[#10] What I Wish People Knew Before Orthopedic Surgery

Surgery can be life-changing when it's the right treatment, but it's not a shortcut or magic fix. As a physical therapist who has helped hundreds of people recover from orthopedic surgeries, I've seen firsthand how unrealistic expectations can lead to disappointment, even when the surgery itself was technically successful. 

In this episode, I share what I wish everyone considering surgery understood beforehand, from what recovery actually looks like to why rehabilitation is just as important as the operation itself.

Main topics covered:

• Why surgery isn't always a shortcut people expect, and when it may not be the best first option.
• What recovery really looks like, including why rehab is often harder and takes longer than expected.
• How surgery repairs tissue but doesn't automatically restore strength, mobility, or performance.
• The importance of setting realistic expectations before surgery to avoid unnecessary disappointment.
• Why returning to sport or full activity requires a progressive plan and not just being "cleared" to return after surgery.

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Transcript

SPEAKER_00 0:00

Today I'm going to go over what I wish all people considering surgery understood as a physical therapist so they can have realistic expectations and give themselves the best chance of a successful outcome. Hello and welcome to Candid Conversations with Dr. Kelsey. I'm your host, Dr. Kelsey, and this is the space where I share my honest thoughts, real experiences, and the no BS conversations I wish more people were having about movement, training, injury recovery, and life as an active human. The goal of this podcast is to help you better understand your body, think more critically about rehab and fitness, and feel more confident making decisions so you can stay active long term. Before we start, a quick reminder. I am a physical therapist, but I am not your physical therapist. Nothing here is medical advice. So if you're dealing with something specific, please reach out to your PT or schedule a session to work with me. Alright, now let's get into today's conversation. I've been a physical therapist for five years now, and in that time I've helped rehab hundreds of people recovering from orthopedic surgeries like joint replacements, rotator cuff repairs, and ACL reconstructions, and I've also had to help a lot of those same patients navigate disappointment with their surgeries because of a mismatch between what they were expecting or what they were told and what recovery actually looked like. Now I'm not trying to throw orthopedic surgeons under the bus, but the reality is that after performing your surgery, they're realistically only going to be seeing you for about 10 minutes once a month, if that. But you're probably going to be spending around 8 to 12 hours a month with your physical therapist. We are the ones with the front row seat to your entire recovery process after the surgery and probably even before the surgery. But I feel like our input isn't taken seriously a lot of times. So today I want to go over what I wish all people considering surgery understood so they can have realistic expectations and give themselves the best chance of a successful outcome. And the first thing I want to talk about is that a lot of people will see surgery as a shortcut, and that's not always the case. So if you rupture your Achilles tendon, depending on the circumstances, like how it ruptured and like all these other things, um, you can recover from that without surgery, but it does take quite a bit longer than getting the surgery. And so depending on what your goals are, like if you're um if you're wanting to get back to like a higher functional level, like the sport, like getting a surgery is probably your best bet. Um, it just really depends on again on the circumstances around the injury and how the injury is presenting and things like that. And so um all of that to say that is in terms of total time for recovery, surgery definitely is sometimes a shortcut in that you know, getting the surgery, you're gonna spend less time recovering. Um, but it's not necessary, it's not necessarily a shortcut on effort. And I feel like a lot of people don't fully understand that because they think they're gonna get the surgery and then everything is going to be 100% fine, like right after this the surgery. Like they don't even if they are told that oh yeah, you're still gonna have to go to rehab after the surgery, I feel like it's not um, it's not something that it's it that is fully understood. And I understand that a lot of times it's it I I think it's one of those things that you have to like experience to understand a lot of like um I mean this is similar to like childbirth and like the the newborn phase where it's something that is described, but um I can tell you personally, like something that I I thought that I understood what that would mean, what that would feel like, but it wasn't until I experienced it myself that I realized like okay, even though I thought I was mentally prepared for this newborn phase, um I nothing, I don't think anything could really prepare me for it besides just going through it. Um, so