ACL Rehabilitation Exercises

Click on any exercise's title to view a graphic of how to perform it.

Any doctor will tell you that ACL rehabilitation is crucial to a full recovery. The typical full recovery time is 6 to 9 months, and rehab begins on day 1. Our information on this page and this website as meant to help guide and inform you, but please don't use this as a substitute for a doctor. Early ACL rehab (meaning the first ~6 weeks) focuses on performing exercises to prevent scar tissue and regain knee motion. After week 6, you will likely begin more knee strength training and leg stretching. It's highly recommended that you get a doctor's approval before returning to sports or any other high-stress physical activity involving your legs.

Warning: Always wear your brace if the exercise requires it, and don't push through too much pain!

Week 1 (Post-Op) Exercises

These early on ACL rehabilitation exercises focus mainly on preventing scar tissue from forming in the knee. I was to perform starting day 1 of my ACL reconstruction surgery. Instructions were to perform a set of each exercise once an hour. Yes, one an hour.

1) Leg Lifts  

Wearing Brace

1 set of 30 reps

While sitting, bend non-injured leg at knee. Straighten injured leg (keep straight entire time), and perform leg lifts no higher than the knee of other leg.

2) Straight Knee Push Down  

1 set of 10 reps

Sit with legs flat on the ground. Push knee down towards the ground, flexing quadriceps in the process. Hold each rep for 10 seconds

3) Straight Leg Ankle Push Down  

1 set of 10 reps

Sit with legs flat on the ground. Push ankle down towards the ground, flexing hamstrings in the process. Hold each rep for 10 seconds

4) Ankle Pumps  

3 sets of 10 reps

While sitting, flex foot forward and backward repeatedly. Try to elevate your injured knee above your heart while performing ankle pumps which (I was told) will help reduce swelling faster by draining what's in the knee.

Physical Therapy, Week 1 Exercises

A week or so after having ACL replacement surgery, you should begin physical therapy. Here are the additional exercises I was given:

1) Calf Stretch  

3 reps, hold for 30 seconds

Your calf muscle will definitely be feeling sore a week after you have ACL surgery from trying not to put too much pressure on the bad knee while you walk. This stretch will help relieve that soreness. Sit down with legs flat, place balled-up towel underneath heel with foot facing upright, place dog leash or something similar around top-ball of foot and pull inwards.

2) Dangling Leg Bend  

5 reps, hold for 10 seconds

Sit on a chair where you are elevated enough to dangle your legs (optional: place balled up towel underneath thigh), and try to bend your injured leg backwards. Use your non-injured leg to add pressure, each rep should loosen it up and you should feel improvement each time.

Physical Therapy, Week 2 Exercises

It had been around two weeks since my ACL surgery when I added the following exercises to the regiment. Also, for added difficulty, a balled up towel was added underneath my ankle while performing Straight Knee Push Downs and my knee was bent over a pillow while performing Straight Leg Ankle Push Downs.

1) Groin Stretch  

As many reps as you need

If you keep up with your exercises regularly, your groin will be the next thing to get sore on a regular basis and bother you. Sit down, and bend your injured leg's knee as much as you can, trying to get your heel flat on the ground. Then, while bent, stretch that leg out to the outside, imitating a regular sitting groin stretch.

2) Downward Facing Leg Bend  

5 reps, hold for 10 seconds

Lay flat on the ground facing downwards. Slowly bring heel back towards your butt, hold when it's as far as it can go, then slowly release back down towards the ground. You will feel your hamstrings getting sore the more you work at this, but it helps restore the knee bend and range of motion.

3) Downward Facing Leg Raises  

Wearing Brace

3 sets of 10 reps

Lay flat on the ground facing downwards. This is essentially an upside down leg raise. Keeping your leg straight, raise your heel off the ground (6-10 inches) and then return it to where your toes rest on the ground to perform a rep.

Fourth & Fifth Sessions of Physical Therapy Exercises

1) Calf Raises  

Wearing Brace

1 set of 40 reps

Stand in front of a counter or something you can rest your hands on for balance and support, and make sure your brace is on for this exercise. A rep consists of rolling your feet forward to where you're standing on your tip-toes, hold for a second, and then return to flat floot.

2) Sideways Leg Lifts  

Wearing Brace

2 sets of 15 reps

Lying down on your side, bend your non-injured leg at the knee and straighten out your injured leg (forming a number '4' shape). Keeping your leg as straight as possible while sideways, slowly lift your injured leg up, and then return back to normal position to perform a rep. This exercise works your hip flexer.

3) Kneecap massage  

Massage your kneecap both up and down, and left to right. Feel the kneecap on your healthy leg for an idea of how much the kneecap is able to move around normally.

