Episode 90 | Top 3 Non-Negotiables in Your ACL Rehab

What is up guys? And welcome back to another episode on the ACL Athlete Podcast. Today, we are kickstarting things a little differently. And I think that in this world, in the current day and age, or at least in my life, things seem to feel fast and sometimes it’s hard to enjoy the moment or even just have a good laugh or just take a pause. Today, we’re going to pause for a second and we’re going to enjoy a dad joke, I heard the other day. Yep, a dad joke. And I currently do not have any kids and can’t wait to inundate them with dad jokes and puns and just embarrass the heck out of them. 

Here we go. I ordered a chicken and an egg on Amazon. I’ll let you know if you get it. I’ll let you know which one comes first: chicken or egg. Come on, you got to admit. It’s a good one. Don’t worry. I’ll be here every week. I know a lot of your thinking. Stick to your normal everyday job. Now, for the good stuff, the real reason why you are here. Episode 90: Top three non-negotiables in your ACL rehab. And these top three non-negotiables, they’re going to seem basic. You’re going to be like, well, yeah, that’s obvious. But I want to talk a bit more in-depth on this and highlight these areas, as well as give you these buckets that we believe make a successful ACL rehab. 

These are the three overarching non-negotiables for us and our company, as well as any other coaching physical therapy program. If you have these three things in place, you’re likely to have a very successful outcome. And what I want you to do is have an audit of your own process. If you are early post-op, maybe you’re pre-op or mid to late stages, this is something that I want you to audit yourself. And if you are a physical therapist or a coach, then this is an opportunity to audit your process and how you guide people and maybe some of the areas that could be improved as you’re working with athletes. And you’re actually going to rate these three non-negotiables as we talk about from 0 to 10. Zero being terrible, would not recommend, 10 is recommended, perfect, couldn’t be any better, and you are perfectly happy with it. Those are the anchor points of 0 to 10. 

Now, here are your three non-negotiables: testing, a plan and program specific to you, and support and guidance; groundbreaking non-negotiables. But these are the three that are going to be so key and the big overarching themes of your process. Now, there are other pieces, but if you can nail these three down, then you are going to crush it and you’re going to have a solid recovery. Do me a favor, if you think about the testing in your ACL rehab, if you think about the planning and the structuring and the programming in your ACL rehab, and if you think about the support and guidance that you get in your ACL rehab, I want you to take that scale of 0 to 10 and rate each one of those in your process. Assign a number and explain a little bit why. I’ll give you a second here to pause and just think about it. 

Now, let’s break down each of these three non-negotiables. Now, the first non-negotiable that I mentioned is testing. We refer to this as performance testing within the company. And this is basically to understand where you currently are, in order to know where you are going. You have to know where your current starting point is, and that’s going to be super important here. And this testing can look very different based on where you’re at. It could be the range of motion testing, it could be capacity testing, it might be strength testing, specific muscle groups, a big movement, it might be power testing, it might be reactive strength testing. There’s a lot of things that fall into this, and they apply to certain parts of the continuum. The most important piece here is that there’s objective numbered testing and that there’s also qualitative testing to see the quality of how you are moving. And this happens along the continuum based on what you are doing with your rehab programming, as well as some of those testing benchmarks.

And now this doesn’t mean you need to know what all those are. Although, if the PT that you’re working with can tell you what those are, that’s great. Then you can make sure that those are checked in and you know when they’re coming up or what we need to meet at that certain time point or later. But what is most important is that there is objective testing that is incorporated to measure certain criteria in this process. And if you’re not getting that, then that’s a big question mark and it’ll probably rank lower on that 0 to 10 scale versus a clinic that measures your peak quad strength and your range of motion and your Y-balance anterior reach, or maybe it’s your 5-0-5 test with change of direction. There are a lot of different measures that we take along the continuum and that’s going to match up to certain benchmarks and things that you’re looking at. And this is going to help to track progress, to know you are moving forward, you’re moving towards your goals, those milestones. And this allows us to have data so that way we can stay honest in this process.

