Doctor Jiu Jitsu Show

ACLs, Jiu Jitsu & Recovery with Dr. X

• Doctor Jiu Jitsu • Season 1 • Episode 3

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Hey guys! I’m so excited to kick off this episode with none other than my mentor and friend, Dr. X—a fellow sports surgeon and a true expert in all things ACL. We dive into the world of sports injuries, especially in jiu jitsu, and break down everything you need to know about ACLs, meniscus, MCL injuries, and how to navigate surgery, recovery, and even whether you really need surgery at all. Whether you’re an athlete, coach, or someone recovering from a knee injury, this one’s packed with insight. We also talk mindset, prehab, neuromuscular training, ice baths, and all the stuff no one tells you until you're in it. Let’s get into it.

 

Episode Highlights:

[0:03] Hanging out with Dr. X and chatting about how his sports injuries led him to ortho.
[2:10] Why your doc needs to understand your sport (especially jiu jitsu!).
[4:45] Wrestlers, boxers, and ACL mechanics—what every athlete should know.
[6:25] Meniscus repair vs trimming—breaking it down in simple terms.
[8:22] The most common jiu jitsu injuries (you’ll definitely relate if you’ve rolled a while).
[12:27] ACL injuries in BJJ: heel hooks, contact injuries, and deciding if you need surgery.
[15:00] Long-term effects of not fixing an ACL—yep, it matters.
[17:30] Prehab, swelling, quad shutdown, and the biggest mistakes people make early.
[22:20] Graft talk: cadaver, quad, patellar, and why we don’t love hamstring grafts.
[27:35] Other injuries that show up with ACL tears—and how they change recovery.
[29:06] Strength vs neuromuscular control in rehab (spoiler: you need both!).
[30:06] All about BFR training—why I love it and use it in my own recovery.
[33:39] Recovery tips: two-a-days, ice baths, and rebuilding after surgery.
[37:07] Why older athletes need to stay moving (my favorite part of the convo!).
[39:49] The mental side of recovery, fear index, and the importance of reps before return.

 

Thanks so much for listening! If this episode helped you—or made you feel a little less alone in your ACL journey—please rate, follow, share, and review the podcast. Your support helps us keep these conversations going. Catch you next time!

To learn more about Dr. Megan Jimenez, check out her website: doctorjiujitsu.com

Megan Jimenez:

Hey guys, I'm Dr Megan Menez. I'm an orthopedic surgeon specializing in sports surgery and jiu jitsu brown belt. I'm here with my mentor and good friend, Dr X who is originally from California and completed his medical school and training in Atlanta, was in Pittsburgh and at Vail for some of his training to be a sports surgeon. He is very well versed in ACLs, and that is his main focus. So I'm really excited to have him here today. Thanks for coming on anytime. Thanks for having me. Yeah, it's awesome to have you here and be in your awesome house. And I want to talk to you about how you got into orthopedics, what brought you to this route. You know, it's

Dr. X:

kind of interesting. When I was in when I was probably a first year, no eighth grade, and I had Osgood slaughter, which is when you grow too fast and you have pain on the front of your knee. And they wanted to bring us to the pediatrician. I wouldn't go, because the guy a year before me that had it, the guy said, oh, you can't play sports for a year. And so I just didn't complain. It didn't go it hurt. But I, you know, I knew was, you know, I didn't want someone to tell me that. And then in high school, I was frustrated, because when, every time you got hurt, they send you the pediatrician, and if you got lucky, I didn't even know what orthopedist was. They sent you to orthopedist when I broke my thumb, and then I had a guy who actually kind of understood sports a little more that was really helpful and really, really helpful for me, because he, you know, understood that I wanted to get back to play and then just say, well, let's just keep you out for three months. And that kind of led me all through played football in college, and our team orthopedist, you know, was helpful, but again, not a guy who ever played the game and that, you know, I said I want to do that, but I want to come at it from a different perspective, because I've been there, and I think that is what made it my lifelong goal.

Megan Jimenez:

Yeah, I think that's super important doctors participating in the sports that we're treating athletes in, because, for example, with Jiu Jitsu, with fight sports, I have a whole different understanding of how athletes are hurting themselves. And you know, when they get back to sport, Hey, can I do this move? Can I do that move? So if you don't know, you might just say you're out for three months. Don't do

Dr. X:

anything Absolutely. And I think when taking care of athletes, even if you know, if you've played a sport, and you train, especially something like football, okay, there's contact, head injuries. It's violent. You train very similarly now to the way most other athletes are training. It's a lot of weight lifting. It's explosive movements you do endurance works very different than being a cross country runner, but I think you still have to learn about these sports. I mean, I I didn't know much about Brazilian Jiu Jitsu, but my roommate in college, the guy named Tim LASIK. And Tim was a defensive tackle and a heavyweight wrestler, and he was actually fought, and I think UFC 29 or 30, early on one of those two. And I learned a lot about because he started boxing, then he started getting his other stuff, and I didn't know what the hell it was, but I just started watching him and Ken Shamrock and these other guys find them UFC, and you started to get some understanding of what's going on. Then you kind of become interested. And you know, you spend a little time talking to people like you or Chris rozzi or other other I've taken care of a bunch of MMA guys at this point. A lot of them are especially Brazilians. Are all jiu jitsu based, so you learn a lot about their sport. And I think that's important with any sport you take care of,

