Episode 285 | The Mental Toll of ACL Rehab Nobody Talks About

What is up team? Today, I just want to get straight into it. I have been doing a lot of thinking, and at this point, I have taken thousands of ACL athlete calls from all over the world, with people in every different stage of the process. We are talking about everything from post-injury, right after the ACL tear, all the way to years and years out. That could be one year, two years, or even 20 years after the injury. You would be surprised by the conversations that come up.

I have been reflecting on these calls with ACLers, some of whom we are fortunate enough to work with, and others who decide not to move forward with us for a variety of reasons. I think about these conversations often and reflect on what people are truly dealing with. It is hard for me not to connect myself to these stories because of how many challenges people are going through during this process.

Recently, there has been something about the nature of what we do, where people are simply running out of options and looking for help. Maybe we are naturally seeing more of these really difficult and complex cases. Of course, we also see people on the front end who are being proactive, and we love being able to jump in early. But we see a lot of hard cases, the ones where people have seen three, five, or even 10 different providers throughout their rehab and still are not getting the results they want. They are searching for options that exist, and we are fortunate to be one of those options for some people.

When I talk with many of these ACLers, there is something happening underneath the surface with what they are dealing with and what they were never prepared for. There is a lot there. As you guys know, I share a lot of this through the podcast, including the misconceptions in this space and the things that often miss the mark.

The thing I want to talk about today, more than anything, and this comes from going through two very difficult injuries and recoveries myself, along with thousands of conversations with ACLers, is that no one prepares you for the mental toll of ACL rehab. They just do not. Whether you are fresh off the injury, just coming out of surgery, months into rehab, or even years into this process, every phase brings its own challenges.

As soon as someone thinks they are through the post-op phase, another challenge appears. That is life, and ACL rehab is such a good example of that. Every phase has challenges, but they all share one thing in common: nobody really warns you how mentally difficult this will be. The surgery gets all the attention. The injury gets all the attention. The physical rehab gets all the attention.

What almost nobody talks about is what this does to your mind. That is what today’s episode is about: the mental side of ACL recovery. If you are feeling this right now, I want you to hear this from me before we go anywhere else in this conversation. I see you. I see you specifically, and I want you to know that this is something that weighs heavily on my heart because it is very personal to me. It is honestly a little strange because this is making me emotional.

But here is the thing about this injury: it takes something you care about and puts it on a shelf for well over a year, sometimes much longer, depending on your journey. We often use this nine-to-12-month range when talking about ACL recovery, but that is not always the reality for everyone.

There are people who rarely finish earlier than that, and there are many people who go far beyond 12 months. Yes, we use that range as a general framework, but in reality, recovery can span 18 months, 24 months, or even longer before someone truly feels like the injury is no longer a barrier.

When this injury takes something away from you, it takes the court, the field, the slopes, the trail, or whatever that thing is that gives you life and makes you feel like yourself. When that is taken away from you, you lose a major part of yourself.

I have experienced this so much throughout my life, and that is a huge reason why this podcast exists and why our company exists. We are trying to help give you that thing back. Whether that means equipping you to take on this journey with your own team or helping guide you through the process ourselves, the goal is the same. We want to make sure you get there because this injury takes a lot from you. It takes away a piece of who you are, and many people do not realize that until they are deep in the process.

Some days, it feels like you are moving mountains just to get through a normal day, doing things that you used to do without even thinking about them. On paper, yes, this is rehabbing a knee. But it is also rehabbing your headspace, your mindset, and your psychological health. Those two things are happening at the same time: rehabbing your knee and rebuilding yourself mentally.

The problem is that only one of those things gets talked about. When you first injure your ACL, there is pain, swelling, and limitations. Then you see the surgeon, usually get an MRI, discuss surgery, talk about rehab, and receive a timeline for recovery. Even during physical therapy, the focus is on all the physical components of recovery.

But how often does your surgeon or physical therapist actually ask about the mental side? How often are they talking about your mindset, your fears, your confidence, or how you are handling the process emotionally?

There are mindset coaches who help athletes deal with performance challenges, trauma, and barriers in life. Yet for some reason, this major injury that influences so many areas of your life often gets treated as only a physical problem.

