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Aug 30, 2023

​​5 ways to ruin ACL rehab

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Dr. Yoni Rosenblatt: Welcome back, ladies and gentlemen to the True Sports Physical Therapy Podcast. This is gonna be a little bit unique in the sense that while we've done solo pods before, they've usually been heavily rooted in literature reviews, keeping the audience up-to-date on all that is sports physical therapy and what the literature really how it guides us for evidence-based practice. This one is a little bit more free flowing, a little bit more the art of sports medicine, and that's the part I'm super passionate about, about what we do for a living as sports physical therapists. It is heavily rooted in that which I've seen over the past, I hate to say it, like 15 years of doing this for a living. Really the things to avoid in that initial evaluation, hopefully, first day post- op of an ACLR. So your patient walks in after undergoing an ACL Reconstruction, and there's so many things that you can do to really screw up that entire rehab process, and I just highlighted, really five or six of the ones that jump off the page at me when I hear patients talk to me about their experience in other practices that are not True Sports. These are really things that get my blood boil and my head about to explode just thinking, "Man, that therapist really didn't set you up for success."

Dr. Yoni Rosenblatt: So obviously by doing the opposite or avoiding these mistakes, you are gonna set your athlete up, your patients up, for success on that first evaluation following their ACL. So without further ado, here are the five ways to royally ruin your ACL rehab from day one. Thanks for listening.

Dr. Yoni Rosenblatt: All right guys, let's get right into the five ways that I have seen ACL rehab ruined from day one. And this first one is a massive one. You've definitely heard me talk about it here, it is a really big point of emphasis in our forthcoming Guide to ACL Rehab, which is gonna be continuing ed, released within the next really month if not sooner, really excited to launch that. It's by myself and Dr. Tim Stone, with a tremendous amount of feedback by Dr. Erika Brager, all True Sports Physical Therapy team members, and we're gonna walk you through exactly how we like to rehab that ACL immediately from post-op day one, all the way through month six, month nine, onto the field, et cetera, but that first day is really rooted in avoiding these mistakes. And the biggest mistake we see is when the therapist does not hammer extension as priority number one. That patient should know before they get surgery, that the number one mission, when they open those eyes, is that that knee needs to get straight and remain straight.

Dr. Yoni Rosenblatt: And so here's what I hate seeing, and conversely, try to hammer home to my patients that I wanna see, is getting that knee all the way, both extended actively and passively. So you have to start, number one, with that passive range of motion, and I think therapists are far too gentle when that patient walks in, day one in trying to coaxing the patient into extension. You'll see it in the course, hopefully you guys sign up for that course, where I like to put my hand either all the way distal femur, and wrap my hands all the way around calcaneus and push down onto femur and pull up onto calcaneus, jamming that knee into extension. Hopefully, it gets there a little bit more gently, if not a rapid press into extension, but I wanna get there and create torque around the knee to push them there and hold them there into extension, it's not gonna be comfortable. Other times I'll put my hand right around to tibial plateau, so I'm just inferior to patella, especially below BTB, and below that scar, if that's what they went through, and again, pulling up on calcaneus, pushing down on tib to just try to get as much glide as we can arthrokinematically, if we really think that's happening, I'm not sure, but, get that patient to extension. If they cannot get there passively, I promise you, they're never gonna get that extension actively.

Dr. Yoni Rosenblatt: And so you got to show them, "Hey, first of all, it ain't dangerous to get towards terminal extension immediately post-op, and their brain has to wrap around the fact that it needs to be there, you got to get comfortable there, and even if it hurts, get there because when you don't, and this is why this is number one on the ways to ruin your ACL rehab from day one, scar tissue will immediately begin to start laying down, and you're talking about those anterior intervals, you're talking about immediately posterior to patella tendon, you're talking about in fat pads, you're talking about lining medial, lateral, right around the patella. Scar tissue starts to lay down, if you don't get all the way towards that terminal extension, that's when you see people just lining up for scopes.

