ACL reconstruction · Knee rehabilitation · Booragoon
Had ACL surgery and wondering what your rehabilitation should look like over the coming months?
In the first few weeks, you might be concentrating on swelling, getting your knee straight again and walking comfortably. Later, the questions change: when can you lift heavier, start running or get back to football, netball or your usual training?
ACL recovery happens in stages, but the calendar isn't the only thing that matters. Your progress also depends on how your knee is moving, how strength is rebuilding, how it responds to exercise and the instructions from your surgeon.
At Adaptive Physiotherapy & Massage in Booragoon, we assess where you are now and help you work towards the activities that matter to you through an individualised rehabilitation plan.
What happens after ACL reconstruction?
The anterior cruciate ligament (ACL) helps stabilise the knee, particularly during pivoting and change-of-direction movements. When an ACL is reconstructed, rehabilitation helps restore knee movement, muscle strength and progressively more demanding physical function. Surgery alone does not rebuild these capacities.
The five phases below reflect the structure of our original guide. Their time ranges are approximate examples, not automatic progression dates. Some people move at different rates, and accompanying meniscus or cartilage procedures can require additional restrictions.
The five phases of ACL recovery after surgery
Post-surgical recovery
Often the first 0–2 weeks- Goals: Manage pain and swelling, protect healing tissues, begin recovering knee extension and activate the quadriceps.
- Early movement: Suitable heel slides, gentle range-of-motion work, ankle pumps and quadriceps sets, following your surgical plan.
- Walking: Crutches, weight-bearing and a brace are used as prescribed; these instructions vary with the operation and any additional procedures.
- Physiotherapy: Check swelling, knee movement, walking and muscle activation. Gentle patellar mobility or other hands-on treatment may be considered when indicated.
Regaining range of motion and walking control
Commonly around weeks 2–6- Goals: Work towards full knee extension, progressively improve knee bending, walking and muscle control.
- Exercise: Progress from early activation to suitable mini squats, heel raises and basic functional exercises as tolerated and permitted.
- Movement and balance: Introduce supported balance and weight-transfer exercises when appropriate.
- Monitor: Persistent swelling, increasing pain or difficulty recovering extension may require reassessment.
Strengthening and stability
Commonly around weeks 6–12- Goals: Rebuild quadriceps, hamstring, glute and calf strength while progressing functional knee control.
- Exercises: May include leg presses, bridges, step-ups, controlled lunges, squats and single-leg balance progressions.
- Assessment: Check technique, strength, swelling and how the knee responds to increasing loads.
- Individualise: Graft choice and any associated surgery may change the timing of particular movements or loading.
Advanced strengthening and preparing for running
Often develops over months 3–6 and beyond- Goals: Build heavier strength, single-leg capacity, confidence and, when criteria are met, preparation for running and jumping.
- Exercises: Progressive single-leg squats, split squats, resistance work and lateral movement drills can develop strength and control.
- Running: Requires appropriate knee motion, minimal swelling, sufficient quadriceps strength and suitable functional testing—not just reaching a certain month.
- Higher-impact work: Hopping, plyometrics and faster movement are added progressively when the knee is ready.
Return-to-sport preparation and participation
Later rehabilitation; frequently 9–12 months or longer for pivoting sports- Goals: Prepare for the actual intensity, speed and unpredictability of sport or physically demanding work.
- Training: Progress cutting, pivoting, jumping, landing, agility and sport-specific drills as appropriate.
- Testing: Assess knee stability, quadriceps and hamstring strength, hop and movement performance, symptom response and psychological readiness.
- Return: Progress from controlled drills to modified training, full training and finally competition with the treating team’s clearance. Passing one test or reaching a date alone is not enough.
Why exercise rehabilitation matters
Progressive exercise is the central part of recovery after ACL reconstruction. The early focus is often on movement and muscle activation; later, it shifts towards restoring strength, running ability, power and confidence in the knee. A programme should respond to individual progress rather than using the same exercises or timelines for everyone.
Strength training
Develop quadriceps, hamstring, glute and calf capacity with gradually increasing resistance.
Balance and movement control
Practise stepping, single-leg stability, landing and changing direction as rehabilitation progresses.
Functional training
Prepare for everyday lifting, stairs, work, running or the specific physical demands of sport.
Reassessment
Use symptoms, objective strength and functional measures to adjust the plan over time.
What role does manual therapy have?
Manual treatment can sometimes support comfort and movement after surgery. Depending on the presentation, a physiotherapist might use gentle joint or patellar mobilisations or soft-tissue techniques for associated muscular discomfort. These are optional additions to active rehabilitation, not substitutes for progressive exercise, and they do not themselves restore ligament or muscle strength.
Other considerations during recovery
- Psychological readiness: Fear of reinjury and confidence in the knee can influence return to sport. Discuss these concerns during rehabilitation rather than waiting until the end.
- Ongoing training: Strength, movement and sport-specific preparation continue after an initial return to activity.
- Individual circumstances: Surgical procedures, other injuries, sporting demands, work and available training time all influence the programme.
- When to seek help: Contact your surgical or medical team promptly for worsening swelling, fever, wound redness or discharge, or a painful swollen calf. Sudden chest pain or breathlessness needs emergency assessment.
How Adaptive approaches ACL rehabilitation
We begin by understanding your surgery, the surgeon’s guidance, your current knee function and what you want to return to. Your physiotherapist can then guide a programme of movement, strengthening, progressive loading and functional assessment, adapting it as you improve.
For people returning to higher-level activity, our Sports Rehabilitation Program can provide a structured pathway from clinical rehabilitation towards sport-specific training when appropriate. You can also explore Your ACL Recovery Journey for the broader recovery process.
Related reading
Book an ACL Rehabilitation Assessment
Recovering from ACL reconstruction and unsure what to work on next? We can assess your movement, strength and current rehabilitation stage, then help plan your next steps.
Adaptive Physiotherapy & Massage
27 Shields Crescent, Booragoon WA 6154
References
- Kotsifaki R, et al. (2023). Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. British Journal of Sports Medicine, 57, 500–514. Read guideline.
- Ardern CL, et al. (2016). 2016 Consensus Statement on Return to Sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine. Read consensus.