And yes, some people will say, “We talk about the mental side,” or “We address some psychological aspects.” But in many cases, it is just surface level. The reality is that the physical side is still where almost all the attention goes, and even that does not always hit the areas where people actually need support.

And I understand why. We are physical therapists, and our role is to help rehabilitate the knee. That is what we see, and that is what we are trained to guide people through. But it is a complete disservice to ignore the mental side, to not talk about how you are doing, how you are navigating this process, and how we are managing your expectations throughout the journey.

This is something we focus on heavily with our athletes. If you looked at the education process when athletes start with us, you would be surprised by how much goes into building that foundation. We are not trying to overwhelm you with information or firehose you with education, but we are making sure you understand what this process actually looks like, no matter where you are in your recovery.

I cannot tell you how often we have to address the mindset before we can truly maximize the physical side. This starts from day one, whether you are doing prehab before surgery, you are early post-op, or you are someone who is 10 months or two years out and still trying to figure things out. The mindset component is always there.

Every single week, there is something for us to address mentally. Sometimes it is through reflection-based conversations. Sometimes it is reviewing certain philosophies, working through exercises, or having conversations with your coach. These things matter because the physical side of ACL rehab gets 99.9% of the attention, while the mindset side is often something that gets added on afterward, if it gets addressed at all.

A lot of people think recovery is clean and linear. They think, “I will be the exception. I will work harder than everyone else. I will crush this. I can outwork any setback.” But the reality is that you are going to experience a rollercoaster throughout this process.

No one is immune to this. Not professional athletes. Not the most organized, type-A person. Not the person who has every detail planned out. We are dealing with life, human biology, and factors that we cannot fully control.

That perfect linear recovery you imagine is not going to happen. As most of you know by now, that is usually not how ACL rehab works. It is a rollercoaster, and it is not just during the early months after surgery. It continues throughout the entire process.

You can be riding high one day, feeling like you finally turned a corner, and then the next day, your knee decides to swell up and get irritated. Suddenly, you are dropped into a low. That low can create a spiral where you start thinking, “Great, now I am going to be set back another two months. I am never going to get back to where I want to be.”

Those negative thoughts start creeping in. And here is the frustrating part: despite all your wins, the negative moments often hit harder. Think about your failures compared to your successes. Which ones stick with you more?

For me personally, the things I missed, the things I did not achieve, and the things I considered failures are often the things that hit the hardest, even when I accomplished something amazing afterward. That is still true today as a parent, a husband, a business owner, a leader, and just as someone trying to navigate life.

The setbacks hit harder, and ACL rehab is no different. I remember feeling that constantly during my own recoveries. And sometimes it is not even a bad day. Sometimes you are simply burned out.

You have been doing this for a long time. You are putting everything into your recovery, but the progress does not feel proportional to the effort you are putting in. That feeling is real.

We have so many athletes who are pushing hard and thinking, “If I could just do more.” They are following the plan. They are doing the work. They are checking every box. But they are still dealing with a knee, biology, and life circumstances that do not always respond perfectly.

Sometimes, there is nothing else you can do except continue showing up, stay consistent, and keep moving the needle forward. That is what makes this process so difficult. You can do everything right and still have moments where it feels like you are not progressing.

I am sharing this because I genuinely hope this connects with you. I hope you feel seen. This is something that is not talked about enough, and it has been weighing heavily on my heart to share this message.

I want you to picture this. Maybe you are eight months out. Maybe you are 10 months, 11 months, 12 months, or even 18 months into recovery. You look down, and your quad is still not fully back. You are still not on the field, the court, the slopes, the trails, or whatever environment matters to you. Maybe your thing is rock climbing. Maybe it is free diving. Maybe it is something completely different. Whatever it is, the anxiety and fear are still sitting right next to you. They are riding shotgun every single day.

It can feel like you are stuck in an endless tunnel. Everyone talks about the light at the end of the tunnel, but if we are honest, sometimes it feels completely dark.

And here is what I need you to hear in that moment: this is more normal than you think. It is much more common than people realize. Most of you listening are dealing with some version of this exact experience. This is not the exception. This is not a small group of people. This is the majority of ACLers going through this process.

