ACL Rehab - What does good rehab look like?
An anterior cruciate ligament (ACL) tear can be one of the most challenging injuries in sport. Beyond the physical damage, its impact reaches deep into an athlete's identity, motivation, and future. Full recovery is possible—but only with a holistic, team-based approach. This blog explores four essential factors that influence ACL rehabilitation success and long-term return to sport.
🧱 1. Prehabilitation: Preparing Before the Repair
Most people think recovery starts after surgery—but the best outcomes often begin before it.
Studies show that structured exercise prior to surgery (“prehab”) improves early and even long-term functional outcomes. Resistance training and neuromuscular work can:
Improve strength and mobility pre-surgery
Enhance post-op recovery up to two years later
Increase chances of returning to pre-injury sport levels
⏳ Key takeaway: Use the waiting period before surgery wisely. Prehab is not a placeholder—it’s a launchpad. However, this is not the time for silly mini-band drills. The athletes I rep can deadlift, squat, split squat, do pull-ups and more! There are so many ways they can put on muscle and get much stronger while they awaiting their surgery. The key is to avoid the following:
High impact activity (no jumping and landing)
Pivoting (planting foot and rotating is a no go)
Walking for long periods - yup, this is actually not a great idea and will piss off the knee
Kicking (even in the pool!) So, if you want to swim, then it’s arms ONLY please.
🔧 2. Surgical Timing & Technique: One Size Doesn’t Fit All
ACL reconstruction is not a uniform process. Decisions around when and how to operate affect outcomes significantly.
Graft types (patellar, hamstring, quadriceps) offer similar outcomes, though pain and healing profiles vary.
📌 Clinical insight: Graft choice and timing should be personalized based on lifestyle, age, and goals. Earlier isn’t always better—but waiting too long can be risky.
🏋️ 3. Rehabilitation Duration & Adherence: Trust the Process
Rehab is not just a checklist—it’s a journey that can last 10–12 months or more. Rushing it increases the chance of re-injury.
Longer, supervised rehab = better outcomes
Physios take care of the early stage (ROM, BFR)
Strength & Conditioning Coaches with education in ACL rehab can take over all exercise prescription at around the 16 week mark
💡 Best practice includes: Crtieria to meet before moving to the next stages, high levels of strength as a pre-req, plyometrics taught by performance specialists (S&C), speed integration and return to practice monitored by S&C. And force plate testing plus Y balance test and LESS test done several times boefore full return.
💡RED FLAGS include: Physiotherapists working without an S&C into late and RTP stages, limb symmetry testing as an outcome measure to return to sport.
🧠 4. Psychological Readiness comes from good rehab
An unready mind is normal when the athlete is underexplosed to game-like demands
Confidence can only be built upon competence. Train propoerly and this is not something an athlete worries about. Spend the whole rehab in a clinic and doing things submaxximally then there will be no confidence to return.
🔁 Final Word: Recovery Is a Team Effort
Successful ACL recovery isn’t just about a skilled surgeon or a great rehab program—it’s about coordination, communication, and commitment across the care team. Physical therapists, must align with strength & conditioning specialists for the best outcomes. This is the essence of Athlete-centered care. Surgeons must become more up date to date on who is having the best successes in this domain. We are no longer in an era where athletes ride the exercise bike and do knee extensions to rehab their ACL. We know much more than this and S&C professionals are also sport scinetists. Athletes are all we see and all we do.
