Why finding the right Physical Therapist is CRUCIAL for ACL rehab // Tips for choosing the best PT

Guys, it's time for some expert advice. Finding the right physical therapist for your ACL recovery journey is definitely one of the most important parts of your recovery journey, but it can be kind of confusing to know what to look for and what might be a red flag, which is why I'm so excited today to introduce you guys to a special guest to this YouTube channel who is going to be doing a deep dive into what are the things you should be looking for in a PT for your ACL rehab journey and what are some red flags. So who do we got? We got Dr. Kiro the Hero coming on today. Dr. Kiro is a doctor of physical therapy and sports and conditioning specialist, and he really works with a ton of athletes in their injury rehab, in particular their knee rehab. And today he's going to drop some major knowledge bombs about how you can go through picking the right physical therapist and the right physical therapy clinic for your ACL injury to make sure that you are getting the best treatment and recovering the best after surgery. One of the things I love about Dr. Kuro is that he is very, very passionate about empowering his patients to getting back to saying I can, because so much of the ACL rehab process is a mental journey. And after going through his own knee injury himself. He realized how frustrating and confusing and demotivating this whole process can be when you're going through an ACL injury in rehab, especially when you don't have the right support. So he decided to become a PT because he wanted to make sure that nobody else had to go through what he went through. So guys, get ready to take some notes on this video because this is going to be super practical information and really, really handy for if you are in that stage of trying to choose the right PT for your ACL injury, or if you are trying to choose a physical therapist for any injury. I think a lot of the points that he makes are important and different things can be extrapolated and used across the board when you are looking for the right specialist to help you out. All right, so let's hear it, Dr. Kiro.

Hello all, my name is Kiro Abdemesih. Victoria hyped the heck out of me, but I'm going to give a brief introduction of who I am to those who kind of skipped that initial part. So my background, I am a sports physical therapist, and actually I went through the ACL process myself many, many years ago. So sophomore year of high school, I ended up tearing my ACL while I was running the suicide during basketball tryouts. Projected to make varsity, had trained for months, running the suicide, went to cut, and I felt that pop and I knew something was wrong. Coach sent me home immediately. I didn't actually end up getting surgery until about a year and a half later, but I ended up getting a hamstring graft. I had some cartilage damage in there and I had some meniscal damage as well that they ended up shaving. So all that to tell you that I understand this process, and I get it, and I get everything that people go through. And I'm not just a physical therapist that has never been through this process. So I want to say first and foremost that I do empathize with people out there going through this process. It's not easy, and I wouldn't wish this injury on my, my worst enemy. The topic for today is how to choose a physical therapist during this ACL process, and that is not an easy thing to do at all. You're going to be with a physical therapist for 3 to 6 months beforehand if you're doing any sort of prehab And then after the surgery, if you end up doing the surgery, it's about 9 to 12 months afterwards, even more for some people, that you're going to be doing rehab as well. So this is a very long process, and to find a physical therapist that you really trust and can empathize with and understand what's, what's going on, it's not an easy process at all. So I am here to help you through that process. Now I'm going to go through 6 main points with an added bonus at the end. These points are key to understanding and choosing your physical therapist. Whether you are in the beginning of the process, you just had an injury, or you're right before surgery, or you just had surgery, or you're months out from surgery and you want to pick a physical therapist in order to kind of guide you through this process. All right, let's get right into it. So the first point is that you don't want to go along with a physical therapist who speaks in extreme languages. And what I mean by that is anyone who speaks in the language of you should always do something, or you should never do something, or this exercise is bad for you, or you should never do this, or they mention accelerated rehab, especially in the ACL process, or they say that if you do this passive modality, it's going to heal you or create an environment for you to be healed. Those kinds of physical therapists you want to steer away from. The reason why is because there is so much nuance when it comes to these things. It is not black and white. It is not just you do this or you do that. No, there's so much nuance to it. There's so much intricacies that go along with it. The complexity of ACL rehab is it kind of goes over the head of a bunch of rehab professionals, and it's a very specialized domain. So I would say if you find someone who in the initial evaluation or afterwards is kind of speaking in that language of always or never, or you should always do this or never do that, I would steer away from those people. Second key point you want to consider is the clinic itself. So does the clinic— does it have the proper facility and the equipment in order for you to be rehabbed properly. So if you walk into a facility and you're a basketball player, volleyball player, a soccer player, or an athlete in general, and you walk in and you see all of these older patients surrounding you, you see these brown carpets and the heaviest weight that they have is 10 pounds, maybe that's not the greatest place for you, especially during the, the mid to later stages of ACL rehab. As an athlete, you need the proper room, you need the proper equipment, heavy weights, squat racks, leg extension machines, leg presses, things like that, in order for you to be rehabbed properly. And if you don't have those things, then it's going to be a lot harder for you to get on that load to make your quad stronger and to develop the strength in the muscles surrounding