In Phases 1 and 2, you built a base of function and strength. Your body is now ready to regain much of your pre-tear functionality. This includes agility, reaction time, power, flexibility, endurance and more.
Some people complete Phase 3 ACL rehabilitation and return to normal activities: they can walk, use stairs and do their jobs. However, for most people stopping rehabilitation after Phase 3 means giving up aggressive running and jumping.
If your goal is to return to your sport, your rehabilitation program will continue beyond Phase 3 with physical therapy and athletic training combined with group and on-your-own workouts.
You begin ACL rehabilitation Phase 3 when your physical therapist, athletic trainer or physician evaluates you and determines:
Phase 3 normally begins seven to ten weeks after surgery. However, the current function of your body, not time, is what matters.
By the end of Phase 3, you want to be able to:
The evidence-based MOON Knee Group anterior cruciate ligament post-surgery rehabilitation program has five phases. 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.
Your new exercises may include basic plyometrics, also known as jump training. Plyometrics muscles use maximum force in a short period. These explosive movements increase speed and strength.
Your physical therapist or athletic trainer will use a half-dozen or more tests to measure your progress.
As you increase your activities and resistance in your exercises, you want to watch your knee for any swelling or decrease in range of motion. These can happen if you skip several days of exercises and then try to do more in your next session. Advancing too quickly can also cause swelling and decreased range of motion.
At this point, your therapist or athletic trainer may discuss the functionality you need to return to your sport. If you have access to a workout facility, they may give you exercises to do on your own or in group sessions.
At the end of Phase 3, you’ll be asked to complete two self-assessments:
Concern about the strength of your knee is normal. An ACL tear is one of the most challenging sports injuries. Recovery takes at least nine months of hard work. Even the most successful ACL reconstruction has a risk of retearing. A confidence assessment can show if something you’re feeling, rather than the condition of your knee, is keeping you from advancing toward your return to your sport.
In both self-assessments, answer honestly. Your rehabilitation team can then use your answers to best guide your recovery. This can include introducing thought techniques to build confidence.
By the end of Phase 3, you’ve almost certainly returned to activities of daily living. Patients willing to forego activities with aggressive running or jumping may end their rehabilitation program here. Your physical therapist or athletic trainer will perform a set of diagnostic tests. Using these and your self-assessment, they’ll recommend when you’re ready to stop rehabilitation or move to the next step like a return-to-sport program.
Important considerations for whether to continue rehabilitation after Phase 3 are:
If you’re unable to resume your previous level of function or you want to return to a sport with running, jumping, pivoting and turning, the recommendation will be to continue your rehab and return-to-sport program. This might also include group, school and independent training. Group physical therapy and workouts mimic a team atmosphere, increase motivation and encourage participation.
Based on research and observation, it is recommended that all patients continue to strengthen and rehab their legs following Phase 3. To cite just one muscle group: at the end of Phase 3, quad strength in your leg with the torn ACL is required only to be 70 to 75 percent of the strength of your uninjured leg.
This is a weight-bearing next step from straight-leg raises. Standing hip flexion challenges your single-leg stability on the stationary leg and the strength of your hip flexors and quadriceps of your moving leg.
This exercise is a weight-bearing next step from the prone stomach-lying leg raises from Phase 1. Single-leg standing hip extensions challenge the stability of your stationary leg and the strength of the hip extensors of your moving leg.
This is a weight-bearing next step from side-lying leg raises. Standing single-leg hip abduction challenges your stability and hip strength on the stationary leg and the strength of your hip abductors of the moving leg.
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.
This exercise will strengthen your calves. This improves your ability to walk, jump and, later in your rehab, run.
This exercise improves the strength of your calves. This improves your ability to walk, jump and later in your rehabilitation, run.
Standing anterior reach improves the stability and strength of your stationary leg.
This body-weight exercise improves your single-leg stability and hip extensor strength. As your strength improves, you can hold a small weight when advised by your physical therapist.
This exercise develops strength and stability. This is key for developing base lateral movement skill.