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ACL Rehab Protocol

February 5, 2024

ACL rehab is one of the longest protocols that a physiotherapist will run through with a patient. From the date of surgery to the completion of the rehab program the planned duration is twelve months. Some high level professional sport people can return to play from nine months onwards with an accelerated program. This is due to their physical conditioning, access to resources and daily monitoring. Some peoples rehab can take a bit longer, as there body takes more time to adjust to the new graft and they may be a bit slower at building up strength levels. This can be due to a variety of reason, but for the average person they also have to content with incorporating their rehab into a busy work and family schedule.


The rehab process starts off straight after surgery, themain aim of the first week is to reduce your pain levels, increase flexibilityof the joint and get you up and moving again. In the initial few days it isimportant to ensure that an infection doesn’t take hold in the incision site.This is rare, however it can have implications on the rehab time - as it canslow or in worst cases halt the program.


During the first week, the aim of the program is to get you walking on both legs and with minimal use of crutches. We also aim to build your competency for the home program and aim to create a space in your day to allow you to run through your program. Consistency is a major component of your rehab, so we want to find a part of your day that you can dedicate solely to you exercises.


As you enter the second week, the aim starts to focus on maintaining the rest of your leg strength. The glutes are a really important muscle at this stage. They will control the knee positioning and reduce stress onto the new ACL graph. You will also need some soft tissue manipulation to loosen the calf, quads and break up scar tissue from the procedure. Knee cap manipulation is also very important, is the knee cap is mal-tracking due to swelling and pain in the knee. Patellofemoral pain can become noticeable in the knee as the rehab progresses.


From here your exercises will progress to incorporate core strengthening, hip, knee and calf flexibility and more functional training.


As you get to the three month post-op date your rehab will start to look at more gym based training, including the introduction of plyometric training. This is where we start to get you jumping on the injured leg again in a very controlled and graduated manor.


From here your rehab should be tailored towards your chosen type of exercises. While you will cover all the areas needed to be trained, you should also start to get back to the gym with a program based on your specific needs.


When you are then safe to return to training, usually around six to  eight months you will need a graduated return to play program. This will start off with a warm up designed to reduce the risk of ACL re-injury. From here you will start to run in straight lines and progress through a gradually more complicated system of exercises until you are safe to return to contact training and play.


To compliment this period you should be starting to return to a sport performance program, with an emphasis on strengthening any areas that show weaknesses from your surgery. This would commonly be aiming to address an asymmetrical differences between your left and right leg, hamstring and glutes strength and lower limb flexibility.


If you have any questions on the stages of an ACL rehab program please call our Dublin city centre clinic on 01 441 0100.