Megan Jimenez:

yeah, so with jiu jitsu in particular, injury patterns, what's the worst you've ever seen? Or fight sports in general,

Dr. X:

you know, fight sports, it's funny, you you know, in boxers, it's, you know, you see that broken hands. You see a lot of dislocated shoulders. You don't see as much knee stuff. You have to understand that if you have, you know, a lower extremity injury, much like a baseball player, you're going to lose your power and your velocity. So like when we have baseball players who hurt their ACL, you know, we got to be very careful when you return them, they're not going to return and throw really well within that first year, they're not strong enough, you know, they can throw again, but if you let them return to the mound too early, they're going to hurt their shoulder, they're going to change their mechanics. So similarly, with boxers or any strikers, you're not going to have the striking power if your lower extremities aren't strong. Yeah, it all comes from the base, right? And then, if you get into, you know, your wrestlers, you got to be very careful. You know what type of ACL you do on them. They spend a lot of time on their knees. They need hyperflexion, which oftentimes, when we fix knees, we'll say, these people look fine, and a football player could lose the ability to bend their knee, if that, you know, no one's going to take a football player and put their heel to their butt, okay? And this is by accident, but you do it in your sports,

Megan Jimenez:

yeah. When I was returning to sport after my ACL, I remember particularly being at one of the Emory PT facilities, and they were like, Oh, your range of motion is zero to 140 degrees. And I was like, that's not good. They were like, That's excellent. I said, No, I. I need, like, 160 right my knee to be sitting on my heels, right? So it's very different. It

Dr. X:

was one of my old football players who played for the Cowboys, and he's coaching at a Texas right now. He's a running back coach, and I did a simple, you know, simple operation on his knee, nothing, no big, complex thing. But he played again. Two weeks later, was in the playoffs, and they interviewed him. To someone said, how was your knee? Said, Fine, with no problem. I talked to him. I said, Hey, to shard, how was your knee? It didn't hurt you. He goes, hell yeah, it hurt. I said, Well, you didn't say that. He goes, they didn't ask me that. What they asked me was, how did I do my knee did fine. He said, If someone tackled me and pushed the heel to my butt, I would have passed out. And it teaches you a lot, because we'll go in on these wrestlers, and we'll do a little simple, little meniscal surgery. We're just trimming something up, but they're back training on the mat within, within a week. But they're not ready to if someone you know is riding them, or someone in jujitsu submits them, they're going to tap out when you get that, if you I mean, it's gonna swell, and it takes time to get that flexion back. So those are little things. I think it's helpful to understand the sport when, when you're when you're working with

Megan Jimenez:

athletes, yeah, and something you brought up there a meniscus, like trimming, right? That meniscus? A lot of people, they've heard the word, but they don't know what it is. And then when you talk about a trimming versus fixing it, you know, you said he went back in a week. But if you're doing different surgeries

Dr. X:

and people, you know when, when people are talking to people like us, I'm not very My language is kind of one of a miscreant, rather than, you know, someone is trying to be smart, but you have, you have to make sure you understand everything we're saying and, and if you don't, I try to, like, look at it and say, you know it, make it as simple as possible, because they want to, you can. Person needs to understand what's going on with their knee. Very similar to me, you know, you coming in as a jiu jitsu person and and telling me, Well, I did this. I got him in a Kimura, I did this. And I'm going to go, Okay, I think I know what you mean, but you better just kind of go over that slowly. So I really understand, you know, what your transition from move one to two is. So I understand that they have to, you have to be the same way. And ask me those questions like that so I can explain it to you. So, like a meniscus is a piece of gristle that looks like a C shape, and it's a pad inside your knee, like a brake pad if you tear it, part of it has blood supply, we can sew it together. That's called a repair and and when you sew it together, that takes time to heal. If it tears where there's no blood supply, then we just trim it. That's that means I trim the meniscus. But people get say, Oh, my meniscus was repaired. And use that to mean both things, and it doesn't, yeah, but there's totally then I say, Hey, you can get back as soon as you can, but realistically, it's about six weeks for most athletes to get back working. After a minute, you can do it sooner, but you're gonna have pain.

Megan Jimenez:

Yeah. All right. So there was a recent paper out in 2021 talking about most common jiu jitsu injuries. I thought it was super interesting. Most people they talked to were competitors, so probably getting after it at a higher level. And what they showed was that the most common injury was the knee. To your point, the most common ones being meniscus, ACL and MCL. So we kind of touched on meniscus a little bit. Can you talk a little bit about ACL, MCL, surgery versus no surgery.