Dr. Yoni Rosenblatt: And I'll tell you what's crazy, is, at this point, certainly in the Baltimore area, I can see a patient walk in that door post-op day one, and depending upon how stiff that knee is into extension, I can almost see who their surgeon was, and that's before I look at their little autograph on the operative name because a really good surgeon will get that knee towards extension while the patient is asleep, they are putting them all the way into extension, all the way into flexion, after the ACL graft has been placed. And so you better believe it's safe, but then how good of a job did that office, maybe, maybe and it's not the orthopedist but it's the orthopedic office, do in fitting that brace. How much did they hammer them, and, hey, tonight you better sleep in that brace, and it better be in terminal extension, and do not put a pillow underneath the knee so that it freezes down into a little bit of knee flexion, which makes the entire process nearly impossible to get towards extension.

Dr. Yoni Rosenblatt: I'm telling you, I can pick those surgeons out, and that's why it is so worth it, if you're a therapist listening to this podcast, to reach out to your surgeons and say, "Here's how I want that brace fitted, make sure you're telling those patients not to put the pillow behind their knee, or even better, send me the patient pre-op, one visit, two visit, whatever it is, so that I can tell them, here's what the brace should do, as soon as you open those eyes, it's gonna be nearly impossible to get your knee as straight as you want it, I don't care, pillow underneath your calcaneus, underneath your heel, let the knees sag towards extension, you have to get there passively in order to get there actively." And that is the number one way you will ruin your patient's rehab progressions, if you do not get their passive extension, day one. Okay.

Dr. Yoni Rosenblatt: Now, I'm gonna throw this into that number one mistake as well, it's like a one beep. It would be not getting them to get there actively. And so you need to first put them there passively, and then what we like to do at True Sports is, I will pull their heel up off the table while I am pushing their knee down into the table, and they get what is called a heel pop. And so when that heel is up off the ground, that is the sign that you're at terminal extension, as long as the back of your knee is all the way down. Then, can they hold it there, or at least try to squeeze your quad, don't let that heel come back down towards the plinth, or towards the mat, and that's how you know, that is the goal, that is the mission for that patient to be able to own that terminal extension with an active quad squeeze even if they don't get it, day one, it's got to be a goal, and if it is not a goal that you are imparting upon your patient, it is a surefire way to ruin their ACL rehab on day one. So you got to help them get there actively.

Dr. Yoni Rosenblatt: Something Dr. Tim Stone, who will star in our ACL rehabilitation course, one of the ways he taught me to try to help the patient get there is, to put a Mobelt around their foot, let them pull themselves into that terminal extension, posterior knee down, calcaneus pops up in the air, you're holding it there with a strap, almost like you're about to do a heel slide, and see if you can then squeeze the quad. That's the way they're gonna do it at home, and their goal is to keep that quad all going on and contracted, then ease up on the Mobelt and still see if that calcaneus, that heel, can stay up. That's how they're gonna begin to get their brain to talk to that quadriceps. They have to be able to hold it there, they have to be able to get there comfortably, and see if they can prevent that heel from coming down.

Dr. Yoni Rosenblatt: Another way I like to cue this is to look at their contralateral limb, have them do a quad set, watch for that heel pop, quad gets engaged, the quadriceps, obviously, everyone listening to this and knows this, the quad totally envelops your patella, and so when that quad is all the way on there is zero movement at the patella, medial, lateral, and you show that to the patient, and let them feel, "Hey, you can't move that patella when the quadriceps is all the way on, let's go back to the operative limb, look how much play there is at this patella, try to lock it down, try to pull that patella up towards your hip by using your quadriceps, and then see if you can self-mob your patella, you should not be able to, obviously."

Dr. Yoni Rosenblatt: Again, just another tactile cue to say, "This is how you do it, this is how you do it, right?" That is the way you own terminal extension post-op, day one. And then also hopefully you have already taught them that previously. So to put a bow on that, not hammering extension, both actively and passively, day one, is a surefire way to ruin your ACL rehab. Sometimes I will spend 30, 40 minutes of that session hammering that because if you don't get that, might as well shut the podcast off now. You're in big trouble, you're gonna end up, like I said, with possibly the arthrofibrotic, or arthrofibrosis, you're also gonna start with quad lags, quad inhibition, pain levels will be higher, et cetera, et cetera. Get that terminal extension.

