In this episode, we discuss how you can help your friends and family understand the physical, mental, emotional and psychological aspects of your ACL journey. But this episode is not just for the ACL athlete! If you find yourself in a supporting role to someone going through the ACL recovery process, the analogies, POVs and resources in this episode will give you a deeper understanding of what they are experiencing.
Welcome back my ACL athletes to the ACL Athlete Podcast. If you are new here today, welcome. Thanks for joining, and thanks for hanging out. If you have any questions, if you have any critiques, go tell someone else. I’m just kidding. Please send them over my way, as we want to make sure we are providing the best resource for all of you out there. Let’s dive into today’s episode, which I’m sure a lot of you are curious about and also wondering how is this going to take shape. It is explaining to friends and family about your ACL injury, surgery, process, and everything, and this is something that I wanted to take a deep dive into. So let’s give it a shot.
I got this question from one of my younger athletes and thought it would be a great topic to focus on for today, and really a much-needed episode and conversation. And I’m going to tell you what she asked and then we’re just going to get straight into it. She said, how can I explain the situation ACL athletes, ACLers are in, the surgery, the recovery, the process, to other people? I’m an open and honest person, but a lot of the time I didn’t even know how to explain my injury and what the recovery process looked like to my coaches and teammates, along with the emotions, the failures, the tiny goals, the loneliness, the isolation, just the fear and the chance of re-injury. A lot of these things can creep up. And aside from that, it was an extensive surgery that has to take 9 to 12 months of recovery time. This is a really great question and it is not easy to answer because there’s just so much that goes into it. And really the only people who truly understand this are the people who have gone through this. And not to discredit anyone who has not, that does not mean that you don’t understand or see it. But there’s just something about walking in the shoes of someone who has gone through this injury to fully know the beginning, middle, and end of how this process really takes shape, how it impacts the psychological side, the functional side, the emotional, the physical, all the things that we talk about.
And as someone who has gone through to myself, and both experiences being so far apart and so different, it had such different implications in the current context of my life. And so I want to try and bring this full circle and talk to you guys about how to explain this to friends and family. And if you are someone who is listening, who is in support of someone who has had an ACL injury, maybe you are a parent, maybe you are a teammate, maybe you are a coach, a physical therapist, anyone who is a support role in this, I want you to take this into mind and think about just the perspective of the ACL athlete, the person that you were trying to support. And for you ACL athletes, these are just things to just kind of think about and hopefully, this can help to explain a little bit of a big-picture view but also simplified. And I’m going to try and do that here in this episode. All right, kicking this off.
The ACL is the anterior cruciate ligament, it is one of four major ligaments in your knee. Ligaments connect bone to bone, so they allow those to stay supported. And the way you can think about it is think about a major bridge and the ropes or the cords that are going to attach it to help it suspend in the air. That’s how our ligaments work in terms of our knees. But think about there only being four and you just had one of those four tears. And so you have other things to support you. But depending on the build of the bridge, as well as the other structures around it, there’s going to be a lot of gray area in terms of how it’s being truly functional and supported based on the strength as well as the other ligaments, the type of injury itself. All those things are going to play a massive role here. But it is a very big injury. And when you think about when you’re watching TV or a sport, anytime you see a knee injury, you’re always probably like an ACL. Why do people know about this? Because it’s such a common injury.
To give you a good example, this is a study from Griffin in 2006 where they saw 250,000 annual ACLs per year. And this is something that’s probably an undershot number at this point because that was in 2006. And these numbers have continued to increase since then. It happens to a lot of people. And if you look online, there are tons of people who go through this injury. And it’s one of those things where it’s not just shoulder pain, it’s not just knee pain, it’s not something that you threw your back out, it’s something that is a very major injury. And when we talk about re-injury rates themselves, one in four people can go on to have another ACL injury. I hate that that’s the number. But when you think about it, 25% roughly will have another ACL injury. That’s another long-term injury that’s just waiting to happen. And so that’s why this can be such a tough process why it’s so serious and why rehab is so important.
And to hammer some of these other statistics home, young athletes who return to sport nine months after ACL reconstruction are seven times more likely to have a second ACL entry[?] in 2020 than the percentages of actually returning to sport or getting back to the sport only 55% really return to true competitive sports, and that’s by Ardern in 2014. And then mental health, the other piece that I want to talk about, mental health is 28% don’t return due to a fear of re-injury, and that’s by Toole in 2021. These are all true, they’re statistics. If you look it up, they have some of the highest not return rates and highest re-injury rates. So that alone makes this injury really difficult.