Dr. X:

You know, it's interesting. As I see more and more injuries, I'm starting to see guys 40 to 60 starting to get involved in Jiu Jitsu, who've never done wrestling or anything ever, and they're having a blast doing it. But you're seeing so in that age group, it's funny, we've seen a lot of groin injuries, okay? And we're seeing a lot of you know, because guys don't stretch, they lose pliability and and so we're seeing a lot of groins. We're seeing a lot of muscular tenderness, injuries that aren't necessarily surgical. They're just irritating, and some cases could be debilitating. When you look at a knee, you got to think of your knee is just two, two bricks on top of each other and their head held together by four rubber bands. You got a rubber band on each side that prevents your your brick from going this way, and two rubber bands in the middle that control this and also rotation. The two most common injure to those rubber bands are the rubber band on the outside, on the inside part of your knee that goes on, you know, right underneath your skin, and that's called the MCL. Now, the MCL is what some injury. The MCL happens when you get hit from the side. So think about it, you know, if someone strikes, you know, kicks you a Muay Thai guy hitting you on the outside of the knee, that's going to be an MCL injury. Okay, so that's the first thing to go, just like if you're a football player and someone rolls into you when these offensive linemen, you'll see them in knee braces. That's usually not because of ACLs, although they think it helps their ACLs, it helps an MCL injury, because if they get hit on the side, it actually stops their leg from bowing in now, those injuries are interesting. Because when I was in Pittsburgh, they would make the young guys see all these five foot tall, 350 pound women who slip on ice, okay, very common injury up there, first time it snows. And they would have trampolines too, yep. And they have MCL injuries, yep. And why did they make us see them? Because they all heal. Okay, 90% of you very rarely have to operate on them, but they hurt for six to eight months, and so people keep coming back. It hurts. You have to explain to them. And when orthopedists, you know, we all hate when we can't fix something and it's going to heal over time, because it doesn't make the patient happy, okay, if we can't fix it, we know it's going to heal. Then we do a myriad of other things to try to, you know, try to get them to be happier with their situation. So MCL heal. It is because it's a big, thick, wide ligament that is stuck between two planes. So it's like a peanut butter and jelly sandwich, if you, if you tear the jelly inside the bread, but the bread is still intact, and the peanut butter is intact. It holds it there, just kind of all, you know, slushes together again and heals. The ACL is different. The ACL is like a rope, and the PCL are ropes on the inside of your knee which attach the bricks together. Now they're little ropes, and if they pull apart and break, they retract like a rubber band. And then, since they never go back together, they don't heal. And then that's the problem, because those injuries are usually, you know, getting hit from the side and rotating. If you watch football, it's almost always non contact. They jump and they land on the knee. You'll see it. And the UFC by, you know, when guys, you know, they'll go, go, he'll kick a guy, and they'll grab his leg and hold one of them, and then he jumps around, you know, kind of that leg that's on the ground, he's being twisted. He lands. You'll see it with again, if you get hit inside of the knee, oftentimes you'll tear the MCL, and if it's a big enough blow, you can tear the ACL on top of it. So you do both those things, and it's hard. That's a near impossible injury to compete with if you're a you know, if you're an MMA guy or a boxer. Now, interestingly, there's been plenty of really good jiu jitsu guys who are ACL deficient because they're not spending much time on their legs most of the time, especially in Brazilian Jiu Jitsu, they do their best work on the ground. And you don't need an ACL for that. You need an ACL for planning and pivoting. And some people can get away without

Megan Jimenez:

it. Yeah, and so we talked about planting and pivoting main way, like football, soccer, anybody in those kinds of chain, change direction. Type sports on their feet. In jujitsu, though it's often a contact type injury, and it can happen a lot of ways the legs locked up, or how my your My way was a heel hook. And so heel hook is one of the top three submissions for creating an issue in the knee. Yeah, your

Dr. X:

injury, because you see it. In fact, I'm going to show your injury. I have to give a talk in Pittsburgh at the end of the year on ACL injuries, and the other one that's on the internet, I just saw it the other day, and this guy was doing like a, you know, the sit up machines, but he planted his feet, and he's leaning back with a weight, and he goes back, and you see, poo poo. Yep, both, right. I saw that one. And so you're looking at these things, you realize that it's a rope. So when, if you put tension on it and keep going, it's going to break, just like if you if your arm barring someone, you could break their arm. It's no different with an ACL, and that's what you see in jujitsu. Like your injury, you know, I knew it was coming. You can see it. You could see it. And then you kind of rolled it and, you know, and I'm and pop,

Megan Jimenez:

yep. And so with jiu jitsu as well, I think this is an opinion. I think a lot of people walk around with partial tears, maybe not full, like mine, because that rotation happens kind of more slowly. And you can spin, you can do things to kind of relieve the tension, and it's not totally too late where the whole knee explodes. And

Dr. X:

I know, I know, I know one of the best Brazilian Jiu Jitsu guys of all time, who was a soccer player until he was about 12, because at 1213, he had knee injury. He didn't know what's going on. He's in Rio de Janeiro. He didn't, didn't have a doctor. And then he has another injury. Said, you know, I can't play soccer too. I'll get him in jujitsu. And he's, I don't know he's ever been beaten. I mean, he was amazing. And he came to me with a complaint of the doctor because he had ACL injuries and two meniscal tears. They said they want to reconstruct them. And he's like, they're not, you know, and it's a long recovery. And then when I have to start talking to him and looking at him, I realized that his ACLs have been out for for 15 years. So from soccer, or from soccer, yeah, not even. So we went in, just took care of his meniscus and on both sides, and he did great. He did. He finished out his career. He's, and he's, you know, he's, he's coaching and doing other stuff now. Never had him fixed because he doesn't do anything that requires them and his style of fighting, he didn't need his ACLs.

