Back to blog articles

How long after ACL surgery (anterior cruciate ligament) should you start physio? Learn about the benefits of physical therapy and ACL rehabilitation post-surgery

Published: 14 October 2024

ACL injuries are unfortunately commonplace among athletes and those who participate in sports. At The Physio Clinic Glasgow, we are experts in assisting those with ACL injuries to get back to doing what they love by providing tailored treatment and rehabilitation plans together with education to minimise the risk of re-injury. People with ACL injuries often ask whether they will require physiotherapy or surgery. The truth is that sometimes, it isn't a binary choice. If you undergo surgery to repair an ACL tear, you should consult with an expert physiotherapist who can support your rehab by increasing range (in particular knee extension) and mobility, strengthening your muscles and stabilising your knee.

What is an ACL tear?

An ACL tear refers to the tearing of the anterior cruciate ligament (ACL), one of the key ligaments that helps stabilise the knee joint. The ACL connects the thigh bone (femur) to the shin bone (tibia) and is crucial for proper knee movement and stability.

This injury is common among athletes, particularly in sports that involve sudden stops and changes in direction, such as soccer, basketball, football, and skiing. Symptoms of an ACL tear include:

A loud "pop" sound at the time of injury
Severe pain and inability to continue activity
Rapid swelling of the knee
Loss of range of motion
A feeling of instability or "giving way" with weight-bearing

What is ACL reconstruction surgery?

ACL surgery, or anterior cruciate ligament reconstruction, is a surgical procedure used to repair or provide a graft in place of the torn ACL in the knee. The ACL is crucial for knee stability, especially in movements involving pivoting, jumping, or sudden changes in direction. ACL surgery is a significant but common procedure for treating ACL injuries, especially among active individuals and athletes, providing a pathway back to active lifestyles following injury.

The primary goal of ACL surgery is to restore normal or near-normal stability in the knee, allowing the individual to return to pre-injury levels of activity without knee instability. Achieving full knee extension, knee flexion and strength and explosiveness are keen post-operative goals.

Success rates are generally high, but recovery and return to sports can depend on multiple factors particularly a progressive rehabilitation programme encapsulating hamstring, quadriceps strengthening and much more.

When should you begin physical therapy and rehabilitation after ACL surgery?

The initiation of physiotherapy and rehabilitation exercises after ACL reconstruction surgery should be within the days following ACL reconstruction. Here’s a general timeline:

Immediate Post-Op (0-1 week): Physiotherapy often starts within the first week after surgery. Early goals include reducing swelling, managing pain, and preventing blood clots. Patients may begin gentle range-of-motion exercises to help maintain joint movement, quadriceps exercises, and it may be advised to use crutches when you start walking.
Early Rehabilitation (1-4 weeks): During this phase, physiotherapy focuses on regaining more knee mobility, continuing to manage swelling, and beginning weight-bearing activities as tolerated following ACL surgery. Therapists will often aim to achieve full knee extension, have the ability to bend your knee to 90 degrees and commence more strengthening/ balance exercises.
Intermediate Rehabilitation (1-3 months): This stage emphasises strengthening exercises to improve muscle strength (particularly your thigh and hamstrings), including strengthening the knee, increasing the range of motion of the knee, and starting more functional activities that are tailored to the patient's lifestyle and sports-specific needs.
Late Rehabilitation (3-6 months and beyond): The focus shifts to restoring full strength and agility with advanced training that prepares the individual to return to their regular activities or competitive sports after knee surgery. Quadriceps and hamstrings strength may be testing, along with a variety of hop tests will be used to assess function following ACL surgery to reduce the risk of ACL injuries in the future.

Starting physiotherapy early is crucial for optimal recovery. At The Physio Clinic Glasgow, we will guide you every step of the way, if you are post-ACL surgery or know that you are having treatment soon, contact our clinic for specialist and tailored programmes.

The risk of not engaging in ACL rehabilitation

Successful rehabilitation cannot be underestimated. Delaying physiotherapy after ACL surgery can lead to several complications and negatively impact the overall success of the surgery and the long-term health of the knee. Ultimately, it may affect your ability to have a complete recovery or to return to sport or exercise however, other associated risks are having a reduced range of motion, muscle wastage (atrophy), continuing or increased pain and swelling, decreased function and risk of re-injury. It is not unusual to experience secondary pains such as patellofemoral (kneecap) or anterior knee pain if rehab is inadequate.

Delays in rehabilitation can also have psychological effects, such as reduced motivation, increased anxiety about recovery, and a slower return to normal activities or sports, impacting overall well-being.

Return to sport and exercise with The Physio Clinic Glasgow

Recovering from an ACL injury is a mentally and physically challenging process which can take up to 9 months. At The Physio Clinic Glasgow, we want to support you through your injury and get back to doing the things you love most. With a focus on evidence-based practice, our experienced, fully qualified physiotherapists will perform a thorough initial assessment, allowing us to give you a simple explanation for your injury and a rehab programme specific to the individual goals you have set. Your physiotherapist will guide you through your personalised rehabilitation plan to ensure it meets your needs and fits into your schedule. Contact our expert team on 07936 035234.