So that creates a lot of fear around it. I know any of you who are listening right now, you have had that fear. I know I had that fear. It’s a very true thing. And so that sets in and there’s these internal things that we’re thinking that we don’t want to happen. But as soon as the injury happens, it hits you in the face. You’re not familiar with it. You have to research, you have to find potentially a good surgeon, you have to potentially figure out what graft you’re going to get, you’re going to have to figure out how to navigate the first parts of reconstructive surgery if that’s the route you go, and then you’re going to have to figure out, how can I get around? How can I do my work? How can I go to school? There’s a lot of things in question. And a lot of the time we don’t know until it happens. No one’s prepared for it until you get hit in the face. I think that’s the quote by Mike Tyson. Everyone’s all good until you get hit in the face with it, and then you get knocked down. That’s kind of how ACL rehab really is. And then it’s drinking out of a fire hose, literally. You’re trying to figure out, okay, what are the next steps? What do I do?
To bring this back around, if we’re talking about time, it is typically a 9- to 12-month recovery for anyone who has surgery. It’s a major surgery. What I want you to think about is what all goes into building a home. That’s how ACL surgery looks inside the knee. That’s why it’s called ACL reconstruction, and it’s a major surgery for your knee. And anyone who’s gone through it knows that it’s not just something where they just snipped one thing. It’s like, no, there were screws put in place. The knee was cleaned out. You have this new ACL that comes in, it’s anchored to these screws. It’s typically taken from another part of your body. Sometimes it’s not. But then that adds to the pain and the recovery. And then, if we’re talking about the graft itself. So that’s what is taken to be put in as your new ACL, takes a very long time to heal. To put this on a scale, it takes four to eight weeks on average for a bone to heal. You could break seven different bones in your body all at separate time points before your ACL is fully matured and healed, seven times. That is a very long time to be able to break a lot of bones and still not have your ACL fully matured and healed to be doing its full job.
And usually what we’ll see is ligamentization is the term. And it will take typically around two years. That doesn’t necessarily mean it’s not fully operating and doing its job, but we know that roughly around nine months to a year is whenever that maturity has reached a certain stage to be able to function well. However, a lot of research has shown us that it might take up to two years or even longer for it to fully mature into that ACL. That’s a really long time. That’s why this is so complex and so hard.
Now, let’s talk about function. You get all your basic needs completely wiped away for a short period of time, typically, walking, sleeping, using the bathroom, and stairs, for a short period of time. And anyone who is listening, who’s an ACL athlete, you’re like, yep, all this changed for me. You have to relearn the basic functions. So think about having to relearn how to walk, relearning how to sit down again. There are a lot of things that play into this. And when you start talking about pain and swelling, and no matter how much you physically want to do, you can’t necessarily always do it because you have to respect the healing and what the knee is going through. You have a lot of compromise function, especially in the beginning but again, this is typically done. This is injured when you’re doing something active. So that’s the middle to later stages of this spectrum where you can’t do the thing that you want to do, the thing that you love, the thing that makes you you. And that’ll be taken away for a period of time. That is the basic functioning of your every day, your ADLs are what we call, your activities of daily living. You’ll have to have someone to potentially support you and help you in this. No one likes to be dependent on other people. And ultimately, your function is to be able to be active, to be able to work out, to stress relief, a lot of those things can be difficult if you’re not in the right situation, and that makes things hard. You might not have the resources to be able to get all those things that you need.
Now, let’s talk about the psychological part. This is the hardest part of this process. Anyone who’s gone through it will tell you that. The mental side is so much harder than the physical. The physical is all that you typically see with people because you’ll see them in a knee brace or they’re walking around or whatever it is. But internally, there is a lot going on psychologically and mentally with any of my A C L athletes. I struggle with this so much with my first and second one, and this weighs a lot. It’s one of the things if it’s only a few weeks and you know there’s an endpoint in sight and usually with hard things, we know that there is some sort of endpoint in sight. But it’s another thing when you miss an entire season or a year of things that you really love to do, that takes a huge toll on you mentally, emotionally, and physically. And the fear of this injury is real, it really is. It’s really tough. Each person this happens to has to deal with the fear no matter who they are.
