The First Step in Your Recovery

This week’s newsletter is going to cover possibly the single most important topic in ACL Rehab.

Get this piece right and every other aspect of your recovery will go more smoothly.

Get this piece wrong and everything will be slower, harder, and more frustrating.

This principle is BLOOD FLOW

With this on your side you will be able to recover easier, progress faster, and quickly fix any issues that come up in training.

With this working against you recovery will take longer, you will feel stuck doing the same things over and over, and the smallest hiccup in training will magnify and take ages to resolve.

This concept is our foundation because it is what everything else is built on.

Want to heal and repair new tissue? Need blood flow to bring in fresh nutrients and building blocks and clear out old, dead tissue.

Want to build back strength and muscle mass? Same thing.

Dealing with pain, stiffness, or inflammation? Need blood flow to sooth and lubricate the joint to get it moving more freely, feeling less tender, and clear out the fluid trapped there.

Anything you are doing to counteract this process (like icing!) is going to reduce the effectiveness of all the hard work you are doing in training.

In fact the entire R.I.C.E. Protocol (Rest, Ice, Compression, Elevation) is now being widely rejected for this exact reason — everything in that protocol is going to reduce blood flow and circulation to the joint.

Now this protocol can be helpful for dealing with pain, but in terms of healing, it is going to have the opposite effect of what we are looking for.

So, we want to maximize blood flow and circulation as much as we can. Great. But how do we do that without causing damage, inflammation and irritation to the joint (especially in the early stages of recovery < 4 months)?

You want to work hard, but you don’t want to do more than you’re supposed to and make things worse.

Trust me, I get it.

The key here is: Exercise Selection (what movements we’re doing)

Running, jumping and squatting are probably off the table for us (even if we are far enough where we can do these, they’re going to load the joint more than increase blood flow which isn’t what we’re looking for just yet) so then what can we do?

Enter: Concentric-Only Training

Ok, bare with me for just a second as I explain some basic exercise science terminology.

A movement like a squat can be broken up into 3 phases:

1. Eccentric Phase: Lowering the weight down

2. Isometric Phase: The pause (if any) in the bottom

3. Concentric Phase: Lifting the weight back up

Ok so why is this relevant?

Because the eccentric phase is what does the majority of the muscle damage and loading on the joint. This is what rips up muscle fibers to stimulate new growth but also leaves you feeling like you can’t walk for a few days after a hard leg workout.

The dreaded D.O.M.S. (Delayed-Onset Muscle Soreness) is largely a result of this phase of the movement.

So, if we can eliminate this phase of the movement, we can greatly reduce the stress we are placing on the muscles and — in particular — the joint.

This would allow us to get a great workout (even in the early stages) without overloading the knee itself.

But how is this possible? How can we stand up without first squatting down?

This is where we have to get a bit clever. This is where we start training backwards.

Picture yourself walking backwards. As you reach your leg behind you (the eccentric portion of the movement) there is no weight or resistance to your movement.

It’s not until your foot touches the ground and you push through it (the concentric) that you encounter any resistance (the force of gravity).

So every step you take backwards you get a little push, a little muscle contraction that pulls blood flow into the muscle and into the joint, with very little loading on the joint itself.

Backwards walking is an amazing place to start and a daily requirement for all my athletes I help come back from ACL and other serious knee injuries, but it doesn’t stop there.

What if we could challenge you even more, get even more of a metabolic response, even more blood flow, without overloading the joint?

Enter backwards sledding.

This is where the magic really happens and what starts to transform people’s recovery. Just 5 - 10 minutes walking backwards dragging a weight that feels like a good challenge to you can get an amazing workout for the knees in a way that makes the joint feel better after you’re done rather than worse.

And the best part, it scales to any level whether you’re 5 weeks post-surgery or a professional athlete trying to work on fitness and keep their knees healthy.

Same exercise.

Just scaling the intensity.

If you can walk, you can probably walk backwards.

If you can walk backwards you can probably drag a 1lb weight with you.

How bout 2? Can you increase it to 5 next week?

Now you’re on the road to recovery with measurable, systematic improvement.

THIS is how I’m able to get athletes still in their big knee brace, scared to push things at all, into the best knee workout of their life (and feel better afterwards and excited to train!).

The other awesome feature of this training style? No soreness afterwards.

It’s the eccentric portion of the movement that creates most of the soreness remember?

By eliminating that we take away the main source of soreness.

This means I can challenge my athletes to get an absolutely amazing knee workout without causing any pain, any increases in swelling, AND any soreness the next day.

So guess what? We’ll do it again the next day. And the day after that.

That’s right. I get my athletes to train hard (even the ones early in the recovery process) every single day, and feel BETTER after each session!

I get my athletes to WIN each workout and stack those wins over days, weeks, and months to make insane progress in a short amount of time.

This is how I was able to get Donovan, a professional soccer player in Argentina, from walking with a limp and a brace 5-weeks post ACL surgery to loaded full range of motion by week 12.

The key to this is patience and gradually building up to best PAIN-FREE muscle burn you can get.

You don’t even need an actual sled for this. I spent 6 months at a local park using a couple sand bags inside of a duffle bag. I’ve used treadmills left turned off, facing backwards, and using the internal resistance of the treadmill to get an amazing burn that way. Hills provide a great form of resistance walking backwards as well (just be sure to control the way back down).

And when all else fails simply getting outside and walking backwards — barefoot in a grass field is ideal — is a 100% equipment free option.

If you want the exact protocol I use with my athletes in the early stages of their recovery here it is:

• AM: 10 minute backwards walk (outside, barefoot, in the grass ideally

• PM: 10 minutes backwards sled

That’s it. Seems simple and it is. But repeated daily for the first couple weeks of our training really gets their knees just feeling way better — feeling loose, feeling strong — and set’s them up to crush the strength work we get into next.

This is also where I will start for people that have lingering knee pain they can’t get rid of. Get things warm, get things moving, and you’ll find things start moving much better than they were before.

That’s it for this week!

If you found this article helpful send it to a friend who could benefit from this information.

If you’re looking for help with your own recovery fill out my training application here:

This isn’t a commitment or guarantee of training just a conversation starter.

If you want an overview of my entire approach to helping athletes coming back from ACL and other knee injuries check out that article here.

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Till then, peace. ✌🏼