Recovering from an ACL injury is not about returning to basic day to day function.

It’s about returning stronger, more confident, and more resilient than before.

ACL rehab is a long-term, progressive journey, and skipping steps can increase the risk of re-injury or long-term knee instability.

In this article, we’ll break down the five key phases of ACL rehabilitation that form the foundation of a successful return to sport.

Each phase has specific goals, priorities, and progressions based on objective criteria, not just timelines.



Phase 1: Regaining Full Knee Range of Motion 🤸‍♂️

Goal: Achieve full extension and flexion of the knee
Typical timeline: Weeks 0–6 post-surgery (or injury if non-operative)

After ACL reconstruction, the first and most urgent priority is restoring the full range of motion (ROM)—especially full knee extension. Without this, everything downstream in your rehab becomes harder.

Key Objectives:
    •    Full knee extension (equal to the other leg)
    •    Flexion to at least 120–130° by week 4–6
    •    Reduce swelling and inflammation
    •    Reactivate the quadriceps

Key Exercises:
    •    Heel slides
    •    Prone hangs
    •    Wall slides
    •    Patella mobilisations
    •    Quad sets and straight leg raises

🔍 Tip: Swelling and limited extension are the most common causes of delayed rehab progress. Focus on these daily.

Phase 2: Regaining Muscle Capacity and Strength 💪

Goal: Build foundational strength in the quads, hamstrings, and glutes
Typical timeline: Weeks 6–16+

Once full ROM is achieved and pain is under control, you can shift your focus to rebuilding strength, especially in the quadriceps, which tend to suffer significant atrophy post-surgery.

Key Objectives:
    •    Restore symmetrical strength (especially quads and hamstrings)
    •    Develop neuromuscular control and proprioception
    •    Improve single-leg stability and balance

Key Exercises:
    •    Step-ups and split squats
    •    Hamstring bridges and curls
    •    Glute-focused movements (e.g., hip thrusts, monster walks)
    •    Early-stage isometric and isotonic strength work
    •    Balance drills (e.g., single-leg holds, wobble board)

🧠 Remember: Control, tempo, and intent matter, especially early on.

Phase 3: Return to Running 🏃‍♀️

Goal: Safely reintroduce impact and dynamic movement
Typical timeline: Around 3–6 months post-op (based on strength and movement quality)

Running is a huge milestone in ACL rehab—but it’s not as simple as waiting three months and heading out for a jog. You need to earn the right to run through objective testing and movement readiness.

Criteria to Begin Running:
    •    80–90% strength symmetry (particularly quads)
    •    Good single-leg control in landing and hopping tasks
    •    Minimal knee swelling after increased loading
    •    Confidence and pain-free movement patterns

Return to Running Progression:
    •    Walk–run intervals on soft surfaces
    •    Gradual increases in total volume and intensity
    •    Monitoring response (swelling, soreness, instability)

✅ Use a structured running progression rather than jumping straight into long-distance or sport-specific sessions.

Phase 4: Return to Sport 🏑⚽🏀

Goal: Reintroduce full-speed, chaotic, and contact sport demands
Typical timeline: 9–12+ months post-op (criteria-based)

Returning to sport is the ultimate goal for most ACL rehab clients—but it’s also where re-injury risk is highest. A rushed return often leads to setbacks or even a second ACL tear.

This phase blends sport-specific skills, physical conditioning, and psychological readiness.

Key Criteria:
    •    90%+ symmetry in strength and hop tests
    •    High-level change of direction and deceleration mechanics
    •    Completion of controlled training and full-contact sessions without symptoms
    •    Confidence and mental readiness to compete

Key Components:
    •    Sprinting, cutting, jumping, and reactive drills
    •    Agility and decision-making under fatigue
    •    Gradual reintegration into team training
    •    Psychological strategies to reduce fear of re-injury

🧠 Note: Fear of re-injury is a strong predictor of second ACL injuries. Confidence and trust in your knee matter as much as your strength scores.

Phase 5: Injury Prevention 🔁

Goal: Keep the knee strong, stable, and ready for long-term athletic demands
Typical timeline: Ongoing

ACL rehab doesn’t end at 9 or 12 months. True success is measured by what happens 12–24 months after returning to sport. That’s where injury prevention strategies come in.

Focus Areas:
    •    Maintain a strength programme 3x/week
    •    Include regular neuromuscular warm-ups (e.g., FIFA 11+ or NetballSmart)
    •    Continue plyometrics and landing mechanics
    •    Track fatigue and recovery
    •    Periodically re-test strength and hop performance