ACL Rehab

ACL Rehab Timelines , Schedules & Dates for Rehabilitation:

ACL Surgery Rehab
Don’t have ACL surgery too soon! Make sure your swelling subsides and full range of motion returns in your knee, before having surgery!

This ACL Surgery site provides real, unbiased, useful information to ACL patients. It was created by people who actually had ACL surgery and needed more information about cost, recovery time, rehab, insurance issues, choosing a surgeon, and more. Learning from actual ACL patients who have gone through it is the best way. Learn from the mistakes and successes of others and enjoy your visit!

One of the major problems in the past for ACL surgeries was the failure of regaining full knee motion, especially extension (straightening the leg). Studies have shown that timing of the surgery following the injury has significant influents on the development of knee stiffness. The highest incidence of knee stiffness occurs if the surgery is done within the first 3 weeks following the injury. During this time, the knee is typically painful, swollen, and have limited range of motion. The incidence of stiffness decreases if the surgery is delayed at least 3 weeks or until the swelling has fully subsided and the knee has regained a full, normal range of motion.

First 24 hours after surgery

1. Control pain
2. Control swelling
3. Work on leg extension and begin quadriceps strengthening exercises

Following your release from the hospital, you should go home, elevate your leg and keep the knee iced. Some people rent a Cryocuff cold leg wrap. You may get up to eat and use the bathroom, but otherwise, rest with your leg elevated- ideally above your heart. Ice water in the leg wrap will last 30min to 1hr and should be rechilled. The ice water in the machine container may last 2-3 hours. Tip: use larger chunks of ice- such as made from a 16oz cup, rather than small ice cubes.

Days 1 – 7

1. Control pain
2. Control swelling
3. Work on leg extension and begin
4. Quadriceps and hamstringĀ strengthening exercises
5. Gait training

ACL Surgery Quad Strength

Days 7 – 14

1. Maintain full leg extension* (top priority)
2. Flex (bend, or ROM [range of motion]) 90-120 degrees
3. Decrease knee swelling
4. Develop muscular control of leg

Weeks 3 – 14

1. Range of motion should be full extension to 100-110 degrees
2. Start training exercises such as stationary bike, stair climber, Nordic track, inclined leg press, swimming

AVOID KNEE EXTENSIONS

Weeks 14 – 24 (6 months)

Start straight ahead jogging and backward jogging.
Start agility drills, zig-zags, and crossover drills

6 Months

This is the earliest you should expect to return to full sports. To return to sports, use this criteria:

1. Quad strength should be at least 70% of the normal leg
2. Hamstring strength should be at least 80% of normal leg
3. Full ROM (range of motion)
4. Minimal swelling
5. Good stability
6. Have completed a running program and jump training (injury prevention) program

1 Year

Some people take an entire year before returning to full sports, for instance soccer or skiing, but it varies person to person. There is no risk in taking more time, aside from developing the full ROM as soon as possible- the only risk is in returning to sports too early, as some people do and fail by re-tearing their ACL. This results in a very frustrating and expensive process to repeat.

ACL Rehab Programs (PDF files)

http://www.utc.edu/Academic/GraduateAthleticTraining/docs/acl/Accelerated%20ACL%20Rehabilitation%202007.pdf

http://docs.google.com/viewer?a=v&q=cache:9iPvfCoN1ggJ:www.peninsulaortho.com/downloads/acl_rehab.pdf+acl+rehab+filetype:pdf&hl=en&gl=us&pid=bl&srcid=ADGEEShr9EEp3Ji_ffpST2hjpVPqZpuSOn2aMvnwDA5IciSY_FzWNjnhXc5fiM7vhUjTNzM0PdbtC21NgmtkeD0reX1z0vWYY0ZClRDfuzjvYoxHm_3pJvBBVZNLcxkywA769U8UMdvK&sig=AHIEtbQ2RMzzVubJznYpFhVzSTIwKWz9OQ

http://www.palomarortho.com/protocols/antcruciateligament.pdf

http://goortho.net/pdf/Rehab/ACL_Rehab.pdf

http://www.drwaltlowe.com/attachments/wysiwyg/File/ACLAccelerated.pdf

http://www.drwaltlowe.com/attachments/wysiwyg/File/ACLDelayed.pdf

38 thoughts on “ACL Rehab

  1. Very good, thanks for sharing the rehab programs. I tore my ACL 2 years ago and its been a long road, but I’m getting back on my feet and doing 95% of the sports I was doing before.

