Physical Therapy Priorities Of Your First Month Post ACL Surgery

“After an ACL injury and surgery, the knee is never “normal.” But most people regain enough strength and range of motion to return to their usual activities.”WebMD

The difference between your knee never being “normal,” and coming back stronger than ever is your commitment to physical therapy. The dreaded day has finally passed, you’re out of the surgery room and back home drugged up on pain meds, but still have the eager subconscious to begin physical therapy. Your doctor most likely advised you to rest, ice and bare no weight on your injured knee. I know the little devil in your head thinks you can bare weight, but trust me, you want to stay off that knee as often as possible the first few weeks to allow your meniscus to fully heal(that is, if you tore your meniscus as well). Additionally, your doctor may have provided your care taker  a guide to follow since you were too loopy and incoherent to understand anything. With that being said, let’s run through an outline of things to expect for your first month of acl physical therapy.

Main Priorities First Month Post ACL Surgery:

  •  Reduce Pain And Swelling Around The Knee.
post acl tear surgery. Icing your knee

Icing your knee post acl surgery.

As you may know by now, your knee is pretty damn swollen and bruised. The goal here is to ice your knee for 10-12 minutes at a time, 3 times a day, especially after physical therapy. Be sure to follow the RICE technique which stands for Rest, Ice, Compression, Elevation. Doing so will help speed the healing process.

  • Regain Full Range of Motion(ROM).

    Knee full range of motion

    Knee full range of motion

It is extremely important that you are consistently working to regain full knee flexion and extension.   “Loss of knee flexion has been demonstrated to cause altered gait pattern affecting the ankle and hip, limited functional squatting, and difficulty negotiating stairs and sitting.The loss of knee extension can cause altered gait pattern affecting the ankle and hip, inability to attain the closed packed position of the knee, and difficulty running and jumping.”North American Journal of Sports Physical Therapy.

  • Patellar Mobilization.
Patellar mobilization

Patellar mobilization

The goal here is to restore a healthy patellar tendon by mobilizing the knee cap as scar tissue from knee surgery often can restrict mobility making it difficult to accomplish knee extension and knee flexion. By mobilizing your knee cap, you increase the speed of restore full range of motion.

  • Restore Volitional Quadriceps Control.
NMES Post ACL surgery

NMES Post ACL surgery

After ACL surgery you lose the ability to contract your quadriceps muscles. It’s a weird feeling to not be able to tell what your muscles do. The way to have faster volitional quadriceps control is through the use of a neuromuscular electrical system(NMES). Prepare yourself, it’s quite a funny feeling to have electrical pulses running through your quadriceps and contracting that muscle. I will superimpose most early quad exercises that we perform with NMES.  This includes quad sets, straight leg raises, and knee extension exercises.”World Renowned Physical Therapist, Mike Renoid.

  • Restore Independent Ambulation.  acl-post-op-brace-1 (Small)

After you’ve achieved the above priorities. Now it’s time to combine everything that you’ve done and to start learning to walk on your own again, unless you’ve torn your meniscus which should not bare weight until 1 week after your surgery to allow it to heal properly, although one may bare weight as tolerated. To regain the normal walking motions, Mike Renoid suggests slowly walking over a set of cones to focus on transferring your weight and transitioning to single leg stance. Doing this in reverse will also help to achieve knee extension.

As you can see, it’s pretty straight forward for the first month. The goal is to be consistent with these priorities in order to have a fast and strong acl recovery. The first month post acl surgery will be the most difficult, especially if this is your first time. One thing I learned from my first acl surgery was to be disciplined and consistent. By doing so, you turn your physical therapy routine into a daily habit. Doing this routine should stick as a lifetime habit in order to further strengthen your knee and prevent any future knee injury. Your daily routine should be done 2-3 times a day and target every muscle group in your leg from quadriceps, hamstrings, calves, hip adductors, hip abductors and glutes. Let’s take a look at some knee exercises to expect for your first month post acl surgery.

Knee Exercises First Month Post ACL Surgery:

Week 1-2

  • Straight-Leg Raises (3×10). 
  • Heal Slides w/towel ( 10x5sec. hold)
  • Quad Sets ( 10x 5sec. hold)
  • Standing Straight Leg Raises ( 3×10)
  • Glute Contractions ( 10 x 5sec. hold)
  • Exercise Bike ( 5 minutes)

Week 3-4

  • Knee Bend, Partial, Single Leg
  • Step-Ups, Forward
  • Step-Ups, Lateral
  • Hamstring Stretch, Supine
  • Hamstring Stretch, Supine
  • Walking


Now that we’ve got an idea of what to expect for the first month after acl surgery, let’s look at some important takeaways. Do NOT forget what your main priorities are immediately after acl surgery. Your focus is to restore full range of motion, reduce swelling, and do physical therapy 2-3 times a day. I suggest waiting a week post acl surgery if you have acquired a meniscus tear as well.  Putting all these things together with regards to the instruction by your physical therapist, you will regain the trust and confidence in your knee better than you did before.


Sources: 6 Keys To The Early Phases Of Rehabilitation Following ACL Reconstruction Surgery

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