This leads me to my next point, which is to create a plan and a program based on that testing, and that data, that information informs our game plan. What is this path going to look like for you? Is there something that we need to address right now? And what is it that this is going to look like based on your goals and where you’re currently at? We build out of the plan, and your program is going to be built specifically for you. That’s the thing in this process. If you are using a generic template or a program or random exercises, then they might be okay. But at the end of the day, you need something specific to you because every single ACLer’s injury and surgery and recovery is so different, even with the same graft types, even with, let’s say a medial meniscus repair. People are still going to heal differently.

And let’s talk about the goals and just the genetic factors, there are a lot of pieces that play into this. So having a specific plan is going to be key. And the only way we know how specific we can get is if we have testing to inform that. And that’s going to help with our plan and our programming to make sure we are hitting those specific milestones and benchmarks that I talked about. That’s how it informs the process. And it becomes this cycle, where you end up testing, and you program for that testing. And then that is going to help iterate the plan, and that’s going to help move you forward. And if it’s not, then that needs to be shifted. And usually, that comes back to testing again or adapting along the process with the plan and having the program fulfill what that is.

We have testing and we have a plan and program. And then lastly, this third non-negotiable is support and guidance. This is so key in this process. You could crush the testing and you could have a plan and program, but I really do believe that the support and the guidance are so key in this. You are not supposed to operate this road alone, and that’s we’re making sure that you can have the GPS with you, which is your support and guidance to help get you to the end destination, that’s your goal. The plan and the program are essentially the roadmap. But then you need that GPS to be able to help note, do we need to take a detour? Do we need to avoid this traffic? Oh, maybe there is a certain situation on this road. Well, let’s pivot to another direction to be able to make sure we get there, and as efficient of a way as possible.

And so for us, this all falls into our E-3 philosophy as the ACL athlete as a company. The pillars that are so important to us. Those are education, exposure, and empowerment. Education is key to make sure you are informed in this process. If you guys can’t tell, I care so much about educating you and making sure that you know what’s going on. And there’s still so much we will cover in future episodes. But we’re trying to do as much as we can to be able to push out information to help educate you, so you are in control. Again, your coach, your PT is not in the driver’s seat. You’re in the driver’s seat. Your coach and your PT is your GPS. They help you get there and assist along the way. Education helps us set the foundation.

Exposure is to help expose you to the proper stresses in your ACL rehab and life, possibly to psychological stressors that are going to be healthy for you. And that’s going to be so key in this process, especially if you’re trying to get to something that’s going to be more demanding, like cutting, pivoting, jumping, some daunting sports that might seem like a re-injury is higher to happen. Well, exposure to those environments, to those stressors, that’s what a good program all along this continuum is. It’s exposure in a graded way to the things that you need. It’s filling in the gaps and making sure there’s no stone left unturned. And that way you get to that endpoint and you are not operating blindly or wondering, is my ACL going to tear? You are sure that you have been exposed and you’ve done everything you can to be able to make sure that you are as ready as possible.

And the last piece here is empowerment. We are so big on empowering folks, and that’s through education, coaching, support and guidance. That’s so key for us with any of our remote athletes. They have a one-on-one coach as well as a whole team behind them. And that is what is so key with this process to be able to make sure you have the support, you’re being guided, you know where you’re going, and your GPS is keeping you along that path. There’s no guesswork. You’re not worrying about the assurance that am I doing the right thing, or are we on the right plan? No, we’re locked in, we’re good to go. If we need to adapt, we will. But that’s where the communication and athlete support comes in.

And here’s where I truly believe that the traditional model, whether it’s in the U.S. or if it’s international, it misses the mark on this because it’s just such a different process. ACL rehab is so different than shoulder pain, back pain, than a hamstring strain, an ankle break, you name it. It’s so different. And every single one of you who is listening to this is like, I know it’s so different. And it’s so hard to explain to anyone who has not gone through this process. And as someone who coaches tons of athletes through this, as someone who’s been through it twice, I get it. With the traditional model, there’s a lack of testing, there’s a lack of structured planning. It’s just a general protocol, typically. Not many PTs understand programming or strength and conditioning, to be honest. And so that is the thing that is tough because there is the initial acute phases where it’s pretty basic. But that’s super key to making sure we build a strong foundation. And then it should eventually look like a strength and conditioning program. That’s how your ACL rehab should be. If it is not looking like that, then that’s a big question mark. 

