Movement Buckets

In this episode, I’m sharing the story of a young, athletic patient who did everything “right” after a meniscus injury—PT, injections, surgery—but still couldn’t get back to playing the sport they loved: soccer. Sound familiar?

We dig into the mental and physical challenges of recovery when pain lingers, even after everything looks fine on imaging. I introduce a tool I use often with frustrated athletes and weekend warriors—the Movement Bucket Framework. It’s my way of helping people understand how to keep moving forward, even when they’re not 100% yet.

🎯 Key Topics & Time Stamps:

• [00:37] The case of the soccer player – Doing everything “right” and still not better
• [02:03] Exhausting all the options – PT, surgery, injections... then what?
• [04:51] When “everything looks fine” doesn’t feel fine – Navigating invisible barriers
• [06:18] The cost of waiting – The real price of standing still
• [08:00] Introducing the Movement Buckets – Everyday, Most Days, and Challenge Day
• [11:04] How the buckets work together – And how to know if you’re doing too much
• [12:00] Momentum is medicine – Why some movement is better than none
• [13:00] Getting buy-in (or not) – What happens when people don’t like the plan
• [14:00] Why movement is non-negotiable – The bottom line in rehab

This one’s for the folks stuck in limbo—the “I’m not in crisis, but I’m not myself” crew. Whether you’re a clinician or a patient, I hope this episode helps you see rehab as a journey, not a single moment of “healed.”

🧠 Movement isn’t just medicine—it’s a mindset. Let’s talk about how to build that mindset, even when it’s tough.

🎧 Thanks for tuning in to the Talking Rehab Podcast. If this episode spoke to you, I’d love it if you subscribed, shared it with a friend, or left a review.

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Let me know if you'd like a condensed version for social media, or if you want to turn the "Movement Bucket Framework" into a graphic or handout!

