Anterior Cruciate Ligament (ACL) injuries are among the most common knee injuries, particularly in sports such as football, netball, rugby, and skiing. Rehabilitation following an ACL injury whether managed surgically or non-surgically is essential to restoring knee function, building strength, and preventing re-injury.
This guide will walk you through the key stages of ACL rehabilitation, the role of physiotherapy, and what to expect on your journey back to sport or everyday life.
What is an ACL Injury?
The ACL is a crucial ligament in the knee that provides stability during twisting and pivoting movements. Injuries typically occur due to sudden changes in direction, landing awkwardly, or direct trauma to the knee.
Symptoms often include:
- A popping sound at the time of injury
- Rapid swelling of the knee
- Instability or “giving way”
- Difficulty bearing weight
Why ACL Rehabilitation Matters
Rehabilitation is not just about recovery it’s about reducing the risk of re-injury and long-term knee problems. Without proper rehab, people are at higher risk of developing chronic instability, reduced performance, and even early-onset osteoarthritis (Filbay et al., 2019).
Physiotherapy plays a central role in:
- Restoring full range of motion
- Building strength in the quadriceps, hamstrings, and glutes
- Improving proprioception and balance
- Safely guiding return to sport or activity
Stages of ACL Rehabilitation
1. Early Stage (0–6 weeks post-injury/surgery)
Focus: Reducing swelling, regaining knee extension, and activating muscles.
- Ice, compression, and elevation
- Gentle range of motion exercises
- Quadriceps activation (e.g., isometric holds)
- Gait retraining
Did you know nutrition can speed up tissue healing? Speak to our Dietitian about an anti-inflammatory meal plan to support your graft recovery during these early weeks.
2. Strength and Control (6–12 weeks)
Focus: Building strength and stability.
- Squats, lunges, and bridges
- Hamstring and quadriceps strengthening
- Balance and proprioception training
- Low-impact cardio (bike, elliptical)
As your training volume increases, muscle tightness is common. Our Remedial Massage Therapist can help manage load-related aches so you don’t miss a rehab session.
3. Advanced Strengthening (3–6 months)
Focus: Sport-specific conditioning.
- Plyometric training (e.g., jump squats, box jumps)
- Agility and change-of-direction drills
- Heavier resistance strength work
- Running progression
We don’t guess your progress; we measure it. We use VALD Force Decks technology to ensure your left-to-right leg strength is balanced before you start running.
4. Return-to-Sport Phase (6–12+ months)
Focus: High-level performance and minimising re-injury risk.
- Sprinting, cutting, pivoting drills
- Sport-specific conditioning
- Functional testing to assess readiness (e.g., hop tests, strength symmetry)
Surgical vs Non-Surgical Rehab
Not every ACL injury requires surgery. For some patients particularly those who are less active or do not participate in high-demand pivoting sports non-surgical rehabilitation may be appropriate (Grindem et al., 2019).
However, surgery is often recommended for young, active individuals wishing to return to pivot-heavy sports. Regardless of the pathway, physiotherapy remains essential.
Preventing Re-Injury
Re-injury rates can be high if rehab is rushed. Research shows that athletes who return to sport before 9 months post-surgery are at a significantly higher risk of re-injury (Grindem et al., 2016).
Strategies to reduce risk:
- Following a structured, progressive program
- Completing functional performance tests before clearance
- Ongoing strength and neuromuscular training
When to See a Physiotherapist
If you’ve sustained an ACL injury, seeing a physiotherapist early is key. A physio can:
- Assess your injury and guide you to appropriate imaging or referrals
- Tailor a rehab plan specific to your goals and sport
- Progress your rehab safely to avoid setbacks
- Work with your surgeon and other healthcare providers for a multidisciplinary approach
Key Takeaways
- ACL rehab is a long-term process, often taking 9–12 months.
- Physiotherapy is essential for restoring function, building strength, and reducing re-injury risk.
- Whether surgical or non-surgical, following a structured program is critical for long-term success.
- Returning to sport too early can increase the risk of re-injury.
Click here to book in with one of our therapists!
References
- Filbay, S. R., Grindem, H., & Roos, E. M. (2019). Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Practice & Research Clinical Rheumatology, 33(1), 33–47. https://doi.org/10.1016/j.berh.2019.01.018
- Grindem, H., Eitzen, I., Moksnes, H., Snyder-Mackler, L., & Risberg, M. A. (2016). A pair-matched comparison of return to pivoting sports at 1 year in anterior cruciate ligament–injured patients after a nonoperative versus an operative treatment course. The American Journal of Sports Medicine, 40(11), 2509–2516. https://doi.org/10.1177/0363546512458424
- Grindem, H., Wellsandt, E., Failla, M., Snyder-Mackler, L., & Risberg, M. A. (2019). Anterior cruciate ligament injury—who succeeds without reconstructive surgery? British Journal of Sports Medicine, 53(13), 946–952. https://doi.org/10.1136/bjsports-2018-100020
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