I tell you any single person that I’ve worked with, no matter the caliber of the athlete, this fear can sink to some degree. And that’s where good guidance and good rehab are going to make a huge difference in getting that taken care of. And also making sure that we’re mentally approaching this and getting that taken care of as well. Whether that’s seeing a therapist and working on the mindset pieces, that is so integral to be able to drive your behaviors and to make sure that fear is not something that will just set in and it takes time. And we need to see this physically and we also need to see this mentally. The psychological mental piece is a very big part of this. And this is my way of explaining, it’s present in everyone’s mind for a good amount of time until we are doing the right things and getting back to being our normal selves.
Next point is that it’s a lot of work. The rehab is hard. Imagine your knee hurting, getting puffy, swelling up all the time, having random aches, and always kind of thinking that you might have messed it up based on a pop or something. And so that’s common. It’s rare for people who don’t continue to experience this pain and discomfort through the process. It’s not like the first three weeks it’s pain and then all of a sudden it’s gone. It’s likely that you’ll feel the stuff through the process. It’s just fine-tuning and being able to know what is appropriate and what’s not. Especially with rehab and performance, we’re always trying to push to the edge of our discomfort and our abilities to move forward. But sometimes we can push too hard and that can also make it tough. And that’s where pain and discomfort will take its place. Plus the knee is still healing. And as I had mentioned earlier, the ligament is still turning into an ACL. And your body is trying to accept it.
The rehab process itself feels like a part-time job. Every single one of you, you’re probably nodding your head. You’re like, it feels like a job. Always working on my range of motion, flexion, my extension, and I do quad sets all the time. But then even later on when you’re training, it’s almost like your upper body feels like it might take a little bit of a hit because there’s so much focus on the lower body. It feels like you’re literally taking on a job or a major project on top of your life already.
Another piece to this is going to be that it’s out of our control. You can do every single step, you could find the best surgeon, the best physical therapist, the best game plan, you could do everything right, and things still might not work out exactly how we want it to. And that’s because at the end of the day, we’re playing against biology and the way that our knee is healing and responding and that takes a toll. Imagine doing every single thing, right, doing all your research, everything you can, and your knee is still not doing what we need it to do. That is a lot, and that’s mentally exhausting. It’s out of our control at times. And that’s the thing that, again, coming back to having good guidance and a plan, is being able to pivot to make sure that we can do what we can in our control. But that doesn’t necessarily make what is going wrong, easier to handle. It almost makes it harder because we can’t necessarily do something about it. We’re always playing against biology and trying to cultivate as much as we can of a healing environment and creating the adaptations that we want. But again, we can’t always do that so perfectly and it’s non-linear.
Another point I want to bring around here is that you might be walking around normally. But there’s still a lot that can be going on. There’s plenty of us who are walking around, doing perfectly fine in terms of just when you see them walk. The biggest thing I’ll see is that people walk off a field all the time after the injury and people assume it’s not an ACL. If there’s an ACL tear, you should be immobilized, your knees should fall apart, and there’s no way that you’re going to be able to get up unless you’re on a stretcher. And that is simply not true. I would probably say 90%, this is a random guess. But more than not people who tear their ACL L are able to somewhat walk or hobble and get off the field or the court or whatever way that they do it. They just kind of limp off and are rarely carried off or stretchered off. And then people assume it’s not an ACL when a lot of the time it can be. It just depends on the injury, what went into it, and how the knee responds.
After my two ACLs, I walked off the field. I limped, but I walked off the field. I didn’t know what happened. I just heard a pop. And then I went to the sideline and then the whole story ensued. And then going back to my first one, I remember that my entire junior year of sports was wiped out. The athletic trainer checked my ACL and they told me that it was torn, or they think it’s torn. I just knew what that was. I knew that that meant I wasn’t going to play that next year, and that was so hard for me in terms of being able to process and all the hard work that I put in to get to that point was going to be taken away from me for a year.
And so going back to this whole walking normal, people will assume that if you’re walking fine, then you’re probably back to normal. They’re probably like, hey, when are you going to start running? Or Why aren’t you running? Or Why aren’t you jumping? Or, why aren’t you out at practice again? And it might just be maybe even, I don’t know, maybe four to six weeks after your injury and you’re walking fine. You look normal. And they’re probably like, hey, well, like, when are you getting there? And you say, well, it’s still like 6, 9, 12 months away. And they’re like, what? They look at you like you’re crazy. But again, it’s one of these things when you look at the things that we’ve already talked about, that’s why it’s such a huge injury and the re-injury rates are real.
