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  • Isabel Jones, PT, DPT, ATC

Returning to Sports After ACL Surgery: Timeline + Steps

Updated: Dec 18, 2023

An anterior cruciate ligament (ACL) tear is an extremely common injury in athletes; approximately 200,000 ACL injuries are diagnosed each year in the U.S. alone. ACL injuries can be devastating to athletes, as the recovery process is lengthy and requires commitment; however, returning to sports before the recommended time frame can delay the healing process and even risk re-injury. According to the Journal of Orthopaedic & Sports Physical Therapy, athletes who returned to sports too soon after ACL surgery (before nine months), were associated with seven times an increased rate of a second ACL injury.



girl practicing kicking for soccer in physical therapy.


Why an Athlete Needs Proper Rehabilitation After ACL Surgery


An athlete needs proper rehabilitation after ACL surgery in order to be as safe as possible and maximize their potential for returning back to their respective sport. Having proper ACL rehabilitation helps to improve confidence within the patient; it guides them through the necessary steps while respecting the tissue healing process, and also helps to decrease the incidence of a second ACL tear. ACL surgery is not a short rehabilitation process and as physical therapists, we know that it is a long road to recovery. That’s why we are there for guidance and support during the process to improve the overall outcomes of the patient with the main goal being to return to the sport that they love.


When Should an Athlete Begin PT After Surgery?


An athlete can begin physical therapy as soon as a few days after surgery. Physical therapists prefer to see patients as early as possible in order to start working on decreasing swelling, improving range of motion, managing pain/discomfort, gait training, improving muscle activation, and education on the rehabilitation process while respecting the surgical site.


What Does the Timeline Look Like?


The timeline varies depending on the patient, what are their goals for rehabilitation, what sport they are returning back to, and what their prior level of function was. Each individual heals at different rates, therefore every patient’s recovery will look a bit different.


Early Stage

The early stage of rehabilitation focuses on managing pain, decreasing swelling, improving range of motion, re-introducing muscle activation, improving proprioception, and normalizing the gait pattern.


Early-Mid Stage

The early-mid stage of ACL rehabilitation continues to utilize principles from the early stage but the patient will be able to progress to strengthening exercises in multiple directions, proprioception, and balance.


Mid-Late Stage

The mid-late stage of ACL rehabilitation focuses on force absorption, learning how to decelerate the knee, and improving single-leg loading mechanics in order to help the patient return back to running.


Late Stage

The late stage of ACL rehabilitation mainly focuses on improving single leg power development, landing mechanics, change of direction, neuromuscular control, and increase in sport-specific activities in order to help return the patient back to playing their specific sport.


Protocol for Return to Sport


In order to be cleared for a sport after ACL surgery, a return to sport assessment is necessary. Rehab United’s staff has created an extremely extensive and unique multi-stage protocol based on current physiology and post-operative literature, which will properly assess patients' readiness for the demands of their respective sport. This assessment is a detailed evaluation of strength, balance, range of motion, motor control, and sport-specific movement patterns.


Prior to administering this assessment, the physical therapist will utilize their clinical judgment and specific objective measures to deem the patient appropriate and safe to perform the testing protocol.


The return to sport assessment is usually administered between 9-12 months post-op after the patient has gone through a rigorous rehabilitation program that focuses on mobility, muscular and ligamentous strength, endurance, power, shock attenuation, loading mechanics, change of direction/agility, neuro-cognitive development, and sport-specific activities.


Once the patient has achieved a passing score on our testing protocol, the patient will be cleared to return to their sport.



Examples of Prevention Exercises & Strategies


Although ACL tears may not be fully prevented in athletics, it is still important to reduce the incidence of injury. The main focus of these strategies is focusing on single-leg strengthening, improving cutting mechanics, and increasing the body’s ability to control the knee joint. This is not an exhaustive list but it gives an idea of what athletes should be working on in order to help reduce the incidence of ACL tears.


1. Single-Leg Retro Squat Off a 12” Box With a Medicine Ball Diagonal Chop


2. Single-Leg Balance 3-Way Posterior Reach Off 6” Box


3. Depth Jumps From a 12” Box


This video covers all three examples in the respective order:




How Rehab United Works With Athletes for ACL Recovery


Rehab United works with athletes from their first visit post-op through the return to sport phase and eventually clears athletes for a full return to their sport. We use a comprehensive approach for athletes that are rehabilitating from ACL reconstruction and utilize the principles of Applied Functional Science to aid in this process. We address not only the knee joint but every joint in the body. Athletes utilize their entire body in order to participate in their sport, and when athletes are recovering from ACL reconstruction, it is important to not only treat the knee joint, but also the joints that can affect the knee. The main focus at Rehab United is facilitating and guiding the patient through the rehabilitation process and making it as fun and rewarding as possible. It is our main goal to return athletes back to the sport they love as safely and with as much confidence as possible.


Recover With Rehab United!


We strive to not only return athletes back to their prior level of function but to exceed expectations and optimize their performance. Our physical therapists focus on providing comprehensive sports rehabilitation for all types of athletes. If you have a sports injury, recover with us! Request an appointment today.



 

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Dr. Jones is a physical therapist and a Certified Athletic Trainer with a passion for physical activity and functional movement. She received her Doctorate of Physical Therapy in 2021 from the University of St. Augustine in San Marcos, CA, joining Rehab United quickly after.





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