Episode 81 | Is Your ACL Rehab Challenging You?

What is up guys? Hope you’re having a good day, a good week so far, wherever and whenever you’re listening to this. Today is episode 81, and we are diving into the question: Is your ACL rehab challenging you? And what I encourage you to do right now is to pause this episode and think about this question, answer it, and then let’s roll into it. This episode plays into my previous episode of: Are You an Athlete? And in that episode we dive into the definition of an athlete, what that looks like for us at the ACL athlete, our philosophy behind that, and how that will drive your identity and will drive your actions and your behaviors, which are going to get you to the outcome that you want. It’s really important as the foundation. And today, I want to branch off of that and talk about whether your ACL rehab is truly challenging you. And this could come from a number of different factors, and that’s part of what I’m going to cover today. And so I get messages all the time and speak with ACLers daily who need advice or help.

And one consistent theme I hear is that they are doing the same things over and over and over, with no rhyme or reason. And I ask them if it’s challenging, and oftentimes they’ll say no. I’ll give you an example. One of our ACL athletes is a high-level soccer athlete, and he was only doing straight-leg raises and hip abduction. If y’all are familiar, the four-way hip raise is the term that is usually used. These were the exercises that he was doing four months post-op at home. That was it. He wasn’t given anything else. It was just a way to work his hips. And it wasn’t even bending or anything like that. It was just straight-leg raises in different directions. His PT in-person consisted of balance exercises and leg presses. That’s pretty much it. Finally, after being frustrated, he said that was enough, and he eventually reached out to us to work together. 

First off, do you think that these types of movements are going to be challenging at four months post-op for this athlete who’s a high-level soccer athlete, do you think that that’s going to get him closer to playing soccer, which is his end goal? And this ends up coming back to poor planning and poor guidance, not understanding the goal of the person in front of you. And frankly, it was just not really good care. And I hate that, but that’s just kind of the situation that he was in. 

Let’s talk about why this happens in terms of maybe the ACL rehab is not challenging you or it’s not meeting you where you’re at. Let’s break this down. It could be based on the PT or coach you’re working with, this could be based on their expertise or skillset, the time they have available to work with you. And if I could just be honest for one second, a lot of PTs and professionals are not equipped to handle this, whether it is the skillset or the expertise or they don’t have the resources available, the time they don’t do any testing. Maybe it’s not the performance background that helps blend with this or the ability to refer out. And that creates a lot of problems, and that also creates something where it’s not as challenging for you or meeting you where you’re at. What this can lead to is an over-reliance on protocols and timeframes because they are not familiar or they don’t have the experience or they don’t have the time, frankly. You have to go to something that is a little bit more standardized and they feel relatively in control with it. 

And so that can also dictate how your outcomes are and what you’re doing at certain points in time. Because a protocol is saying at three months you need to be running when your knee still looks like a balloon, and your quad strength is 20% of the other. And this is something I hear and see a lot and it ends up coming back to who you’re working with. This can also be based on the clinic. It could be based on that environment and it not being set up to really help you well. If there’s only weights that go up to 20 pounds, it’s going to be pretty difficult to get strong and to be able to build from where you’re at. Because one of the biggest things that we see in ACL rehab is that people don’t get their strength back. And if there’s a ceiling for 20 pounds of weight in the clinic, that’s going to be really hard. No matter how much you try to use that 20 pounds, you’re going to need to be pushing way more than that. And so that’s going to be a clinical limitation or an environment limitation. And so that’s where you might have to evaluate—is your rehab challenging or not for you and where you’re at? And sometimes it’s a combination of both. Maybe they don’t treat you as an athlete as we had talked about before.

They see you and your goals of getting back to skiing aren’t as important or as intense as the high school athlete who just signed a D1 scholarship for football. Your rehab might look a little different than theirs. I’m not saying it shouldn’t look different, it’s just more so that maybe they’re not challenging you at the intensity that you would like and need just because you’re not going to something that might not seem as serious as a D1 scholarship. And these are just some of the factors that play into it. The main ones that I’ve seen and heard from other ACL athletes, talking to other professionals. And there are other things that definitely exist. 

Communication is definitely another big one that I see. And it might be something where the PT and the patient are not communicating well. There might not be enough time available to do that. But the big thing that I want to stress here is that your PT and your rehab should treat you as an athlete. Any good practitioner in this space will always scale things appropriately to fit your needs, keep your goals in sight, and continue to keep challenging you. And that’s the way that you’re going to grow in this ACL rehab process. ACL rehab should be hard and it should be challenging. I know that because I’ve been through it twice myself, working alongside many other ACL athletes who are going through this process. And this is not easy. And that’s where having someone with you and a good plan is going to be key. But you need to make sure that this is something that continues to challenge you.

Otherwise, you’re going to feel like you’re spinning your wheels for a while. And it should always meet you where you’re at. We talked about the Goldilocks’ sweet spot, not too hot, not too cold. This is always agile and can change based on the context and the needs as time goes on. My call to action for you is to do an audit of where your ACL rehab is and how it’s going. Is it truly challenging you? Do you feel like you know your short and long-term goals? Do you feel like you’re spinning your wheels? Are you getting objectively tested? And is progress being measured? Do you feel like you can communicate with your provider if things aren’t working? And I hope that you can answer yes to these. And if you can, then that’s awesome. Keep rolling. Give whoever you’re working with a high five, that’s awesome. If you answer no to any of these questions, then it might be time to have a conversation with who you’re working with. And it might be just as simple as that, having a conversation and maybe there was just a miscommunication or not being on the same page.

As a physical therapist and coach, and with our whole team, the whole goal is always to make sure that we are on the same page with any of our athletes and make sure that we are the ones who are leading, helping, and guiding. And you as the athlete do not have to do that work. That is very important in this process because we’re supposed to be the ones who are experienced. And as an ACL, you’re the one who needs the guidance and the roadmap, and that’s where we come in. 

But let’s say that you do have this conversation and they don’t care to address these concerns, or maybe they say they will and they forget or don’t do it, then it might be time to find someone else who will. There’s an opportunity cost with waiting. And I think that that is important to consider no matter where you are in this process. And if you don’t know of other options, reach out and we can help point you in the right direction. A big takeaway today is to do an audit [?] is your ACL rehab truly challenging you and then dive into why or why not. And I think that might be the thing that you need in order to move the needle in the right direction.

All right, guys, that’s going to do it for today. Make sure that you continue to keep your ACL rehab challenging, find the sweet spot, and work with your guide to get to that end goal. Thanks so much for listening. This is your host, Ravi Patel, signing off.