18 Commonly Forgotten ACL Physical Therapy Exercises to Rehab ACL Injury

An ACL injury, also known as anterior cruciate ligament injury is a serious injury with a long recovery process. I know this, because I have torn my ACL 4 times. Many ACL injuries result in ACL surgery followed by a long ACL rehabilitation with a physical therapist.

These specific ACL physical therapy exercises designed by a physical therapist and someone who has gone through the ACL recovery process 4 times will help to rehab your acl injury. The 18 commonly forgotten ACL physical therapy exercises in this article will get you back to all of the activities that you love.

The ACL provides a great deal of stability to the knee so when you have an ACL tear, your knee is significantly more unstable. This can cause the injured knee to “give out.” The injured leg may even cause you to limp due to pain or lack of full range of motion in the knee joint.

ACL Physical Therapy Exercises

ACL physical therapy exercises are designed to progressively rebuild the muscles around the knee, enhance joint stability, and ensure a safe return to daily activities and sports. The ACL physical therapy exercises are 1. Quad Sets 2. Heel Slides 3. Stationary Bike 4. Straight Leg Raise Hip Flexion 5. Straight Leg Raise Hip Abduction 6. Straight Leg Raise Adduction 7. Straight Leg Raise Extension 8. Terminal Knee Extension 9. Modified Single Leg Balance 10. Bridge 11. Bridge With Hamstring Curl 12. Hamstring Curl 13. Heel Raises 14. Calf Stretch 15. Step Up 16. Staggered Sit To Stand 17. Mini Squats 18. Wall Squats.

1 Week Post ACl Surgery Exercises

1 week post ACL surgery exercises should focus on improving knee range of motion and quad activation. The best exercises for this are 1. Heel slides and 2. Quad sets.

1. Quad Sets

• The main goal in an early rehabilitation program after an ACL knee injury or ACL knee surgery is to regain full range of motion in knee flexion and full extension and increase quadriceps strength.
  • The quadriceps are the front thigh muscles of your injured leg.
• To perform this exercise you will place a small towel roll underneath your ankle.
• You will now squeeze/tighten your quad.
  • Think about trying to push the back of your knee down into the surface below you. Hold this for 5 seconds and then relax.
• This is one of the best exercises to perform right after an acl surgical repair because you lose so much muscle mass.
  • This loss of muscle mass is called atrophy.
• Some physical therapists recommend to place the small towel roll underneath the knee, however I prefer the ankle because it allows gravity to assist with improving knee extension (the ability of your leg to be in a straight line.)

2. Heel Slides

• For this exercise you will lie on your back with a long towel, sheet or strap around the bottom of your foot.
• You can buy a stretch strap here.
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• You will gently bend your knee towards you by actively bending your knee while pulling the sheet with your arms.
  • Go to a point of a little discomfort, but not pain and then slowly return to starting position.
• It is a good idea to perform this exercise early in the healing process to regain knee flexion.
• A functional knee flexion is at least 120 degrees, however an ideal knee flexion’s closer to 135 degrees.
  • If your knee is not at least 120 degrees you will have compensations when walking, and going up the stairs etc.
• Be patient with this exercise.
  • You are not going to get to 120 degrees overnight.
    • Be consistent with performing your exercises every day to regain your normal knee flexion.

ACL Strengthening Exercises

The best ACL strengthening exercises are the 3. Stationary Bike 4. Straight Leg Raise Flexion 5.Straight Leg Raise Abduction 6. Straight Leg Raise Extension 7. Straight Leg Raise Adduction 8. Terminal Knee Extension 9. Modified Single Leg Bridge 10. Bridge 11. Bridge on Physioball With Hamstring Curl 12. Standing Hamstring Curl 13. Heel Raises 14. Calf Stetch 15. Step Up 16. Sit To Stand 17. Mini Squats and 18. Wall Squats.

3. Stationary Bike

• Riding a stationary bike with no resistance is a great exercise early on in ACL rehab process because it helps to regain knee flexion range of motion.
• This is the ability for your knee to bend.
• It also helps to get more mobility in the knee so that it feels less stiff.
• Start with the seat high and as you gain more knee flexion you can lower the seat.

4. Straight Leg Raise Flexion

• Start by lying on your back with your good knee bent and your affected leg straight.
• Now tighten your quad like you did with the quad sets and lift your affected leg up while keeping it straight.
• This exercise will strengthen your quadriceps, the large muscle group in front of your thigh.
• The key with this exercise is that if you have an extension lag then you should not perform this exercise.
  • An extension lag is present when you actively lift the leg up and the knee is slightly bent.
• This exercise is what is known as an open-chain exercise.