Megan Jimenez:

So there are some people that we can say, do not need the surgeries and Jiu Jitsu. I think may be one sure that we but you have you weigh the risks and and and benefits like I did, right and talk to people that you trust. So I mean, I have wonderful colleagues and wonderful people in my network. How do you how do you tell people to go find a doctor that they can trust?

Dr. X:

Well, I think, you know, let me get back that one point. First you have hockey players never had their they didn't. They don't need an ACL to play hockey, most of them now, why do they get they used to not get their ACLs fixed, 25 years ago, why do they get them fixed? Especially now, because probably around, you know, in the mid 90s, when the steel, I mean, the penguins, started getting big hockey players. They were all little guys, Dwayne Gretzky type. Then you started getting the samuelsons and Mary lemu. These are big guys, 652, 40, and now they're training like football players. So they need to run, cut, clean, jerk. You need an ACL for all those activities. So you may not need it for the certain moves you're doing on the mat, but to train, to be good at that, and the cross train, like all we all do now, you need an ACL

Megan Jimenez:

for that. And I think the wrestling component of Jiu Jitsu, there are some, especially

Dr. X:

when you're if you spend, if you're more of a judo guy, yeah, then you need an ACL. You can't be a judo person without an ACL.

Megan Jimenez:

So if you were to have somebody that said, Look, I don't want my ACL touched, but they say, what could happen down the line, like, Are there any repercussions to not doing it?

Dr. X:

Absolutely, the same guy that I told you about, that did fine, lost both of his meniscus because he had an unstable knee, and his meniscus was, was, was doing more than many people's doing it tears. So when you have undiagnosed meniscal tears in young kid, all of them, if they do that, and when they're when they're under 14, every one of them will have irreparable meniscal tear by the time they're 20. Okay? And that's what leads to arthritis and leads to problems at the knee. So it's not as easy as, oh, I don't want to get it fixed. I'm going to go play. You know, you never hear during football, tore an ACL, and we're going to fix it. At the end of the year, you hear tore it, tear the ACL. We're going to get it fixed. He's out for the year. And almost every sport you hear that, okay, so the sport involves running, jumping, cutting. So, you know, it's to protect the knee and allow the athlete a longer lifespan.

Megan Jimenez:

Yeah, awesome. So talking about ACL surgeries, you indicate somebody for an ACL, yeah. What kind of talk do you have with athletes about what you're gonna do?

Dr. X:

So I think the important thing is, if someone says, Hey, you have an ACL tear, you gotta sit down and say, and have someone look at your knee and see how unstable you are, meaning how much they can move your knee, and then talk to you about what your goals are and what your training is like, and what you're feeling. It's super important not to rush into surgery. ACL is not urgent surgery. The most important thing is, when you have this injury, you're going to swell, you're going to get stiff, is to get right back in the gym, get on a bike right away. Work on getting your full motion out, getting it straight, bending it, getting back to full lifting. It's aggressive prehab. And as soon as you tear an ACL, the neurologic connection between your brain and your quad muscle gets disrupted because there's a nerve in the ACL that goes back to the spinal cord. And it's amazing, because as soon as you do it, you'll start, you're going to start losing size and strength. And if people get put in a knee immobilizer, or they don't, they takes three weeks to get in to see a doctor, they're way behind the eight

Megan Jimenez:

ball. That's how we get them a lot, because I went to the ER and they're in an immobilizer, exactly.

Dr. X:

And it's the work of the devil. I hate it. So I have, a I have a website that as soon as someone says, Hey, I got an injury, I just send it to them, because you're not going to hurt yourself by going on a stationary bike. And if you get that thing working immediately and start getting your motion back and get your quad working, you're going to do better sooner, because an ACL is not hey, it's a six month thing. Okay? It takes, it takes nine months to get all your strength back, for the ligament itself to be strong enough to sustain a blow and for you to start training aggressively again. Then you know, there's a difference between training and competing, too. So NBA basketball guys are some of the best athletes in the world. And you go and take care of these guys, and they're back doing things, you know, everything at nine months, okay? And by 12 months, they say, I'm ready to go. Well, if you're one or two guard, you're not going to be ready for the NBA at that time. It's going to take, you know, between 12 and 18 months to really play well. Most people on the latter end of that, you know, I just had a guy with a fixed that's he's awesome, and he didn't mind me telling the story, but he came back, did well, but went from the NBA into the G League, and he was MVP of the G league the same year after he had his ACL done. And that that is unbelievable. Now, what you don't what people don't talk about, is how great. An athlete it takes to be in the NBA. These guys are phenomenal athletes, and a better athlete you are, the better you're going to do. But even with those guys, it takes time. And I think the discussion I have with people right when they come in is, number one, get all your you know, the prehab part, and then number two, the length of time it takes. And then number three, the RE injury rate, because I think you got to drive that home, especially when younger athletes. It's not zero. Between 14 and 22 years old, elite athletes have a 10% chance of re injuring their ACL, 15% chance of tearing their other one. That is a big number that's with a patellar tendon or quad tendon. ACL, the best surgeon doing it, and we have that data, that's not little, that's one in 10. You'd say, hey, I'll bet any day and 90% I'm going to go to Vegas and take that bet. Yeah, that's great, unless you're in that 10% okay? Because you're not just betting 100 bucks. You're been betting your your life savings, on this. So I think that then I go in and talk to him about the actual surgery. That's the last thing I talked to him apart, because they have to understand what they're getting into, what they need, what they can and can't do, and what they're looking at.