  2. My ACL surgery was no problem, but the recovery was a bear. It took about a year of steady effort and finally got through it. Stick with it and you’ll make it. Use the jump rope a lot! That’s what I did instead of jump training and my knees are much stronger now.

  3. Hi,
    It’s been 21 months since since my ACL surgery on my right knee and I my thigh muscles are still not as strong or same same size as my left leg. I have tried a lot of things and I making very little progress. There is still some swelling in my knee. It get sore and very hard to stand on it when I ‘m sitting for a long time, but after few steps it will fell good. Is there anything I need to do to strengthen my muscles in my leg. The other that I noticed is I still can’t bend my leg straight.

    1. I am recovering from an acl surgery. I am on my 9th week and I am having problems bending. Do you have any suggestions or recommend anything I can do to get this to bend more? Also, do you happen to know how much longer i will be doing physical therapy? I have been going 2x’s a week and it is getting costly.

      1. dr.venkat says:

        Hi, I have seen your reguest about knee bending@ cost for taking physio.
        . my opinion is do bending exercises on your own which physio thought U.
        And cal d physio one’s in week for six weeks.

        1. dr.venkat says:

          Genarally it takes 6 to 8 weeks to get full knee rom from date of surgery.

  4. I had surgery a little over two weeks ago (hamstring). It looks like I’m in that stage where it’s not happy straight, it’s not happy bent, and it’s definitely not happy when I lay on my side. Does anyone have tips on positions/pillow arrangements they found comfortable? Bonus points for side sleeper configurations!

    Extra info: extension is at 100% and my flexion is about 100 degrees. No repairs to the meniscus, so I’m out of the stabilizer.

    1. I’m on my second ACL surgery, I’ve had both patella and hamstring. Hamstring is definitely less painful post-op. But the work to get your hamstring back to full strength is not fun either. I am three months out of my second one and just started running again yesterday : )

      Sarah — to answer your question, what I have always found most helpful, esp as fresh-out as you are, is to get a long body pillow and try to sleep with it in between your legs. Sleeping on your back is definitely no walk in the park but at least this way gives you a little bit of lee way to roll to your side. Hope it helps!

      1. Lindsey,

        Which technique do you prefer? I’m always interested to hear from people who have experienced both. I had a patella tendon reconstruction done 6 years ago and had a good experience.

  5. 7 weeks post-op hamstring graft. still have little swelling on the arthroscopic portals. Whenever I straighten my knee (standing up straight), then I bend it (to walk), I feel something that moves or sometimes blocks inside my knee. The slow moving / and sometimes blocking sensation is felt near the outer arthroscopic portal (right portal from your point of view). What could this be? Talked with my OS over the phone, and told me it is not a retear. What could this be? Could it be from the swelling? Anyone out here experienced the same?

  6. What is the success rate of acl surgery?

  7. Jay Poudyal says:

    Hi, I had my ACL surgery 5 weeks back. I can just bend my knee a little. I wouldn’t call it bending. I am really worried. Do anyone have had such experience? My doctor has asked me to move my knee cap from left to right and right to left and ask me to visit him after 10 days. I just want to know if it is going to be ok and if Ill be able to bend my knee.

  8. Hey everyone!
    So going in to get my ACL replaced in about 3 weeks. I am leaning towards Patellar but have also heard that cadaver is good… I am a very active 23 year old female and want to continue with that lifestyle. Just would like some input and other experiences from you all :)

    Also, just wondering what kinda things were helpful right after surgery? Like the icing machine etc? and any other good tricks that helped. Thank you!!

    1. They have my daughter in a portable machine that forces the knee to bend. But don’t worry. You control the speed and the degree of angle. You can lie down or sit up. she loves it. just lays her leg in, and it does all the flexing. She’s 15.

    2. I would definitely recommend the patella tendon reconstruction. Had it done about 5.5 years ago (I was 17) and the knee has felt fine from about 9 months post op to present.
      To me it doesn’t make any sense to take strength away from the hamstring muscle when that is something that can cause an ACL tear in the first place (imbalance in the strength of quads/hamstrings). Plus there are studies that show that the patella tendon regenerates itself over time.

