Anterior Cruciate Ligament (ACL) Injury Advanced Exercise Programme
Aim to perform this programme a minimum of once per day unless prescribed otherwise. As with any new exercise, start slowly (repetitions as able) and build up as you are able within the guidelines below.
Pain should not exceed 4/10 whilst completing this exercise programme.
1. Split squat
- Place one foot forward and the other back to form a comfortable stride with the feet hip-width apart – you can gently hold on to something for balance.
- Keep the chest up and core engaged whilst simultaneously bending both knees so that the hips lower directly downwards – emphasis should be placed on pushing up through the front foot, and keeping the knee in line with the hip and ankle.
- With the trailing knee just of the floor, hold this position for a count of 3 seconds before pushing down through the feet to straighten the knees and return to the starting position.
- To progress, hold a small amount of weight in the opposite hand to the leading leg and gradually increase this as strength develops.
2. Single leg deadlift
- Perform this exercise standing on the affected leg and have a wall/stable object nearby to assist with balance.
- Shift your weight on to the affected leg and ‘hover’ the other leg off the floor.
- Bend forward from the hip to move towards touching your toes.
- At the same time, the trailing leg should stay straight and will travel backwards to act as a counterbalance whilst keeping your spine straight.
- As you get close to touching your toes, you should feel a pull in the hamstrings and buttock of the standing leg.
- Squeeze the buttock muscles to reverse the movement and return to standing.
- To progress, hold a small amount of weight in the opposite hand to the leading leg and gradually increase this as strength develops.
3. Weighted squat
- Stand upright with your feet hip-width apart and a weight placed evenly across your shoulders (back squat) or holding it securely against your chest (goblet squat).
- Engage the abdominal region and in a controlled manner, sit back as if you are sitting into a chair.
- At the same time, your head and chest will come forwards to maintain your balance, aim to keep your back straight.
- Go down as far as you feel comfortable or until your thighs are parallel with the floor.
- Come back up to standing and repeat.
We recommend consulting a musculoskeletal physiotherapist to ensure exercises are best suited to your recovery. If you are carrying out an exercise regime without consulting a healthcare professional, you do so at your own risk. If you have any concerns whilst completing these exercises, please contact a healthcare professional.
More Plans
The primary goals post-operatively are the reduction of swelling and pain, and to normalise your walking pattern and patella mobility as soon as possible. The physiotherapist will prescribe exercises to regain knee extension and flexion within the first few days post-operatively. Full knee extension should be retained as early as possible, ideally within the first few weeks, and knee flexion should be regained fully within the first 6 weeks.
Quadricep activation exercises should start within the first few days post-operatively, progressing onto closed kinetic chain exercises at the knee between 0-60º. It is important that we do not solely focus on the knee joint and look to strengthen the entire lower limb including the glute, calf and hamstring with exercises focusing on muscle hypertrophy.
Cardiovascular training on a static bike can begin when 100º of knee flexion is achieved and neuromuscular training should begin in the first few weeks (8,9). Pain should not exceed 3/10 on your perceived pain scale whilst completing this exercise programme.
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When certain criteria have been met, you can then progress to the next stage of rehabilitation. During this stage, you will start to complete more dynamic exercises, including progressing onto single leg open and closed chain exercises and low-level plyometric exercises. Focus in the early phase of this stage will continue to be increasing load capacity, muscle hypertrophy and eventually returning to running (9,11). Pain should not exceed 4/10 whilst completing this exercise programme.
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