Megan Jimenez:

Yeah, I think the biggest thing that I have also implemented since my injury, because a lot has trained, has changed about how I approach it's mine. I almost learned more than residency when I just going through mine was when I called you after I tore mine, and I was so sad. I was like, I'm out. This sucks. And you said, Get on the bike right now. I was like, I'm already there. And so I my right leg was bigger than my left leg going into surgery right like my my injured leg, because I was at the gym every day. How long did you take before injury and surgery? A month four weeks. But I was every day on it immediately. Every day I was in PT already, doing proprioception, so single leg balancing stuff, strengthening my glutes, doing pistol squats. I was, you know, extend I was doing everything. I was leg pressing like a maniac, right? And I just wanted to be as strong as I could, because that surgery is a second injury, yeah, and then you're back to square one. So you don't want to be back negative,

Dr. X:

yeah, which you will be many people, and they all want to rush into surgery. I'm like, Nah, just give it a little time.

Megan Jimenez:

Yep, all right. And so the next thing you talked you said quad versus BTB when you were mentioning the rates of injury. So let's talk about that.

Dr. X:

So when you're looking at ACLs, you can fix them in two big groups, either using dead people tissue or using your own. There's dead people tissue is not a good option if you're under 30. If you're over 30, it can be a good option. The older you get, it's a better and better option. What are the downsides? Well, the upside of it is it hurts a lot less. It's a faster surgery. The initial recovery is faster. So for the dead, the cadaver the dead people, yeah, cadaver, the dead, you're getting dead tissue. So a dead guy, you're borrowing his tissue. You don't borrow his ACL, you borrow the tendon from the front of his his ankle, usually is what we use. Keep it, don't give it back. Yeah, we keep it. Yeah. We borrow, we take it, but when we use that your it never totally becomes your tissue. Some people, their body attacks it a little bit. Other people, they don't incorporate it. Mean it doesn't heal in as well. Some people heal in and really well. But it's the it's unpredictable. So the RE injury rate is higher. It kind of levels off at about 35 so 35 and over, we tend to do a lot of cadaver graphs. 35 and younger, we tend to do a lot of your own tissue.

Megan Jimenez:

What's the oldest person that you've done their own tissue for?

Dr. X:

Probably 54 and that's because they wanted it. Yeah. Which leads us to the second big group is borrowing from yourself. So if you're gonna on a younger or higher level athlete, we're gonna take their own tissue, and you can either take a little piece of their quad tendon from above the knee, some of their kneecap bone tendon and bone from the front, or some of their hamstring tendon. Now the problem with the hamstring tendon is the failure rates higher. And if you're a judo guy and you do a hamstring on someone, they'll hate you because you can't heel hook. You can't you're going to lose strength beyond 90 degrees of flexion. So when you start pulling here, you're going to lose some strength. So you got to so I don't use that graft at all anymore. Patellar tendons are good. It's a great graft we've been using a long time. But when you kneel on it, the chances of getting frontal knee pain are higher, so you spend a lot of time on your knees. That's a problem. Quad tendon doesn't have that issue. And outcomes and are almost exactly the same as patellar tendon, but the collateral damage URL is a lot less. So that's kind of my go to Graph. But there's, you know, outcomes wise, there's really no difference between taking a quad and a patella. 10,

Megan Jimenez:

yeah. And I agree with you the, I mean, I learned quad from you when I got to Atlanta, because I we were doing mostly the BTB, the Patel attendant in training. When I see wrestlers, or any type of Jiu Jitsu, anybody that's going to be on their knees with when they're competing, I do push them towards quad. But if anyone. Other athletes, I usually give them the option between the two, and I say exactly. We're not doing hamstring because of the higher failure rates. And then allograft is or the cadavers out of the question when they're young athletes,

Dr. X:

right? And I think the important thing is, is people get really caught up in the type of graphs. And I think there's some bad like, you got a 20 year old you don't want to do a cadaver, or that's a bad choice, the dead person graft. But in that 20 year old, if your doctor says, Listen, I do patellar tendon, I don't do quads, you want to do with what he's comfortable doing, or find another. If you really want the quad, you want to find someone who's done them. Okay? And so when you're picking a doctor, if people are too dogmatic, if they say, this is the best graph, you know, I'm not sure that's a true statement, you can say, this is the best graph in my hands. That's a good statement. If they say, look, I do, you know, I do all of them, I say, Look, you can, you can choose this. This is what I would recommend your mentor. When we started, about 2000 When did you train? What

Megan Jimenez:

year? When I was a Dr matava, yeah, that was 2019 to 20.

