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10 Keys to a Successful ACL Rehab

Updated: Feb 11

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. We believe 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 of the prehab program should be to get as close to "normal" as possible. The goal is to normalize strength, range of motion and stability before surgery. This allows us to make much faster gains in the early stages of rehab.

2. Don't Wait for Rehab

Common practice is to wait to go to physical therapy 2-4 weeks after ACL surgery. This is a HUGE mistake. This is an incredibly important window in time where we can get the healing process started. So many patients are behind the 8 ball because they have just been hanging out for two weeks instead of initiating the rehab process. We prefer to start rehab 48-72 hours after surgery depending on pain levels. This allows us to normalize ROM earlier, get better quad activation faster, and normalize gait ASAP.

3. Don't Ditch the Crutches Too Early

I get it. 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 digs us further into the compensation hole as well as leads to more swelling. We need to ensure our quad is strong enough to walk without a limp before we ditch the crutches. Our typical progression is two crutches -> one crutch -> no crutch.

4. 3x10 Is Not Enough

It takes about 2000-3000 reps to create a new motor pathway, which is the major key in ACL rehab. We need HIGH amount of reps. Instead of just doing 10 or 20 reps how about 250 reps? 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 get go. Nothing impedes progress like missing extension ROM in those early stages. This also helps prevent from scar tissue build up and a Cyclops lesion which often requires a second surgery to remove. The faster we can get full extension the better. We recommend spending a lot of time outside the brace with the knee propped. Here is a video with some extension options:

Knee extension is our chief priority post op, but flexion is also an important factor. We recommend hundreds to thousands of reps per day working on flexion poking the pain point. No need to blow through the pain paint, but go right next to it into some discomfort. Here are some good flexion options:

6. Quad Activation ASAP

Getting the quad firing WELL is a huge priority and we should have some urgency in gaining the ability quickly. The quicker and better that quad gets firing the better. Here are a couple tips to get the quad firing.

Once you have a voluntary contraction we highly recommend using e-stim to enhance the contraction and improve cortical motor excitability. You can find a very affordable e-stim unit here on AMAZON.

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 should be to stay as fit and strong as possible. Part of the prevalence of re-injury of other body parts after coming back from ACL rehab is neglecting the other body parts and them getting weaker because of it.

8. Dual Tasking

Rehab tends to create this dependence on overthinking about the knee. We help develop this crutch of having to always thing about the quad or the knee while doing tasks we used to do without thinking about it at all. This may be necessary at the beginning, but as we achieve "motor mastery" or master a movement we should begin to dual task. This involves doing two or more tasks at once in order to keep our focus off the knee. This helps us break the habit of thinking about the knee. If we are still thinking about the knee as we get into sports we are in trouble because you do not have time to think about the knee. Here is an example of what that would look like:

9. Quad Strength

Quad strengthening is key for ACL rehab. DO NOT shy away from leg extensions. They are one of the best exercises you can be doing in the rehab process. The fear of leg extensions over stressing the graft are not warranted considering walking and squatting has been shown to produce more strain on the ACL graft than a leg extension. Be smart - if it is causing you issues a SL Wall Sit is another good option.

10. Mental Game

This is a tough injury with a tough recovery. Getting over the psychological side of this injury can be tough. We recommend if you are struggling to talk with your loved ones or a professional. Make sure to not secluded yourself as much as possible. Use this time in rehab to do stuff with friends, learn new things, get a new hobby, make new friends, and grow as a person. This does not have to be a waste unless you let it!

Alright folks. That about sums it up. If you do these 10 things well these should set you up for success in your ACL rehab journey. Let us know if you have any questions!

Need sports medicine physical therapy? We are located near North Canton/Akron, OH and would love to work with you.

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