Dr. Yoni Rosenblatt: Okay, next. I'd say number two of our five ways to ruin your ACL rehab on day one, would be spending too much time on gait and I threw squats in there. And obviously this is when weight pairing is tolerated, patients are aware weight pairing is tolerated. Stop teaching gait on day one, it's not that important, and I kind of look at this the way I look at so many things in my life. If you're spending time doing this, it means you're not spending the time doing the right things, and so when I see therapists putting patients through stepping over hurdles, or stepping over Gatorade cups in a training room on day one or really early in rehab, it boggles my mind because it's time that should be spent hammering that extension, and if they have the extension beautifully, progress it towards their straight leg raise perfectly, in which that heel never hits the ground, and it's just the calf. Or just spend your time more efficiently on imperative endeavors, because stepping over Gatorade cups is not an imperative endeavor, certainly not on day one.

Dr. Yoni Rosenblatt: Same thing with the squats. It kills me to watch therapists try to teach a perfect bilateral squat or a weight shift. I've seen therapists put foam rollers on the contralateral side to force a lean on to that newly shredded knee immediately post-op. They don't have quad control, they don't have terminal extension, and you're doing squats with them. That goes right in there, that's a 2b. If 2a is spending too much time on gait, 2b is spending too much time like playing around with their squats, they never get it. The patient never gets the bilateral squat super early in rehab, so please stop trying to teach it that early, and if you can come up with an awesome reason as to why we should be doing that, shoot me a DM, I'm happy to change my tune. It just drives me nuts seeing it now. So I think that's, again, low hanging fruit, it's an easy thing to learn to avoid, so that we can get a little bit more streamlined and spend more time doing what freaking matters.

Dr. Yoni Rosenblatt: Okay, let's move on to number three. So if spending too much time on gait and squats is 2a and 2b, spending too much time on hip strength, in general, I think is a waste of time on day one, and it could be a good way to ruin your ACL rehab. It kind of falls in line with the gait and squats, which is, "Do I care how well this athlete's hip muscles are working if I haven't spent all the time in the world hammering the knee into extension?" And by the way, I'd rather you even jump to flexion, before we get to hip strength. There's so many more things that we could be doing than hip strength. I see it time and again, I get patients that have come to me and I grill them, they'll come to me two weeks, three weeks, three months post-op ACL, and they've started rehab elsewhere and I really try to dig deep as to, what was your first session like? What was it like when you walked in? What was it like on every other session? How did it start? How much time was the therapist with you? What exercises where you're doing? And when they tell me that their first home exercise program consisted of a hip sequence, or a hip circuit and bridging, it kills me.

Dr. Yoni Rosenblatt: And by the way, those are the athletes that invariably have stiff ass knees, because no one's been hammering their mobility and their motion. And for some reason somewhere, it was preached in the PT Bible that we need to spend time doing hip abduction, or bridging early on in rehab. We got to do it, don't get me wrong, and that's why I love podcasting, because I'm able to provide some nuance around this, and I understand that there's nuance, that, yes, of course the athlete needs hip control, but they better have knee control first, they better have knee motion first. And so, don't spend too much time on your hip musculature, not to be confused with muscles, and strengthening those, if you haven't done your basics, you got to build that foundation of getting terminal extension. So spending too much time on hip strength, I see as a massive mistake, and a great way to ruin your ACL rehab, on day one.

Dr. Yoni Rosenblatt: Number four, I really think is a massive mistake I see is when patients don't spend time with electric stim on their quad. I hate seeing patients come in and telling me, "Yeah, I spent time with the PT, at so and so chain and, yeah, oh, they did stim," and so I'm like, "Okay, awesome, so where did they put the stim?" "Oh, they put two below my knee and two above my knee, and they did it under ice," and I'm like, "We got to stop doing that as a profession." We know that that works for pain modulation, and it works via the gate theory in which you're flooding that knee with a different stimulus, which is going to activate, I think the delta fibers, and it's going to decrease pain. I believe that only sticks around for about 20 minutes. But my point, just like I've been making all day is, you should be spending that time doing other things, and I think that's just a ploy of the industry to treat more patients, so set them up on Interferential click, go for 20 minutes, or have the tech click, go for 20 minutes and you go treat another patient. Terrible use of stim, terrible use of the patient's time, borderline insurance fraud.

Dr. Yoni Rosenblatt: Spend time using electric stim via neuromuscular electrical stimulation, put it on their quad, ramp that bastard up, so it forces the quadricep to turn on. Now, we harken back to all of those cues we used previously, let that patella sit down into its groove, should not be movable. Let that heel pop up off that table, let the patient hold it for a given amount of time that they can really wrap their head around like, "This is exactly what's happening, my quad is being totally engaged," let them try to show that quadricep off with each contraction, and let the electric stim, pull that on. This, I will harken back to literature because there's a tremendous amount looking at both short-term and long-term effects when you include Russian stimulation, neuromuscular electrical stimulation in a rehab process post-op ACL. It helps with pain modulation, it increases quad strength at all of those previously mentioned intervals, and it increases patient functional abilities, and that's been proven time and again.

