What to Expect with ACL Rehab

No matter the severity of the injury or stage of healing you’re in, ACL rehab is crucial for maximizing your knee recovery. Tears of the anterior cruciate ligament are common injuries that respond well to structured rehab. Talk to your doctor for recommendations or simply go straight to your favorite physical therapy clinic to get started.

Goals of Rehabilitation

The ultimate goal of rehab is to get back to your normal daily activities or sports with full knee function. With the right treatment, you should be able to return to your previous level of function. For each stage of the healing process, below is a general timeline for what to expect. Of course, it all depends on your overall health, the severity of the injury, past injuries, and fitness level.

2-3 Weeks

Manage pain and swelling. Initiate low-level strength exercise, focusing on the thigh. Gradually increase the range of motion of the knee using flexion and extension.

3-6 Weeks

Build tolerance for strength exercises within a gained range of motion. Work on returning to a full range of motion to the knee. Initiate more functional moves that can stay controlled, such as squats and lunges.

Following Months

Addressing any lingering issues with strength and flexibility. Increase functional strength and agility while maintaining range of motion to return to daily activities and higher-level movements, such as running, jumping, and stairs.

Pre-Surgery and Conservative Rehab

Regardless of whether there is a plan for surgery or not, start rehab as soon as possible after a knee injury to optimize the healing process and decrease the amount of downtime necessary. The goal is to minimize the loss of strength and range of motion. The focus will be on knee bending, knee extension, stretching exercises, thigh and hip strengthening exercises, balance and proprioception exercises.

For conservative treatment, rehab will decrease overall stiffness and maximize strength to get you back to life as usual as quickly as possible. If you are preparing for surgery, there is even more benefit to rehab as it will decrease the chance of complications and also maximize your recovery. 

Use RICE to Control Swelling

As soon as you sustain an ACL tear, you can expect immediate pain and swelling that will limit normal knee function. This is a protective function of the body that forces you to slow down and allow the knee to heal. To decrease pain and minimize the use of pain medications, start using the RICE method often for the first 72 hours. Then, use it as often as needed after that. Here is a quick review of each step:

How to Use Crutches

You may need crutches if you can’t walk without a significant limp. Your doctor or physical therapist may also recommend crutches initially to allow rest and healing of the knee. Crutches are simple to use with the proper setup. Follow the steps below:

1. With your arms resting at your side, the handles should line up with your wrists to allow a slight bend in the elbows with use. It will also help prevent forward slouching and excessive arm discomfort.
2. Adjust the upper arm pads to allow a few inches of play under the armpit.  There are typically suggested settings based on your height. Keep in mind, direct pressure to the armpits can lead to arm nerve damage.
3. Keeping the injured leg lifted up as you bring both crutches in front of you. How far will depend on your comfort and stability, start small if needed. Then, swing the good leg forward. You can bring your leg in line with the crutches or place your food slightly past them. Keep the crutches at a 20-25 degree angle from your body throughout the movement.
4. If you are allowed to put some weight through your injured leg, follow the same guidelines above. You will now simply keep your injured knee in sequence with the crutches.

For more in-depth instructions and a visual see this video:

Post-Surgery Rehab

The exact protocol for ACL rehabilitation and healing time frame following surgery will depend on the severity of injury (especially if other areas were injured such as the meniscus), the type of graft (hamstring, synthetic, or cadaver), the success of pre-surgical rehab, and your overall health. The first is to manage swelling and regain a full range of motion of the knee. The rehabilitation program following ACL surgery can be broken up into different phases, dictated by your sports medicine surgeon.

Phase 1

The first several weeks will be spent managing swelling, increasing knee joint range of motion, and building quadriceps strength with a selection of exercises. This time will be spent resting and being educated on what to expect throughout the rehab process. Your surgeon may give you weight-bearing restrictions for the first 1-3 weeks as well.

Phase 2

The first 6 weeks will be spent gradually regaining full knee flexion range of motion and regaining knee strength and coordination. More functional activities, such as steps and squats, will be initiated when tolerated.

Phase 3

A continued gradual progression of knee strength and coordination will occur up to around the 3-month mark. This will ultimately build proprioception and confidence in using the knee. It will also prepare the knee for higher-level single leg activities such as running.

Phase 4

The last few months (4-6) of the rehab process will fully prepare the knee, physically and psychologically, to fully return to sports or exercise. Any remaining deficits in strength, flexibility, and coordination will be addressed. Plus, a maintenance program and further education for injury prevention will be initiated.

Phase 5

Around 6 months, you can expect a full discharge from rehab with approval from your surgeon. Full strength, range of motion, and proprioception should be available to the knee.

Rehab Tips

Recovering from an ACL tear and surgery requires a delicate balance of rest and pushing the knee when possible. Here are some tips to keep in mind to optimize the rehab process.

• Avoid hyperextension, twisting, and kneeling right after surgery.
• Avoid straining the knee with high-level strengthening, such as a leg press, until cleared by your surgeon. 
• Do not force knee range of motion. Discomfort is okay, severe pain is not.
• If using pain medications, try timing them with your rehab sessions to help with tolerance.
• Don’t drive until you can walk unaided and are no longer taking pain medications.
• Don’t walk without crutches until you can keep a normal gait pattern, without a significant limp or pain.
• Follow your surgeon’s orders closely for use of crutches, knee braces, and when to progress your rehab program. 
• You will only have a small scar from the arthroscopy surgery, keep an eye on this scar and massage it to minimize sensitivity and stiffness. 

How long is ACL Rehab?

The average time for recovering from ACL reconstruction surgery ranges from 6-9 months. As you gain confidence and awareness, you may do a lot of your rehab program on your own and only check in with your doctor and physical therapist as needed for recommendations and assessments. When you finish rehab, you should feel ready to get back to your previous level of activity.

Taking Precautions During ACL Rehab

A past knee injury significantly increases your chance of future injuries. Even after recovery, diligence with a maintenance program is crucial for minimizing the chances of re-injury. ACL tears and surgical reconstruction also correlate to the onset of osteoarthritis later in life. Keeping an active lifestyle, a positive mindset, and well-balanced lower body strength will minimize this risk as well. If you ever have questions or concerns about your knee health talk to your doctor or physical therapist.