5. Straight Leg Raise Abduction

• Now lie on your side with your affected side up.
• Bend your bottom knee and keep your top leg straight and lift it up.
• Try to avoid your hips rotating when performing this exercise.
• Your leg should be slightly behind you as you are lifting it up.
  • If it starts to creep forward, reset so that your hips are perfectly stacked on top of each other.

6. Straight Leg Raise Adduction

• Lie on your affected side and bend your good knee over your affected leg.
• Now lift your affected leg off the mat.
• Keep your leg straight throughout this exercise.

7. Single Leg Raise Extension

• Lie on your stomach with your legs straight and lift your leg up.
• All of these exercises are targeting your leg strength.
• As you get stronger throughout your recovery process you can start adding an ankle cuff weight for added resistance.
• If you just had surgery you may have to perform these 4 directions of straight leg raises with your brace on.

8. Terminal Knee Extension

• Stand with a resistance band around your knee and attached to a sturdy object or cable column.
• Start with your affected knee bent and then slowly straighten your knee by pushing your knee into the back of the band while squeezing your quadriceps muscles.
• Hold this position with your knee fully extended for 5 seconds and then slowly return to the original starting position.
• You can buy a pack of resistance bands here.
• *As an Amazon Associate I earn from qualifying purchases.

9. Modified Single Leg Balance

• After surgery it may be very difficult to fully weight bear on your affected knee.
  • This may affect your ability to perform physical activity and your overall knee function.
• It is important to perform exercises that will force you to fully weight bear on your affected knee.
• To perform this exercise stand with your good leg on an elevated surface such as a step and your affected knee on the ground on a lower level.
  • Maintain knee extension on your affected leg, focusing on activating your quads and hold this position for 30 seconds.
• If you are looking for more balance exercises you can find them at 11 Creative Dynamic Balance Exercises To Improve Stability.

10. Bridge

• Bend both your knees and squeeze your glutes and abdominal muscles and lift your hips and butt off of the mat.
• Pause at the top and then slowly lower yourself down.
• As you get stronger throughout your rehab process, you can start performing this with as a single leg bridge.
• Back pain is common after an ACL surgery due to walking with compensations and decreasing your usual activity level.
  • You can find 11 Miraculous Exercises For Lower Back And Hamstring Pain here.

11. Bridge on Physioball with Hamstring Curl

• Lie on your back with your feet on a physioball.
• Keep your knees straight and perform a bridge by lifting up your hips from the ground.
• Now maintain the bridge position with your hips elevated and slowly bend your knees towards you.
• This will roll the physioball closer toward you.
• Now, slowly and controlled, straighten your knees and return to the starting position with your legs straight.
• This exercise targets your hamstrings and glutes!

12. Standing Hamstring Curl

• Lie on your stomach with your legs straight and slowly bend your knee.
• This exercise targets your hamstrings, the muscles in the back of your thigh.
• Performing this exercise on your stomach forces you to fight against gravity to bend your knee.
• If this is too difficult, you can perform this exercise in standing as seen in the picture.
• If either of these exercises are too easy you can add an ankle weight for added resistance.
• With both of these exercises it is important to slowly straighten the knee after bending it.
• You do not want to just let gravity uncontrollably bring your leg down.

13. Heel Raises

• Stand against a wall or another supportive surface and push up onto your toes.
• Now slowly lower yourself down to the ground.
• You will feel the back of your calves or lower legs working with this exercise.
• If you are feeling strong then perform a single heel raise.

14. Calf Stretch

• Calves can get very tight after ACL surgery, especially when you are walking on a bent knee if you have no regained your full knee extension yet.
• To stretch the calves stand facing a wall with your good leg in front of you and your affected leg behind you and slowly lean forward while pushing your back heel into the ground.
  • You should feel a stretch in your calf.
  • Hold this stretch for 30 seconds.
• Calf pain after ACL surgery is very common.
• Calf pain can be due to calf tightness.
  • This can occur from walking on a bent knee, which typically happens when you do not have your full knee extension.
• This exercise should help to provide some calf pain relief.
• Here you can find 11 Best Exercises For Calf Pain After Knee Surgery.

