Successful recovery from a torn ACL begins before reconstruction surgery. Long-term ACL research clearly shows the stronger and more functional your injured knee before surgery, the further ahead you’ll be in your rehabilitation after.
What you do before surgery is referred to as prehabilitation or just prehab. The MOON Knee Group recommended prehabilitation exercises on this page will:
The two most critical goals before and after ACL surgery are to:
Other pre-surgery goals are to:
The exercises on this page will help you work toward these goals. These exercises are also used in the Phase 1 rehabilitation program that begins immediately following surgery. (See this chart for which exercises are recommended in prehab through Phase 3.)
The evidence-based MOON Knee Group anterior cruciate ligament post-surgery rehabilitation program has five phases plus prehabilitation. Each has specific goals, exercises and instructions based on two decades of research.
Success depends on completing each phase before moving on to the next. Your physician, physical therapist or athletic trainer will measure your progress and instruct you on when to advance.
If you’ve torn your ACL, it is normal to experience discomfort, swelling and bruising. Here are ways to manage the discomfort and swelling to prepare your knee for surgery.
If you’ve torn your ACL, the recommendation is to ice, elevate and rest your knee to control swelling, inflammation and pain.
The recommended exercises include ones to improve your mobility and ones to improve strength. Doing at least the primary exercises in both areas is important for successful rehabilitation.
If you’ve injured your ACL, you might not feel like moving your knee. However, keeping knee motion and working toward full leg extension (straightness) are important in preparing for surgery and successful recovery after.
The MOON Knee Group ACL rehabilitation exercises are designed to move you step by step. Exercises are identified as primary, alternate and optional.
Consult with your medical team about which exercises are advisable for you, particularly if you experience increased pain and swelling.
Gaining full knee extension (straightness) is a critical goal before surgery and in Phase 1.
Also every day: perform the supine or prone knee extensions below before and after your heel slide mobility exercises.
The Quadriceps Set is vital in restoring your quadriceps strength. It is also the foundation for many other exercises as you progress. Focus on correct muscle activation (tense and then relax) and technique.
You have four hamstring muscles along the back of each thigh. These help control the knee with many activities including walking and stairs. Restoring hamstring strength is just as important as it is for the quadriceps on the front of your thigh. These two hamstring sets help improve muscle activation on the back of your thigh.
Hamstring and quadriceps co-contraction will help activate (tense and then relax) both these muscles together. This is important for walking, taking stairs, standing up and sitting down.
Straight leg raises (SLR) let you continue to develop quadricep strength and function for return to walking and daily activities. Begin these after you’ve made progress with quadriceps sets and can perform a straight leg raise. It will be a main exercise in your postoperative rehabilitation.
Focus on working the correct muscles.
Prone straight leg raises strengthen your hip and gluteal muscles. This will help with daily activities. Perform this exercise lying on your stomach.
If you notice increased lower back pain, place a pillow under your abdomen. This helps reduce back stress and improve gluteal muscle use. Remove the pillow once you get stronger.
Standing hip extensions increase your ability to bear weight on your operative leg while walking. They also strengthen muscles around your hip.
Do this exercise with a smooth and controlled movement.
Perform prone hamstring curls on your stomach for strengthening and to improve range of motion (the ability to bend your knee).
Heel raises improve calf strength. This will help you walk and, later in your rehabilitation, jump and run.
Make sure your motion is vertical. Do not rock forward or use your arms to lift you.
Once you are comfortable performing prone hamstring curls and can bear weight (stand) on your operative leg with control, standing hamstring curls can improve hamstring strength.
It is important to feel the muscles working in the back of your thigh. Your body might try to compensate by moving the hip up. Limit this by keeping the correct starting position and following the instructions.
Double-leg quarter squats provide an important transition to strengthen further your quadriceps, gluteal muscles and hamstrings. They also enable you to improve weight-bearing movements through your knees.
There are multiple important steps to this exercise. Avoid having non-targeted muscles perform the workload (called compensation). This will help you achieve your goals more efficiently.
You might find it useful to do these squats in front of a mirror. This will show you whether you’re keeping weight evenly on each leg.
Side-lying hip abductions improve muscle strength in the side and the back of your hip. This helps you walk. Follow the instructions and cues carefully to improve exercise effectiveness.
Side-lying hip adduction increases strength on the inside of your leg and improves function. It requires a good starting position.
Caution: If you have had an MCL injury or repair, do this exercise only with the approval of your surgeon and physical therapist.