Booked in for ACL surgery? What you do before the operation can make a difference to your rehabilitation afterwards.
You might be waiting for your reconstruction date while your knee is still swollen, stiff or weaker than usual. It's understandable to think the real rehabilitation starts after surgery—but there is useful work you can do beforehand.
That preparation is called prehabilitation, or prehab. At Adaptive Physiotherapy & Massage in Booragoon, we help you work on movement, strength and everyday function before surgery, based on your injury and your surgeon's advice.
What is ACL prehab?
Prehab is a structured period of physiotherapy and exercise rehabilitation before anterior cruciate ligament (ACL) reconstruction. The original article describes a typical six-to-eight-week period. In practice, the available time varies depending on surgery scheduling, knee symptoms and associated injuries; prehab can still be useful when that window is shorter.
The main aims are to settle swelling, restore comfortable knee movement—particularly extension—improve muscle activation and rebuild strength and confidence with everyday tasks. It's about arriving at surgery with the knee functioning as well as reasonably possible, rather than simply waiting for the operation.
Prehab isn't a substitute for surgery or post-operative rehabilitation. It helps prepare you for the next stage, and gives you a clearer understanding of what recovery will involve.
What does prehab involve?
Your plan depends on the initial injury, whether you have meniscus or cartilage damage, how the knee responds to exercise and any restrictions from your surgeon. The original approach can be understood in two overlapping stages.
Stage 1: Settle symptoms and restore movement
When the knee is painful or swollen, the initial priority is to regain comfortable function.
- Manage swelling: Compression, elevation and ice may help with short-term comfort where appropriate.
- Restore knee movement: Work towards full extension and comfortable flexion, as your injury allows.
- Improve walking: Gradually recover a more comfortable gait and everyday tasks, such as getting out of a chair or climbing stairs.
Stage 2: Rebuild strength and capacity
As the knee settles, the focus shifts towards purposeful strengthening and controlled activity.
- Strength: Quadriceps, hamstrings, glutes and calves with an individualised loading plan.
- Functional exercises: Suitable squat, step-up, sit-to-stand and lunge progressions.
- Balance and control: Weight shifts, single-leg balance and other appropriate coordination drills.
These aren't rigid stages: strengthening may begin early where safe and appropriate, and swelling management can remain useful throughout. Your physiotherapist will adjust the plan according to progress and any surgical restrictions.
Why is prehab important before ACL surgery?
Build a stronger starting point for post-operative rehabilitation
After ACL reconstruction, regaining knee movement and quadriceps strength is a major focus. Working on these before surgery may help you begin post-operative rehabilitation with better movement and muscle activation.
Prepare for returning to training and sport
If you want to return to football, netball, running or the gym, strengthening begins well before return-to-sport testing. Prehab provides a chance to work on the physical qualities you'll continue developing after surgery.
Research suggests pre-operative rehabilitation may improve early postoperative strength and movement, and may help with return to activity; it doesn't guarantee a faster return to sport.
Understand whether rehabilitation-first management is an option
Some people with ACL tears can achieve good function through a structured rehabilitation-first approach. For others, reconstruction remains the preferred option because of knee instability, associated injuries or activity demands.
If surgery has already been recommended, any decision to change that plan should be made with your orthopaedic surgeon and treating team. You can read more about operative versus non-operative ACL management.
Work towards better range of motion before surgery
Regaining knee extension and improving flexion are common pre-operative priorities. A persistently stiff knee may complicate rehabilitation, although what's achievable depends on the injury and surgical plan.
If motion is limited by a locked knee or associated injury, don't force it. Seek advice from your surgeon or physiotherapist.
Reduce muscle weakness and learn what comes next
Swelling and pain can make it difficult to fully activate the quadriceps. Prehab gives you a chance to practise suitable exercises, understand the early post-operative expectations and plan for practical needs at home, work or school.
The bigger picture: preparing the person, not just the knee
There is more to ACL recovery than a set of knee exercises. It helps to know what your post-operative restrictions might be, how you'll get around in the first few weeks, what support you'll need, and how your activity goals affect the rehabilitation plan.
At Adaptive, we start with the person: where you are now, what surgery is planned and what you want to return to doing. We then guide and progress your program, reassessing as your knee changes.
If your goal is to return to sport, prehab is the start of a longer process. See Your ACL Recovery Journey for the stages after injury and Returning to Sport After ACL Injury for later-stage preparation and testing.
Book an ACL prehab assessment in Booragoon
If you're preparing for ACL reconstruction, a physiotherapy assessment can help you understand what exercises are appropriate now, what to work on before surgery and how to plan for the rehabilitation ahead.
Adaptive Physiotherapy & Massage · 27 Shields Crescent, Booragoon WA 6154 · Free onsite parking
References
- Kotsifaki R, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine. 2023;57:500–514. Read the guideline.
- Adaptive Physiotherapy & Massage. The Importance of Prehab Before ACL Repair Surgery. Original Adaptive article used as the source for this redesign.