12 Best Exercises to Help With ACL Rehabilitation

If you've had an anterior cruciate ligament (ACL) injury, your healthcare provider may recommend rehabilitation exercises to help improve your knee health.

An ACL injury is often caused by overstretching or tearing this ligament in the middle of the knee. It can affect the stability of your knee and result in loss of leg strength and a restriction in the knee's range of motion.

Severe tears or ruptures will often require surgery. You may need extensive rehabilitation to fully restore your mobility.

This article provides instructions for performing exercises that will aid in your recovery from an ACL injury. Remember to check with your healthcare provider before starting any exercise program.

At-Home Rehabilitation for ACL Injuries

These at-home exercises can help you recover from an ACL injury. Doing these exercises can help you regain strength and movement without causing further injury to the ACL.

It is important to avoid exercise that compresses or puts weight on your knee. Instead, the focus should be on strengthening the muscles surrounding the knee.

These muscles include the quadriceps muscles ("quads") in the front of your leg and the hamstrings ("hams") in the back part of your thigh. Strengthening these muscles will help you gradually extend your range of motion so your knee doesn't "freeze."

These exercises can be done at home, ideally with the input of your doctor or physical therapist. They can help prepare you for ACL surgery, or complement your structured rehabilitation program.

Safest ACL Rehab Exercises to Start

The following exercises should begin within one to three days post-operation, and continued for two to four weeks.

As you move through these exercises, pay close attention to the sensations in your knee. If an exercise is causing pain, stop doing it.

Exercises that do not cause pain can be performed one to four times per day.

Heel Slides

This exercise extends the knee without bearing any weight.

1. Start by sitting on the floor with your legs outstretched.
2. Slowly bend the injured knee while sliding your heel across the floor toward you. Slowly slide the foot back into the starting position.
3. Repeat 10 times.

Isometric Quad Contractions

This exercise is also done while seated.

1. Sit on the floor with your injured leg extended and your other leg bent.
2. If you feel pain, place a rolled towel under your knee for support.
3. Slowly squeeze the quadriceps of the injured knee without moving the leg. The quadriceps are the muscles on the front of your thigh.
4. Hold for 10 seconds.
5. Relax.
6. Repeat 10 times.

Prone Knee Flexion

This exercise is performed while lying on your stomach.

1. Lie on your stomach with your legs straight.
2. Bend your injured knee and bring your heel toward your buttocks.
3. Hold 5 seconds.
4. Relax.
5. Repeat 10 times.

Prone Hip Extension

This exercise is similar to prone knee flexion, except it does not involve bending the knee.

1. Lie on your stomach with your head on a pillow.
2. Keeping your injured knee straight, squeeze your buttocks and lift your injured leg off the ground.
3. Do ten leg lifts then rest and repeat once more.

Sitting Towel Calf Stretch

For this exercise, all you will need is a towel and somewhere to sit.

1. Sit on the floor with both legs straight in front of you.
2. Place the middle of the towel on the bottom of the foot on your injured side while holding both ends.
3. Pull the ends of the towel toward you, feeling the stretch in your calf.
4. Repeat twice for 30 seconds each.
   

Ankle Pumps

This exercise begins by lying flat on your back with your legs outstretched.

1. Bend your "good leg" up, propping your foot on the floor for support.
2. On your injured side, flex your toes up toward the ceiling.
3. Then point your toes away from you.
4. Do ten repetitions.
5. Repeat twice.

ACL Exercises When Swelling Subsides

Around four to six weeks post-operation, you will know you are ready to begin the next phase of rehabilitation exercises when:

• You are able to stand squarely on both feet without favoring the injured leg.
• You can lift your leg in all directions without assistance.
• You are able to walk with crutches and/or a brace.
• Your swelling is gone.

If you don't meet these criteria, you may not be ready to move on to the following exercises. If you are unsure, call your physical therapist.

The following exercises can be done one to four times per day, pain-permitting.

Passive Knee Extensions

This exercise requires two chairs of equal height. Place the chairs facing each other. The distance between them should be slightly shorter than the length of your leg.

1. Sit in one chair and place your heel on the seat of the other.
2. Relax your leg and let your knee straighten.
3. Rest in this position for 1 to 2 minutes several times a day. This will gradually stretch out your hamstrings.

Heel Raises

This exercise is done while standing.

1. Start by placing one hand on the back of a chair for balance.
2. Now slowly lift your heels, standing on your tiptoes.
3. Stay there for 5 to 10 seconds.
4. Slowly lower your heels.
5. Repeat 10 times.

Half Squats

This exercise is done standing while holding a sturdy table with both hands.

1. Place your feet shoulders-width apart. Slowly bend your knees and lower your hips into a half squat.
2. Hold for 10 seconds and then slowly return to a standing position.
3. Repeat 10 times.

Knee Flexion

This exercise requires either a TheraBand or a length of an exercise band.

1. To begin, loop one end of the band around the leg of a sturdy table. Loop the other end around the ankle of your injured leg. Alternately, tie both ends of the band around the table leg and insert the ankle of your injured leg into the loop.
2. Facing the table, slowly bend your knee about 45 degrees against the resistance of the tubing.
3. Hold for a few seconds and slowly return to a standing position.
4. Repeat 10 times.

Standing on One Leg

Standing on one leg is a great way to test and build your strength and balance.

1. Stand on both feet.
2. Lift the uninjured leg and stand unassisted on the injured leg for 10 seconds.

This exercise may not be easy at first. With time and patience, though, it should become easier.

Partial Lunges

Unlike a full lunge, in which your back knee lowers to the ground, partial lunges only involve bending your front knee slightly.

• Stand with your legs hips-width apart and your hands on your hips.
• Step forward with your injured leg.
• Bend your injured leg slightly, keeping your back leg straight with a softly bent back knee.

Summary

An ACL injury happens when you overstretch or tear the ACL ligament in the knee. You may need surgery or extensive rehabilitation to recover from this injury.

Exercises you can do at home can help you while you wait for surgery or work on your rehabilitation. Start with the safest exercises and avoid compressing or putting weight on your injured knee.

After the swelling subsides, you can try exercises that are done while standing on both legs.