I feel like when it comes to rehab after surgery, I feel like that's kind of the same thing where um maybe the surgeon or even the physical therapist are are saying, like, okay, you're gonna get the surgery and then you're gonna get rehab after, but I think it's something that you have to really experience to completely understand like how difficult that rehab process after the surgery really is. And so if you're given a choice, because sometimes there are there are times where you do have to get the surgery, like non-operative is not really an option, but if there is a choice um between getting a surgery and not getting it not getting the surgery, recovering without the surgery, um you have to fully consider the implications of both and the rehab timeline amount of work that's to be done in like how long it will take, not only to for the tissue to heal, but how long it'll take to recover after that and regain all of the strength and mobility um deficits or regain all of the strength and mobility that you lose in the time it takes to recover from the injury. Um, and so with that, a lot of people end up getting surgery um just to help with pain. And what I mean, I'm not trying to trivialize pain because I understand how I I have a front again, I have a front row seat to what people are experiencing every day. Um and but if you don't have any functional deficits, meaning like let's talk about the shoulder, like you're able to reach overhead, you're able to lift, you're able to do everything that a shoulder normally does, just the only thing is that you're having a lot of it's painful. Getting surgery just to fix pain or only to fix pain is I don't want to say it's setting you up for failure, but you have to consider that when you get the surgery, surgery causes a different type of pain. You're gonna have the surgical pain, and so you know, you're causing pain to help with pain. And so, and so I feel like a lot of um the people that get disappointed that um in my experience, a lot of them were fine before the surgery, except for the pain, obviously, or sometimes they had minimal pain, um, but they figured, okay, well, I need to repair this thing in my shoulder in this example, and they get the surgery, and after the surgery, they're in more pain. Um, and then depending on if it was like uh like a quote unquote cleanup or if it was a repair, um, if it was just a re or not a re just if it was a repair, then now they have more pain, and also they can't use their arm for at least two months, um, because that's just how it is after repairs, which I'll go over in a little bit. Um, but sometimes if it's not a repair, if it's quote unquote a if it's just a quote unquote cleanup, um, some people do end up with more pain than they had before. Um and so like maybe again, maybe I'm just biased because I only see the bad outcomes, but um this is especially true with with uh spine surgeries. If they're not having like the numbness and tingling and weakness of their lower of their legs or anything, and they're getting surgery just because they have back pain, like those are the ones that I see who regret their surgery the most because either the pain doesn't change or the pain is worse, or the pain doesn't change, and now they can't do certain things. And so um again, be wary of getting surgery only to help with pain, um, versus not trying some other things like physical therapy before getting the surgery because I have also seen people who they are able to use their shoulder and everything, everything's functional, but they've also tried physical therapy, and I say they've tried it like uh quality physical therapy for at least three months, and pain has not changed, and then they go to get the surgery, and then they feel much better after the surgery. So it is possible, like there, it's not like it's a scam, like there, um, there is a reason why surgeons will bring this up as an option, so it can help, it's just that you know, you need to. I think a lot of people don't consider all of the consequences of getting surgery, and so if you're thinking about getting surgery and the only thing that you're having trouble with is pain and you haven't tried something like physical therapy, um then I feel like you might be setting yourself up for disappointment. So um hopefully I get that got that point across, but um yeah, and again, if there's something on your imaging or something, and so let's say again, going back to the scenario, you can do everything with your shoulder. Um, maybe you have minimal pain, maybe you have like a little bit of pain, like a one or two out of ten or something, which before you had zero, but now you have one or two, but it's very, very minimal. You're able to do everything with your shoulder, and you're only getting surgery just because something on your imaging said that there was like a tear or something. Again, a lot of times that leads to disappointment later because, like I mentioned, you're getting cut into um, you're causing pain with like the surgery is gonna cause some pain, and because if it's a repair, you're going to lose the use of your arm for a couple months while those tissues heal. So at that point, you need to weigh the two outcomes. It's like, okay, you want