      1. Great to see a site that has practically built a cnoiummty of ACL to-be and has-been. Very informative. Most from the US her I am from Bangalore, India, 41 yrs old male. Had my ACL surgery on the left knee on July 8th this year with a Hamstring autograft. Tore it while playing badminton though my regular game is more like tennis. Faced similar situation, the first doc I went to (drove to the nearest hospital myself after the injury!) young and enthusiastic and very helpful correctly diagnosed it (before the MRI confirmation happened) and recommended a quick surgery using the patellar, even told me about the hamstring vs. patellar debate and all. All of these were very nearly Latin to me then, of course.Went with the second doc I saw in a more reputed hospital here, incidentally one which is also a favorite amongst those who resort to medical tourism (what a term!) so a lot of Westerners and others flock here to get there surgeries done. Well, this doc was clear on his recommendation for the hamstring thingy, and given that his credentials were also far superior, went with him even though I clearly also liked Doc 1. At that time I couldn’t care less really, just wanted to find a Doc I was comfortable with on doing the carpentry work on my leg.Op went fine, on GA and following that a femural block very very effective on pain management saw one other person in this blog mentioning and recommending it. 3 weeks with brace, 4 on a crutch (more for safety I was told). Now off both, and seemingly recovering well. Lots of PT some 15 different exercises 7 of them with a 2 kg ankle weight (twice a day, takes an hour to complete all!). Gait still not normal but reasonable stability. Full flexion, achieve 120 degrees on stretch. Doing stationary cycling now as well, and driving is a breeze, so now really looking forward to getting back to playing, though that is probably still 5 months away.Oh, quite incidentally, the screws he used to fasten the new ACL were something called bioscrews apparently they are a lil more expensive but kind of dissolve into the tissue in a couple of years so hopefully will not have to be removed. My entire surgery including a 2 day hospital stay post surgery in a great room cost approx 4400 US of course with 80% coverage from insurance.

    3. Hi Emily,I had cadaver I didn’t want to rob peter to pay Paul. 11 years ago like new today still.. A lot of rehab though

    4. Just had my second ACL surgery 10 days ago. My first was at the age of 40 and was back to skiing in six months . I’m 48 and this seems to be going just as good. The icing machine is great. Ice and elavate as much as possible. Make sure you do all the therapy even at home . I think that makes a difference.

  9. What a great site! My story is a little long and different since i did not tear my ACL playing sports so here it goes……..I have been an athlete since i was able to crawl. I have played all sports growing up but focused on hockey and baseball in high school then just baseball in college. The extent of my injury history was 2 pulled hamstrings, one in high school, one in college, both baseball related. Last April I was in my backyard, I had a new fence installed, it is about 3 feet tall. I was on one side of the fence and wanted to get over to the other side. Instead of walking about 50ft to the gate I decided to try to jump over the fence by vaulting myself over(2 hands on the fence and push off and over). Well upon landing, my ankle rolled on me and my knee just crumbled! Down for the count I went. I heard the pop. It swelled up like a balloon that night. I knew! Did not go to a doctor. Swelling went away after a week or two so i figured i was wrong. I then decided i was going to starting training to run a 5k and i had no issues, trained for it, ran it in June. Kept running after that, ran another one at Yankee Stadium. No problem. Then one night in October while on the treadmill at the gym i felt a pull on the inside of the knee and i knew i needed to get checked out. Went to the dr., he did the Lachman test on me and it was official. I have put it off long enough and I am scheduled for surgery (hamstring graft) on Feb 7th at Columbia Presbyterian in NYC. For the past month i have been hitting the gym hard doing my own pre-hab. My legs feel the strongest they have ever felt (and I have strong legs from baseball and hockey). But I am still terrified of the first few days after the surgery! Help! 34 year old male from NY.

    1. Hi Peter, seems like you had your surgery a day before mine and the same technique. How are you recovering? I would be curious to know how flexible is your leg, do you have pain, and is the swelling gone completely. Thanks and all the best to you on the road of recovery!

  10. Just had ACL surgery yesterday, and was just wondering where pain is usually felt
    ? Only pain I really have is the back of my knee and calf area. Is this normal? Also had a small meniscus tear they fixed.

    Just want to make sure this normal, and that I shouldn’t worry about blood clots.

    Any one remember?

    1. Hey, I had surgery on 19th and my pain is mostly in the same places. My leg brace pulls on the stitches, however. Bending my knee for the PT excercises can be excruciating, but I push through it.

      1. Hi Mark, my doc told me I should not do anything that hurts, only push until it is not painful. I had my surgery on the 8th of feb. Good luck with recovery!