Physical Therapy, Week 5 & 6 Exercises

1) Stationary Bike  

5-7 minutes

The stationary bike is a great way to warm up your legs before doing knee strength training exercise. Adjust the seat so that you're sitting higher than would normally feel comfortable so that you can ease your bad knee into the stretches.

* After loosening up on the bike, it's always a good idea to warm up your calves and hamstrings using some of the stretches from previous weeks. *

2) Weighted Hamstring Curls  

2 sets of 15 reps

Comfortably seat yourself on the hamstring curling machine, and start out with very low weight (they started me at somewhere around 10 to 20 lbs). While performing leg curls, try to focus most of the work on your bad knee (they told me 80% / 20% split). Also at the end of a repetition, slowly return your legs to the starting position (take your time).

3) Leg Press  

2 sets of 15 reps

Leg Press is a knee rehab exercise that really helps any leg muscles that have atrophied recover their strength. Use around 45lbs and perform repetitions slowly, and be careful not to lock your legs at the end of a rep with the weight pressuring your legs.

* Update from week 7 - Leg Press *
Add a toy ball or light medicine ball between your knees and apply pressure throughout the reps to increase the workout on your legs. Trust me on this one, I really felt the difference in my hamstrings.

4) Leg Vectors  

5 sets

"Vectors" as the physical therapist called it is an ACL rehab exercise that isolate your bad leg while your other leg provides the pressure. The exercise requires you to stand on your bad leg and move your other leg to a total of 3 other position, holding at each for 5 seconds before the set is over. The 3 positions are in-front, to the side, and behind, and remember that the good leg never touches the ground during a set (use your hand on the counter for support if you're off balance).

Stand near a counter that you can hold onto with a finger or two to keep your balance.

5) Step Ups  

30 reps

Step ups, for lack of a better name, are a knee strengthening exercise that require simple stepping up and down repetitions with your bad leg. Using a step about 8 to 10" tall, put your good leg's foot on the step, where it will remain throughout the set. Your bad leg will step up and then step down, while extending your leg straight at the top of the rep.

6) Squats  

3 45 second long sets

Grab a plastic kids ball and place it between your legs. Stand in front of a counter that you can hold on to, and with your weight on your heels, perform as many squats as you can (in an almost up and down bouncing motion) in 45 seconds. Remember to always keep good form when performing squats even if they aren't weighted, to strengthen your knee without reinjuring it.

7) Balance Board  

2 2 minute sets

Stand on the balance board, and try to balance on it (unassisted) for 2 minutes. For the next set, rotate the balance board 90 degrees so that you now are balancing the other two directions (front/back or left/right). Working on balance like this will strengthen your leg after ACL surgery using instability.

8) Weighted Hamstring Flexes  

2 sets of 15

While standing, place a strap around your bent knee and put 5 or 10lbs of weight on the machine that the strap is tied to. One rep consists of flexing your knee back, into a straight leg motion, then returning it to the bent position where the weight no longer pressures the leg.

Physical Therapy, Week 7+ Exercises

1) Leg Vectors While Ball Juggling  

5 sets

Just like the aforementioned leg vectors exercise where you stand on your bad leg with knee slightly bent and move your good leg into three positions (front / side / back) and hold for 5 seconds at each position, except this time find a small ball to juggle back and forth between your hands to add more instability.

2) Rolling Chair Pulls  

1 set

This knee rehab exercise is exactly what it sounds like. Sit in a rolling office chair, map out a course that will take about 2 to 3 minutes to pull yourself around, and then begin your lap(s) by pulling yourself around using only your bad leg. Dig your heel into the ground with each pull!

3) Bosu Ball Balance  

2 sets of 1 minute each

Bust out the bosu ball, and place it near a surface that you can hold for balance (using only 1 finger ideally - but don't fall and hurt yourself!). One set consists of balancing on the bosu ball for 1 minute, while on only your bad leg. The balancing aspect makes this a great knee rehab exercise, which is why you don't want to rely too heavily on your hand (but make sure there's something nearby you can use to catch yourself at all times!). For the second set, flip the bosu ball over, and do repeat.

4) Stationary Bike Training With Interval Resistance  

1 set, increase length over time

The stationary bike is one of the only cardiovascular exercises you can perform while rehabbing your knee that isn't considered "overdoing it". I was told at physical therapy to work my way up to 30 minute sessions on the stationary bike, with interval resistance, and to not overdo it by going too high with the resistance levels.

Week 10+ Exercises

After week 10 I was instructed to focus on primarily leg strength exercises. The following exercises should probably be performed at a gym. Don't forget to keep stretching as well, as range of motion is important to maintain!

Check out the Knee Surgery ACL Forum for more information!

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