Often we get asked when it is safe to return to sport following an ACL injury or ACL surgery. The answer is generally at least 9 months. This is with combination of completing many goals which should challenge you to become fitter and stronger during your rehabilitation.
Here I present you the phases of recovery from surgery. This plan can be used for non-operative return to sports as well as many other lower limb injuries. Your physiotherapist should be able to help you achieve each of these hurdles.
Phase one: Recovery from surgery
Let the knee settle for the first 1-2 weeks with basic range and quadricep exercises in combination with ice & compression.
- Knee Straightening to 0o
- Knee Bending to 125o
- Swelling reduced to zero (no wave produced on downstroke on the inner knee)
- Strength: No quadricep lag (able to maintain full straightening when lifting leg off the ground)
Phase two: Strength and Neuromuscular control – think getting your brain to work better with your knee muscles
Regaining muscle strength, balance and basic co-ordination are the goals here. This phase progresses from bodyweight exercises to weight type exercises for running and agility preparation.
- Equal knee Straightening to opposite side
- Knee bending to 125+o
- Maintains zero swelling
- Able to maintain a functional alignment during a single leg squat from a chair
- Single leg bridges >20 repetitions and 90% compared with other side
- Single calf raises > 20 repetitions and 90% compared with other side
- Side Bridge Endurance test > 30 seconds and 90% compared with other side
- Single Leg squat > 22 repetitions and 90% compared with opposite side
- Single Leg Press 1.5 x Body weight – 1 repetition max (RM) (also 15 reps of bodyweight)
- Squat 1.5 x Body weight – 1 RM
*RM: the maximum amount of weight that a person can possibly lift for one repetition
Phase 3: Running, Agility and Landings
This phase sees a return to running and change of direction training. The knee should be pain free here and rest between sessions should be monitored. Sporting drills should be mastered here before progressing to phase 4.
- Hop Testing
- Single Hop Test 95% compared to opposite side
- Triple Hop 95% compared to opposite side
- Triple Crossover Hop 95% compared to opposite side
- Side Hop Test 95% compared to opposite side
- Single Leg Press 1.8 times bodyweight
- Squat 1.8 time bodyweight
Phase 4: Return to Sport
Here we look at Subjective and Objective measures to determine you are strong and fit to return to sport.
*Subjective tests help us understand how confident you are in your knee
*Objective tests help us see how fit and ready you are to return to sport
- IKDC Subjective Knee Evaluation Form & ACL RSI
- Tampa Scale of Kinesiophobia
- Functional Testing (Phase 3)
- General Fitness Testing
- Beep Test
- Timed Run
- Scandinavian Box Jump Test
- Functional testing should be in a fatigued state
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By Patrick Mcfadyen
