Episode 300 | Losing Your Outlet After An ACL Injury

Okay, it’s typically the time when you are physically active. You are doing your thing, whether it is early in the morning, around lunchtime, or in the evening. Maybe for some of you, it is after school or after work. It could be any part of the day, and it could be at the gym, running, at practice, on the trails, on the mat, or on the court, whatever your version of being active looks like.

Let us throw out 5:00 PM. It is now 5:00 PM, or whatever time you would normally train. You are on the couch with your leg elevated, and you have no idea what to do with yourself. The day was stressful. You had a lot going on, and the pressure is still sitting on your chest. The one thing that always took the edge off is not necessarily available anymore.

If that is where you are right now, this episode is for you. You do not necessarily have that thing you have cared about so much, the thing that allows you to be yourself and allows you to move. That is what we are talking about today, so let us get into it. Thank you so much for being here.

Today is episode 300. That is a pretty big deal. It is essentially 300 straight weeks of this podcast coming out, and it is something I am incredibly proud of. I did not even know what would come of this podcast when I started. I was just putting things out there and trying to organize my thoughts so I could make sense of them. It has become useful to you, and hearing that has meant so much to me. I am incredibly appreciative of what this has become.

This is not stopping anytime soon, and I am proud of these 300 episodes. If you are listening, thank you so much for your support. If you have just started listening, thank you for joining us. I hope you get something out of this that helps you feel a little better. The world can feel heavy right now, and the ACL rehabilitation process can feel even heavier. My hope is that this episode gives you some answers, some clarity, or, more than anything, the feeling that someone sees and understands you.

I am going to keep this episode short because I have gone on a few tangents in previous episodes. I apologize for that. I am not intentionally trying to stretch these episodes out, but I have had a lot to say recently. My goal today is to keep this brief.

I want to do two things. First, I want to say out loud that losing your outlet is one of the hardest parts of an ACL injury, and it is not discussed enough. It is often treated as something you just have to deal with. But you lose something that is incredibly important to you. If your activity is seasonal, you may lose the thing you love most right when that season arrives. For most people, an ACL injury changes their lives drastically, and we do not talk about that enough.

I see you. I have personally dealt with this many times in my life, including last year when I had my own major hip procedure. I resonate with what you are experiencing because it sucks. I get it. 

Second, I want to give you a few practical things you can do about it. That does not mean you cannot complain about what you are going through. It is okay to feel frustrated, to let it out, and to acknowledge how difficult this is. That is important, rather than always telling yourself to get through it and celebrate the small wins.

Yes, those small wins matter, and they help maintain momentum. But it is also okay to have difficult moments. As athletes going through this process, we need to be able to experience those moments and then work through them rather than staying stuck in the misery. Sometimes, expressing those feelings can be cathartic, and I think it is necessary because people do not always understand what someone is experiencing when they are in the middle of this process.

As much as I would love to say that you do not really understand until you have walked in someone else’s shoes, even every person’s journey is different. It is difficult to generalize the experience across everyone going through ACL rehabilitation. But I want to be transparent and real about this. When people hear about the ACL process, they think about the knee, the physical injury, the ligament, the surgery, and the rehabilitation. They think about the physical side of it.

What they do not see is what you actually lose. You lose the thing that might get you out of bed in the morning. You lose the thing that drives you, makes you feel strong and confident, and allows you to feel capable and like yourself. ACL injuries do not happen exclusively to people who are physically active. We have seen people who are sedentary experience an ACL injury through an unexpected accident, whether it is a car accident, a fall from a chair, or something else entirely.

However, I would estimate that more than 95% of the people we see with these injuries were doing something physical when it happened or had physical activity as an important part of their lives. That is one of the hardest parts of this injury because the thing you lose may also have been the place you went when work was crushing you, your kids were having a difficult day, school felt overwhelming, or you were feeling pressure from your peers. Whatever your circumstances, I understand how much that outlet can matter.

Your brain might not shut off. You have so many things weighing on you, and the general pressures of life do not stop just because you have injured your knee. I have been there. I tore my first ACL when I was 16, and I could not play sports during my junior year of high school. At that age, sports were essentially my whole personality. I played sports year-round, and my friends were involved in the same activities.

When I tore my ACL, I had to watch from the sidelines and participate in ways that did not involve being active. I could not exert myself in the same way, and it sucked. I had to take time away from sports to rehabilitate my knee and try to get it back into a better place. I also missed some of the hangouts my friends would attend, whether it was going to the lake or the beach, riding bikes, or simply spending time together.