to fix the thing that the imaging says is well, for lack of a better term, broken. However, currently you're able to use your arm, like you have minimal pain. Um, it's kind of there, but it's not something you think about all the time. It's not something that keeps you up at night. You have to look at the consequences of both. Like, if you continue on like this, would that be acceptable? Versus if you get surgery, are you okay with being in more pain and potentially the pain not going away and going through a couple months of not being able to use your arm? And a lot of times I feel like people kind of get wrapped up around what their imaging looks like and don't really um consider all of the possible outcomes of getting surgery versus not getting surgery. So um all of that is kind of alluding to my next point that you know I think people don't realize that surgery is still is controlled trauma, like it's it's still trauma to you, like you're getting cut open, um, and so it's not something that's gonna be painless. There is going to be a degree of pain after the surgery, even even though they're repairing something, like it's your body is going to react to it the same way as if you injured your shoulder. Um, and so obviously if you injured it doing like if you like dislocated your shoulder or like um you did something to tear it um acutely, meaning that like I don't know, your shoulder got wrenched or something and you immediately tore your rotator uh part of your rotator cuff, that's different than like over time like starting to experience pain because of like a for example, a um they call it not a regenerative, that's the opposite, but um degenerative, a degenerative rotator cuff tear, just meaning that like as you're living your life, like eventually the rotator cuff kind of like gets used, and now there's like a small tear, but it's not something that like you like it didn't get wrenched and like get like torn from a specific event. So if you have an actual injury, then a lot of times, like most of those, yeah, you do need a repair. Um, but for some of those more degenerative type of um injuries where it's like, oh, over time now you're starting to get a little bit more pain and all that stuff, and then like you know, imaging shows something, but it's something that has been building up over time, like you have to realize you didn't necessarily go through a trauma yet. Um I guess I guess it could be called like a low-level trauma over several years, but not you didn't go over like an acute trauma. But then now if you go if you get surgery to repair this degenerative tear instead of using physical therapy to try to build up the muscles around it so that um so that it can help out the one muscle that you're potentially overusing and regain function that way, then getting surgery is introducing trauma to that shoulder. And so um and so there there's still gonna be a healing process and there's gonna be potentially a lot more pain than you were experiencing right before the surgery. And I feel like a lot of people get really surprised about that um because they forget that because even they think that I mean they think that they're I think it's because since something is being repaired, they feel like they think they're getting they're going to feel better right away. But in reality, yeah, you'll probably feel better, but that's gonna be like three to four months from now versus like the day after the surgery. So don't forget that surgery is a even though it's controlled, it's still a trauma. And that brings me to setting realistic expectations of the of the recovery process once you get surgery. Because again, like I mentioned, I have seen so many people who think that the day after they get their surgery, maybe even the week after, they think they'll be 100 back to 100%, but that's not true. Um, and even for the quote unquote cleanups, um, like even if you're not getting anything repaired, but they're just kind of like cleaning up your shoulder or your knee or whatever, um, like those recovery times don't take as long. I I will say, like, it takes usually it. I mean, again, it depends on how it what how what your function was before getting the surgery, but I've seen a lot of people be able to recover in under a month. But the thing is, even with the cleanup, you're still introducing trauma, you're still getting trauma, but you're getting cut into your tissues, are getting um irritated as they're like cleaning stuff up, and so it's still going to trigger a response from your body saying, like, oh, something happened. Let me like heal some stuff because something did happen to your shoulder or your knee or whatever. Um, and so I feel like that mismatch and expectation, people thinking that they're going to be back to 100% like one or two weeks after their surgery, sometimes that ends up ends up prolonging their pain as well, because they start trying to like over like use their their body part more than they should. Because at that time, like you're you have to let things calm down, the tissues calm down because they just got like super irritated by the surgery. Um, and then so the tissue is super irritated, they start trying to that's why you have the sling, um, but they start trying