Episode 88 | Should You Fire Your PT?

What is up guys? Welcome back to another episode of the ACL Athlete Podcast. Today is episode 88, and we are talking should you fire your pt, your physical therapist, or your physio. And honestly, this could be anyone who is involved in your process, any stakeholders. It could be your surgeon, it could be your strength coach, it could be your sports coach, whoever it is. But today, we are going to focus specifically on your physical therapist, your physio, it could be your athletic trainer for some people, but this is essentially the person who is guiding your day-to-day in your ACL rehab. This is a question and topic that we often get from people reaching out, needing some help, or needing some advice.

This one stemmed from a PT student named Erin, who is also going through her ACL journey. She is seven weeks after her ACL reconstruction, post-op. She’s doing her rehab and she mentioned that she’s not feeling very challenged. And she tried to talk to her physical therapist and her physical therapist essentially was just like, “Nah, I think it’s good.” She’s been frustrated with her PT and with her process. She said that she doesn’t want to come off as a know-it-all. She wants to respect him and his expertise. But she’s also wanting to try to get the most out of her treatment and to have a say in that process. And so she’s asking for advice. I’m going to give you my own advice here on this situation because we have so many ACLers reaching out, asking this.

And Erin, this is an awesome question, so I am pumped to talk about this. When I first read this, immediately that popped into my head was some red flags. The main thing is the communication aspect. And my advice here is to have an open and honest conversation with your physical therapist. Communication is and should be the foundation of all relationships, especially in ACL rehab. There can be a lot of moving pieces and being on the same page with your physical therapist is going to be very key. What I suggest is to start by asking questions to gain some insight and be respectable about it. Maybe your PT has some things in their mind and assumes maybe you don’t care to know. Or maybe they’re following a protocol and are scared to deviate, or maybe they’re just too busy to really individualize, so they say it’s good. It’s what we always do. And it’s hard to know without gaining more insight from them and creating more context by asking questions.

The next thing that comes to mind is assessing the game plan for your ACL journey, and assessing the goals. So I use the A-B-Z framework with a lot of my athletes. The way that we anchor this is: A is currently where you are and Z is your end goal. What are we trying to work towards? And then in that middle B is your next step. What’s the next benchmark or target that you’re aiming for? Is it foundational strength and movement patterns? Is it return to running? Is it introducing a change of direction? In this process, we’re always aiming for specific criteria as prerequisites to get to certain points. Whether that’s achieving a quiet knee, maybe it’s capacity testing, maybe it’s strength testing for your quads. Maybe it’s doing Pogo variations and assessing competency there. There are a lot of different criteria and benchmarks that we are trying to hit. Being able to assess, okay, where am I at, your end goal. But then also knowing b, what your next step is, or that short-term goal can help to keep things moving forward.

And this helps add meaning to what you might be currently doing without really knowing it. Being able to assess and have that conversation with your physical therapist to know, okay, here’s where I’m at. What is a target that I need to aim for in the next four to six weeks so we can keep the needle moving, hopefully, they should be able to answer that. And maybe you’re unsure about why you’re doing a particular exercise, ask them why you’re doing it. If it’s too easy or not challenging, then ask. Maybe there’s a rhyme and a reason to it. Gain clarity around why. And your PT should always- and I don’t typically speak in absolutes, but this is one thing that is important to me and ingrained in me. Ever since I was an intern at UGA as a strength and conditioning coach. You always have a rationale for why. Be able to explain your reasoning and the narrative behind it, there should always be a rhyme and a reason, whether that’s the exercise, the loading, the rep scheme, the tempo, the organization of your workouts or rehab, the structure, everything.

And there might not be a randomized controlled trial for every single thing that’s justified. However, there should be a rationale for why that is implemented in your program to help move the needle. And if the response or the reason why is because the protocol says so, that is not going to work. And you’re going to need a little bit more of a critical thinking response as opposed to blaming the protocol. So that’s a red flag in and of itself, but there has to be a rhyme and a reason for everything that you’re doing. And this should be aimed towards that next checkpoint, getting you closer to your goal.

Now, let’s say that you’ve had a conversation with your physical therapist. You’ve tried to have that open and honest conversation to ask questions. You’re respectable and you’re trying to assess your goals, what you’re currently doing, and how that’s getting you closer to the next checkpoint. And for the bigger goal, which is the end goal. And you’ve done all this and you’re trying to understand why you’re doing what you’re doing. You still feel frustrated. You feel like you don’t have any answers. You feel like you’re in the dark, you’re not getting the care that you deserve. Well, guess what? There is absolutely nothing wrong with firing your medical professional and shopping for a different one.

For some reason, with ACL rehab and physical therapy, we have this innate concern that you need to be with the same person or because they are nice. Oh no, not the nice PT reason. I get this all the time. That’s awesome that they are nice. Are they good with ACLs? Are they experts in this area? Are they able to get you to that end goal? These are the questions that you want to answer. If you want nice, just go drive through a Chick-fil-A drive-through or something. They’ll be totally nice to you. But if your goal is to get back to the thing that you love to do, the thing that this ACL rehab is keeping you from, then you need someone who is an expert in this process, who individualizes things to you, who’s going to help guide you in this process That is exactly what you need, and communication is going to be the foundation for that.