the knee joint. So when you walk into a facility, your first impression of— do I have space to run? Is there a treadmill? Are there machines? Do they have certain testing equipment? Do they have turf? Do they have heavy weights? Things like that you want to consider. Maybe in the beginning you might be with a physical therapist who doesn't have access to that stuff. Maybe you're part of a surgical center that kind of just sends you over to physical therapy that's in-house, and you go to them for the first 2 to 3 months and then you're functioning fine. But later on when you're more towards the return to sport, especially if you're an athlete, you want to make sure that the facility and the equipment that they have is the right thing, or they have the things necessary for you to be rehabbed properly. The third point is how many people or how many patients does the PTC per hour? So you'll have PTs who are working clinics that see 1 person per hour and their entire attention is really focused on you. But then you'll have other clinics, those corporate mill clinics that see 4, 5, 6 people an hour. And this is not to blame the PT at all because it is not their fault. But in the end, if the focus isn't strictly on you and you're not getting the physical therapist's undivided attention, that mental real estate of seeing other, other patients will crowd their head and not give you optimal care. So if you want to ask questions or you want them to check out your form of certain exercises, or they have other patients coming in and you want to understand what to do for a home exercise program and they have all these people in the clinic, even if they have a tech or an aide or someone to help them along with that stuff, you don't want a college student or, a high school student who's shadowing, um, to run you through this process. You want to make sure that you have the physical therapist who has a doctorate to have their eyes on you, um, and to supervise the entire process. And again, this is not their fault because with these corporate mills, all they want to do is just bring in as many patients as possible in order to bring in revenue to the clinic. So be aware of clinics that see multiple patients an hour because then you won't be able to get their undivided attention. And that leads to suboptimal care. The fourth point, as I mentioned before, ACL rehab is very complex. People want to simplify it as much as possible, but there's so many nuances with it. People respond differently. There are many different grafts, genetics, inflammatory cascades, surgical technique. There's so many different things that surrounds the rehab of a person going through the ACL process that every single person is different. And you need to have a person who has experience with ACL injuries. If you kind of go to a new grad or someone who doesn't have any experience with ACL injuries, they will follow the protocol. So they will take the sheet of paper that the surgeon gives them and they will follow things to the T, which is— may not necessarily be a bad thing, but you need to understand the rules pretty well in order to break them and understand when you can break them. And I always tell people that the methods are many. There I could do something different than another physical therapist who's experienced with ACL injuries, than another physical therapist who's experienced with ACL injuries, and so on and so forth. But the whole thing is that we have solid principles that we're basing all of our dosages and our exercise prescription and everything on. So I have a certain principle in my head. I know that I need to get the quad stronger, and I know that certain exercises like just a bodyweight squat or a barbell squat or things like that won't get quads stronger because you are not isolating the quads, and there are also other muscle groups that are at work. So doing things like the leg extension machine or heel elevated squats or the leg press with your feet lower on the platform or hack squats or things like that will help more of the quads and emphasize the quads more than other muscle groups. And I know that I need to be doing this amount in terms of the exercise dosage, and that's what I give you. So I have that principle in my head and I'm giving you the exercise or the method that allows me to follow the principle that I need to, to get you to your goals. The fifth point is you want to have a PT who validates your concerns. Have you ever had a physical therapist or even a person when you're speaking to them about a certain pain that you're having in your life and they're just like, yeah, yeah, it's going to go away with time. Even though there are some things that can go away with time, they still need to be able to validate your concerns. And understand or sympathize with your pain. I, even though I went through ACL surgery and I went through the whole shebang and all that, I may not understand exactly what the person in front of me is going through because they have a different graft or they have different circumstances or they have different stressors in their life or things like that. But what I want to do is I want to make sure that the patient is heard. So when they speak to me, I sympathize with them and I sit down with them and try to understand what's going on and what can we do to to fix it. You need to be able to differentiate, like, does this person need a shoulder to lean on or to cry on, or does this person need solutions? And I think that's just a life lesson for people, that in order for you to be a good provider, you need to be a good human as well. And that includes validating the person in front of you. That is super important because every human in the world wants to be understood, heard, validated. And last but not least, the sixth point is do you vibe with the physical therapist? And yes, I'm using the millennial Gen Z slang terminology, whatever it is. Do you vibe with the person? Do— are you on the same wavelength with the person? If you go to them and they smell or they talk about their political views all the time, you're going to be with them for months. And do you really want to be surrounded by a person or by a clinic with staff that kind of forces that stuff on you all the time? Or do you want to be with a person who focuses on your ACL rehab and you're able to kind of vibe with and give back and forth? Because you're going to have setbacks. Things are going to happen. It's not a linear progress where