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5 Missing Keys in ACL Rehab

We are not very good at ACL rehab.

  • 50-60% of athletes do not reach pre-injury level

  • 16-31% of athletes re-tear the same or different leg

  • 30-50% of athletes don't return to competitive sports

  • 85% of ACL patients NEVER regain full quad strength

Yikes. Despite all our advances we are not seeing improvements in these numbers. Here are 5 things I think are lacking in the current approach to ACL rehab.

1. Train the Opposite Leg

Too many athletes allow their non-operative leg to detrain during rehab and then tear their "good" leg due to it being neglected for a full 6-12 months. While rehabbing their operative leg they will perform the same exercises on both legs. For example, lets use a 4 in step down. The 4 in step down is super hard on the operative leg and a sufficient stimulus to build strength, on the non-operative leg this is super easy and not enough of a stimulus to improve strength. We need to increase the height of the box, add weight, or do a totally different exercise for the non-op leg to reach a high enough stimulus to get stronger.

Don't be afraid to grab different weights each side, the operative leg WILL catch up!

This also applies to plyometrics. We should be jumping on the non operative leg as soon as we can safely. Here is a good example of a safe option we could perform early on in rehab on the non-operative side.

2. Nutriton/Supplementation

Nutrition and supplementation are a huge cornerstone of ensuring you are recovering optimally that is traditionally neglected. We cover these topics in depth in our ACL Blueprint course as well as everything else we are talking about here. We highly recommend you check it out.

3. Extensive Plyometrics

I see too many athletes rushing back to running and plyometrics without building a solid foundation of extensive plyometrics (think jumping rope). We need to prepare and condition the foot and ankle to be able to handle dynamic loads required by jumping and running before we start running and jumping. Too many people just start running without working on these different hopping drills to build the springs and muscles around the foot and ankle.

Here is a good example of a progression we could use:

4. Order to Chaos

In the return to sport world we spend too much time on pre-planned, pre determined drills. Sports are chaotic and reactionary. There are endless movement problems thrown at you that you must solve in a split second or risk getting beat or worse injury. Too much of our rehab involves the opposite. Very strict, pre-planned, pre-determined drills that require very little movement problems or solutions. That may be a good place to start and I think you should to build confidence and prepare tissues, BUT before we get back to sport we need to be introduced to some chaos.

Good example of introducing chaos in a large group.

5. Load

This one seems pretty obvious to me but I see it all the time, continue to strength train through a full range of motion. Now I get it, I am not asking you to be a meat head (unless you want to be), but pick a couple super solid exercises like a back squat, rear foot elevated split squat, leg press, single leg RDL or leg extension and get really good at them. I am talking full range of motion all the way down and progressively overload it. So you should be adding weight every week to couple weeks depending on how long you've been training.

This may require you to put your ego aside for a bit, elevate your heels and actually squat till your hamstring touch your calves. Hamstring covering calves is a full depth squat and what you need to get stronger and decrease injury risk. If you still struggle to back squat full depth

Front squats are a solid way to ensure you get full depth as well.


There you have it folks, 5 things that I think we could do a lot better in to ensure we give our ACL patients the care they need and deserve! Feel free to email or DM any questions! Till next time!


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