Post-Op ACL Surgery: 5 Keys to Long-Term Success

Post-Op ACL Surgery: 5 Keys to Long-Term Success

Anterior Cruciate Ligament (ACL) injuries are terrifying and happen more often than you think. Annually, more than 250,000 ACL knee injuries occur in the United States alone. A common theme I have recognized with current clients is a lack of knowledge about how to proceed after completing a four-week postoperative ACL rehabilitation program.

Many people can’t afford additional rehab due to lack of insurance coverage along with high costs of continuing rehab or hiring a personal trainer. People are sent away with an outdated packet of exercises with poor pictures and this situation sets them up for failure. As a result they stop moving, weight training, and performing soft tissue work.

After finishing a post-operation ACL rehabilitation program (4-6 weeks) here are 5 things you must do to speed up recovery time.

1.  Walking

Gaining and maintaining full knee-extension is one of the most vital objectives to complete. According to Mike Reinold, a physical therapist in the Boston area and owner of Champion Physical Therapy, he states “Various studies have shown loss of motion to be one of the most important factors associated with the development of arthritis after ACL surgery.” By simply walking people can deter this loss of ROM by moving the knee through a full ROM. 

Perform 3 sets forward and reverse. Be sure to perform with a strong emphasis on knee flexion and extension.

Just think of rusty hinges that attach to a door. These rusty hinges make the door harder to open and place through a full ROM. One quick fix to this is to spray WD-40 to the hinges and open and close the door through a wide range of motion to establish a full fluid ROM. The same can be said for ones knee. If a person rarely moves their knee it’s going to become stiff, rusty, and hard to move.

YOUR BODY IS A MACHINE AND IT WILL ADAPT TO THE POSITIVE OR NEGATIVE DEMANDS PLACED UPON IT. If you stop moving your joints through a full range of motion you will lose range of motion fast. On the contrary, if you continue to move your body (walking) through a controlled range of motion you will gain positive range of motion.

Walking, when done with complete focus, can place the knee through both flexion and extension, improve strength endurance, and improve your ability to walk farther distances without fatigue.


2. Train the Opposite Leg

You still have two working arms, one solid leg, and a core that needs your attention. By performing various push-pull exercises, and hammering single-leg work on the non-injured leg, you can induce positive neural adaptations to the injured leg. This “cross-education” effect according to Lee, Michael “has positive training effects in the untrained limb by 8% after contralateral strength training.”

Perform 3x10/s focusing on pushing your heel through the ground and squeezing your butt at the top.

In other words “cross education” is like my younger sister watching me play softball. She is unable to play (injured leg) however; she is still gather information about the game such as (rules, positional movements, objectives, and even studying my reactions to certain scenarios). The injured leg is always learning from your good leg so set a good example for it. 




3. Anterior Core Strength

Perform 3 sets of 5 breaths per side. Focus on creating high tension throughout your body. 

The core plays an important role in stabilizing the lower extremities along with knee movement.  For example, if I tell a novice athletes to perform a forward lunge, they might be able to perform the movement; however, during the downward phase they lose their balance because of the lack of core stability. On the other hand, if I instruct them to lunge and cue them “Rib cage to belly button” or “Brace like I am about to punch your stomach,” the lunge will feel more stable due to the increase of core stability.



4. Soft Tissue Quality

Take time to perform soft tissue work, ITS WORTH THE INVESTMENT.

Take time to perform soft tissue work, ITS WORTH THE INVESTMENT.

After you have had surgery, your body will start the healing process. Scar tissue is a tad different because it is made up of individualized cells that align in a single direction. This tissue can become dense and can prevent you from achieving full ROM. If you have had a patella tendon graft, it is important to perform patella mobilizations along with soft tissue work around the peronalials and insertion points surrounding the knee. Various self-care methods (foam rolling, lax ball, etc.) and manual techniques offered by ones physical therapist will assist in a speedy recovery.


5. Balance

Perform 3x8/side  [}


After surgery, proprioception (knowing where your body is in space) on the injured side is significantly decreased. When injured ACL clients first jump on a bike or begin to walk and bear weight, they tend to feel their knee wobbling from side to side or mention having lack of control. Performing exercises that challenge balance and control is a great way to increase stability and work towards gaining confidence with moving again.


If you are in the early stages of an ACL recovery (4-6 weeks post-op), give these keys for success a try. Here is a sample program and warm-up for an ACL (patella tendon graft) client who has completed 4-6 weeks of physical therapy.





Here is a Sample Program: 

**Disclaimer: Please check with your doctors and physcial therapist before trying anything in this article above.


Ambegaonkar, J. P., Mettinger, L. M., Caswell, S. V., Burtt, A., & Cortes, N. (2014). Relationships Between Core Endurance, Hip Strength, and Balance In Collegiate Female Athletes.. International Journal Of Sports Physical Therapy,9(5), 604-616.

Lee, M., Gandevia, S. C., & Carroll, T. J. (2009). Unilateral strength training increases voluntary activation of the opposite untrained limb. Clinical Neurophysiology, 120(4), 802-808. doi:10.1016/j.clinph.2009.01.002

Reinold, M. (2013). 6 Keys to the Early Phases of Rehabilitation Following ACL Reconstruction Surgery - Mike Reinold. Retrieved April 29, 2016, from