Dr. X:

Okay, he was getting into, at the time, Matt's Patel attending guy, Jim Bradley, Walt low, other NFL guys were all Patel attended. And I have this stat in 2013 I think my fir or 14, my first quad 10, and went to the NFL and they downgraded them. Or say, Well, we're gonna, when you sit there and you looked they were going to downgrade them like in the combine, in the combine, so when you evaluate everyone before the draft. Now, Walt Lowe is 70% quad, and Jim Bradley is probably 35 to 40% quad, and they don't downgrade them at all anymore. And Matt's probably, I don't know what Matt is. He's probably 35 40% question, a lot of quads now. So we evolve too. So if someone you know doesn't want to evolve and is stuck in what they do, that's great if you're not doing very many of these. But I think you had to ask someone you know, I think it's a valid statement, how many of these do you do a year? And is this your primary area of focus? Are you doing knee replacements, or ankle replacements, or, you know, are you all over the place? And that allows you to pick someone who does, you know, a fair amount of these.

Megan Jimenez:

Yeah, the last thing I kind of want to talk to you about was with ACL injuries. So people come into the gym a lot, or they come see me and they say, Hey, I had an ACL on this knee. And we just talked about what the importance is of the different types of graphs, you want to know what exactly was done. But there's a lot of other injuries that can happen alongside an ACL. So how does that change things? What should people look out for? What should they what kind of questions should they ask their doctor to see if anything else is going on that is important,

Dr. X:

right? So an MC, if it's a significant MCL injury, not something the guy says, oh, on MRI I saw, but you have a lot of pain on the inside of your knee. You got to watch for stiffness. So those people, we got to move. If you're going to have ACL surgery, you better get on a bike right away. And you got to move. I don't use, like, knee braces. I don't use them for most injuries, most ACL injuries, MCL, I will use them. I want these people putting weight on it pretty quick. And I want them moving quick. Now, if you had damage to the end of the bone, your articular cartilage, and they had to repair that, that's going to slow things down significantly. If you had a meniscal repair, again, it depends on the doctor, unless it's a huge repair, I'm moving you just as fast, but you have to be aware that progression is not to get back to doing sport in the first three months or running in the first three months or jumping. It's it's neuromuscular control, strength, strength, strength and more strength. It you've got to get the strong strength back. We want you to have neuromuscular control, but often therapists are concentrating all that and not worrying about strength. You can't do anything without strength. So we start the leg extensions, leg curls, leg press, squats, lunges quickly. And, you know, it's not an ass to the grass type thing. It's go, you know, doing squats slowly and where you're comfortable, but the fast, faster we get your core region to your knees firing, the better off you're going to

Megan Jimenez:

be, yeah, and I'm a big fan of BFR. You send your athletes. I post a lot about it. It's like, yeah, blood pressure cuffs on the thighs, and it kind of decreases a little bit of the oxygen, so you're working in more of an anaerobic state. Because as athletes, we want to be squatting more. We want to be, you know, breaking our record doing more, but you can't when you're right out. So BFR allows you to do more reps and feel that intensity,

Dr. X:

yeah. And BFR, especially in the beginning, once you can get your once you can do a straight contraction, then people find it very helpful. It jump starts things. And sometimes the hardest thing to do after an ACL, as we know, is, you see these people in their quads asleep. What are we going to do? We got to wake it up. And BFR is one of those, those things that people are athletes like, and it's simple. You don't need a million dollar cuff. You can use you can use a rubber band. You can use a. Blood pressure cuff. I mean, the thing that costs a couple grand, it's, it's a blood pressure cuff, yeah,

Megan Jimenez:

and the PTS mostly have it. I bought a set because I like to go to the gym, and sometimes I'll put it on my arms, and if I don't feel like lifting heavy that day, just get a light set in with a lot of reps. It's rough,

Dr. X:

yeah, my son broke his ankle, so he's got to work his calf. So we did BFR, and he absolutely, after he got rid of thing is, I never want to see that damn table again. It sucks. It works. But he says, I That's good. I'm not training with that thing ever again. So it's kind of

Megan Jimenez:

funny, yeah, I mean, and to your point, with the quad being asleep, I remember one of my first physical therapy sessions a week out, I couldn't lift my legs straight up, and I started crying. I was just like, I knew this was going to happen, right? But when it happens, you

Dr. X:

just in total shock. And you know, I always call people on Sunday after the week after their surgery, I say, Hey, could you do straight leg lift? And then they get all kind of depressed. Well, you know, 80% of my can't lift my leg up. And I said, Okay, that's normal. Can you contract your quad? And they said, I'm starting to see moving. I said, good, and you just keep at it, and sooner or later, they'll get it up. Usually happens in within a week to 10 days, so we don't get too upset. And that's why I love to start walking on it or with crutches. Is putting weight, because it helps that

Megan Jimenez:

quad wake up. Yeah, another thing stiffness that we kind of talked about, just MCL injuries. I remember when I first started, and I had a big lineman that had an MCL, and I called you, and I said, Man, this is a big boy. He's got higher grade MCL. And I was like, What are the biggest things that you look out for? And you said, stiffness, and not just MCL, even though they are more prone to getting stiff after ACLs, people get so stiff. And I see I have a bunch of friends post op years out that can't sit on their on their heels. So how do you promote that safely in the beginning?