to use their or the or knee brace or whatever, they start trying to use their arm or their leg or something, and then they just constantly keep irritating that tissue and don't give it the time it needs to calm down, and and sometimes it prolongs their pain. There's like more complicated processes behind this, but that's kind of like the gist of it. Um, so so there's that, or um but most repairs though, so that I'm talking about like rotator cuff repair, I'm talking about like ACL surgery, especially ACL surgery, um, I'm talking about any other types of repairs, those take three months minimum to get back to like maybe 85%. And when I'm saying 85%, that's being able to go back to your daily life, maybe being able to like lift pots and pans and things like that, but not necessarily going back to your sport. And this is especially true for ACL repairs. I feel like there's been a lot of um, I think part of it is because there used to be what's called a what do they call it? Um uh an accelerated program for ACL rehab after surgery. Um, but now with you know up updated research and looking at outcomes, it's been realized that hey, the accelerated uh ACL um rehab actually doesn't do any like it doesn't help. It still leads to um the accelerated rehab still has I think it was high levels of retails, and so you can't accelerate rehab for that, especially if you're going back to something that involves a lot of cutting, like soccer, um, or like lacrosse. So with ACL surgeries, I would say it's yeah, three months minimum for like going back to walking, uh, maybe light drive, like if you had or an airport and had to run from one gate to the other, like yeah, but if you want to get back to sports, that's at for ACL, um, a lot of people aren't comfortable until like about a year out for other surgeries, like the rotator cuff repairs and um some other surgeries, it's like maybe six months-ish. So it really depends on it depends on a lot of things like your strength and and how your function before the surgery, but um, and like the activity that you want to get back to. But I think people are I don't again going back to like the thing where even if they're told this, it's not something they fully understand until they've experienced it. Um, I feel like not enough, I think it's because not enough people talk about the time it takes to get to that point that it becomes expected that they'll be back to their sport in like three months, when three months is really back to just everyday life. Um and so they and then so I um on the flip side I don't think it's the flip side, but so there's that, and then of like automatic of uh automatically expecting they'll be a hundred percent after the surgery, you can get back to a hundred percent, it just takes a lot longer and a lot more work than people realize. Um on the flip side of that, so here's where my transition is on the flip side of that, if they're not back to 100% by like a certain like some sort of random time frame, so like maybe in like the two to three months, um they feel like okay, well, I guess I'll never get back to 100%, and then they're like, Okay, well, I guess I'm just always going to be, um, I'm just always gonna have these functional deficits because of my surgery, when in reality it's because they never finish their rehab. Um, so I always not always, but I usually have this con it's usually about the six-week mark where people um kind of like I've mentioned in my previous podcast episodes of being in the messy middle, because that's when they're like, okay, maybe they were super motivated, like after the like maybe they understood, like, okay, we're gonna have a lot of work. Um, like, yes, I'm having some more pain after the surgery, but this is normal, and they're excited to start rehab, they're like, okay, I'm over the hard part. Um, when in reality, the hard part is the rehab, the easy part's the surgery because it's being done to you, but the hard part's the rehab because that's where you have to put in the work. Um, so at about the six, the four to six week mark, uh, people that at that point, like it's the body part is or the surgery uh the surgical area is healed enough where okay, now we're starting to do more stuff, now we're starting to walk. Maybe if they had like a knee or hip surgery, now we're uh without crutches, now we're starting to move your arm if uh you had uh shoulder surgery. But there's still a long way to go. Like that being able to use the body part was just one. Milestone out of many. Um, and so it's like at around this part where they're kind of like, okay, well, when am I going to like I still can't do all of these things, why can't I do all of these things? And it's like, well, you're in you're one month into a like three plus month like recovery process, and it you're not behind or anything, it's just like it's gonna take longer than um than you want to really. Um, and I know like for me as the physical therapist, like I only see them like two to three times a week. You know, I'm not there 24-7, but the patient themselves, like they're with themselves 24-7. And so um, it can be hard to be patient and to wait and um and yeah, and to wait for things to get better. Um and um, and that and that's why it can