We hear and see it all the time. “My quad feels so weak.” “My quad isn’t getting stronger.”

These are common phrases that athletes after an ACL reconstruction utter, whether it be immediately post-op (after surgery) or months after surgery.

After an ACL reconstruction, due to the swelling, loss of range of motion, and immobilization to active movement, the quad can atrophy and lose size and strength relatively quickly.

We can do a few things as an athlete and clinician to help with this.

Early on, we like to utilize Neuromuscular Re-Education, a.k.a Russian Stim with a Quad Set.

This is where we utilize an electric stimulation machine to help facilitate a quad contraction as the athlete is actively contracting their quad. We like to start this ASAP after an ACL reconstruction as it can help to minimize the loss of the quadriceps muscle.

Other movements we like to incorporate early on are:

Standing Terminal Knee Extension (TKE) with a Ball

Key Points:

• Start with your foot slightly away from the wall.

• Place a small ball behind your knee and in contact with the wall.

• Press the back of the knee into the ball and tighten up your quad.

• Make sure to push the back of the knee in and NOT just lean your trunk forward.

The TKE’s can also be done using a band attached to an immovable object, and you are pulling the back of your knee into the band and tightening up your quad.

Long Arc Knee Extension

There are differing opinions in the rehab world about using this exercise. Multiple studies have shown that it places as much stress on the ACL as walking and other daily activities. This can be a great option if someone has difficulty strengthening their quad.

Quadruped Resisted Knee Extension

Tall Kneeling Nordic Quads

What is also common after an ACL reconstruction is not getting the athlete into a well-structured strength and conditioning routine when they can. Good quality strength and conditioning will help athletes get back to doing what they love.

Exercises such as:

Squats

Deadlifts

Lunge Variations

Single Leg Deadlifts

We can also utilize something called Blood Flow Restriction. We advise this to be performed under the supervision of someone trained in this technique. Do NOT just tie something around your leg and start working out. If you are interested in something like this, seek a licensed medical provider trained in this.

Blood Flow Restriction (BFR) is the use of an inflated cuff to slow down arterial blood flow and stop venous return in the body. By doing this, it helps to stimulate natural growth factors to help with healing tissue. What it also can do when implemented with an exercise is to make an easy exercise very challenging.

The point of making an easy exercise very challenging is that after surgery, it can be difficult to load tissue if the athlete is de-conditioned or can’t put a considerable amount of weight on a bar or in their hands to train.

We like to incorporate BFR with many different movements, including:

Resisted Knee Extension, Tall Kneeling Nordic Quads, Stability Ball Bridges

Step Ups

Reverse Sled Drags, Quadruped Resisted Knee Extension

BFR can be implemented with any exercise. Make sure to seek someone out who is trained in this technique.

In Closing: Quad Weakness After ACL Reconstruction

It is common to have quad weakness after an ACL reconstruction, but if you are having trouble improving your quad strength, try these options or seek out someone who understands the demands of ACL rehab and what it takes to get back to sports.