Evidence-based rehabilitation protocols, phase-by-phase exercises, and criteria for progressing through your ACL recovery journey.
Goals: Protect graft, control pain/swelling, achieve full extension, reactivate quadriceps.
Key exercises: Quad sets, ankle pumps, heel slides, passive extension, straight leg raises.
Goals: Full ROM, normalize gait, improve quad strength, wean from assistive devices.
Key exercises: Mini squats, step-ups, stationary bike, balance exercises.
Goals: Build strength, improve balance and proprioception, cardiovascular fitness.
Key exercises: Leg press, lunges, Romanian deadlifts, single-leg balance.
Goals: Return to running, introduce jumping, sport-specific movement prep.
Key exercises: Walk-jog progression, two-leg plyometrics, agility ladder.
Goals: Advanced agility, cutting/pivoting, sport-specific skills.
Key exercises: Single-leg plyometrics, cutting drills, sport-specific agility.
Goals: Meet return-to-sport criteria, graduated return, prevention program.
Key activities: Return-to-sport testing, practice participation, game return.
Resistance band for final 30° extension
Closed chain strengthening (after week 6)
Prone or seated machine curls
Hip hinge pattern, hamstring emphasis
Eccentric strengthening (advanced)
Double and single-leg progressions
Progress: eyes closed, unstable surface
Single leg on unstable surface
React to external pushes/pulls
Criteria to begin:
Progression:
Criteria to begin:
Progression:
| Phase | PT Visits/Week | Home Exercise |
|---|---|---|
| Weeks 1-6 | 2-3x | Daily (1-2 hours) |
| Weeks 6-12 | 2x | Daily (1-2 hours) |
| Months 3-6 | 1-2x | 4-5x/week |
| Months 6-9 | 1x or biweekly | 3-4x/week + sport |
| Months 9+ | Monthly or as needed | Maintenance + sport |
Your PT visits are for:
The majority of your rehab happens at home. Doing exercises only during PT visits is not enough for optimal recovery.
Meeting objective criteria before returning to sport reduces re-injury risk.
| Category | Test/Measure | Target |
|---|---|---|
| Time | Months post-surgery | ≥9 months (some say 12) |
| Strength | Quad Limb Symmetry Index | ≥90% |
| Strength | Hamstring Limb Symmetry Index | ≥90% |
| Functional | Single Hop for Distance | ≥90% symmetry |
| Functional | Triple Hop for Distance | ≥90% symmetry |
| Functional | Crossover Hop for Distance | ≥90% symmetry |
| Functional | 6-meter Timed Hop | ≥90% symmetry |
| Psychological | ACL-RSI Score | ≥65 (ideally >80) |
| Clinical | ROM, swelling, stability | Normal |
Research shows that for each month of delay in returning to sport up to 9 months, re-injury risk decreases by approximately 51%. Returning before 9 months significantly increases re-tear risk. However, time alone isn't sufficient—you must also meet strength and functional criteria. Some research suggests waiting until 12 months may be even safer for high-risk sports.
Yes, much of ACL rehab can be done at home, but supervised physical therapy is strongly recommended, especially in the first 3-6 months. Home exercises are essential—you should exercise daily at home between PT visits. However, PT provides manual therapy, progression guidance, form correction, and access to equipment that's difficult to replicate at home. A hybrid approach (PT visits + home exercise) is ideal. If access is limited, telehealth PT and detailed protocols can help.
Signs you're overdoing it: increased swelling after exercise (that doesn't resolve with ice/rest), pain lasting more than 24 hours post-exercise, regression in ROM or function, excessive fatigue, and sleep disruption due to pain. "No pain, no gain" does NOT apply to ACL rehab. Listen to your body and communicate with your PT. Some muscle soreness is normal; joint pain and swelling are warning signs.
Both are critically important, but quad strength is often the limiting factor in ACL recovery. The quad is inhibited after surgery (arthrogenic muscle inhibition) and takes active effort to restore. Hamstrings are important because they protect the ACL by preventing anterior tibial translation. A balanced quad:hamstring ratio (ideally 60:40 or better) is optimal. Focus heavily on quad exercises throughout recovery while maintaining hamstring strength.
Cutting and pivoting typically begin around 6-9 months, after meeting criteria: full ROM, minimal swelling, strength LSI >85%, successful plyometric progression, and PT/surgeon clearance. Progression: start with planned, slow cuts, then increase speed, then add reactive/unplanned cuts. This is the highest-risk activity for re-tear, so don't rush. Proper cutting mechanics (avoid knee valgus) are essential.
Use our assessment tools to measure your rehabilitation progress and readiness for return to sport.