ACL Rehab Timeline

Updated: Jan 8

Congratulations! You have made it through surgery. You may be a little taken aback by the limitations you feel but have no worry, following the timeline below will have you back to your sport in 9 months. Best of all, you will be better than you were pre-injury.


Many famous athletes have endured a similar injury to yours and have had great outcomes. Adrian Peterson, Tom Brady, Rob Gronkowski, Shaun Livingston, Alex Morgan, Jamal Crawford and many more. These athletes have all gone on to have successful and in many cases dominating athletic careers. You will get there. This is a general timeline that most people will flow through over the next year. It may not look like much on paper, but your individualized program will have between 45-90 minutes of exercise 5-6 days a week for the next several months.


Weeks 0-4


Goal:

  • Full extension ROM

  • Elimination of quad lag

  • Full weight bearing (w/o meniscus involvement)



Treatment: NMES, Manual therapy, isometrics, PNF, cold wrap compression, AROM

The first month is the hardest. Ideally pain is pretty low, but without dedication to reaching first month goals long term issues can start.







Weeks 4-12


Goal:

  • 70% strength of surgical leg to non surgical leg

  • Full ROM (135* of flexion)


Treatment: bike, light strengthening exercise, manual resistance, single leg balance, BFR


Now it's time to get back on the horse. We get moving safely to protect the ACL graft but we need to start getting strong again as well.



Week 12-16


Goal:

  • Straight running

  • 80% strength of surgical vs non surgical legs

  • Static single leg balance = to opposite side



Treatment: jogging, compound movement strength exercise progression, single balance in all three planes of motion



Getting back into running is an exciting time for athletes. In most cases we begin with light jogging 3 times per week for short distances. This allows athletes to begin working on their running technique while we continue to train symmetry of the legs.











Weeks 16-32


Goal:

  • 90% strength between surgical and non surgical sides, confidence with turning while running

  • Confidence with landing mechanics (limited valgus moment compared to other side)

  • Equal single leg hop to other side

  • Equal triple hop distance to other side

  • Symmetry of thigh hypertrophy


Treatment: Progressive strengthening program, agility drills, neuromuscular control, drop landings, plyometrics, sprinting


The meat of an ACL program includes all forms of exercise. Strength training, plyometrics, agility drills, sprints, and dynamic balance exercise are all vital to restoring normal mind body control over your body. Spending a significant time injured can impact how your body responds to different stimuli. For instance, ground reaction time during cutting, landing mechanics, and one side dominance need to be fully resolved before we move on.




Weeks 32-36


Goal:

  • Equal Single Leg Broad Jump

  • Equal Single Leg Forward Hop

  • Equal Timed 6 Meter Single Leg Hop Test

  • Equal Triple Hop Test, 90-100% equal on leg strength

  • Equal Single Leg Squat Test

  • Equal Lateral/Medial Hop Tests

  • Equal Rotating Lateral/Medial Hop Tests

  • Shuttle Run (confidence or timed)

  • Return to sport


Treatment: Progressive strength training, advanced plyometrics, agility drills, sport specific drills, vision training, competitive environment training


During the late stage of ACL rehab we need to make sure you feel 100% ready to return. Often times the physical goals have been met, but the psychological aspect continues to limit activity. This is where we add in competitive environment training and sport specific drills. This will ease you out of the "I need to get better" mindset to "I need to win."


Summary

This timeline is about as bare bones as they come. This is designed to give you an idea of where you should be in rehab so you know what the next steps are. The final goal of any ACL rehabilitation program is full function and athletic ability. From what research has shown, 9 months is a rather aggressive timeline for return to sport. A year has been shown to be safer in many cases, especially for athletes that have not met their major milestones. Keep this in mind while progressing through the stages of rehab. With hard work, you will meet your goals. Rushing through pain and apprehension is not the way to get there the fastest.

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