Rehabilitation of ACL Injuries

This is for information purposes only. We recommend seeking professional advice before undertaking any rehabilitation programme.

This rehab program is an example only and may differ from patient to patient depending on the site of the graft used (hamstring or patella tendon). Your surgeon or physiotherapist will be able to advise you on this.

Phase 1: Prior to surgery

• Aims - to reduce swelling and restore full mobility and strength
• Duration - Variable, depending on operation date
• Apply cold therapy to the knee, initially every 3 hours for a duration of 15 minutes to reduce swelling. You may also wish to wear a knee support to compress the knee to reduce swelling and help with stability
• Mobility exercises to increase the range of motion at the knee. These should not be performed if painful
• Strengthening exercises can also be commenced, providing they are pain free. Try exercises 1, 2 & 3 on the strengthening page
• The athlete may be able to walk, swim or cycle in order to maintain fitness
• You may wish to tape the knee to help support it during day-to-day activities

Phase 2: Immediately following surgery

• Aims - to control swelling, straighten the leg fully, improve quadriceps strength and hamstring flexibility
• Duration: 0-2 weeks
• The initial protocol will be largely down to your surgeon. Previously a brace was worn to limit the knees movement, this is now falling out of practice.
• Rest and use of crutches
• Ice and compression as before to reduce post-operative swelling
• Mobility exercises to regain full range of motion
• Hamstring stretching (see mobility page)
• Strengthening exercises: Static quadriceps contractions (lying down), static hamstring contractions, calf raises.

Phase 3: Two weeks following surgery

• Aims -to eliminate swelling, 120 degrees of flexion (bending), full weight bearing and equal hamstring flexibility on both legs
• Duration: 2-6 weeks
• Increase walking and ensure normal gait (walking) cycle
• Continue mobility and strengthening exercises
• Progress hamstring curl exercises to using tubing or a resistance machine
• Introduce half squats and shallow lunges
• Start hip flexor strengthening and adduction and abduction exercises with tubing
• Balance and proprioception drills (see strengthening page)
• Continue icing after activity if swelling persists

Phase 4: Six weeks following surgery

• Aims - Full range of motion and strength, good balance and control, no swelling
• Duration: 6-12 weeks
• Progress to full lunges and squats, add weight for extra resistance
• Increase resistance/reps for strengthening exercises
• Single leg press or half squats
• Start straight line jogging

Phase 5: Twelve weeks following surgery

• Aims - Return to sports specific training
• Duration: 3-6 months
• Use a mix of training activities such as running, cycling, swimming to build aerobic fitness
• Gradually increase speed and duration of running
• Introduce running drills incorporating sideways and backwards running, change of direction and cutting maneuvers
• Jump and land drills
• Sports specific drills (e.g. football/hockey dribbling/passing)
• Continue with flexibility and strengthening exercises as before
• When a surgeon gives permission the athlete will be free to return to competition.