Transcript

0:00

What is rehab or rehabilitation? My name is Fred Begaris, a board-certified sports and spine medicine physician in Virginia Beach, Virginia. After 10 years of practice, I still find musculoskeletal medicine both fascinating and challenging. This podcast is about the lingering thoughts and questions I've had after residency and fellowship. My hope is to spark discussion, challenge dogma, and share my experiences in musculoskeletal medicine. Welcome to the Talking Rehab Podcast. I had a patient recently that injured their knee playing soccer. And this is a very physically active person, young, healthy, works out every day, plays recreational soccer. And being a very physically active athletic person has been a big part of their life. And they played soccer from a young age through college. They are now a young professional and continue to play. And they just really love the sport. They love movement. They really identify with being an athlete. And soccer players have definitely had their share of injuries. They're no stranger to that. But this was just an ordinary play. They planted their foot, felt a pop in their knee, ended up with a meniscus tear. A pretty typical mechanism. Nothing in particular was unusual. They went on to rehab their knee with physical therapy. But they did not improve. Eventually, they had a surgery to repair the meniscus. And for the most part, everything was feeling pretty good. But they still were not able to get back to playing soccer the way that they're used to. And from an orthopedic standpoint, everything structurally was sound. But it was just certain movements that just really aggravated them. And that's when I came into the picture. And so, by the time that I saw them, they have done pretty much the whole gamut of everything. Meaning they did physical therapy, excellent student. They did injections. They did a surgery. They had repeat physical or post-operative physical therapy, post-operative injections. And they basically continued to have symptoms. They just were not able to get past a certain point without a certain level of pain. And from a rehab standpoint, they can do essentially everything that's asked of them. But then when it comes to the only thing that they want to do, playing soccer, which is a very dynamic sport, it just wasn't really getting there. And so, I get a lot of these types of cases where the question is, what can I do? Often the discussion is, can I do some sort of regenerative something? But from an imaging standpoint, a repeat imaging standpoint, everything looked pretty normal. There's nothing really to treat per se. And they were not necessarily interested in doing anything that they've done in the past. So, a large part of the rehab game plan at that point was trying to help explain or come up with a way to get them moving again. And up until that point, the only way that they were ever interested in moving was simply just playing soccer. And they could go to the gym. They could run. But when it came to kicking or planting and cutting, that was really very, it was still bothering them. And it wasn't like a swollen knee or it wasn't like debilitating in that it was affecting every aspect of their life. It was mainly athletics. That being said, it was a huge part of their life. Again, they played soccer pretty much from four years old up and through college and into young adulthood. So, it was a big piece. And this was a pretty challenging case because there was a lot of frustration from the patient because they've gone from doctor to doctor and everyone says everything looks quote unquote fine. And yet, they still did not really have a pathway forward. This particular client reminds me that when injuries occur, most of them just, they just get better with time. Rest, ice, typical stuff, six to eight weeks, fairly typical timeline for most injuries. But we hope that it always just gets better. But unfortunately, sometimes it doesn't. And that is a potential consequence even after you've had a surgery. Sometimes the surgery goes completely fine. But there is a population of folks that still have some symptoms. So, what do you do then? And in this particular case, they were not interested in doing anything that didn't result in them playing soccer. And that's a pretty tough proposition. It's basically saying, do you have something that I can just skip to the end and everything is fine? And the short answer is no, I don't. There's sometimes, even if pain is completely gone, there are steps in between that not necessarily should be skipped. And most people will use pain as their guide for a green light to move forward, that everything is fine. And if you've done this enough, you just know that pain is a big factor to be managed. But it's not the only thing that matters when it comes to rehabilitation. It might be for a patient, but from a rehab doc, that's not necessarily the only thing that matters. So, I tried to explain to them their, what is your movement plan, essentially. And they didn't really have one. And that was obviously why they were coming to see me. And so, I started talking to them about potential options. And I could tell they were getting frustrated. And I just hit the nail on the head and said, what do you think is the cost of waiting? And you're essentially asking for a treatment with a guaranteed outcome. And that's just not the way things go. But if you don't try what I'm proposing, what is the cost of waiting? And we've talked through it. And a lot of times, they're just like, well, I can't move. And so, it's just really bothering me. And the more and more we got into it, we started to get into the cost of waiting. The cost of waiting, pain and inactivity. But it has a variety of effects. And not just from a physical standpoint, there's the loss of strength. Joints get stiffer. Tendons and ligaments also become also stiffer, which changes overall movement, right? So, that part is obvious. From a mental standpoint, it can be fatiguing. It can affect your day-to-day. It's almost like something that's nagging in your brain. And I can't do something that I love. And that just sticks in your head. It can affect your work performance. It can affect your sleep. It can affect just about every aspect of your life. Even though it's not terribly debilitating with day-to-day movements. When you can't do something that you want to do, it's just like a record that plays in your brain. And it's hard to ignore that. Obviously, there's the emotional aspect of it. Pain leads to suffering. Leads to a variety of feelings. Anxiety, depression, you name it. It's, you can only imagine not doing something for extended periods of time. It can definitely weigh on you from an emotional standpoint. Essentially, I came up with this idea of movement buckets. And it sounds kind of weird. But when I have these type of cases, I try to counsel people into thinking of movement in terms of movement buckets. So there's three movement buckets. There's an everyday movement. Second bucket is most days bucket. And the last one is the challenge days. And so the way I look at it is everyday bucket includes exercises and movements that you know that your body can tolerate every single day. No matter what. You know, when people have chronic pain, you know, they have three good days, four bad days, any combination. But an everyday movement bucket is like an activity or a collection of exercises or movements that you can do no matter what kind of day you're having. A good day or bad day. This could be walking for five to ten minutes. This could be riding a bicycle, doing your PT exercises. In this particular case, this person could do upper body stuff, things like that. Or they could do very structured lower body activities. The second bucket is the most days bucket. So this is slightly more challenging. But it is a type of activity where you probably would not want to do it two to three days in a row. Because for whatever reason, it might evoke symptoms, pain, swelling, things like that. The last bucket, again, is the challenge day. So this is not necessarily playing soccer in this case, like in a game. But this might be sprinting in one direction or another or just practicing kicks or shuffling. Something that you would ordinarily do. It might be a unique movement or it might be a very specific skill in a sport that you're trying to get back to. But it will be an athletic movement. It will often be a powerful movement. But it doesn't necessarily have to be that way. It's just something that challenges you. Something that you know that this is going to require you to be, essentially, be on a really good day. Where you physically, mentally, and emotionally feel like pushing yourself. And it should be hard. That being said, it shouldn't be so painful that it doesn't allow you to do an everyday bucket type movement. And so these three categories, they blend with each other in the sense that a challenge bucket movement shouldn't affect your ability to do an everyday movement the next day. If it does, then that challenge bucket movement might be a little bit too much. And maybe in a week or two when you try and do it again, a challenge bucket day, you have to modify it a little bit. And that's how you know that things are starting to get better. Or let's say you tweak it a little bit, maybe one less set, five minutes less on that particular challenge day. Or let's say that you tone it down the next time you do a challenge day. You reevaluate the following day and see how you feel. And if you can do an everyday movement, then you know that's probably the right amount of intensity for a challenge movement day. Same thing goes for the most days bucket. It shouldn't, whatever activity you choose for that, it shouldn't prevent you from doing an everyday movement. The overall goals of these buckets is essentially to build momentum. You know, I think a lot of times pain just limits us so much that it just prevents us from even trying any harder. I know it's going to hurt and I know it's not going to allow me to get to my final destination, so I'm not even going to try it. But the problem with that is that when you're not moving anywhere, the whole point of momentum is to get you moving at least a little bit. And eventually as you continue each day, each movement, you're slowly getting better. You're getting closer and closer towards the goal. So building momentum is a big reason I like to use this movement bucket framework for people. It also slows down the effects of waiting. It starts to get you a little bit more physical. It may allow you to break a sweat. And at least that way, you're starting to get back into some amount of physical activity because physical activity, no matter what, can help most things. It keeps everything healthy from a physical standpoint and an emotional standpoint. And the last piece is that it should show you a scalable way back to your particular goal. Even though playing a sport you've played every day since you're four years old, it's still a challenging sport. It's not always easy to just pick up where you left off. And I find that a lot of my clients, they're looking for a way. Now, they might not like this whole movement bucket idea. That being said, I have seen it work. And whether or not they try to choose that pathway is always up to them. If a lot of some people say yes, some people say no, and they just keep looking for that magic bullet. And sometimes they get there. Sometimes it just really takes more time. Or maybe they find a particular treatment that works for them. But unfortunately, a lot of people continue to wait. And my main goal, again, is to keep people moving in any shape or form. Pain, obviously, is a factor that I will address. But movement is a non-negotiable piece to the rehabilitation program. We have to find ways to keep you moving. So, think about this, guys. I call it the movement bucket framework. I'm sure there's a lot of different ways that this has been described. Or people probably have very similar methods. But this just works for me. Again, an everyday bucket, a most days bucket, and a challenge day bucket. Give it a try if you're having a hard time moving. Hope you guys enjoyed this one. Take care. Thank you for listening to the Talking Rehab Podcast. I hope that this podcast stimulates you to question your own practice and how you approach rehabilitation. I truly appreciate your time and attention. If you enjoyed listening, make sure to like and subscribe to the podcast. I wish you a movement-filled day. Take care.