ACL Rehabilitation: Clinical Perspective on What Your Rehab Look Like?

Joseph Smith
4 days ago
4 min read

Joseph Smith

Sports Physiotherapist – MOVE Sports Physiotherapy & Pilates Geelong

The 6 stages of ACL Rehabilitation

When will you be ready to run? What do you need to achieve before returning to sport?

We will look at the different ACL rehabilitation phases, the importance of each, what you should expect during each phase, what we want to acheive during each phase, and why achieve these goals before moving forward will be paramount in your long-term recovery and future performance.

Phase 1: Pre-habilitation

What's involved?

This involves exercises such as stairs, knee extension or body weight squats to allow quads to regain strength, in conjunction with cycling to help regain movement / muscular endurance.

Along with movement, we also want to reduce any swelling by using ice and compression.

What are our goals?

We want to have a ‘quiet knee’ when going into surgery. The knee should have only a small amount of swelling with only a soft effusion present, good active terminal knee extension (straightening), and to be able to ride a stationary bike.

We also want to be able to get the knee as straight as possible, ideally fully straight. On top of this you need to be psychologically ready for the surgery. Once you have achieved these things it should almost feel like you don’t need surgery.

Why?

It has been shown that those who undergo a period of pre-habilitation get better outcomes from ACL surgery compared to those who do not https://pubmed.ncbi.nlm.nih.gov/40276858/.

The time you dedicate now, will pay you back later during your rehab phase, allowing you to recover from surgery better and faster.

Phase 2: Recovery from surgery

What's involved?

This stage involves gentle exercise to help the knee settle which includes regular icing, compression of the knee and lower limb.

Exercises may include; Quadricep setting, and mobility exercises for range of motion.

What are our goals?

Our goals at this stage look similar to our pre-surgery goals - reduce swelling to a low level and gain passive and active knee extension/flexion, whilst re-building strength and control in the quadriceps.

Your clinician may create specific (low/no pain) movement milestones to achieve, or use strength testing technology to track your progress objectively.

Why?

Achieving these milestones will show us that your knee is ready to perform strength training effectively, and for you to move efficiently on your knee during day to day life.

Phase 3: Strength and Neuromuscular control

What's involved?

Client working with Physioherapist Tanner at Move Sports Physio on muscle control

This stage involves progressive strength training.

Typically starting with body weight strength, balance, and control exercises such as squats, lunges and single leg drills. Progressing to heavier and more complex exercises such as deadlifts, barbell back squats.

What are our goals?

The goals of stage 3 is to re-gain muscular strength, balance and coordination. We want to reduce swelling to zero, regain full rage of motion and get our strength to >80% of the contralateral side.

Why?

We need to build the capacity of the body to be able to effectively perform running, jumping and landing drills, without increasing pain or swelling in the knee.

Phase 4: Running / Agility / Landings

What's involve?

This stage involves running drills such as;

A skip
B skip
Box jumps or drop downs
Skipping

Whilst progressive overloading in the gym.

What are our goals?

The goal is to attain excellent hopping and landing performance to dictate running 'readiness'.

Progress successfully through running and agility program.

Regain full strength and balance in our gym program.

Why?

This stage is crucial in making a successful return to sports participation.

Further, those who perform plyometrics as part of their rehabilitation are shown to have far superior outcomes than those who do not*.

How do I know if i'm ready for running?

Returning to running requires a certain level of strength and coordination to confidently perform the activity without aggravation.

An example of outcome measures to achieve before running is below (this may differ between clinicians).

Return to run checklist for ACL rehab patients.

Phase 5: Return to sport

What's involved?

Sports specific training should be highly individualized depending on the individual's sport, lifestyle and goals. This will include sports specific training in conjunction with continued strength and neuromuscular training.

What are our goals?

Your physio will assess your readiness to return to sport with a battery of tests including, strength testing, functional testing (hopping and running), psychological tests.

The goal is to assess you and your knee's readiness to return sport.

Why?

ACL re-ruptures are unfortunately common. Therefor it's important to be as fit and confident as possible to return to sport. Hower meeting criteria for strength, functional movement and physiological readiness will greatly reduced this risk.

VALD strength testing at Move Sports Physiotherapy & Pilates

Phase 6: Long term injury prevention

What's involed?

This involves an on-going plyometric, balance and strength program to be performed for at least 10 minutes before every training session and game.

What are our goals?

The goal of this is to continue to build strength and neuromuscular control, to help reduce the risk of sustaining another ACL injury.

Why?

Studies have shown that prevention programs can reduce the risk of sustaining an ACL injury.