Exercises in the early stage after ACL injury

After injuring your cruciate ligament and waiting for possible surgery, you still need to maintain strength and range of motion in the limb.

First published in 2008, and reviewed August 2023 by Dr Sheila Strover (Clinical Editor)

 

During this early phase simple exercises to maintain pain-free range of movement and some muscle function are useful.

It is important to be able to straighten the knee fully as well as bend it. Here are some simple exercises you can practise while resting:

 

Static quads - brace the muscle on the front of the thigh (quads) to straighten the knee and hold for ten seconds. Relax and repeat approximately 10X hourly.
Gently bend your knee up & down
An extension stretch - rest heel & allow knee to stretch back fully straight. Do this for five minutes every hour if possible.

 

As inflammation settles down you will move into the repair phase of healing and exercises can be progressed. It is important at this stage to gradually increase movement in the joint (getting the knee absolutely straight is very important) and to begin graduated strengthening exercises - be careful not to push too hard or you may make the knee swell again. You should gradually wean off the crutches (if you have been using them), but only when you can walk safely and without a limp.

During this early stage of recovery it is advisable to work on exercises which do not involve any twisting or turning movements. The knee may feel unstable or 'wobbly' and tend to give way if unexpected twisting occurs.

Worth mentioning at this stage are the hamstring muscles that pass down the back of the thigh, behind the knee and attach to the top of the shin bones just below the joint. When these muscles are working they tend to hold the shin bone back in relation to the femur, thus reinforcing the action of the ACL. It therefore follows that if you have a damaged or ruptured ACL, strong hamstring muscles will be beneficial!

Suggested simple exercise progression which can be done at home - those on the left are hamstring progressions, those on the right are for the quadriceps muscles. Those on the right should be done slowly and carefully so that the movement is controlled. When an exercise becomes easy move onto the next respective progression. You can also practise standing and balancing on one leg but be sure to have something to hold near by in case you wobble -

 

	Knee bending - assist with other leg		Small dips on both legs
	Knee bend - no assistance		Progress to single leg
	Knee bends with small ankle weight		Step-ups on bottom stair

 

The aim is to achieve full movement - both flexion (bend) and extension (straightness) equal to your other leg. Strength and co-ordination (balance) are also important.

You should also be able to get about more easily now. It is very important that you regain full movement and strength before you attempt to return to sport.

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