you just go straight up and rehab is completely fine. No, there's going to be ups and downs and there's fluctuations, and you need to have a person who supports you through that entire process. And that's not easy. It's not easy to, to, to find. And that's why in the beginning of all this, what you should do is that If your surgical center, if you went through the surgery, gives you a physical therapist that they recommend, especially if they're in-house, they have to do that because this is all business for them. So go to that physical therapist, go to the initial evaluation and see, do you vibe with them? Do you not? What's going on? Do they have the experience? Do they not? The facilities, the equipment, are they seeing multiple patients an hour? Things like that. And see what's going on. If you don't like them, you can request another physical therapist. If you don't think you're vibe with any of the physical therapists in that clinic altogether, then it's within your right to go to a different physical therapy clinic altogether. So it's okay for you to ask for a prescription from your surgeon or your physician in order for you to go to a different physical therapy clinic. Now, in some states there are direct access, like in New Jersey where I'm at, where you can just go to another physical therapist without having a prescription in hand. So consider those things. And in the end, again, you're going to be with this person person for months and months and months, and you want to make sure that you have the right person who is in your corner, who is going to fight for you, and who is looking for your best interest. Now, that added bonus. This added bonus is your physical therapist should be in contact, or at least willing to communicate with your surgical team or your medical team. A lot of the times people come up to me and say, hey, my surgeon said one thing, and then another physical therapist said another thing altogether. And then they get this conflicting pieces of advice back and forth and they're like, I don't know, should I do the leg extension machine or should I not? Should I do this exercise? Should I not? Am I able to weight bear? Am I not? And then they're internally stressed and then it's just a tug of war back and forth and that's not fair to the patient at all. So what I would say is ask your physical therapist. If they're in-house, then they should be able to communicate with their surgeon. If not, the physical therapist should be willing to call your surgeon or your medical team, the PA, the nurses, whomever, in order to make sure that they have the correct protocol and they understand the operating procedure and technique and what they do and what the surgeon is looking for and what restrictions there are, et cetera, et cetera. What I personally do is someone who comes into the clinic, the first thing that I do is I call the surgical center And I say, hey, can you send over the operative note so I know exactly what you did inside of there? And then can you also send me any like protocols, restrictions, or anything that I should be adhering to? I don't like the term protocol because protocol just means cookie cutter. Everyone should be going through this like it's an assembly line. What I like to use is use it as a guideline. So what restrictions do I have? And then I use my knowledge and my doctorate as a sports physical therapist to figure out, okay, these— this is The outlines are the boundaries that I have within my sandbox. Let me play within the sandbox now. Let me do whatever it is. So the physical therapist should be in contact or at least willing to communicate with the surgeon every so often to make sure that the best care is given to you. In the end, you want to be with a physical therapist who is knowledgeable, who is kind, who is experienced, who is intentional with the goals and not trying to do certain things because the protocol is there and then over the course of months it ends up setting you back. They have to have access to proper equipment and facilities and understand the specific phase that you're in and is honestly looking for your best interest. That's really what you want to be looking for in a physical therapist. Now that might not be easy. You may not get that the first time or the second time or even the third time that you go through with a physical therapist. You want to ask around, you want to search, on websites. You want to do your own research. You want to ask the surgeon, the providers over there at the hospital who have done the surgery, or even before then, any friends, word-of-mouth referrals, things like that. But in the end, certain people vibe with other people, and if you don't vibe with that physical therapist, that is completely fine. It is okay for you to seek a second or even third physical therapist. Now, some people may have the financial aspects or the financial resources in order to see multiple physical therapists, and not worry about insurance at all. Sometimes insurance does dictate where you can go, and if you go and do an evaluation, a couple sessions in a first clinic, and you don't like them, they may have to discharge you for you to be able to go over to the next clinic and do physical therapy somewhere else, really depending on the insurance. So again, everyone has many different circumstances. There's so many different things that to consider here, and I encourage you, I encourage you to do the best that you can in in order to advocate for yourself, because in the end, this is your body, and this is one of the hardest injuries and recoveries to go through, and you want to make sure that you have people who are willing to be on your team and to fight for you.

All right, you guys, thank you so much for watching, and thank you so much to Dr. Quiro for coming on the channel and offering his expert advice and sharing all about how to pick the best PT for your ACL rehab journey. As he mentioned, it is so, so important to have the right professional on your side. And speaking of finding the right professional, if you want to connect with Dr. Kiro directly, you can find him on Instagram at kiro.dpt. He shares some great information on his page, and I'm sure you guys will benefit from it. And he's just a cool human to connect with. So go ahead and give him a follow. And if you like this video, give it a thumbs up and subscribe to the channel. As always, guys, I greatly appreciate all your support, and I will see you guys next time. Bye.