And I am not saying this from the outside looking in. I am not just someone observing this. I have felt this in my own body and experienced it firsthand.

I have had two ACL tears of my own, one in high school and one in college. Neither recovery was smooth, and both came with their own challenges, including struggles with the mental health side of recovery.

More recently, I went through a major hip procedure. I essentially had a total hip replacement, with the exception that the entire joint was not removed. My hip was dislocated, and I had a metal implant placed because I had osteoarthritis that was not improving and was drastically limiting my life.

That put me right back into the same mental space. I am a little over a year out from that procedure, and I am still not fully there. There have been lows. There are still moments in the gym where something happens and I question whether everything was worth it.

But when I look back, I see that I stayed consistent. I had a coach in my corner guiding me. I trusted the plan. And I am in a much better place now than I was before surgery. But it has not been sunshine and rainbows. I still have moments where I wonder if I will ever feel normal again.

And I put “normal” in quotes because I have had to redefine what normal means for me. Not because I am afraid of what my future looks like, but because I understand that my hip is different. My knees are different because of the surgeries I have had.

That does not mean I have to limit myself. It does not mean I have to lower my goals. I can still strive toward the things I want to accomplish.

Going through two ACL injuries did not make this easier. If anything, it made it harder because I know that tunnel. I know what it feels like when there does not seem to be any light.

And the thing I want you to lean into is this: even when it feels dark, light does show up. It takes time. It takes work. But it does come.

When I talk about this, it is not just theory. I am not a physical therapist, simply telling you that your knee will get better. I have lived this. I have walked through it myself, and I have watched hundreds and thousands of ACLers experience this same journey.

There is another part of this process that nobody warns you about, especially with a physical surgery and rehabilitation like ACL recovery.

At some point, people stop asking. The brace comes off. The crutches go away. The visible signs of injury disappear. And suddenly, everyone around you assumes you are good now. You look fine, so you must be fine. That is what people think. They do not understand the difference between looking recovered and actually being recovered.

You will have people say things like, “Oh, you are probably back to playing soccer now,” or “You are probably skiing again,” because from the outside, everything looks normal. They do not understand that you might only be two months out, that you are still rebuilding strength, confidence, and trust in your knee.

You are still in it. You are still in the thick of it. You are still carrying the weight of a long-term recovery, but now you are doing it more quietly. The world feels like it has moved on, but you are still right there in the middle of it. That is an incredibly lonely place to be, and we see it constantly.

We see ACLers who are 12 months out, 18 months out, 24 months out, and even years beyond their surgery who are still carrying this. They are still trying to figure out what is missing. They are still searching for answers.

We have had recent ACLers start with us who are in these exact timeframes. Yes, we have athletes who join us pre-op or early after surgery, and we love being able to start with people as early as possible. But we also see the harder cases, the people who have worked with others for a year, two years, three years, or even longer and are still looking for help. They are carrying this weight with them.

If that is you, I want you to hear me clearly. If you are months out or years out, you are not broken. You did not necessarily fail somewhere. There could be a system issue. There could be a physical therapy issue. There could have been poor guidance from the beginning. There could be many different factors involved, and unfortunately, we see that often.

But this is not automatically your fault. Now, if someone did not show up, did not put in effort, or completely ignored the process, then yes, there is ownership that needs to be taken. We all have responsibility for our own recovery.

But if you showed up, you worked hard, you followed the guidance you were given, and you are still feeling stuck because the guidance was not there, the expectations were unclear, or your knee simply is not responding the way you hoped, that does not mean you failed.

You are dealing with a part of this process that nobody handed you a roadmap for. And honestly, I wish there were a clearer roadmap, especially for the mental and emotional side of recovery.

There should absolutely be a roadmap for the physical side of ACL rehab. You should know what the process looks like, what milestones matter, and what direction you are heading. But the mindset side is something that is often left unaddressed.

The reality is that this was never just physical rehabilitation. It is mental and psychological rehabilitation too. It is the same recovery with two different halves.

And for many people, the mental half is actually the harder one. It is the part that gets ignored, even though it can have the biggest impact on how someone experiences their recovery.

