ACL: Quad Strength is KING

If you have no idea what to do for your ACL rehab, a really easy place to start is getting the quads freaky strong. We have a LOT of literature to support that quad strength is the most significant predictor of successful rehab and return to function.

So How Do We Do It?

Initially, we will experience a huge decrease in quad strength and size. Re-establishing the neural connection between the brain and the quad is crucial. I always recommend being able to achieve a voluntary quad contraction first BEFORE adding electrical stimulation.

Early on, frequency is your best friend. I advocate for daily mobility sessions multiple times per day as well as quad sets throughout the day. The goal should be to get 500-1,000 reps in per day.

How About Later Stages?

Quad sets and straight leg raises may be good for the first week or two, but we should progress pretty quickly. My next step is progressing patients into a wall sit and isometric lunge. These two pillars will be in their program for the duration of therapy — work up to 2-5 minutes on each position.

At the 4-6 week mark, I start introducing open chain quad exercises like single leg extensions. And before you say it — THEY ARE SAFE! The idea that leg extensions increase ACL laxity is false. Research shows walking and squatting induce MORE shear forces on the ACL than leg extensions.

Single leg extensions are one of the best exercises you can do for the quads because they do not allow you to cheat. I love squats and split squats too, but it's much easier to compensate and not actually load the quad during those movements. The leg extension leaves you no choice.