Episode 79 | Subjective vs. Objective Wins in ACL Rehab

What’s up, guys? Today, we have a short and sweet episode straight to the punch. I say that all the time and then it ends up being longer than it should. But today is going to be a short one, I promise you that. Today, we are talking about subjective versus objective wins in ACL rehab. And this came up from a conversation I had with one of my ACL athletes. And for her, it has not been a very easy process. We connected a little bit later after she was post-op, and there were some big deficits. She was working with someone who wasn’t very familiar with the process. And so they were super conservative and there were things that were limiting her in terms of making progress. One of those things is the range of motion. And so as we started working together, she started gaining ground on these things. But in the past few weeks, it’s been less noticeable changes and it almost fluctuates back and forth. There have been other factors in her life with work and her kid and other things that have come up that have not allowed as much opportunity to work on these things as compared to immediately post-op.

And this is one of those things that I always stress to you guys as soon as you have surgery or post-injury, get to working on some of this stuff because it will make a huge difference in terms of the later process of your ACL rehab. And so for her, it was easy to get into this negative mindset of: “Man, I’m not making any progress in my range of motion.” It’s teetering right at this, like zero or negative three. And then for flexion, it kind of hovers around 120, 110. And this could be really tough mentally if you’re two or three months post-op like she is. And we’re still working on this stuff, still trying to build strength. But sometimes people get stuck in this place where their range of motion doesn’t progress like we want it to. And there could be a number of factors out there. Why? And so while we’re consistently working on this, we’re still building in other pieces to her rehab to make sure we’re strengthening within those ranges and continuing to work on the range of motion. But one of the things that we talked about is the subjective versus objective wins.

And what I mean by this is the objective, that’s the thing that we usually attach numbers to. And that’s a lot of the KPIs or key performance indicators that we have. It might be range of motion quad strength or a leg press. All of these things that we can associate a number to or time or reps or weight that is easier to track and we need these things in ACL rehab. Super important to make sure that we have objective markers that we can track long time. And the range of motion is one of those big ones, especially early on because we’re trying to get it to match the unoperated side. That’s one of the things that we as humans will track. And even if you think about our own upbringing, like whether it’s school or whether it’s our jobs or whatever it is, we use numbers in all of those things or letters to be able to quantify how we’re doing.

And then you have the flip side of things where it’s subjective. It’s almost a bit more gray. It varies from person to person and it can be defined very differently. But it’s less of putting numbers to it, if you will, and more of a description or a bit more abstract. And so this is dependent on each and every person because their subjective experience based on their own lives is going to be very different. And so with this conversation with this athlete, what we focused on was really not getting too hung up on the objective pieces within these past few weeks where it’s easy to be like, well, my range of motion is not improving very much. We flipped it over to the subjective. And I was like, so what are some of the things that have gone well for you and what are some wins along that line? And so for her, she said that now she can drive her own car, which means that she does not have to be driven around by someone else. She could drive to the gym now, which is a happy place for her. She can go on longer walks without her knee blowing up or getting grumpy. And she also does not have a limp anymore, which is actually really great. 

Then, we can re-ingrain a good gait pattern within the range that she has. She no longer has to take two steps with each stair. You guys know what I’m talking about, where you take one step and then the next foot meets it. You take the next step and the next foot meets it. Instead, now she can alternate, which is huge in terms of just not having to be on the stairs as long and being able to move quicker. That’s a huge thing that we take for granted just like walking with crutches versus normal without crutches. It’s something that we don’t realize until we have to go through the hard way that we’re like, man, I wish I had that back. And for her, she now can do that, alternating up and down the stairs. 

The other bonus to this too, is that she can take her kiddo up and down the stairs. That’s a huge relief, as opposed to having to take one stair each time and then also worrying about potentially dropping your kid. That’s the last thing you want to worry about as a mom. And so those are huge. 

And then the last thing that we talked about was sleeping. Even that being more comfortable based on the work she’s put in, the range, the strengthening, and the knee healing, and getting to a better place, she can sleep in better positions, which is awesome. And that’s going to help contribute to her recovery and her healing process and her muscle building and all of the things that we need as she’s going along in her ACL rehab. And so these are things that are a bit more subjective. Can you tie a number to it? Sure. But at the end of the day, these are a bit more gray. It’s more of each person’s own experience, and each of you will have your own things that you’re navigating throughout your own ACL journey that might not be as straightforward as you know.

Range of motion degrees or quad strength or the weight on a back squat. All of these things are great, but there are other things that happen that are wins as well. And those are the subjective wins that I encourage you guys to also track along in this process. And I’ve done a podcast episode in the past talking about small wins that I encourage you to go and check out which pairs well with this. But I don’t want to get too lost on it, it needs to be something associated with a number. It could be something that is subjective, that is meaningful to you, that might not seem like very much. But it might just take a little bit of reflecting to see where you were last week or even a few days ago compared to where you are today.

And so that’s the reflection strategy I want you to take. At the end of each day or each week, whatever you prefer, ask yourself, what was a small win? And if you can’t necessarily find anything that is objective, and it doesn’t have to be, find something that is subjective and that is meaningful to you, whether it is navigating the stairs without having to step to each one or driving in your car to go to the gym, or being able to go on a walk. Or, maybe it’s now you can go to the pub with your friends and watch some soccer. It’s all the little things in there that add up that you’re like, wow, this actually has changed. And it might not just be the stuff that I’m doing in the gym or in my rehab that is necessarily the things that are shifting dramatically.

And just remember every day isn’t going to always feel like a win. There are going to be plenty of those days and it might be even like a week or two or even longer, where you’re not feeling like you’re making any progress at all. That’s where I’m going to encourage you to find the things that are a little less obvious, find out what they are, and reflect on them. And the goal is to use these small wins, whether they’re objective or subjective. Just categorize that as the umbrella of wins, and use that as momentum to help you with your mindset. And we know that all this is a big part of the rehab process to help drive our actions. Make sure that you are writing those down, and reflecting on them. Even if it doesn’t seem like very much, they all count and it’s going to keep moving you forward.

All right, team, that’s going to be it for today. I told you guys short and sweet to the point. Keep tracking those wins no matter where you are in the process. This is your host, Ravi Patel, signed off.