ACL Rehab After Reconstructive Surgery – Lina Englund, Physiotherapist

Rehabilitation after an ACL reconstructive surgery is generally divided into three different phases. If you are still waiting for surgery you should go through the phases as prep. Rest from aggravating activities throughout the process. It is pain, swelling, tissue repair, mobility and quality of movement that decide the level and progression of exercises.

Phase 1: 0-2 weeks

Aims to reduce pain and swelling while restoring mobility and avoiding muscle atrophy. 15 min ice sessions may be applied to reduce swelling. Note: After surgery you should only flex the knee to about 100 degrees during this phase, double check with your physiotherapist or surgeon.

  • Heel slides with or without support from rubber band
  • Static quad contraction
  • Hamstring holds
  • Clam shell
  • Leg lift
  • Supported calf raises
  • Stationary bicycle
  • Gait re-education

Physiotherapy Treatment

Cryotherapy, electrotherapy, compression, manual therapy, gait re-education, patient education, exercise supervision and prescription.

Phase II: 2-12 weeks

Aims to restore a normal unrestricted walking pattern and full extension and flexion of the knee. Normal range of motion varies and one way is to compare to the uninjured leg, but you should aim for at least 130 degrees of flexion and full extension. The exercises will progress to include resistance, instability, and greater ranges of motion.

  • Mini squats
  • Mini lunges
  • Leg press
  • Bridges
  • Hip abduction with rubber band
  • Hip extension with rubber band
  • Single-leg calf raises
  • Balance and proprioception
  • Stationary bicycle

The swelling of the knee should be completely gone by the end of this phase. Do not progress further if the exercises still aggravate your knee.

Physiotherapy treatment

Cryotherapy, electrotherapy, compression, manual therapy, gait re-education, exercise supervision and prescription.

Phase III: 3-6 months

Aims to gradually achieve full range of motion, strength, power, endurance and agility and slow return to restricted sport-specific drills. You can start doing cardio work on even surfaces, i.e. do not go ride or run the north shore in Vancouver unless you plan to go up and down the fire road on Fromme. The exercises include increased difficulty in terms of resistance, range of motion and instability. You can progress to exercises including jumping, landing, direction changes etc.

  • Jogging
  • Skater jumps
  • One-leg jumps
  • Burpees
  • Running

Physiotherapy treatment

Safe progression of exercise program. If you still have a limited range of motion your physiotherapist can apply manual therapy to correct this.

Phase IV: 6-12 months

Return to sport. The final phase includes progressive high-level sport specific strengthening as required. Specific tests can determine whether or not you are ready to return to full sports activity. See your physiotherapist or sports medicine specialist for the final word.

General tips throughout:

  • Stay picky with the form. A rehabilitation period can be a great chance for you to retrain previously faulty movement patterns and it is important that you keep the movements clean as you return to your sport. A correct movement pattern increases the function of your body and its ability to perform on a higher level.
  • Be aware of any swelling or increased pain. It probably means that you are progressing too fast. Visit your physiotherapist for advice.
  • Hang in there. The process can seem long and boring, but if you don’t fully commit to it, chances are high that you’ll regret it down the road.

Make sure you consult with your health professional before starting any kind of rehabilitation program.

Take home message: Be diligent about your home exercises, both for strength and mobility. The rate of success is determined by your own commitment.


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