Dr. Yoni Rosenblatt: I'll put some of those studies in the show notes 'cause that was a worthwhile dive, I'm always thinking like, "No, do we need to be doing stim?" Hell, yeah, we need to be doing stim, and we need to be doing neuro-stim on the quadriceps and time it with active contraction as much as possible. If you're not doing it, there's a chance you're ruining your patient's ACL rehab on day one.

Dr. Yoni Rosenblatt: Okay. Last but not least, and this is an overarchingly really larger topic. Poor dosing and appointment frequency in early ACL rehabilitation I think can be a massive mistake that therapists make. And so, let me tease this out a little bit, I have this very candid conversation with every patient that walks in, especially post-op, when, whether it's the prep school athlete or the parents saying, "Okay, how many times do we need to come in?" Or, I'm first broaching that topic. I'll give them two recommendations, I'll say, "Number one, I'm gonna talk to you as if there's no such ridiculousness as this insurance game, as if the American medical model is totally seamless, and faultless, and I'm just gonna talk to as you're gonna get... What would I recommend if money were not an issue, if insurance was not an issue?" When I talk to this patient population concerning that, I say, you should be in this office every single day. You should be here seven days a week. If you can only make six, great, if you can only make five, we'll take it, but you should be here five to seven days a week, and here's what we're gonna be doing during those sessions.

Dr. Yoni Rosenblatt: We are going to convince ourselves so concretely that you have your terminal extension, passively, and then actively. We are then going to immediately convince ourselves that you have as a much flexion as you are able to have, if you don't have any range of motion restrictions, we want you to have full knee flexion within three weeks, that's our goal. And I wanna see you every single goddamn day until we get to those goals. Now, we live in the real world, and so if you don't have an awesome secondary insurance, or money is an issue, or you're worried about visits, so if your insurance company gives you 30 to 50 visits, we wanna make sure that we're not wasting on, I still will not work with an ACL post-op without seeing them three days a week for the first two to three weeks, and that is because of these motion concerns. I need to hold them accountable, that they're doing their exercises properly, that they're doing them enough, that they are simply hitting the benchmarks that I need. If we're three months in and they still have quad atrophy or weakness, that's fine, we can make that up.

Dr. Yoni Rosenblatt: If we're one month in and they don't have terminal extension, and darn near close to terminal flexion, we're in big trouble, we're pushing the panic button, we're calling that doctor, we're saying, I'm doing it at two weeks, if I can't get them to comfortable extension, something's up, for whatever reason. Is it a scar tissue? It's probably little early for that. How was the tunnel placement? Is there an underlying infection? Something's going on that I'm not getting at, but I need to see them three days a week, at a bare minimum. I wanna burn those visits or use those visits early in that process because there's no turning back. And so that's why I say, when I talk about appointment frequency, you need to convey that to the patient, to the patient's parent, that this early stuff, even though it looks small when you're on the table, it is imperative. This also comes into, I wanna talk to those patients pre-op, I wanna talk to the surgeons who are sending me these patients because I want them on board, I want them to understand why that is, I want them to preach it.

Dr. Yoni Rosenblatt: And here's why I say that, because, hopefully, everyone listening to this podcast, works in a really busy, successful Sports Physical Therapy atmosphere, where that patient comes in and they've only booked their evaluation, if you wanna see them three to five days a week, you're gonna be full, so how is this patient gonna get in? They need to book that out in advance, they know they're getting ACL surgery, call it a week before they actually get cut, they should be making their appointments then, and booking them out appropriately, and that's why my front desk will say, "Okay, oh, you're post-op ACL. The protocol here is to be seen at a minimum three days a week, let's go ahead and schedule that. If you don't need it, we're happy to take them off, but I'd rather you have it and then pull them off than have some therapists need to come in at six in the morning, or not be seen," or the patient doesn't get seen, and then everyone loses.