    2. I had mine done 3 weeks ago, and that’s exactly where I felt pain too. I had the hamstring graft, and they told me to expect pain in those areas because of it.

    3. Hi Brian, I had and still have (although somewhat subsided) pain on the back of the knee (when I try to stretch it especially), calf, back of the leg (where they harvested the tendon from) and on the inner front side of the knee. I have extreme pain normally at night, and have difficulty finding the position to sleep.
      I am also getting daily blood thinner injections against blood clotting. This is standard in Switzerland until I am mobile again 100%.
      I have a “passive movement” machine which I use to stretch the leg and bend it without using my own muscles. I find it very helpful.
      Make sure to rest and don’t try to do much right away. Let your leg recover from the trauma of surgery first (at least 7-9 days) before you start moving it. I think I might have pain, because I started putting weight on it and exercising it too early. Good luck with recovery!

  11. Anybody get really itchy in the days and weeks after surgery? Reading online it can be a reaction to the medication(which i am no longer taking), an infection(my wife is a nurse and does not see any indication that there is an infection), or it could be the nerves repairing.

  12. Hi, I had ACL surgery on the 8th of feb. I am slowly putting weight on my left leg again, but still can’t stretch it out all the way, I’m standing like I was on skis. Also I can now bend about 60%. I have awful pain at night, can’t sleep. They took me off medication, due to vomiting and kidney values too high. So I’m suffering at night.
    Anyone has tips for sleeping positions? Will my knee and leg ever be back to how it was before?

  13. Had my ACL hamstring quad op on the 25th Feb, touch wood I have been minimal pain and moderate swelling with swelling decreasing by the day and brushing appearing now. I was able to walk and place weight through the leg in hospital and had solid quad control which was the first thing I tested when I came through the op, as when the original injury I couldn’t perform the function for two weeks.
    I tore it 7 monts earlier but was misdiagnosed by a few docs, but in retrospect it seemed to be a blessing as I slammed the leg with solid workouts per-op for 8 weeks.
    I have good ROM and the PT and doc work on the same principle of getting you and moving ASAP.
    I have smashed my leg with ice using the aircast with compression and works well and elevation over above the heart. So far I more than pleased, getting into PT wall squat, single leg raises, one leg balance and only just restarting hamstring curls lying down on my bed…..keep you posted.

  14. My 13 yo daughter tore her ACL last weekend playing soccer. She is scheduled for surgery the first week of April. We haven’t met with her surgeon yet, (next week) but I know that he prefers the hamstring, with his reasoning that in his experience, the cadavor tends to fail at a much higher rate than the hamstring. The Dr. is a pediatric orthoped. Anyone have any questions I should be asking and answers that I should hear? Also, since I want to save as many of the PT visits as possible, where should I look for pre-surgery excerises for her to start on? She is walking with a brace (hinged) with a slight limp.
    Thanks!

    1. Hi Dawn,
      I could be wrong as every experience is different but since she just tore the acl last weekend and is scheduled for surgery the first week of April I am not sure that will be enough time to do any meaningful pre-hab. I imagine she may still have some pain and swelling from the initial tear? If that is the case she will need some time for the pain and swelling to subside before being able to do some pre-hab. I am older,35, but i did pre-hab for a month and a half prior to surgery. I did heavy leg work. You may want to consider pushing the surgery back a month to allow for her to #1 let the swelling and pain subside and #2 do some meaningful pre-hab. That was very important and helpful for me.

      As far as questions, I would ask about anesthesia options(which will be covered on the day of surgery as well), i would ask the doctor to give you the pain med prescriptions the day you meet him and get them filled prior to the surgery. You want them readily available the moment you get home. Ask about how long she will be on crutches, how long she will be in a brace, how soon she will start rehab. I would read a lot of the experiences on this site and generate more questions from there. Best of luck to your daughter.

    2. Shannon Isbell says:

      Hi Dawn!