And the thing about the walking is that that is only 5% of the entire journey. Realistically, it’s a small piece. And when people don’t see a brace or they don’t see you on crutches, any type of another additional item, then they’re going to be assuming that you are on your way or you’re close to there, or that internally there might not be as much going on because clearly, you’re walking, so you’re fine. But then there’s a whole other 95% that is still not telling what internally you are feeling. I hope that that made sense there. It’s essentially that you could be walking around, but there could still be so much going on. And you could be feeling that in the knee or mentally or physically, and there’s still such a long road to go.
And this is just one thing that I want to share that a lot of us ACL athletes feel. If you’re feeling this way right now, I feel you. I remember when people were like, hey, when are you going to get back to some cutting? And I’m like, yeah, I could barely squat right now. I could walk, but I could barely squat. And this is something that is hard to see unless they’re in the ins and outs of it with you.
I want to talk about this analogy if we can. So think about building a house, and this is something that you can maybe talk to with friends, family, coaches, whoever it is to be able to explain, this is kind of how it looks. If you give them an example of building a house, ask them how long it takes to build a house. Typically, I’ll say not sure about time, but we know that it takes a while. And it’s going to depend on the type of house, the location. Is there a frame already built? Is it land? Do they have to clear it out? There’s so much. But we need to know the context. But, at the end of the day, most people are gonna recognize it’s going to take some time to build a house. It’s not going to take a day, and it will probably take months. I’ve been staring at this house that is apart from where me and my wife live. It is a bunch of these condos and man, they crushed the beginning of getting these houses up, but it has taken such a long time.
Supply issues, am I right? But literally, it’s taken so much time because they have had issues with getting those supplies. We would’ve thought they’d be done by now for how long we are here. And we’ve seen them building and the progress that they made initially. But who knows? Maybe there were some hiccups in it, whether it was internally, maybe there was some one little thing that they couldn’t get.
And so that’s another example I want to throw out here really look at it as like building a house. And that’s what we’re doing at the knee. It takes a while. We have to start with the foundation of the house. We have to build that, put it down, we have to build the first floor, the second floor, and on. And then a lot of the time the house frame is built, but the internal still needs a lot of work. The same for the knee. It might look normal. Someone might be like, you’re walking around, fine. And you look normal and done. But on the inside, there is still a lot of work to be done. And there can be setbacks and delays in the house-building process.
As I had mentioned, the supply issues, whether it’s the cost or getting the items, may cause something to break. The weather is an issue. There are a lot of things that can come on that can delay or set back the process. As I had mentioned these houses that I’m literally looking at right now, have taken so long to come to full completion after months and months. And it’s been well over a year at this point that they’re still building these homes. This is no different than our ACL process. We got to make sure that we build the foundation, we build the first floor, the second floor, and so on. And that’s going to be these different phases that build on each other over time, from range of motion to just basic walking, to strengthen different areas towards running, towards dynamic movements, towards power, towards cutting, changing direction, jumping, all these different pieces that we need to be able to add in. But it takes time. It takes time just like building a home.
And so I hope that that helps to potentially explain this to someone else, or if you’re someone listening to see how much goes into this process from the injury to the surgery or not surgery. And then the way that this has to be built out. And the knee is healing, the amount of time it takes for these types of things to take its place.
We also have to keep in mind the setbacks or the delays based on the different things that can happen. A lot of times it’s pain, swelling, maybe it’s life circumstances. But it’s not smooth and it’s definitely not linear. There are a lot of things that we did not necessarily dive super deep into, like navigating the early phases where you might not be able to put weight down for four weeks or six weeks or even longer. And then having to go to school or to work. I’ve had some people in some pretty sticky situations in terms of finances and working and recovering. It’s hard to prioritize all of these things.
And as I had mentioned, this can feel a lot like a part-time job. And then if you also tack on going to in-person physical therapy, the commuting, the driving, all these basic functions, that can be a bit tough. There are so many different areas and buckets of it that we did not even talk about today. But this is just a very big 30,000-foot view of being able to see, okay, what does this look like? How can we explain it? And my suggestion is to think about the house building and the process of it, the time, the planning, the delays, setbacks. All of these things are very natural and there’s a lot of heartache with it. Maybe you’re someone who is in the supporting role listening to this. And I hope that this has provided some clarity to you about how to better understand what the person you are supporting is dealing with.
And now I want to pivot to practical items because I think this is so key. And that’s a big goal for this podcast—how can you support your ACL or your ACL athlete in the best way that you can? And for parents, teammates, any supporting role, cheer them on like a sport, support them, advocate for them, check in with them, hang out with them. If they need a venting session because of where they’re at in the process, be a safe place for them. It’s hard sometimes because this process can be so isolating. I remember I felt so isolated because no one else was going through it. I didn’t have teammates going through it, so it was tough. And sometimes you don’t want to almost feel like you’re complaining, but you’re in this place where maybe it is very difficult and you just want to vent. Be a safe place for them, validate the things they’re feeling, and send positive vibes, whether it’s a text message or a video, or a call, just check in on them.. Make sure that they know that they’re being supported and really put yourself in their shoes.