Dr. X:

Well, the most important thing we work on the band is extension, and that's our being in existence. And I look at it, and there's a orthopedic surgeon named Don Shelburne, who's in his 70s now, but he studied his patients, and he's always said, if you lose any extension straightening, you're not never going to get your strength back. You're not going to be as good. And we look at that. And so we get them, if we're in three months and that person can't get his leg straight compared to the other side, we'll do a quick little, you know, three minute surgery to go in and take out scar tissue, then they can get their legs straight, then they're going to get strong faster. No one wants to do that. And people ignore that, but you ignore that, in athletes, you're going to have problems, especially if you're, you know. Look, if you're, if you're playing in the, you know, NFL, you may get away with that, but you're not going to be as strong as you were before, and the average guy won't, and then the bending usually comes back. And while you're going to get as much extension as you're going to get by, probably three to probably four months after, it's not going to get big more than that flexion, you're going to keep doing more, and you got to push it, and you don't stop, you got to do a child's pose, and it's going to hurt,

Megan Jimenez:

yeah, it's pushing it, you know? And I

Dr. X:

think you gotta, and I, you know, when, if you're gonna take the time to undergo this operation, an operation not like an ACL, you got to buy into it, because it is not hard. You know, there's an old movie called Brian song about Brian piccolo died of cancer, and Gail, and Gail Sayers has an ACL, and part of the movie was him coming back. And this is archaic ACL surgery. They, you know, in the 60s, when they cut your whole knee open, ended your career most of the time. But the work and that it takes to get better from that has never gotten easier.

Megan Jimenez:

Yeah. I mean, I was doing two a days sometimes in PT just to get the swelling down. Brutal. Yeah, it's, it's a real

Dr. X:

especially when you're trying to be. I have a real job, and you're on the feet as much as you are as an orthopedic surgeon, it's

Megan Jimenez:

hard, yeah, I mean, I waited about five weeks to operate again, but even then, I would at the end of the day swollen, you know, and just really cold tub, my ice baths, I know I got you into cold tubs. The ice baths became very important. I couldn't ice bath for two weeks because I wanted my incisions to heal, right? So, there's videos of my friends like lowering me into the ice bath with my leg out, so that the incisions, because even just on the rest of my body that effect, it has your inflammation Absolutely, yeah. How do you like the ice bath?

Dr. X:

I love it, you know, for old guys. Okay, so I'm old and I'm stiff, and, you know, you get in there, and this is not like, you use a lot of things you can do that make you feel good, like massage, it makes you feel good. I don't know if anyone's ever shown a real benefit to it, but we all like it, and it makes me feel better. This is different, because when you go in there, there's a there's a chemical reaction, and I know it's happening because I get out of that thing this, and I don't drink coffee, but it's like I drank shots of coffee without the jitteriness, and it lasts all day at work. And it's addicting. So no, drop, you don't drop like no. And it's, it's full on addicting because I don't want to do I wake up in the morning. It's miserable, and then, and then I warm up a little bit, do my workout. By the time I'm at the end of my. Workout, I look forward to just hopping in there and, you know, the first 30 seconds sucks, but then after that, it doesn't matter, staying forever, and then you get out, and then there's that you're warming up. Is like, is like, your, your it's like energy exploding in your body, and it's norepinephrine, yeah, there's dopamine. There's dopamine. Something's coming up. Is there's a real response happening, because your body's trying to make sure you don't die. So, but, but that, whatever, that, that stuff, the rest of the day is awesome.

Megan Jimenez:

The funny thing is, you said that you're, I don't think you're old, but you said, Oh, I'm old and stiff. So a lot of people think ice creating more stiffness. So see,

Dr. X:

it's funny because, you know, we ice, people, you know ice, you know, should stop the enzymatic activity. So people say, Well, isn't that bad for healing? And you would think that if you ice just your ankle, sometimes you feel like you're stiff afterwards, but when you do it in your whole body, I mean, I every day I wake up with low back pain, okay, and I don't have I'm just arthritis and from squatting and cleaning and all that. So I'm stiff now, if I take to a leave, I feel better, right? But who wants to take a leave every day I don't, and I'll forget. I mean, I guess sometimes you may need it, but when I get in that damn ice bath, if I'm really stiff in the morning before a workout, I'll get in for a minute, and then I get out and I'm it's like I've spent 45 minutes warming up, yeah, and so that's not in my head. There's something going on there. So, you know, I don't, I don't care what you know people say, you know, I don't know if there's data that backs it up. It's one of those things like it, you know, works for me, and it works for a lot of my I was just telling telling you earlier, I've had a bunch of my buddies buy these things who are my age. I'm 59 as of Saturday, and that's, that's horrible, you know, you kind of think, but when you get in your 50s, it's harder to keep your training doing the same, because, you know, you got everything against you. Your body's wearing out. Hormones are down. It's not the same. You can't lift as hard because, not because your muscles can't take it, because your tendon joints don't take it. So I try to keep up with my kids and really lift after about three weeks I have tendonitis, so I have to either I have to cross train better and do different things.

