ACL rehab is not all the same. Most physical therapists can do a great job in phase 1 of ACL rehab. This is the period of time immediately after surgery to about 1 month post-op (after surgery). The main objectives are to decrease swelling, improve mobility, specifically knee extension range of motion, and improve quadriceps muscle firing/activation.

After rehabbing countless ACL reconstructions, there are many myths that are accompanied by this type of injury and rehab.

Let’s get right to it.

Myth #1: "Professional Athlete Joe Shmo came back in 4-6 months, so can I."

No offense, you are not that high-level professional athlete. Even if you are a professional athlete, these instances of athletes coming back that quickly are typically outliers and are exceptions to the rule. It is a major advantage after ACL reconstruction to be confident and driven in your rehab to return to sport or any other high-level activity. Professional athletes have physical therapy 2x/a day, 6 days a week. The typical athlete who is not a professional athlete has rehab at most 3x/week.

That professional athlete is receiving treatment 3x as much as the non-professional athlete. Our job as physical therapists has many facets to it. One of those facets is managing expectations. From the start of rehab and before surgery, physical therapists must educate the client on the potential length of rehab. Research has shown that athletes who spend 9 solid months of rehabbing and performing well-structured strength and conditioning have better outcomes when they return to sport and reduce their risk for reinjury by 51%.

Rushing through ACL rehab to get back for 6 months after surgery is unrealistic, nor should someone try to be ready to play their respective sport in that time frame. I am all for hard work and dedication to the process, but not spending the time to get stronger, faster, more powerful, etc. than before surgery is setting yourself up for failure.

Myth #2: Just Keep Doing Your PT Exercises

This is a statement that we have heard uttered from countless athletes over the years. They have been advised by their physical therapist to continue to do their straight leg raises, quad sets, and bridges and they will be fine to continue to do that until they want to go back to their sport.

This may be one of the most detrimental things someone can do. The exercises mentioned above and countless others, are very important in the beginning stages of ACL rehab. They can help set the stage for movements down the road. But, if that is all you are doing to prepare yourself for the demands of your respective sport, you will be significantly under-prepared. Once an athlete has mastered those movements on the PT table, they need to get up and move around and perform higher-level movements to build overall strength, power, and injury resiliency.

Movements such as:

Trap Bar DL

Squats

Single Leg Deadlifts

Lunges

and the list can go on and on. Multi-joint movements seen in most strength and conditioning facilities are going to be key to helping an athlete get stronger, faster, and more powerful to help them return to their sport.

There is also a time, and a place for quadricep-focused exercises such as:

Resisted Knee Extension

Quadruped Resisted Knee Extension

But, athletes need to be engaging in multi-joint movements to best prepare themselves for the rigors of their sport

Myth #3: "I'm 6 months post-op, I'm Cleared!"

This is another statement that we hear time and time again. Just because you are 6 months out from your surgery and your surgeon said "you're cleared" doesn't mean you can return to your sport. What if you sat on the couch for 6 months and did nothing? Does that mean you are ready to return to sport?

As we tell all of our athletes, each step is built off of the previous one. This means you must improve your range of motion and quad strength and get your swelling down first. Then you need to get stronger at simple movements on the table. Once you have done that, then progress to higher level movements and so on. A well-structured strength and conditioning routine that prepares your body for the demands of your sport, month after month, is key to preparing you.

We need to stop focusing on time-based returns and focus on criteria-based return-to-sport.

What do we mean by that? What that means is that an athlete has to prove that they can progress to the next phase of rehab. Have they put the months of preparation in to prepare themselves with strength and power work to be able to run? Have they put the time in to be able to jump, cut, pivot, change direction, etc.?

Are there objective strength and single leg stability measures that they are proficient at to possess a base level of strength?

As physical therapists, we have switched over to criteria-based assessments for our return to running and return to sport as well as have the athlete put the time in with their training to be ready. Just basing your return to sport on how many months or days you are out from surgery may leave you significantly under-prepared and may be detrimental to your success as an athlete.

If you have had an ACL reconstruction, these are honest truths we spoke about above. Be honest with yourself, put the hard work in, and use this time to prepare your body for the demands of your sport. Recovery from this type of injury and surgery is long and hard, but you will set yourself up for success if you find the right physical therapist and strength and conditioning coaches who understand this type of recovery.