ACL Rehab: A Clear, Patient-First Guide
ACL Rehab: A Clear, Patient-First Guide; by Rob Tuomey (Chartered Sports Physiotherapist)
Anterior cruciate ligament (ACL) rehab works best when it’s criteria-based, objective, and patient-specific. Expect 9–12+ months from injury to full return to cutting/pivoting sports. We progress when your symptoms, movement quality, strength, and test results say you’re ready—not just because a date on the calendar arrives.
What is the ACL—and why does it matter?
The ACL is a key stabiliser inside your knee that helps control twisting, cutting, and deceleration. People often injure it during a sudden change of direction, awkward landing, or contact. Some people manage well without surgery; others (especially in pivoting sports) benefit from reconstruction. Either way, good rehab is essential.
Surgery or no surgery?
Non-operative (rehab-first): Can suit those with lower-demand goals, good knee stability, and no major associated damage.
Surgical (ACL reconstruction): Common for athletes in pivoting/competitive sports, or if the knee feels unstable in daily life.
Bottom line: We discuss your sport, goals, knee stability, and imaging findings, then choose the path that sets you up for long-term success.
The ACL Rehab Roadmap (milestones > time)
Durations below are typical ranges. We move forward when you hit clear criteria, not just because Week X has arrived.
Phase 1: Calm the knee, restore basics (Weeks 0–3)
Goals:
Settle pain/effusion (swelling)
Achieve full knee extension early, and regain comfortable flexion
Normalise walking pattern
Activate quadriceps and glutes
What we do: gentle range of motion, patellar mobility, quad sets, straight-leg raises, supported squats, bike as tolerated, gait retraining.
Progress when: minimal swelling, full extension, improving quad activation, walking without a limp.
Phase 2: Strength & movement foundations (Weeks 3–12)
Goals:
Build quadriceps, hamstrings, and hip strength
Improve balance and single-leg control
Maintain cardiovascular fitness
What we do: progressive squats/lunges/hinges, step-ups, bridges, core work, balance tasks, controlled leg press, bike/erg.
Progress when: good single-leg squat control, minimal next-day soreness, and strength trending up on testing.
Phase 3: Return-to-run prep → Return to running (≈ Weeks 10–16+)
Before running, you should have:
Minimal/no swelling, full range of motion
Strong, pain-free hop-in-place or pogo contacts
Good single-leg squat/step-down mechanics
Sufficient quadriceps/hamstring strength (measured, not guessed)
What we do: walk-jog progressions, controlled plyometrics, tempo runs, continued strength (don’t stop the gym work).
Phase 4: Agility, plyometrics & sport skills (≈ Months 4–7+)
Goals:
Deceleration/braking control
Change of direction (planned → reactive)
Sport-specific skills at increasing speed and fatigue
What we do: hops and bounds, cutting drills, shuttles, reactive footwork, progressive contact preparation (if relevant), ongoing strength.
Phase 5: Return to sport (often ≥ 9–12+ months)
You’re ready when (criteria example):
Strength: ≥ 90–95% limb symmetry (quads/hamstrings)
Hop tests & force-plate metrics: ≥ 90–95% symmetry plus good landing mechanics
Movement quality: no dynamic valgus, confident deceleration and cutting
Workload tolerance: can complete full-intensity training without swelling or pain flare
Rushing back too early raises the risk of re-injury—especially in younger athletes. We’ll help you return strong and confident, not just “cleared.”
Testing makes rehab safer (and smarter)
At Rob Tuomey Physiotherapy, your progress isn’t based on guesswork. We use objective testing to guide decisions:
Strength testing (e.g., isometric quadriceps/hamstrings)
Force-plate assessments (landing forces, impulse, asymmetry)
Hop tests (single, triple, crossover, timed) with quality ratings
Movement analysis (single-leg squat/step-down, change-of-direction)
These numbers help us individualise your program, reduce re-injury risk, and choose the right time to run, train, and compete.
Common pitfalls to avoid
Chasing timelines instead of meeting criteria
Dropping strength work when running resumes
Skipping deceleration and landing mechanics
Ignoring next-day swelling or pain (your knee’s early warning system)
What your sessions look like with us
Assessment & plan: clear goals, clear tests, clear roadmap
Progressive programming: strength + plyo + agility + conditioning
Regular re-testing: we show you the numbers and what they mean
Return-to-sport strategy: training minutes, positions/roles, and load progressions that make sense for yoursport
FAQs
How long will it take?
Most return to pivoting sport between 9 and 12+ months—earlier only if you meet strict criteria.
Will I definitely need surgery?
Not always. Some people do well with rehab-first, especially outside pivoting sports. We’ll decide together.
When can I start running?
When swelling is controlled, range is full, movement quality is good, and strength/impact tests meet targets. For many, that’s roughly 10–16+ weeks.
How do we reduce re-injury risk?
Hit objective strength and hop/force-plate criteria, master deceleration and cutting, and don’t rush the final stages.
Ready to start a smarter ACL rehab plan with Rob Tuomey Physio?
If you’d like an assessment—or a second opinion on your current program—book an appointment and we’ll map out your next steps with clear milestones and objective testing.