      I was thrilled to see your post as it mirrors our daughter. She tore her ACL this past Sunday the 16th and is scheduled for her surgery on 4/3/14. Our ortho is recommending the patella graft, particularly over the cadaver. We have had a couple recommendations for the patella as well so will most likely go with that. However, its hard to overlook some of the case reports I’ve seen on the hamstring. Anyway, one thing we did a couple days after her injury to help with swelling is acupunture. Now, mind you, we are not tree huggers :o) But we have a couple friends who are amazing athletes/coaches who do this and swear by it. Have to admit, it was remarkable in it’s effect on swelling. Want to do again today, and will definitely do post-op. Otherwise, she is working on straightening/bending – do 5-7 reps, hold for a few seconds – do each time she goes to a new class. Seems to be helping ? She is walking now with the help of one crutch. She can “walk” without it, but her gait is awkward and we’re afraid that will have negative effects on other parts of the body. So using one crutch allows support and still be weight bearing. Still has trouble with extension.

      Would love to hear your experience, both for your daughter, and for you and her dad. It’s been an emotional roller coaster for us. Would love to have a “support group” buddy :o)

      Good luck and I look forward to your reply!
      Shannon

  15. Hi y’all, I just tore my ACL and will not be having surgery until August. I had a question about staying in shape until then. Can I swim and bike on my injury this summer? Also, what about golfing?

    1. Hi Logan,

      Yes, definitely strengthen your legs, keep flexibility, keep your shape as much as you can. Just don’t do things that risk tearing your ACL more or injuring it further. Since its likely loose, you are in increased risk of injury. With that caution in mind, things like biking and swimming are very low impact safe ways to get exercise. Keep in mind it depends on the tear. Some have torn ACLs and never elect to have the surgery- I heard one person was even able to do snow skiing with a torn ACL with no problem. He highly strengthened his muscles to help compensate for the lack of stability. Hope that helps! Good luck to you.

  16. Jen Kennedy says:

    In 2007 I had a right ACL recon using my hamstring. I had a complete rupture, fracture where the ACL tore off the bone MCL tear and meniscus tear. I was 27 at the time. I can’t stress how important pre-rehab is after consulting either a physio or you orthopaedic surgeon. I did the initial injury in May, Sx in July and was back playing soccer, surfing, running etc the next February. Follow the exercises given by your physio religiously and do them at home as much as you can.
    It does not feel like your own knee for a good few month, odd sensation but it will come back.
    P.S Just ruptured my ACL in my Left knee last night playing soccer. So her it goes again!

  17. I tore my acl completely last year. The OS told me my legs were strong enough and stable enough to avoid surgery. I’m very active and do excersizes such as crossfit. I joined a flag football team this year and in our last game landed on my bad leg with all my waight. I felt the same sensation when I tore it last year only its seeming to feel better faster. I’m worried I may have torn somthing else though. Now I’m waiting for my MRI appointment in three weeks. Is there a possibility I tore somthing else even though it feels more like a sprain now? Or should I be concerned and just stay away from high activity until I get the MRI done? Thanks

    1. I completely tore my acl on my right knee about one month ago playing soccer. I’m trying to stay away from surgery as I have pretty strong legs. The only time I felt pain was when te injury occurred… After that, I haven’t experienced any pain. I am lifting weights and work out my legs hard and with somewhat heavy weight (considering I have a torn ligament). I can’t quite run yet mainly because I’m scared to fall. I noticed I have lost muscle mass on my right knee though and i have a hard time flexing my quad. It doesn’t hurt when I try to flex but I just don’t see it working properly. Is here a reason why? Will I be able to build muscle mass on it with time and be able to flex it an get it back to the same size as my left quad? I workout everyday.. Eat healthy, and live a healthy life style … I just want to know if I will get better in a few months or will I be this way until I’m forced to consider surgery? I am doing my own therapy and working hard to get better. I just need some advice …

  18. I tore my ACL on February 28th playing soccer, and had my surgery on April 7th I had the hamstring graft. Yes it took some more strength away from the knee, but the scarring is minimal, and the amount taken is so small that it won’t do much in the long run. I started with simple bending and straightening exercises. Since I did not have meniscus damage I was not put in any type of brace. It’s been 3 months and I should be able to jog by next week. It’s a hard and time consuming process but it’s worth it to get back to your sport.

  19. I had ACL surgery a year and a half ago, very successful. Tearing my ACL was a wake up call and led me in the right direction of what to due with my life. That being said I have decided to become a physical therapist. I have to write a ten page paper on a topic of interest in my field of study and I chose to write about the effects of prehabilitation on post surgical recovery. In my research I found your website. You might want to update it. The links aren’t up to date and many of them can’t be found and display 404 error messages. Just a suggestion that if you’re going to inform the public you should be up to date on procedures.

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