If you ask any of our athletes, they’re like, yeah, this basically looks like a training program. You look at everything they’re doing, they’re doing plyometrics, change of direction, strength stuff, they’re doing reactive stuff. I’m sure there’s the range of motion stuff built in and mobility X, Y, and Z. But they are doing the athletic stuff that is trying to get them to that end goal, getting them prepared, and that’s what it should look like. And I think that that’s what is tough because, in the traditional setting, it is hard for that to be facilitated, whether it’s limited insurance visits, whether it is the environment where there’s only 500 square feet to work with, or maybe it’s just machined, or it could be the skill set of the professional you’re working with.

And then lastly is the support and guidance. This is probably the biggest thing. Many people feel like their plan is unstructured. And their support to try and figure that out, the physical therapist they’re working with, the coach, whatever that looks like. It’s just you show up to the sessions, you check in, you might be pawned off to a tech or someone who’s not really familiar, and you basically have to do your rehab. And there are some touchpoints, but it feels very limited. I talk to athletes all the time who are like, I just wish I could have a conversation, I wish I could communicate, I have questions in between. 

And then sometimes it’s almost too far too gone, whenever it’s a week or two later, or maybe even longer. And they’re not able to really communicate and feel that support through this process. They don’t really feel like there’s a GPS there. They just kind of feel like, all right, there’s a person on the side of the road that you just roll the window down to, and you’re like, yeah, try this way. And then that’s how it feels versus a GPS on your iPhone, being like, all right, take this turn, do this, do that. But you know what? There’s always another route, and that’s the thing that’s most important. I did not expect to get fired up on this episode, but I kind of did and I’m not sorry about it. I hope you guys can feel that and appreciate it.

This is one of those things that means a lot to me and is near and dear. It’s why the company exists. And it’s one of the things that’s most important in this process. If you can nail down these three buckets: testing, plan and program, and guide and support. Man, you’re going to be in a pretty solid position to have a really good ACL rehab.

Now, going back to that auditing question and the 0 to 10 scale. After talking through that, how do you guys feel when you go back to look at your testing, your plan and your program that you have, where you’re at, your support, and your guidance, what would you rate that? And if it is not a 9 or a 10, then I’m going to ask you, why not? And then I’m going to ask: okay, well, is it something that is okay to let be a five or maybe a six? If it’s less than a five, man, we got to pivot, we got to do something else. Because this is like a three-legged stool and you got to make sure that all three of these are there. And if one of them is not there, then it’s going to tip over. And that’s going to be what’s going to be key here, is to make sure that there’s enough support, guidance, enough of a clear and structured plan, and enough testing there to make sure that this is a solid process for you. Nothing left up to guessing, nothing left up to figuring it out on your own. It all should be provided, specific, supported, and this is what I want for you. Reflect on that. See where you’re at. Maybe this is something you can have a conversation with your physical therapist or your coach. 

If you are one of those who are listening, then I suggest where you think you can improve on this. Can we improve in testing and build it when the client comes in? Can you make sure that you have an overall general outlook for your client by presenting a plan of the big picture and then maybe the next short-term goal? Am I providing my athlete with enough support and guidance? Am I answering all their questions? Do they feel educated, and empowered in this process? And if you’re an athlete listening to this, did you feel that? Do you feel this with who you’re working with? You do not deserve any less than this. And I know that resources can be slim and there are other options out there.

If you’re looking for them, please reach out. If you are looking for just a general direction, reach out. We’re always here to help support you guys. I get emails and messages all the time from athletes asking: hey, what should I do with this? Or, hey, I’m interested in this, or whatever it looks like. We are here to make sure that you make the most of this process, that you are not led blindly, and that you can get back to what you love doing.

All right, guys. That’s going to be it for today. The top three non-negotiables: testing, plan and program, support, and guidance. Make sure you hit those. Thank you, guys, so much for listening. This is your host, Ravi Patel, signing off.