Dr. Yoni Rosenblatt: Patient loses, therapist loses, and the surgeon's gonna lose, reputationally speaking. I think that's worthwhile thinking through and having some of that forethought to say, "This is the way I wanna schedule the appointments, this is how to frame that conversation and make it worthwhile." 'Cause I think a lot of patients don't understand the input of frequency and I think they've been somewhat scarred or miseducated by the rest of our population that either it's, "Hey, it's two days a week, everyone's two days a week," or, "It's just cookie-cutter," and it's not really explained why they need to be there and what they're gonna be doing in each session. If you don't recommend or prescribe the proper appointment frequency, it can be a surefire way to ruin your ACL rehab from day one. I love the way I put that, it can be a surefire way. What I mean to say is, it's a way to screw it up, so try to avoid that.

Dr. Yoni Rosenblatt: Now, this poor dosing aspect, it's not just poor dosing of appointments, it's poor dosing of the exercise intervention. And I would say, with this poor dosing idea, one massive mistake to avoid would be, the home exercise program prescription. Now, sometimes it's not prescribing the proper amount of holds or reps or sets, other times it's giving them the wrong exercises, or I would say, too many exercises. You cannot go wrong early post-op ACL with a home exercise of the following. You need to be doing either bag hangs, and that's with your heel supported, you're in a seated position and your heels are on a coffee table, you're sitting high enough off the ground that you can hang like a gym bag with the straps, one superior to patella, one inferior to patella, with the bag weight hanging down, pulling it down into terminal. The extension, it's got to be either that, it's got to be your tried and true prone hang, or it's got to be like a heel elevated with, again, a weight on the knee, but, like an ankle weight, so it's not hanging down.

Dr. Yoni Rosenblatt: I prefer the first, the bag hang, I find that it's most comfortable, I find it's easiest to avoid cheating, so toes have to stay straight towards the ceiling, and that they can usually tolerate that better. I'd say that is the number one thing I learned from my OCS test, which isn't saying much, but I think it was on there for some reason, but that's the first time I saw it. So I call them the bag hangs, if you have a home exercise of a bag hang, and a quad set with stim, I don't think you could go wrong, I think those are the essentials. Now, how much? What is the proper dosing of that? So what we like to do at True Sports is, we like to say, you got to hang, and again, that's either with the bag hang, a weight hang, or a prone hang, for a minimum of 60 minutes a day. Obviously, early post-op, they're not gonna be able to sit there for 30 minutes, say they're able to eke out five minutes. That means they have to do that the obvious amount of time. They have to sit there and really live in that terminal extension all the way for an hour.

Dr. Yoni Rosenblatt: So like I said, if you can only get five minutes, it means you got to do 12 rounds of that, throughout the day. I don't care when you do them, but you have to accumulate that time under tension, low load, long duration, so that bag shouldn't be so heavy. But they got to sit there for an hour, and like I said, if they can get up to 10 minutes, awesome, do it six times, but that's a minimum. Okay? They come in, their extension should be better, if they're doing that properly. That's why I wanna see them so often, but again, if you're giving them less than that, you're not forcing the knee into that uncomfortable extension position, they're gonna shy away from it and they're gonna end up with that quad leg or that flexion contracture because that's where they're gonna spend more time there, so I think that's one poorly dosed exercise, and again, we like to jump to the 60 minutes.

Dr. Yoni Rosenblatt: The other thing is quad sets and whether that's with stim or not with stim. I wanna see 20 repetitions of quad sets, five-second holds, every hour, that is your mission, and that is a crap ton of reps, but we got to get them awesome at that. And the more times they attempt to squeeze their quadriceps, and they're focusing on distal quad, they're focusing on patella getting glued down, the better they're gonna be at. So I would say that's a must that my patient has to leave after day one with those two exercises and they have to be awesome at it, I will take videos of it, we have our own True Sports Physical Therapy exercise app, so they are uploaded every single time into that app, it is me narrating those exercises, and so they leave with that information. If you're not doing that, you're screwing up your ACL rehab from day one. And then the only other things I wanna layer on top of that home exercise program or into that exercise program is compression, you cannot do it enough, so keeping a good bit of compression on that knee, and then if I'm able to progress them into flexion, I wanna add some flexion range of motion.

