It is very common to see an athlete come in after an ACL surgery and present with a swollen knee, atrophied thigh, and overall be deconditioned.

Surgery is a major event and should never be taken lightly no matter what the type of surgery is.

A common trend that we see as healthcare practitioners and strength and conditioning professionals is that these athletes present with weakness in their quad as well as throughout their body for a prolonged period of time after surgery.

There are athletes who still present with quadriceps atrophy for almost 6 months after surgery. We have heard stories of athletes doing straight leg raises on the treatment table at 3 months after surgery.

From what we have seen is that these athletes aren’t doing enough well-structured strength and conditioning after surgery. We aren’t just talking lower body training. We are talking lower body, upper body, as well as core strengthening for months on end after surgery. We need to prepare our athletes for the demands of their sport and they need to put the time and effort in after surgery to properly prepare their bodies.

So what are we missing?

1 . Gradual Progressive Overload

This is just a long series of words meaning that we need to challenge our athletes. We need to get our athletes off the treatment table and up doing compound movements. This is not to say that isolated quadriceps work isn’t important. Isolated quadriceps work is VERY important, but we want to make sure our athletes are performing compound upper and lower body movements to help set a foundation to put more strength and power work on top of as they progress through their rehab.

*DISCLAIMER* - these should only be performed when the athlete is able to and ready. Don’t try to perform these too soon when the athlete is not ready from a mobility, balance, or strength standpoint.

Movements such as:

Single-Leg Deadlifts

Lunge Variations

Squat Variations

Deadlift Variations

2. Don’t Forget The Quad

As much as we want to build up overall strength throughout the body, the caveat of doing multi-joint movements is that it is difficult to isolate one muscle group. With an ACL reconstruction, it is important to build up the glutes and hamstrings, but it is just as important to build up quadriceps strength as this is going to help buttress and stabilize the knee during running and jumping.

Isolated quad movements that can be supersetted or put into any strength and conditioning program are:

Resisted Knee Extension

Quadruped Resisted Knee Extension

Tall Kneeling Nordic Quads

and there are many other quad focused movements that can and should be implemented.

3. Core Strength

Athletes coming back from an injury and surgery like an ACL surgery absolutely need core strength and stability work. The core musculature helps to stabilize the pelvis and hip and in turn the knee and ankle. If an athlete has difficulty controlling their trunk on 1 or 2 legs, this will make it difficult for them to be able to control their body and in turn affect them on the court or field.

Core strengthening drills such as:

Anti-Extension

TRX Fallouts

Anti-Rotation

Anti-Rotation Press

Wide Stance Anti-Rotation Chop

Anti-Lateral Flexion

Feet Elevated Side Planks

Suitcase Carries

When recovering from an ACL reconstruction, make sure you are implementing strength training movements consisting of:

• Lunge Variations

• Single Leg Deadlift Variations

• Squat Variations

• Deadlift Variations

• Quad Focused Work

• Core Strengthening

These movements, as well as many others, can help prepare your body to be resilient and strong when you return to your respective sport.

Make sure when you are pre-habbing (rehab before surgery), going through your rehab, etc., that your physical therapist and/or strength and conditioning coach (when you are ready to do so) are progressing you appropriately and performing similar movements as mentioned above to help get you back to where you need to be.

We provide Physical Therapy in Hudson, MA and surrounding Massachusetts areas.