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ACL INJURY BLOG SERIES – PART 3 (Rehabilitation)

Want to know more about the ACL rehab? Read on !!!

In the most basic terms, something we’ve all heard before, you must “trust the process” when it comes to your rehabilitation. In the previous blog regarding surgical Vs non-surgical options for ACL rupture, rehabilitation was imperative, for both, in optimising function and the successful return to sport/activity.

Rushing the rehabilitation or “I feel confident now, I’m ok” is not the mindset of a successful return to activity sport patient. A study by Beischer S et al 2020 states that returning to sport before 9 months post ACL surgery was associated with a 7x increase risk of re-rupture.

It is extremely important to follow a guided, progressive program to take your ‘injured’ knee to the conditioning of the good knee. Below I will briefly outline the stages involved in the program we use at Insync Physiotherapy from the ‘Melbourne ACL rehabilitation guide 2.0’ for both surgical and non-surgical rehabilitations. Click here to find out more about the guideline. I will provide some basic insight into each of the stages and some statistics to highlight the importance.


Pre-operation phase

It is very easy to sit back and ‘wait for the surgery’. The pre-conditioning of the knee will decrease the loss that will inevitably take place after the reconstruction. A study by Eitzen et al 2009 states that a 20% quads strength deficit going into the reconstruction resulted in persistent quads deficits at least TWO YEARS post -op.

In addition, my experience with treating clients that persisted in this pre-habilitation phase found it easier post-operation; patients developed a ‘feel’ for the process as well as a degree of muscle memory.


Phase 1 (for surgical option) (weeks 0-2): Recovery from surgery

The first 2-3 weeks post-surgery is crucial for the return of basic functions such as walking. it is also imperative to return the basic physiological requirements of the knee i.e. knee extension (your ability to fully straighten the knee) and quads activation. In this phase it is also important to ‘handle with care’ being so fresh out of a traumatic surgery – regular ice, compression and advice from your Doctor regarding pain/inflammation medication is recommended.


Phase 1 (for non-surgical option) (weeks 0-2): Recovery from injury

The basics of early rehabilitation for those opting for conservative treatment won’t differ too much from surgical treatment. Not only is knee extension crucial, pain and swelling management is also a priority as a swollen knee will inhibit quad activation.


Phase 2 (weeks 3-12): Strength and neuromuscular control

It is important to progress the knee as it allows you in this stage, it is wise to ‘listen to the knee’ as your basic neuromuscular pathways are formed during this stage and any compensation would inhibit proper progression – near perfect technique is crucial prior to progressing. Any increase in pain or swelling indicates you are pushing too hard.  A study by Sigward et al 2018, states that at 3 months post op patients shift their load away to their uninjured limb during body weight exercises and at 5 months post op, they shift their load up to their hip muscles.

Some of the exercises in this phase may include: bridging, calf raises, step ups, squats, hip strengthening and balancing.


Phase 3 (from week 13): Running, agility and landings

As most sports require change of direction it is important to test patients in multiple planes as opposed to the normal forward dynamic movements. If these broken-down movements are not tested and trained in a supervised, controlled environment, an integral part of a SUCCESSFUL return to sport would be missing and the chance of re-rupture is imminent. These should be performed a minimum of 6 months post op. The single leg hop and triple leg hop are more likely to expose deficits compared to the standard forward hop test – that is, the ability to achieve greater than 90% symmetry between the injured and uninjured leg.


Phase 4 (>9 months): Return to sport

There is a strict criteria that have to be met before you are cleared to return to playing proper games. You will be tested on your strength, power, landing techniques, and fitness level. In addition, mental state of readiness to return to sport is crucial. You have to be feeling confident to play again, or you’ll be risking a re-rupture. Current research suggests that 9 months is a minimum before returning to sport and a successful completion of the Melbourne criteria 2.0 testing of above 95%.


Phase 5: Prevention of re-injury (or instability)

Some sort of program has to be in place to maintain the progress that you’ve achieved over months of rehabilitation. It is also We will be covering this in the next blog post, stay tuned!


Since the ACL rehabilitation is all about numbers, I will leave you with this statistic, A study by Raysmith & Drew 2016 reported that athletes who were available for >80% of planned training weeks were 7x more likely to achieve their performance goals. So the question is, how committed are you really to return to full activity??? If you are committed the team at Insync Physiotherapy has a thorough, progressive program to guide you through to achieve all your goals. Good luck!

Call us at (02) 7226 3432 or email us at for more info.



Part 1: What is an ACL injury?

Part 2: Surgery or No Surgery?

Part 3: Rehabilitation

Part 4: Prevention