And one of the questions that I often ask these athletes is: what is the opportunity cost of staying exactly where you are to be with that same person maybe who is not delivering that good enough care that you deserve and not moving forward? What’s the opportunity cost of that? Is it days? Is it weeks? Is it months? Is it not going on a certain trip? Is it not doing this specific activity that you’re aiming to do, but you don’t get there? What’s that opportunity cost to stay exactly with this same PT versus moving forward and finding someone else to serve you better? We do it all the time with everything else.

A plumber doesn’t get the job done. Guess what? You’re going to find a new one. A real estate agent doesn’t help you find a home. You’re going to find a new one. An accountant messes up your taxes and sucks at communicating. You’re probably going to find a new one. And to give you guys a specific example, my wife had a pretty negative experience with a recent healthcare provider. Guess what? We fired them. And found someone else who’s going to get the job done, who is going to communicate better, and who is going to empower her in this process, not tear her down. As a healthcare provider myself, this is so important to be able to empower folks, to educate them, to meet them where they are, to make sure that we are equipping you with as much as you can have to build you up versus break you down. There’s too much of the breaking down in medicine and creating this dependency on medicine in order to have the solution. When there are other options and other people out there who will give you the decency to take the time to be able to talk to you, to tell you about what the path is, how we’re going to get there. It does not take very much. You don’t need some super crazy skillset to do that. You just have to be a good human being and be in a system that allows you to do that. If we’re okay with firing for these other positions or jobs and finding alternative options, why would this be any different for our physical therapist, our strength coach, or our surgeon, if they are not serving you?

And this is your health we are talking about. I’d argue that this is where you should have a better filter and be more judicial in your choices than anything else. And to round this episode out, I just want to finish with any good rehab or coaching professional who will take the time to talk through this with you. They should. Education and communication are our foundation for ACL athletes. We’re on the same page with all of our athletes. If they have any questions, they know exactly how to reach us. And there is never a question that goes unanswered. We’re always going to be there to help educate anything that people want that we’re going to provide because they deserve it.

If you are someone who feels trapped in this, if you feel like your PT is not serving you, if you feel like you’re spinning your wheels, then give this process a shot. Have a conversation with your physical therapist. Be respectful, ask questions, and discuss your goals and your benchmarks. Communicate and be on the same page. If your PT isn’t checking out after trying to do this, don’t spin your wheels. Your time is precious. There’s an opportunity cost. Fire them and find another option. Find someone who cares, and find someone who can help guide you in this process. Don’t do it alone. Trust me on that. If you’re someone who feels stuck or doesn’t know what your next steps are to do this, reach out to us. Whether that’s finding another provider near you, or if you’re looking for remote options, we just want to make sure that you are taken care of and on the right path. It could be for any remote option. I don’t really care. Just take care of yourself, and your ACL rehab. If you feel like you’re not being served, then make sure you find another option.

Before we sign off, I want to share this one story that is near and dear to me. I talked about my wife earlier, and now I’m going to tell you about my dad. My dad has had health complications as he’s gotten older. He’s had some heart issues. He’s been on some medication. There’s just some things that are not controllable. There are some genetic factors. Anyway, I was in my first year of PT school. I was at a clinical, and I remember my dad telling me about something going on. So I asked him to go and get it checked out by a primary care physician. And so he did. He went in, they talked to him for about five minutes, assessed a few things, said it was muscle pain, and then sent him out the door with muscle relaxers. That was it. That night I almost lost my dad. He was rushed to an ER. He was having a heart attack. And this was all based on what was going on in his heart. He had blockage in two of his arteries. And this went unchecked, undiagnosed, nothing happened and they chopped it up to muscle relaxers and muscle tension. I was five hours away from my dad. And I didn’t know what to do. My brother and I had to immediately get in the car and drive to my dad. And I will never forget that moment, those phone calls leading up to it, and everything in between. If those medical professionals had done their job, communicated with my dad, listened to him, and referred him to the right place to get more testing done, that could have all been avoided.

And there might be so of you thinking, well, that might have been a coincidence as well as he did go, and maybe he didn’t present that way. Well, you can’t really gather that much from five minutes of seeing a human being when they’re dealing with something like this. My point of this saying is that if there had been clear communication, my dad could have been referred to a better place to be preventative on that, getting more testing and getting more conversations going about what was going on versus being sent home with muscle relaxers. Because they just didn’t have enough time to have a conversation with him. So when people ask why I’m so passionate about this, it goes much deeper than ACL rehab. It goes deeper than my own ACL rehabs, and my own experiences. It’s touching all the people who I’m connected with, whether it’s my athletes or whether it’s my family. And it all starts with being a good human being and communicating and not writing people off. This is what medicine should be. This is how your ACL rehab should be. Do not settle for anything less than what you deserve.

Man, you guys really pulling on the heartstrings today. So I’m going to sign off after that. But before I do, please do us a favor and leave us a review. Whether you’re listening on Spotify or Apple Podcast, it takes a few seconds. And it means the world to us because what happens is that we are able to reach more ACLers because it creates more reach and it helps us to educate and empower you guys to take control of your own process. That is the end goal of this podcast, with this platform so go and do it. Poured out my guts about my dad, about my wife, so help us out. 

All right, that’s going to do it for today guys. I’m going to go and find a tissue or something masculine to do. Until next time, this is your host, Ravi Patel, signing off.