As human beings, we can never do this enough. But especially for, if you’re like, hey, how can I help support this person? Put yourself in their shoes, and look through the lens of some of the things that we talked about today, and that’s only a drop in the bucket, realistically, of the other things that are going on in life and during this process. But it’ll help you to be able to see through the lens and be able to support them as best as you can.
If you’re a coach, maybe it’s how can they be included in hanging out or the practices or the sports or the camaraderie of it. That’s a huge piece. And then providing encouragement and letting them know that they’re a part of something or something bigger. We all want to be a part of some sort of association or group. That’s why team and camaraderie and sports are so big because we love being loyal and a part of something. So that’s how athletes can be supported by their coaches.
And one of the things I want to mention to you is that the ACL Club is a great resource. The ACL Club has its own website, which we’ll put in the show notes with pages and support. Even these like documents for you to be able to see and be able to use as a coach or as the ACL athlete themselves, or the parent or teammate. They’re really great, so we’ll put that in the show notes. They’re the guides by the ACL Club. And it’s a great group for people who are looking for more support in this.
If you are an ACL athlete listening, I hope that this gives you some clarity. I know we talked about the downsides a little bit in this episode, but I think it’s important to be able to highlight this, and explain it. And I want it to be very practical for you to be able to explain to a family member. And these are some of the things that I would essentially bring up and be like, this is honestly how it feels. And there are other things to it, but these are the big pieces; whether it’s the the time, the physical, the emotional, the psychological. Being able to also explain the reinjury rates, the degree of time it takes to rehab from this and to do it really well and come back as the same athlete you were before.
And if you are a supporting role, coach, parent, athlete, teammate, surgeon, trainer, or anyone in this process, if you’re a supporting role, kudos to you for listening to this episode because it is so important to get into the shoes of the person who’s going through this. Hat tip to all of you guys, thank you all so much for listening in this episode. This was kind of great for me to be able to explain honestly the internal feelings that I’ve felt, as well as being able to see a lot of my ACL athletes, the things that they communicate to me and the things that we have conversations about, the things that we talk about that are kind of big problems in this space. And it’s good to put this into this episode and be able to hopefully have a better way to explain to family and friends how an ACL injury is the journey, the experience. And how it’s just not a cakewalk, essentially. Allow yourself to use that analogy of building the house in order to find the best way to explain it. I think as humans, we respond best to stories and analogies, and that will help to give a very good insight. Oh, it’s not just you get the surgery and you’re good to rock and roll. It’s, no, we’re building a house here and that house is in my knee, it’s in my body, and it’s going to take some time. But we’re going to do this. We’re going to do it well. I just need your support in this and to understand it more than anything. That’s all we’re asking for.
As we end this episode, if you are someone who is an ACL athlete or maybe a supporting role, you have any questions, if you’re like, hey, I’m dif dealing with a difficult case and you need some help with it, please reach out to me and our team firstname.lastname@example.org. The information is in the show notes, so please reach out. I would love to help in any way that I can. You can reach out on Instagram as well at ravipatel.dpt. And we will chat that way. You can send a carrier pigeon, whatever you want. I just want to connect with you guys and make sure that we are moving the needle in this profession, in this rehab, in this space as best as we can. And that starts with supporting and communicating well with our ACL athletes.
And maybe your soul was touched during this conversation in the podcast today. Do me a favor, and leave a review. Give us five stars. That way we can share this with more ACL athletes, and other supporting roles who are looking for information. And that makes a huge difference because then it allows for better reach. And we just want to make sure that we can be equipped in this process. So help me out. And last but not least, share this episode. Share it on Instagram. Maybe there are certain people that will see it and they’ll be able to understand it better. Maybe you don’t even want to intentionally direct it at the person. You could share it on Instagram, or maybe you have to text it to the person to be like, hey, you’re not supporting me very well. This isn’t going well. So I’m going to send you this episode so you can get a better insight into actually what I’m dealing with, as opposed to thinking this is just a cakewalk. Share it, let them know, be supported, be supporting, and we will tune in next week and keep building from here.
All right, team, until next time. Thank you all so much for listening. This is your host, Ravi Patel, signing off.
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