Rehabbing an ACL injury is a journey that requires patience, dedication, and a systematic approach. From pre-surgery preparation to the gradual return to sports, each stage of the ACL rehab timeline plays a crucial role in restoring strength, stability, and confidence in your knee.

In this article, we'll outline the key stages of ACL rehab, providing clear guidance on timelines while emphasizing the importance of a criteria-based rehabilitation process.


Pre-Surgery Preparation:

Before undergoing ACL reconstruction surgery, you will need to complete pre-surgery preparation to optimise your physical strength and mental readiness for the procedure.

This phase typically includes:

1. Prehabilitation: Engaging in prehab exercises to strengthen the key muscles, improve range of motion, and reduce swelling. Prehab exercises may include quad sets, hamstring curls, straight leg raises.

2. Education: Meeting with your surgeon to discuss the surgical procedure, post-op expectations, and the rehab process as a whole. It’s important to understand how you can improve your adherence to the rehab program and the potential challenges you may face during recovery.

3. Mental Preparation: Address any fears or anxieties about the surgery and recovery process through coaching and education. Building a positive mindset can help you approach surgery with confidence and resilience. One of the keys here is to address possible setbacks that may pop up unexpectedly. If you know what to do when this happens you’ll be much better prepared to handle them. Fear of re-injury has been identified as a key factor in second ACL tear post surgery (Paterno et al., 2017).


Surgery and Immediate Post-Operative Phase:

Following ACL reconstruction surgery, you enter the immediate post-op phase, focussing on pain management, and early mobility. Key aspects of this stage include:

1. Pain Management: Utilising prescribed pain medications as directed by healthcare professionals to manage post-op discomfort. Ice therapy and elevation can also help reduce swelling and pain.

2. Early Mobilisation: Engage in range of motion exercises under the guidance of a physical therapist or S&C coach to prevent stiffness and promote range of motion. Exercises may include ankle pumps, heel slides, and knee flexion/extension within a pain-free range. Getting knee extension and flexion back as soon as possible is a key indicator of successful ACL rehab (Delaloye et al., 2018).

3. Knee Care: Keeping the surgical incision clean and dry to prevent infection. Following healthcare provider instructions regarding dressing changes and showering restrictions.

4. Crutch Walking: Gradually transitioning from non-weight-bearing to partial weight-bearing using crutches or a walker to protect the surgical site and promote stability. Weight-bearing status is determined by the surgeon's recommendations and the individual's pain tolerance.


Mid to Late Rehabilitation Phase:

As the initial post-operative phase progresses, you will transition into the mid to late rehabilitation phase, focussing on restoring strength, mobility, and proprioception. Key components of this stage include:

1. Progressive Strength Training: Gradually increasing resistance and intensity of exercises to strengthen the quadriceps, hamstrings, glutes, and calf muscles. Resistance training may involve bodyweight exercises, resistance bands, and eventually, weightlifting equipment.

2. Range of Motion Restoration: Continuously working to improve flexibility and joint mobility through stretching, passive range of motion exercises, and manual therapy techniques. Achieving full knee extension and flexion is a primary goal during this phase.

3. Proprioceptive Training: Incorporating balance and stability exercises to enhance proprioception and neuromuscular control. Activities such as single-leg stance, balance boards, and agility drills help improve coordination and reduce the risk of re-injury.

4. Cardiovascular Conditioning: Implementing low-impact cardiovascular activities such as stationary biking, swimming, or elliptical training to improve cardiovascular fitness without compromising knee stability. Gradually increasing duration and intensity based on individual tolerance.

5. Functional Movement Training: Integrating sport-specific movements and activities into the rehab program to simulate real-life demands and prepare athletes for a safe return to sports. Exercises may include cutting, jumping, pivoting, and landing mechanics.


Return to Sport Phase:

The final stage of ACL rehab involves a gradual return to sports, focusing on sport-specific training, agility drills, and mental readiness. This phase typically includes:

1. Criteria-Based Progression: Following a criteria-based approach to determine readiness for return to sports, including objective measures of strength, stability, range of motion, and functional performance. Clearance for return to sports is typically given by the treating surgeon or physical therapist (Grindem et al., 2016).

2. Sport-Specific Training: Gradually reintroducing sport-specific activities and movements while monitoring for any signs of pain, instability, or functional limitations. Athletes may work with a sports-specific trainer or coach to tailor their training program to their sport's demands.

3. Gradual Progression: Incrementally increasing the intensity, duration, and complexity of sports-related drills and activities over time. Starting with low-risk, controlled environments and gradually advancing to full-speed, game-like scenarios.

4. Mental Readiness: Addressing any psychological barriers or apprehensions about returning to sports through counseling, visualization techniques, and confidence-building exercises. Building trust in the rehabilitated knee and maintaining a positive mindset are essential for a successful return to sports.


Conclusion:

Navigating the ACL rehab timeline requires a comprehensive approach that addresses physical, psychological, and functional aspects of recovery. From pre-surgery preparation to the gradual return to sports, each stage of the rehab process plays a vital role in restoring function and confidence. By following a criteria-based rehabilitation program and working closely with healthcare professionals, athletes can optimize their recovery outcomes and safely return to the sports they love.

Next Steps:

Watch our free ACL masterclass to discover our 3 step system for getting you back to sport post ACL. 


References

Delaloye JR, Murar J, Sánchez MG, Saithna A, Ouanezar H, Thaunat M, Vieira TD, Sonnery-Cottet B. How to Rapidly Abolish Knee Extension Deficit After Injury or Surgery: A Practice-Changing Video Pearl From the Scientific Anterior Cruciate Ligament Network International (SANTI) Study Group. Arthrosc Tech. 2018 May 7;7(6):e601-e605.

Grindem, Hege, et al. "Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study." Br J Sports Med (2016): bjsports-2016.

Paterno, Mark V., et al. "Self-reported fear predicts functional performance and second ACL injury after ACL reconstruction and return to sport: a pilot study." Sports health (2017): 1941738117745806.