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Best Exercises for Torn ACL

by Jaydee Vykoukal, PT, DPT February 19, 2020 0 Comments

Stepping on balance cushion

Recovering from a tear of the ACL, or anterior cruciate ligament requires finding a balance between rest and exercise. ACL tear exercises require paying close attention to your symptoms and knowing how to safely progress them when possible. Keep reading to learn more.

How Do Exercises Aid ACL Injury Recovery?

Exercise plays a crucial role in the ACL recovery process, whether you have ACL surgery or not. With each stage of exercise, the ultimate goal is to maximize a return to full knee function. The focus is on gradually restoring knee range of motion, strength, proprioception and overall coordination. Each stage of healing comes with a change in how to address these goals. It is important to work closely with your orthopedic doctor and physical therapist to select the appropriate exercises for you.

For information on the stages of healing, check out ACL Tear Rehab.

Flexibility and Range of Motion Exercises

The most important thing to focus on following a knee injury is gaining full knee range of motion, between 120 degrees of flexion and 0 degrees of extension. Without the restoration of this knee flexibility, it is nearly impossible to get back to the daily activities and sports that you love with residual problems.

Heel slides

This is a great starting exercise for building knee flexion range (bending). It also works the core muscles as a bonus. Simply lie on your back and tighten the abs. Start bending the knee as you slide your heel as far toward your butt as possible. Hold for 5-10 seconds before returning your knee to the starting position.

Repeat this exercise 10-15 times, 2-3 times per day, gradually increasing knee flexion to tolerance. If you’re having trouble sliding the heel, put a towel or piece of plastic under the heel.

Quad Set

This is the ultimate beginner’s move that you can start immediately. It will help regain knee extension range while also promoting circulation and strength. Sit on the floor or a table with your legs out as straight as possible in front of you. Tighten the top of the thigh muscles as you try to press and straighten the back of your knee down into the floor. If a full extension is hard to tolerate, you can start with a small rolled towel. You should progress to a straight-leg raise when possible too.

Keep the muscle tight for 3-5 seconds before relaxing. Repeat 15 times for 2-3 sets.

Passive Knee Extension

Knee extension range of motion is crucial for all normal standing activities. A basic passive stretch involves simply sitting or lying down with the lower leg propped up. It can be propped on a stool, bolster, or another hard surface directly under the calf and ankle. Let the knee relax as it slowly stretches into a straighter position. This position can be hard to tolerate for an extra painful or stiff knee, so start slowly.

Hold up to 10 minutes. You can modify the stretch by adding ice while holding the stretch for maximum comfort.

Hamstring Curl with Exercise Ball

This is a higher level exercise that you will complete as you regain knee strength and range of motion. Lie on your back with your knees bent and feet resting on your exercise ball about hip-width apart. Lift the butt of the ground by pressing into your heels, then bring the ball toward your butt as you bend the knees. Focus on keeping the core and butt tight throughout.

Move slowly and controlled for 10-15 repetitions, 2-3 sets. If this is too difficult and you experience pain or hamstring cramping, you can modify it by bending the knees without lifting the butt off the ground.

Strengthening Exercises

As you gain knee range of motion and basic strength, you will want to start building more functional strength for returning to normal daily activities. From the trauma of injury, swelling, and pain, the knee can lose a lot of strength and stability, particularly in the quadriceps. So start slowly, while maintaining knee range of motion, to help restore your full strength and confidence in your knee.

Single-Leg Bridges

This is a great leg strengthening progression from the initial exercises following injury. Lie on your back with both knees bent and feet flat on the floor at about hip-width. Straighten one leg and point it toward the ceiling. Push through the heel still on the ground as you lift the butt off the ground 1-5 inches. Keep the core and butt tight to prevent rotation in the hips and back. If this is too hard, you can start with both legs on the ground.

Hold 1-3 seconds, repeat 10-15 times for 2-3 sets.

Mini-Lunges 

You can try this one once you are comfortable putting full weight through your leg and have improved your quad strength. Stand with the feet hip-width apart, step one leg behind you as your front knee bends slightly. Keep the front knee in good alignment and core tight. Return your back foot to the starting position. You can hold onto something for balance if needed. Progress this exercise simply by stepping further back with the leg. Do not lean the body forward as you lunge, rather keep it upright.

