do not have to have any of these products or equipment. Some can be helpful, but it’s not necessary. But focus on these different buckets and you will have a very complete and thorough plan to attack this ACL surgery and your ACL rehab and recovery. 

All right, guys. I hope that this was helpful. I know it was long, but I wanted to make sure that this is thorough and that you have everything at your disposal.

Again, please share this with others. If you have any feedback, please send me a message on Instagram at ravipatel.dpt, or send me an email at ravi@theaclathlete.com. And please, if you have the time, leave a review. Give me some feedback. Please let me know how this is for you.

And as you leave a review, just know you’re doing a benefit to other ACL athletes out there, who are able to see this, and it allows them to get more exposure to this. And that is my goal with these episodes, with this podcast. So please do that for me. That’s going to be it, guys. I have spoken a lot. And these have been some long episodes, but I appreciate all of you for hanging there with me.

Thank you so much for listening. This is your host, Ravi Patel, signing off.

List of Products Mentioned:

• ACE Wrap
• Ankle Weights
• Balego NMES unit
• Bands/ Mini bands
• Compression sleeve/stocking
• Crutches
• Polar Cube or Game Ready (ice pump)
• TENS unit
• Yoga strap/towel