sometimes lead to them being like, you know what, I'm happy with like the level that I am right now, even though it's like 85%, and then eventually they're like, Yeah, I'm I'm fine with not continuing with physical therapy, I'm fine with not returning to soccer or whatever. Um, and then they kind of go about their lives thinking that they can never get back to 100%. When in reality, they just I don't want to say I don't want to minimize it, but it is a in the reality it's they needed to do a little bit more work. They can you can't get back to 100% or at least 99%. I don't like to give 100% guarantees, but you can get back to 99% um if you keep doing the work um and finish your rehab because um that end stage of rehab, uh not all physical therapists help with that, which I'll talk about um a little later. But with that, again, rehab is often a lot harder than people expect. Um so again, for arthroscopic surgeries, like the rotator cuff surgeries, especially, um, rotator cuff repairs, your so the surgeon puts the tissues together. Um, an analogy I've kind of tried using before is like it's like welding two pieces of metal together. So like that's what the surgeon is doing. They're putting the stitches in, they're putting them together, but in welding, um, like I don't know 100% about welding, but in with welding, you weld it together, but you still have to let it set. Like you still have to let the metals like fuse together and set. Like you can't just weld something and then like pull it apart and expect it to hold. Um, at least that's what I assume. Because like you have to let the metal um you have to let the metal like uh cool down and harden um before. Like you have to let it set. So same thing with surgeries. When they repair something, like yes, they're putting the tissues back together, but you have to wait for your body to heal the tissues together, like otherwise they're not going to fuse together and the uh the surgery is not gonna take, uh, so to speak. Um, and for tissue healing, that takes at least like four to six weeks, and that's why you're in the sling for four to six weeks. Um, and I feel like a lot of times people are like, I just got surgery, but I don't know why I still can't use my arm. It's like, okay, well, it's only been like three weeks, like, because first you have to let the tissue heal together, you have to let the surgery uh quote unquote take, and then but because we were waiting for your body to heal, now your shoulder got a lot weaker because we weren't using the shoulder, and that's normal. Um, that is a natural consequence of waiting for your body to heal, and that's um what's that word? It's even though it's a like I guess technically it's a bad thing, like it's something the um the thing that we wanted, the healing, was more important than you being able to use your arm for the first four to six weeks, and that's why we spend the next four to six weeks improving your range of motion and improving your strength. Um, well, we we improve your range of motion in the first four to six weeks as well, but that's why there is a progression for this. Um, and a lot of it is just kind of waiting for for first, or initially waiting for your body to heal, and then after that, like gradually progressing the range of motion and strengthening, which strengthening itself again, it does take a long time to improve as well. Um, and so I think um I'm kind of chuckling because I had a patient recently who is also a healthcare provider, but um, they don't work in orthopedics, they work in their emergency room, and she had the same idea. She's like, Okay, I'm gonna get the surgery and I'm gonna be like 100% better in two weeks and then go back to work. Um, but like it's six weeks later, and then she's not like that's not how and that's not how it works. Um, and then so she's like, oh, she so she was kind of humbled by that. Um, but yeah, rehab is often a lot harder than people expect. Um if you had prehab before, so if the surgeon had you work on like range of motion stuff and strengthening stuff before your surgery, it can help a lot with after the surgery, but there's still it's still gonna be a process and it's still going to take some time. Um and then again, I think I've already mentioned um the recovery timelines, like for repairs, it's at least three months. It's like three months minimum for um joint replacements, like knee replacements and hip replacements, like knee replacements. I would say I have had somebody recover in two months. It was crazy, but um, but again, it's still about three months minimum to be back to normal. And again, when I say normal, I mean like day-to-day, like, oh, you can go for a walk, you can lift your pots and pans to cook, um, maybe you can lift your um carry-on suitcase, not an overly heavy one, but like like just like a moderately weight, uh light or moderate weight uh suitcase to the overhead compartment. Like, that's what the three-month minimum is. And when it comes to returning to like any level of sports, especially trying to return to the same level of sport that you were before, uh, trying to return to the same level you were before, I would say that's more like at least six months. And part of that is just rebuilding the tissues