Megan Jimenez:

The recovery is so important, and it's I've done a few interviews with athletes in their 20s, like young professional jiu jitsu athletes, and they all talk about recovery, but then I don't think that should change when you are not in that even when you're coming out of that pro sport, if anything, increase that recovery so you can stay doing the things that you enjoy. The

Dr. X:

one thing that I'll tell old as you get older, is you never can take off unless you're injured, because when you take time off, it takes you, sometimes you takes forever to get back. So the guys, if you continue what you're doing and you got to cross train so you don't have these other issues, overuse issues. But you know, the older you are, if they if they shut you down for two or three weeks. You know, my dad is 97 My dad worked out. He still works out. He walks, he swims. And during COVID, they shut down the pools. Now, you know, he was in California when things were locked down. They shut his gym down, and they shut his pools down, and that was brutal. I mean, they're worried about him getting COVID. I'm worried about he's worried about himself. It took a year, and I don't know if he ever got back to the same level, but now that he's swimming every day he comes out of there. He's like, a new guy,

Megan Jimenez:

yeah, just what a month probably deconditioned him. Oh, yeah. And it

Dr. X:

was, it was actually, it was more, it was like a six month period, and it was brutal there. But if you do that, you know, in your 40s or 50s, I know you get busy, but figure out the time. That's why I do everything early in the morning. No one's doing anything at five o'clock in the morning except me, and I get it all done. I go to work, then when I come home, you know, all hell's broken loose. And, you know, and you can do everything.

Megan Jimenez:

Yeah, it's super important keeping up with it. And even in young people, Doctor says, hey, look, you're out for X amount of months, some of my athletes, they're like, Okay, well, I'm done. I'm not going to do anything. I'm just going to sit on my couch play video games. That is the worst thing.

Dr. X:

That's a great thing, because I always look at people and say, these high school kids, so you blew out your knee. Well, you know what? That sucks. There's nothing good about that. Nothing I mean, but you got to turn a negative into a positive. And the people that have embraced the training, the weight lifting. I have people that come back bigger, stronger, faster, because they've never trained like that before, and especially female soccer players, who all they do is play soccer all year round. They finally took a break from soccer and trained. And those girls come back as as as beasts. They're they're strong and and they feel different. And they'll tell you, man, that was the one positive after going through this is, yeah, I took time off from playing, but I am a stronger, faster athlete now that I've trained appropriately. Yeah,

Megan Jimenez:

and we didn't really talk about the mindset part of it. I'm hoping to have a sports psychologist on too, because that's so I thought that was bigger than the actual injury itself, physically, like my mind played so. So many games, I was having nightmares. I was really struggling. And then after the surgery, two days later, I'm with my Brit with my like, crutches and everything, doing one legged push ups, doing pull ups, like getting my upper body and on the track right. And that helped my mind too,

Dr. X:

right? Because the PTSD from any of these injuries is real. And if you ever been injured, and it's not like, oh, I popped a hamstring, but if you've ever had a trauma, got knocked out, and if you do get injured, you're gonna have to get through that, that PTSD part of things, and it's real in

Megan Jimenez:

ACLs. It's so real. Because even when I started getting back to training, people were very nervous to get after my leg, and I was very nervous I would give up positions, because I was like, Nope, you could have it if my knee was compromised at all. But then after about a month or so, I was like, No, I actually need people to kind of people I trust to go after that leg, yeah, and just put me in a little bit of a precarious situation, not where we can get injured, but where I have to defend it intelligently, where I have to keep putting myself into it, because the first time somebody put me in the position where I got injured, I was absolutely sweating. I like, stared at them, and they were they freaked out. And I said, it's okay, we're gonna be good. It's the

Dr. X:

first hit. You got to get drilled. And then you say, you know you're back? Yeah, you know, it's a question people eyes, how do you know you're ready to go back? Well, we could test your strength, your biomechanics, everything. We have all these myriad of tests to do, and we do a lot of it, but really it comes down to two questions I ask them. Is Number one, if your your good leg is 100% What's your other leg? And if you say like 95% that's check one, you're ready. The second thing is, there a little voice on your shoulder that says, you know, like little devil and angel thing. And if you're worried in the back your mind that, hey, I made you're not ready yet, you got to progress more and get reps and get used to it. And that's called the Fear Index. We actually measure that, and that's super important. You want both those things. We Hey, I'm 95% I'm not worried. Then you're ready to go.

Megan Jimenez:

Yeah, yeah, awesome. Well, thanks so much. Is there anything else you wanted to add? Or no, that's good. It was fun talking. Yeah, thanks. Where can people find you if they want to come see you? In Atlanta?

Dr. X:

I'm the only doctor x in Atlanta happy to talk to anyone about their injuries, but I know a lot of people if you need a recommendation or anything, I know people probably everywhere you

Megan Jimenez:

guys live. Yeah. So how do you say your last name, zurroiens

Dr. X:

and it's spelt a little. It's x, E, R, O, G, E, A, N, E, S. So everyone looked at that and said

Megan Jimenez:

this, x, yeah. So, and if you type in Dr X, that's

Dr. X:

pretty easy, Emory X, and I'm probably the only one, yeah, cool. All

Megan Jimenez:

right. Well, thanks so much again. You

Buzz Burbank:

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