10 Keys to a Successful ACL Rehab

ACL surgery is a TOUGH road. We have helped hundreds of athletes successfully navigate the ACL rehab journey and get back to sports even better than before. With the proper rehab game plan, you can come back better than before the injury. Here are 10 major keys to ensure a successful rehab program.

1. Prehab Program

Research has shown that a 4-6 week prehab program drastically improves post-operative outcomes such as quad strength and range of motion after ACL surgery. The goal is to normalize strength, range of motion, and stability before surgery so we can make much faster gains in the early stages of rehab.

2. Don't Wait for Rehab

Common practice is to wait 2-4 weeks after ACL surgery to go to physical therapy. This is a HUGE mistake. We prefer to start rehab 48-72 hours after surgery. This allows us to normalize ROM earlier, get better quad activation faster, and normalize gait ASAP.

3. Don't Ditch the Crutches Too Early

The crutches are annoying, BUT we need them until we are able to walk without a limp. Walking with a limp reinforces poor habits and leads to more swelling. Our typical progression is two crutches → one crutch → no crutch.

4. 3x10 Is Not Enough

It takes about 2,000-3,000 reps to create a new motor pathway, which is the major key in ACL rehab. Instead of just doing 10 or 20 reps, how about 250? We need to do enough reps to actually make a change.

5. Extension First, Flexion Next

We recommend being fairly aggressive with extension ROM from the start. Nothing impedes progress like missing extension ROM in those early stages. This also helps prevent scar tissue build up and a Cyclops lesion which often requires a second surgery to remove.

6. Quad Activation ASAP

Getting the quad firing WELL is a huge priority. The quicker and better the quad gets firing, the better. Once you have a voluntary contraction we highly recommend using e-stim to enhance the contraction and improve cortical motor excitability.

7. Calves / Upper Body

While you may be more limited in loading the knee — go to the gym, lift upper body, train calves, train the hips, train the opposite leg. Our goal is to stay as fit and strong as possible throughout the process.

8. Dual Tasking

Rehab tends to create a dependence on overthinking about the knee. Dual tasking involves doing two or more tasks at once to keep focus off the knee. If we are still thinking about the knee as we return to sports, we are in trouble.

9. Quad Strength

DO NOT shy away from leg extensions. They are one of the best exercises you can do in the rehab process. Research shows walking and squatting produces more strain on the ACL graft than a leg extension.

10. Mental Game

This is a tough injury with a tough recovery. Getting over the psychological side can be hard. Use this time to do stuff with friends, learn new things, get a new hobby, and grow as a person. This does not have to be a waste unless you let it!