around the surgical site. Um, and it's a lot different than it's similar, but a lot different than if you had taken like several years' break from um from your sport um because you have to take into consideration all of the trauma that the tissue went through and the ongoing healing process as well, um, especially for joint replacements. Um, those are rough. Uh the surgeon is using, like I'll just say the surgeon has a saw and like a hammer thingy. I don't recommend looking it up. I've never um I've never observed a joint replacement uh surgery, and I do not want to because um they are pretty rough. Excuse me. They are pretty rough, and so um you have to take that into consideration when you know when thinking about okay, how am I going to return to uh my sport after this surgery? Um but yeah, recovery timelines are harder, longer than expected. The rehab process is also harder than a lot of people expect. Um and then so kind of lastly about um surgeries uh and like expectations, um going back to um people thinking that or people wanting to repair their tissues and thinking that's going to solve all of their problems, um the surgery does repair the tissue, so they're sewing the tissues back together, but they're not like granting and restoring your strength and mobility just by sewing those tissues together. All that the and I don't want to say all, I don't want to minimize it, but the surgery, even though yeah, the even though the surgery is putting the tissues together, making it whole, so to speak, like putting the tissues together is not what improves the strength of the muscle. Like you still have to work for it, you still have to go through rehab, which is rehab is essentially progressive strengthening, but starting at a much lower level, um, because you do have to take into consideration the trauma that the tissue went through and all the timelines of healing and all of that stuff. Um, and same thing with the mobility, because especially in the early stages, you know, we don't want to be too aggressive with mobility and stretch the tissues too much because it's still healing. Um, and so, and same thing with strength. Well, whenever your muscle contracts, it's going to be pulling on the repair. And so that's why the first few weeks typically are pretty boring. Um, because we're not allowed to do much because we're trying to balance like letting the tissue heal and um not letting your shoulder get too stiff, because usually it's usually the shoulder that gets like frozen shoulder and stuff like that. But um I think that's like a pretty important part that a lot of people don't um don't consider or maybe don't realize is that um like going back to you know only getting surgery to help uh getting surgery only to help with pain versus like oh you're a functional and everything else, maybe your pain has improved a lot, but you still want to be whole. It's like well, if you're anytime you do a repair, um we have to again have that balance between letting the repair heal and restoring your strength and mobility. And a lot of times during that stage, your strength is gonna go down, and so you're gonna have to redo all of that work to build up your strength again. So repairing the tissue is not gonna automatically restore your strength and mobility that you had before the surgery or even before your injury, if that's why you're having the surgery. And similarly, surgery is not gonna guarantee you're gonna return to your previous level, so uh a previous level of like sport or whatever. Um because same thing, you're gonna have um, or similarly, like maybe you had an injury or like you started having pain and it's progressively getting worse, you probably have started to modify the way either the way you worked out or the way that you're doing your sport. And so your fitness level and um has already started already started like kind of either declining or at least maintaining, and then after getting the surgery, it's going to continue declining a little bit naturally, because again, we're waiting for the body to heal, and so you're not gonna be able to maintain your strength and your level of spark, you're gonna have to pull back a little bit, um, or a lot, and just because everything is healed, so now your level is lower, a lot lower than it was before the injury, and just because everything is healed doesn't mean you're automatically gonna jump back to your previous level right away. It's still gonna take a lot of work. Um, and to that point, uh last year, yeah, I think it was last year, um, I helped an Olympic weightlifter return to her sport after an elbow injury. Um, which, yeah, she had that conversation with me. She had a conversation with her surgeon, and she got a second opinion from a different surgeon and concluded like what was best for her was going to be trying the non-operative route. Um, for me, I was like, okay, you know, whether you get operative or non-operative, like you have you have solid points either way. Um, obviously, my bias is non-operative, but it's not like I don't think it would be a waste if you got the surgery. But and then the surgeon concurred, but also like brought the fact that there can be complications, like you can go through this whole ordeal, the