15. Step Up

• Leading with your affected leg, step up onto a small step.
• Start by holding onto the handrails and using a small step 2 inches-4 inches.
• As this gets easier you can stop using handrails to incorporate balance.
• Slowly progress the height of the step that you are working with.
• Looking for an alternative to the step up exercise?
  • Here are 15 Effective Alternative Exercise For Step Ups For a Full Body Workout.

16. Sit To Stand

• Start by sitting down in a chair.
• Place your feet in a staggered stance with your affected leg slightly behind.
• Now without using your hands, rise to a standing position.
• Now slowly sit back down.
  • Really try to control the descent.
• By placing your affected leg further behind in this staggered stance, it will force you to place more weight on the affected leg.
• This is a great strength training exercise for early on in the rehabilitation process.
• This exercise is a great quad strengthening exercise as well as an eccentric quad training exercise.

17. Mini Squats

• Stand with legs hip width apart and slowly bend your knees to perform a mini squat.
• Focus on maintaining equal weight bearing on both legs throughout this exercise.
• If possible you can perform this exercise in front of a mirror to make sure that you are equally weight bearing on both legs.
• You can perform this exercise by holding onto a sturdy surface such as a parallel bar, counter or trx straps for added stability if needed.

18. Wall Squats

• Stand against a wall with your feet a foot in front of the wall and slowly slide your back down the wall, performing a wall squat.
• Pause at the bottom position for 1 second and then slowly stand up by sliding yourself up the wall again.
• Focus on maintaining equal weight bearing on both legs.
• If necessary place a small step underneath your good foot to force more weight onto your affected leg.

What Is The Best Exercise For ACL Injury?

The best exercise for ACL injury is any exercise focused on quad activation since this is the number one muscle that atrophies or shrinks after an ACL injury. The straight leg raise is the best exercise for the early stages of ACL recovery because it activates the quad without placing too much stress on the ACL.

After surgery, it is important to perform this exercise in a knee brace until you no longer have an extensor lag.

Torn ACL Exercises To Avoid

After an ACL tear you should avoid any exercises that place excessive stress on the ACL. These include deep squats and deep lunges. In general there is nothing inherently wrong with these two exercises, however when performed too early in the rehab process, you can cause damage to the ACL.

In addition to these exercises, it is also important to avoid walking too soon after an ACL injury without the correct support such as a knee extension brace and crutches. If you begin walking before your quad muscle is strong enough you may experience knee buckling and stress the ACL.

Incidence of ACL Tears

ACL Physical therapy exercises are very important in any type of ACL injury. Approximately 1 in 3500 people will tear their ACL this year. Females are at a much higher incidence rate than men.

There are a variety of theories as to why this is the case. The most common theories are that females have more knee valgus and wider hips, which places greater stress on the ACL.

Another theory is that females have weaker hamstrings and rely more on their quadriceps when decelerating. Research has shown that the quadriceps are not nearly as effective at preventing anterior translation as the hamstrings, which can result in a much higher incidence rate of ACL tears.

Can You Do ACL Physical Therapy At Home?

Yes, you can do ACL physical therapy at home, however is is best to perform exercises while supervised by a licensed physical therapist. Your physical therapist will be able to prescribe specific exercises for you and your injury. In addition to this, your physical therapist will be able to correct your form and make sure that you are performing each exercise correctly to avoid injury.

Is Walking Good For ACL Rehab?

Yes, walking can be good for ACL rehab, however it is important to focus on walking with a normal gait to avoid any compensations. Often times after an ACL injury people tend to walk with an uneven step length and limp on the affected knee.

It is important to take nice even steps when walking. You also want to make sure that you are bending your knee when walking and not keeping it straight while trying to use your hip to swing it forward. This type of compensation will give you hip, knee and back pain and will not look good.

Summary of ACL Physical Therapy Exercises

These great examples of exercises play an important role in the rehabilitation process regardless of if you underwent acl reconstruction surgery or are dealing with acl sprains non surgically. The use of this information should be used as a guide in your recovery process of your torn acl.

These exercises may be modified depending on if you had surgery, which ACL graft was used and the length of your recovery process. As always listen to your surgeon and follow the surgeon’s protocol and precautions and work hard in physical therapy.

Believe me, from someone who has gone through it 4 times, you do not want to go through multiple ACL surgeries so put in the work the first time to get your knee function and quality of life back! You can read about more 9 Forgotten Knee Exercises For Pain Relief here.