Dr. Yoni Rosenblatt: If they're not allowed to flex their knee, maybe, and only then, do I go to hip abduction because it's an athlete that really wants to feel some type of burn, or some type of straight leg glute raise just because I know the athlete wants to get rolling and feel like they're getting somewhere, and I'll force them to do that. And then by the time they come back in, now we're already talking blood flow restriction, and now we're talking about how do you own that terminal knee extension? And if they cannot get that quad set, so let me just back up a little bit, would be the graded quad sets, so using, like I said, using that Mobelt previously, to pull up into terminal extension, and sometimes a patient can't even let go of that thing 'cause they don't have the quad contraction, but holding it there, 'cause they got to be in that terminal extension, and then add that recruitment, kind of on top of that. But too often I see therapists giving five, six exercises, this is where the goddamn bridges come in into the home exercise where you should be spending so much more time owning that true quadriceps.

Dr. Yoni Rosenblatt: So these are five ways, like I said, I'd say these are the five cardinal sins that I see on that initial evaluation, immediately post-op ACLR, and we got to get better than that as a profession, and I really believe if I do a podcast like this or a topic like this, in 15 years, I don't know that this changes. I'll humbly submit that maybe it does, but these are so tried and true and they have proven to be so successful, both in the literature, but also anecdotally, to getting the patient where we need to get them. I know for sure early on mistakes that I made would be trying to hammer, say, short-arc quads. Once I learned that, oh, short-arc quads aren't forbidden post-op, I started adding that into my home exercise program, but the patients couldn't get the terminal knee extension, and so they would come back in and they're still missing that last two, three, four degrees. So yeah, maybe their quad activation is better, but they can't activate terminally extended. So that was one mistake I made.

Dr. Yoni Rosenblatt: The TKE stuff early on, where a patient is just living in their glute, I definitely used to make that mistake because I've read the same Bible that unfortunately a lot of other therapists are still reading, or schools are still teaching, where they start adding all these things on, when if we just hit these main points, and avoid the five mistakes, I think you're setting yourself up for success and an easier rehab road, more importantly, you're setting your patient up for a far better outcome, like I said, that's gonna help everyone. And so hopefully, this just made you think a little bit, and totally thrilled to hear how much you disagree with me, I do love getting those DMs and those emails, feel free to email me, yoni, Y-O-N-I,, let me know what you thought, let me know what I missed, what you would have put on your five ways to ruin your patient's ACL rehab from day one. Let me know what you loved, obviously, and as always, it's an open book, so if you wanna shoot me an email and tell me, "Hey, here's a great guest to have, here's a great topic I'd love for you to cover." That's where this came out of. Like I said, got some awesome stuff in the pike, about to do what I think is gonna be a great episode, all about residency, and I'm gonna bring a newly graduated resident on, talk about that, but we also have a tremendous amount more of ACL content.

Dr. Yoni Rosenblatt: So I'm gonna have Tim Stone on the podcast, we're gonna talk about the way we put together this course, why we did it, what's unique about it, 'cause it is so unique. There are definitely ACL courses out there, they don't look like this one. And the reason I say that is because, one, I've taken all those ACL courses, or a lot of them, and two, there's so much of this that is not on other courses, meaning, I wish that these other courses had common mistakes or common questions a therapist gets, or how do you pose some of these prescriptions to patient, to parent of patient? How do you create buy-in? How do you progress? How do you scale? How do you know when your athlete's ready to get back on the field? And what are great ways to progress towards that? Like practice plans and shooting plans and cutting plans. So that's all included with in our True Sports ACL rehab. And we're gonna have one of the nation's foremost surgeons, knee surgeons, orthopedic surgeons, Dr. Jamie Dreese, he's gonna walk you through how he approaches the surgery, and what he is considering, and what the different techniques mean, do, what's actually transpiring in that OR during the operation, so hitting it from all angles, all the way from orthopedic surgeon to physical therapy, to the strength and conditioning and performance side.

Dr. Yoni Rosenblatt: So that True Sports ACL course is coming in a matter of weeks, so make sure you sign up, I'll make it super easy for you to sign up. And anyone listening through the pod and people who have interacted with us, we will make sure we get them their discount codes, but again, you got to get considering it anyway. Obviously, I feel strongly that this is an awesome way to get you better at rehabbing your ACL patients while still getting those continuing ed credits. So stay tuned to that, reach out, any questions you got, you can always DM us, follow us @truesportspt. Can't wait to keep learning from you guys, can't wait to continue to give you more and more of this information that you guys ask for, and thanks so much for listening, guys.


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