ACL rehab

An introduction to anterior cruciate ligament (ACL) injuries

The anterior cruciate ligament (ACL) is one of the major ligaments in the knee acting as a knee stabiliser.

ACL injuries often occur during sports or activities that involve sudden stops, changes in direction, or impacts to the knee.

Surgery, including anterior cruciate reconstruction, may be required to regain knee stability and get back to preinjury activity levels, although non-surgical treatment can also be considered.


Your personalised ACL treatment plan with Chiswick-Physio

Our unique approach to getting you back to your best

At Chiswick-Physio, we follow a specialised ACL rehab protocol that includes multiple phases, regardless of whether you opt for surgical or non-surgical treatment. 

If you choose the surgical route, we strongly recommend pre-operative rehabilitation over a period of 6-12 weeks to reduce post operative complications. 

Our ACL rehab program has four distinct phases, which are followed regardless of whether you have undergone surgery or not. Each phase has specific goals and outcome measures that need to be met before moving on to the next one. We ensure that progress is determined by meeting these criteria, rather than following a pre-determined timeline. Following a strict protocol optimises a safe and successful recovery back to activity and sport.

It is important to not rush the process of ACL injury recovery with 95% of clients taking 12 months or even longer. It is widely accepted that returning to sport-specific preinjury levels before 9 months increases the risk of further ACL injury by 50%.

“Patience, persistence, and perspiration make an unbeatable combination for success.” – Napoleon Hill

    Phases of ACL Rehab

    Phase 1: Recovery Stage

    • After an ACL injury or surgery, it may be tempting to start improving your strength and range of motion right away. However, it’s important to give your knee time to settle first. During this initial period, your main focus should be on achieving full knee extension, minimising swelling, and doing exercises that work your entire leg. 

    Phase 2: Strength and neuromuscular control

    • During Phase 2 of the rehabilitation process, the primary objectives are to regain muscle strength, balance, and basic co-ordination. The phase begins with simple bodyweight exercises and gradually progresses into a gym-based workout routine. The aim is to enhance the muscle strength in the affected leg, enabling you to perform single leg exercises with good control and balance.

    Phase 3: Running agility and landing

    • During Phase 3 of ACL rehabilitation, the focus is on returning to activities such as running, jumping, and agility, while continuing to follow a strength and neuromuscular program at the gym. The main objectives are to achieve excellent performance in single leg hopping, complete an agility program, and regain full strength.

    Phase 4: Return to sport

    • The rehabilitation process for phase 4 ACL should be tailored to the individual, incorporating exercises and training activities that are specific to their sport. The focus should be on gradually increasing the intensity of training, from restricted to unrestricted, leading to a successful return to competition when the individual is ready.

    Surgical vs non-surgical rehab

    Pre-surgery rehabilitation

    Pre-operative rehabilitation is a crucial process that can significantly enhance the outcome of surgery for ACL injuries. It helps the knee to settle and regain strength, which in turn reduces the risk of post-operative complications such as stiffness. 

    Research has found that following a graduated loading programme for at least 6 weeks, preferably 12 weeks before surgery, can lead to the best outcomes. The primary objectives of this rehabilitation phase include:

    • Eliminating swelling
    • Restoring full range of motion
    • Achieving 90% strength in the quadriceps and hamstring muscles compared to the uninjured side. 

    Strengthening exercises are introduced, beginning with body weight and then progressing to loaded exercises as pain and swelling subside. Achieving full range of motion and adequate strength before surgery leads to better outcomes, even if surgery is delayed. Therefore, it is essential to prioritise pre-operative rehabilitation to reduce the risk of complications and ensure a successful recovery.

    Post-surgery rehab

    If you have recently undergone ACL surgery, it is crucial to follow a rehabilitation program to get back to your pre-injury exercise levels. Our West London Physio clinic offers a sport-specific ACL rehab program that helps restore strength, stability, and functionality so that you can get back to what you love doing. Contact us to create an optimal recovery plan that is specific and personalised to you.

    Our four-step process involves gradually moving you through recovery from surgery, focusing on strengthening, balance, dynamic stability, agility exercises and plyometrics for sport-specific movements to enable you to return to your previous level of activity.

    We take a comprehensive approach that prioritises both the physical and psychological aspects of ACL recovery, minimising the risk of re-injury and ensuring a secure return to daily activities and sports.

    Non-operative ACL rehab

    Not everyone is a candidate for ACL surgery. Non-operative rehabilitation should be considered, assessed, and evaluated on a case-by-case basis with you, your physiotherapist and your consultant, taking into account various factors such as.

    • Goals
    • Daily and athletic function
    • Preinjury activity levels

    At Chiswick-Physio, we have a structured rehabilitation process for those who consider non-operative ACL rehabilitation. We follow strict protocols that help our clients resume their pre-activity levels. Clinical experience and research both indicate that the time taken to return to sports is similar regardless of whether you choose surgical or non-surgical treatment.

    Non-operative management offers a compelling alternative for individuals with ACL injuries, presenting advantages regarding return to sport which are further discussed in our blog on knee recovery. 


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    What are the 10 stages of ACL rehab?

    ACL rehab involves a progression from early post-surgery care, pain management, and range of motion recovery to advanced stages of strength, balance, and sports-specific training. The final step aims for a full return to sports, with a continued focus on maintenance and injury prevention to ensure long-term knee health.

    How do you rehab an ACL reconstruction?

    It typically takes 12 months to fully recover, and a gradual return to sports or activities should be guided by a sport specific professional. Compliance with the prescribed ACL  rehabilitation plan is crucial for successful recovery and return to preinjury activity levels.

    What is involved in ACL rehab?

    ACL rehabilitation typically consists of a structured programme aimed at restoring knee stability, muscle strength and function. It includes phases such as:

    • Early range of motion exercises
    • Strengthening of leg muscles
    • Neuromuscular training
    • Eccentric quadriceps training
    • Proprioception training to improve balance and coordination

    At our London clinic your ACL rehabilitation will be supervised by a sport specific physical therapist to get you back to preinjury activity levels.

    How long is rehab after ACL reconstruction?

    ACL rehabilitation can vary in duration, but it often spans around 12+ months for a return to full activity. The exact timeline depends on the individual’s adherence to the ACL rehabilitation programme. It is widely accepted that returning to sport specific preinjury levels before 9 months increases the risk of further ACL injury by 50%.

    What is the protocol after ACL reconstruction?

    The protocol after ACL reconstruction involves structured phases of recovery, including post-surgery care, gradual rehabilitation, and a return to sports phase, tailored to the individual’s needs and progress.

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