These might sound like small things, but for someone who is 13, 14, 16, or 18 years old, they can be a big deal. You are losing physical ability, but you may also be losing social opportunities and experiences that matter to you. My world was not that big at the time, but it was still my world, and that is what matters. This is particularly important for younger athletes to understand.

My second ACL injury happened during my senior year of undergraduate school. It was a completely different stage of life, and going through the process a second time did not make it easier. In some ways, it was harder because there were more setbacks. I did not necessarily have the same people available to care for me as I did in high school, so I had to navigate the process more independently. Financially, I was also in a much more stressful position.

I had put a lot of effort into taking care of my body and getting into good shape, and the injury disrupted all of that. Because it was my second ACL injury, I started rethinking a lot of things and became more fearful of the process and reinjury. I was also applying to graduate school and trying to figure out what came next in my life. I was worried about whether everything was going to work out, and I was carrying a lot of stress.

The difficult part was that I could not release that stress in the ways I normally would. I could not simply go for a run or head to the gym for an intense full-body workout. I felt limited in the things I could usually do to help myself decompress. I know many of you can relate because physical activity does more than help you stay fit. It can help you process your emotions, release stress, and feel like yourself.

The same thing happened with my hip procedure last year, although my circumstances were completely different. I had a child, I was running a business, and there were many moving pieces in my life. Once again, I felt limited by my ability to be physically active. I have also struggled with my weight throughout my life and have had to work hard to manage it. As a child, I was significantly overweight and was picked on, so this has always been a sensitive subject for me.

Those old feelings started coming back. For some of you, there may be a similar personal or physical component to the loss you are experiencing. Perhaps physical activity is closely connected to your identity, or perhaps you are worried about changes to your body. Those feelings can become layered on top of the injury itself, and I want you to know that I understand.

During ACL rehabilitation, the focus can become so heavily centered on the knee that everything outside of it gets pushed aside. I talk to ACLers every week, and although their lives may look very different, I hear similar stories. There is the medical student who goes to the gym between lectures to keep their head clear. There is the busy mom whose 6:00 AM workout is the only hour she gets to herself before a chaotic day begins. There is the CEO who runs at night to process the day, the nurse who finishes a 24-hour shift and needs to move, and the software engineer who sits at a desk for 10 hours and looks forward to lifting weights or climbing in the evening. There is the high school athlete whose entire friend group is their team, the skier facing a winter they might miss because their sport is seasonal, the hiker, the climber, the lacrosse player, and the weekend warrior who simply wants to feel like an athlete.

These people have different lives, but they face a similar challenge. They feel limited in the activities they care about, particularly the outlet that matters most to them. Here is what I want you to hear: “you are not necessarily being dramatic, weak, or negative.” It is fair to feel what you are feeling. You have lost something that was doing a lot of work for you, and you might not fully appreciate how much it mattered until it is gone.

Even something as simple as walking can be taken for granted. When you are on crutches and cannot walk normally, you realize how much you underestimated the ability to move around without thinking about it. When you eventually get that ability back, you may feel grateful for something that previously seemed ordinary. The same principle applies to the activity that was important to you. It helped you, and feeling the loss makes complete sense.

Give yourself a day or a week to be upset about it. You do not have to find the silver lining today. You might be going through a setback and have less flexibility or direction around how to stay active. Perhaps every time you try something, your knee flares up, or your progress is not going the way you hoped. That is okay. I tell my athletes that when they feel this way, they should allow themselves to feel it, work through it, and then try to move forward.

If you need more time to process everything, that is completely fair, too. People can experience burnout during this process, and there can be a lot happening outside rehabilitation itself. We have athletes who lose family members, deal with pregnancy-related challenges, experience work stress, get laid off, or try to get into schools or reach certain levels in their sports. There are so many things that can compound the feeling of not being yourself.

You can give yourself the time and opportunity to work through those experiences rather than feeling that you must immediately be strong, push through everything, and put your feelings aside. Processing those emotions can be helpful, as long as you are also finding ways to keep moving forward rather than remaining stuck in them.

Think about a pressure cooker with a small valve on top that allows steam to escape. If you remove that valve, the pressure does not disappear. It continues to build. Your training was that valve. It helped release some of the pressure you were carrying, and the injury essentially took that outlet away. There are other ways to relieve stress, but the injury may have removed one of your main ways of managing it.

Your life still carries on. You still have stress from school, work, family, relationships, and other personal or professional responsibilities. None of that disappears because you injured your ACL. The pressure continues to build while you are also navigating a long rehabilitation process filled with ups and downs. You might become irritable or feel unlike yourself, and it is understandable that you would feel that way.