whole surgery, and still not be where you want to be. Um, so at least with non-operative, you can try it. If you're still not where you want to be, you can try the surgery after that. So this person um opted not to have surgery, and she was able to get back to competitive Olympic weightlifting, and now it's one year later, and now she's back to her previous PRs. So it still took a year of um progressive strengthening to get back to where she was before. Um, and then it's the same thing whether you get surgery or not or no, because you're still gonna have to rehab after the surgery. Like there's no there's no skipping rehab. It's like either you get rehab uh instead of surgery or rehab before and rehab after your surgery. Um, so there's no skipping the rehab part if you want to get back to some either being functional and like some level of sport. Um, and last the last thing I want to talk about, especially because a lot of my clients are active individuals and do CrossFit or Triathlon or HyRox, like they do, you know, higher like sports and things like that, um, is the importance of having a return to sport plan. Because unfortunately, not all physical therapists are um are equipped to help people return to sport. What I see happen a lot of times is they get back to that 85% that I talked about, like that back to daily living, and then they're just kind of given free reign. They're just saying, they're told, like, okay, you can return to the gym, you can go back to whatever it was you were doing before, and then they're not, um, the patient is not really given a step-by-step plan of returning to whatever level they were before. Um, and that's something that I help with because that annoyed me so much. It like every every I uh because I work, um, it's called PRN now as needed. Like I cover um, I cover when people go on vacations, and I see that when I'm like covering them, and then they're like, Yeah, I don't know how to go back to they, you know, the therapist told me I can go back to the gym, but I don't know how to do that. I'm like, ah so you know, I go step by step and teach them, okay, so let like let's test these things and then let's start at this level if you want to get back to let's say a pull-up or whatever. So maybe you had an amazing physical therapist who helped you in that that first stage, that first three months of rehab, but you have to understand after that first three months, you're still rehabbing if you're trying to return to the sport. Like three to six months plus, you're still gonna be doing some level of rehab, it's just not gonna look like the rehab that most people think about. Um, because you still have work to do to return to your previous level. And so um, when I say it's really important to have a return to sport plan, that it's really important to try to find someone, whether it be a physical therapist who specializes in return to sport or an extremely knowledgeable coach or um personal trainer um who because at this stage there's less risk of like the the tissue stuff and the surgery not taking, um, except for the ACL. Uh for ACL, like there is still a risk of retair, but for the other stuff, there's a little less risk, and so someone like so like um a personal trainer or a coach who is extremely knowledgeable about this um can help with returning to sport, but there has to be some sort of return to sport plan. Um, otherwise, again, that's how people get disappointed. That's how people get shoulder surgeries and return to CrossFit and realize, oh, actually hanging from a bar is super like I can't hang from the bar, much less do even a strict pull-up, like strict banded pull-up, or oh, I can barely lift overhead, or like I am unable to even like my overhead reach on my surgical side is not like my non-surgical side. Like I see the disappointment all the time, and sometimes it leads to people quitting CrossFit, sometimes it leads to people um hurting themselves again, and again, I don't like that, but it's not their fault because again, um, not all physical therapists understand how to return to sport, and so that's all I have today. Um, at the end of the day, the things to take away is that um I think having a conversation with a physical therapist and getting their input on what the rehab side um of recovery is is really important because again, we're the ones that are gonna be with you um throughout this process for a lot more time. We're the ones that are going to be kind of witnessing um basically like your recovery. And so we're so we're the ones that know that see how difficult it is, how long it takes, um, and yeah, how difficult it is and how long it takes. And so um having realistic expectations for the surgery is really important, so that I mean I'm not going to promise that you won't still get be in the messy middle and be like, oh no, like why is it like it's taking so long, but at least um you'll have a little bit better of an understanding, and it won't be as uh devastating um to be in the messy middle and um not realize that oh this is normal, like it does take a lot longer, and it's you know it does take some work. So hopefully you found this helpful, and uh as always, thank you for listening, and I'll see you in the next conversation.