Alternate between the legs 10 times for 2-3 sets.

Wall Squat with Ball Squeeze

Getting into positions that strengthen more than one muscle group at a time is a great way to expedite your recovery. Try this exercise when you are comfortable squatting and want to increase the intensity. Sit against a wall with the feet at about hip-width and 6-12 inches from the wall. Then, slide down the wall until your knees are at a 90-degree angle. Then, place a ball between the knees. You can modify how deep you squat or take away the ball to start if needed.

Hold the wall squat for 30-60 seconds at a time while slowly squeezing and relaxing the ball. Repeat 2-3 times total.

Balance and Proprioception Exercises

Higher-level exercise to address coordination is crucial in the final stages of recovery. Initiating single leg activity can easily create a feeling of instability in the knee. Training your balance will help prepare you for daily activities like walking, running, and stairs. Plus, you can adjust your exercises to make them more sport specific as needed.

Keep in mind that there is always a risk of fall when challenging your balance. Consider supervision or balance assistance if needed.

Single Foot Balance

Nothing assesses the function of your lower leg better than a simple single-leg stance. You will start by shifting your weight into your leg while lifting the other leg off the ground. With the core tight, this may be enough of a challenge to start. After that, there are several ways to progress:

  • Stand on more challenging surfaces, such as foam pad or Bosu ball. 
  • Multitask while standing on one leg, such as moving the arms, turning the head, or throwing a ball. 
  • Close your eyes. This challenges proprioception and is extremely hard so be cautious. 
  • Combine one or more of the options to maximize your knee’s balance strategies.

Hold the hardest balance position possible (or move between different options) for 1-2 minutes at a time for 2-3 sets.

Single-Leg RDL

This is high-level coordination and balance exercise. Standing with all your weight on your injured leg, hinge at your hips as you bring the hands toward the floor and kick the free leg back behind you. Try to keep the back straight and knee slightly bent and stable as you move in and out of this position.

Complete 10-20 repetitions, for 2-3 sets.

Balance Trainers

Other ways to challenge your balance include the use of a wobble board or balance disc. These tools can create unpredictable environments for your knee in preparation for higher-level movements. You can stand on them with both legs, one leg, or even complete exercises with them such as squats, lunges, and more. Balance trainers are a fun way to get creative with your knee strengthening program as you near the end of your rehab sessions. They will also be a great tool for maintaining lower leg health as you transition back to your normal daily life, sports, and an actual maintenance program.

How Often Should I Exercise After ACL Reconstruction?

How often you need to exercise your knee ultimately depends on the stage of your recovery.

  • At 1-6 weeks, you will need to take the time to stretch and strengthen the knee a few times a day. This will help decrease stiffness, promote circulation for healing, and minimize loss of strength.
  • At 3-12 weeks, knee range of motion will still be a daily focus as you start to incorporate higher-level strength exercises into your routine most days of the week.
  • Once you have re-established good knee flexibility and are working on higher-level performance (12+ weeks), you will start to decrease your frequency of exercise to simply maintain range of motion and optimize coordination.

To maximize the tolerance and efficiency of your exercise program, use modalities before and after treatment for addressing pain, swelling, and stiffness. These might include ice, compression, a TENS unit, massage, and heat in the later stages of healing.

For more treatment options, see our Torn ACL Recovery Page

Safe and Effective ACL Rehabilitation Exercises

When completing knee exercises, always pay close attention to your form and how your knee is feeling. Never force anything that feels painful or unstable. Always wait for your doctor or physical therapist to clear you for further exercise progress as the knee is ready. If you experience severe pain, increased swelling, sudden weakness, numbness, tingling, knee instability or any other symptoms of your knee with exercise, get in touch with your medical provider as soon as possible.

SHOP ACL PRODUCTS

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Jaydee Vykoukal, PT, DPT
Jaydee Vykoukal, PT, DPT

JayDee Vykoukal is a Doctor of Physical Therapy, owner of the healthy habit platform Health Means Wealth, and freelance medical writer. She loves traveling and spending time with her family in nature. Her passion is helping others continue to participate in the activities they love through education and proper exercise.



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