If you are feeling any of this, here is what I want you to take away: you are not the only one. You are not weak for feeling this way. And you are not alone. This is something that the majority of ACLers experience in some form. You do not have to carry it by yourself. Tell someone. Lean on the people in your corner. Use your team.

I cannot tell you how many athletes we talk with regularly who simply need someone to help put their anxiety at ease, someone who can help bring clarity to the unknown, and someone who can remind them where they actually are in the process. That is our goal. We want you to have clarity every step of the way. Whoever you are working with—your rehab provider, your coach, your physical therapist—they should be guiding you through this process. They should be like a Sherpa helping you climb Mount Everest. That is what this should feel like.

They should understand the conditions, know when to push forward, know when to slow things down, and be thinking several steps ahead so they can help prevent problems before they happen. Your team needs to be dialed in.

When we start talking with athletes, one of the things we hear often is, “I can finally breathe.” They feel like they do not have to carry the entire weight of the process alone anymore. They do not have to constantly search Instagram or YouTube for exercises. They do not have to piece together their own rehab plan. They do not have to constantly question whether their physical therapist is giving them enough.

Because that uncertainty is one of the things that impacts your mental health the most. And one of the hardest parts of ACL rehab is that the further you get into the process, the more people assume you should be able to handle it yourself. Especially if you have been cleared by your physical therapist or surgeon, deep down, you know you are not actually where you need to be.

That is where things become challenging. You need to communicate that with someone you trust. You need someone who understands what you are feeling and can help you navigate it. And if you do not trust that person, find someone else. Find someone else. No one should go through this alone, regardless of where they are in the process.

If things are becoming really heavy, if it feels dark, talk to someone who can actually help you carry that weight. That could be someone you trust personally, or it could be a professional who specializes in mental health.

We work with mental health professionals, including therapists and psychologists, who we can refer athletes to when this becomes a significant barrier in their recovery.

Because every ACLer is going to deal with the mental side of this to some degree. The question is whether it becomes something that prevents you from moving forward. And we see that happen often.

For someone who has gone through multiple ACL injuries, someone with big goals and high expectations, this can become one of the biggest bottlenecks in the entire process.

That is why we want to make sure this support is available. Working through this is not separate from rehab. It is rehab. Talking through your fears, managing your expectations, and addressing the psychological side of recovery are all vital parts of the process.

We are also working through this with objective measures. We are tracking progress. We are assessing where you are physically and mentally because that matters in ACL rehab and any major physical recovery, especially when we are dealing with high re-injury rates and the challenges that come with returning to sport.

When you talk to a professional or reach out to someone you trust, that is not a step backward. It is not a sign that you are failing. It is actually a sign that you are taking ownership of your recovery.

That is what we are trying to be here at The ACL Athlete: someone who sees the entire picture. Not just the knee. Not just the exercises. Not just the physical milestones. We want to see your mindset, your confidence, your goals, and the entire journey you are going through.

It is not just about the first few months after surgery. It is not just about one phase of rehab. It is the whole thing.

The goal is to support you until you feel like yourself again. Until you feel resilient. Until you feel strong. Until you have those freakishly strong quads and you are confident doing the things you love again.

If you want that support, we are here to help. This is not about pitching anything. It is about making sure you feel heard because that is what matters.

I was honestly debating whether I should do this episode, but it was something that kept weighing on me. Maybe it is becoming a dad and hearing more of these conversations and stories, but there was something about this week that really hit me.

I just wanted to share this with you because I do see you. I see what you guys are doing. I see the work that happens behind the scenes. I see the parts of recovery that nobody talks about. 

To every ACLer who is grinding through the hard part right now, especially the ones who feel like the mental side is not being acknowledged, I want you to know that I see you. Keep going one step at a time. Celebrate the small wins. The small victories matter. The days where you show up, even when you do not feel like it, matter. The moments where you choose consistency over frustration matter.

This process is not easy, and nobody should pretend that it is. But you are not alone in experiencing the difficult parts. Keep moving forward. Keep leaning on your team. Keep asking questions. Keep advocating for yourself. I will see you all in the next episode. Until next time, this is your host, Ravi Patel, signing off.