The goal is to find a new valve as soon as it is safe to do so. Your outlet was doing several jobs for you. It helped relieve stress, build confidence, support your identity as a runner or athlete, provide structure to your day, and, for many people, create opportunities to spend time with others.

There is also a community aspect to physical activity. It might be your sports team, your skiing group, the people you meet on the trails, your tennis club, or an intramural team. Even going to the gym and seeing familiar people you enjoy talking to can be an important part of your routine. These connections are part of what you may be missing when you cannot participate in your usual activities.

Many ACLers try to replace the exact activity they lost, realize they cannot do it yet, and conclude that there is no replacement. Instead, I want you to think about replacing the jobs that activity was doing for you. You can work toward getting the activity itself back later. In the meantime, you can look for other ways to meet some of the same needs.

Start with the mental side. Grab a notebook and write down what training did for you. Then, next to each item, write down one thing you could do this week that might help fill that gap. I know it will not be exactly the same, and you might be tempted to roll your eyes at the suggestion, but give it a try.

A walk with a friend or a phone call might help you maintain the social connection you are missing. Sending a cathartic text to someone you trust might give you an opportunity to let things out. Writing down three wins from rehabilitation could help you recognize progress and build confidence, even if those wins seem small. Journaling or practicing gratitude might sound cheesy, but it can give your brain somewhere to put some of that pressure.

You could also try spending five minutes on one of these activities at the same time you would normally train. That time can begin to mean something again, even if you are not doing your usual workout. You are creating a new routine and giving yourself something to look forward to while you work through rehabilitation.

Second, keep moving. Everything I am about to suggest must fit within the restrictions and guidance provided by your surgeon and physical therapist. Your knee sets the boundaries for what is appropriate, but the rest of your body can still train when it is safe to do so.

An ACL injury does not automatically mean you have to become a couch potato. Depending on your stage of recovery and any restrictions you have, training could include upper-body exercises, strengthening the other leg, using a combination of machines and free weights, isolating specific muscle groups, or doing conditioning that raises your heart rate without placing inappropriate stress on the knee.

We do this with our athletes all the time, starting as early as their circumstances allow. We have worked with people who were locked in a brace and restricted from bearing weight, yet were still able to use options such as the SkiErg or other appropriate training modalities. The goal is to find safe ways to maintain a training stimulus rather than assuming that all physical activity must stop.

It is not necessarily about doing nothing until the knee heals. The key is respecting and protecting the healing process while maintaining as much appropriate fitness as possible. That way, you do not have to rebuild everything from the ground up when you are ready to progress. You can continue to experience some of the benefits of training and maintain a connection to your identity as an athlete.

Third, find someone who understands movement and can make your training intentional. Programming matters. You need someone who can consider your rehabilitation phase, restrictions, and actual life circumstances, then build something specific to you. Your fitness does not have to remain completely on pause just because your knee needs time to heal.

There is an appropriate amount of stress and training stimulus that can be applied within your individual circumstances. That does not mean every ACLer should be training in the same way, or that everyone can safely do the same activities. It means there may be options available beyond simply sitting and doing nothing. In fact, complete inactivity can be counterproductive when safe, appropriately prescribed training is possible.

You still need to respect the healing process, but maintaining your fitness floor and ceiling can make the eventual return to your previous activities less difficult. With the right guidance, you can continue training without making your knee pay for it. That requires an individualized process and someone who understands how to adapt training around an ACL injury.

We work with medical students, moms, CEOs, healthcare workers, engineers, and high school athletes. We had an engineer sign up today, and we had a healthcare worker sign up today. Both conversations included the idea of losing an outlet, and those discussions helped inspire this episode. I thought it was the perfect time to bring this topic to you because many of you are simply going through the motions of rehabilitation, trying to get through the process and return to the activities you love.

But your life does not have to remain entirely on pause. The knee rehabilitation itself still needs to follow the appropriate process. What can change is the training stimulus we build around your life so that you can continue meeting some of your needs while your knee heals. That is important because you deserve to feel some sense of yourself during this journey rather than having to put everything on the shelf until later.

When the time comes around that you would usually be physically active, choose one small thing to do. Write down the jobs your usual outlet performed for you, and next to each one, pick one alternative you can try this week. That is it. You do not have to solve everything at once.

I know this part of ACL rehabilitation is brutal. It sucks, and I see you. You will get your outlet back, and in the meantime, you do not have to go without one. Find an alternative that works for your circumstances, and if you want help building a plan around this process, reach out to us. We are here to help if you need it.

Thank you for listening. I see you, and if you need anything, please reach out. This is your host, Ravi Patel, signing off.