ACL Surgery: Why Does My Knee Hurt with Jumping?

It is quite common to hear many months after an ACL surgery that an athlete’s knee hurts, particularly in their patella tendon or some other adjacent structure.  Even though we hear it quite a bit, we don’t want athletes to have to be experiencing these symptoms.

For the brevity of this post, we won’t be delving into the details of pain, etc.  For today’s post, we are going to discuss various ways an athlete can help themselves and their knee feel better with jumping after an ACL reconstruction.

DISCLAIMER: do not do what is recommended regarding jumping unless you have been “cleared” by your doctor or physical therapist and are ready to do so.

1. Optimize Hip, Knee and Ankle Mobility

Athletes will come in and they have limited mobility in their hip, knee, and/or ankle.  In order to jump effectively and distribute those forces of jumping cross your body, there are a few prerequisites when it comes to mobility that need to be in place.

#1 Ankle Mobility

Key Points:

-Place foot 4 inches away from the wall.

-Heel flat on ground and foot pointed straightahead.

-Try to touch knee to wall without heel coming off ground or knee going inside of toes.

Having full/sufficient ankle mobility is key to take some stress off the knee and allow the ankle to help.

If you want to learn more ways to improve your ankle mobility, check out this article we wrote HERE.

#2 Hip Internal and External Rotation

*Hard to check by yourself.

Hip internal and external rotation is very important as well.  Hip internal rotation (foot going outside of knee, first part of video) and hip external rotation (foot going inside of knee, 2nd part of video) are both vital for good jumping and landing mechanics.

Similar to the ankle, the body needs to have sufficient ranges of motion in order to delegate stress from different movements across the body.  If an area lacks mobility, then other areas of the body have to compensate and pick up the slack.

To find out more about hip mobility drills, check out another post we wrote HERE

#3 Prone Knee Flexion


Having full knee flexion in prone (on your stomach) is key to minimizing the chances for knee pain with jumping.  We like to see our athletes be able to get their heel to their glute (butt) without arching their back or compensating in some fashion.  This quickly tells us that they have sufficient quadriceps mobility for the same reasons why hip and ankle mobility are important.  

To improve mobility for prone knee flexion, you can try Self-Myofascial Release to your quads:

2.  Strength

Another common area that needs to be sufficient is an athlete’s strength.  Far to common after an ACL reconstruction, not enough good quality strength and conditioning is performed to get the athlete stronger and help develop their foundation of strength.  

For example, if you are going to build a tall building, you wouldn’t build it with a small foundation.


A small foundation wouldn’t be able to support a tall building and all of the weight as well as outside forces like weather and people stressing it.

The same goes for injuries and ACL surgeries.  Athletes need to have a sufficient strength and conditioning foundation prior to jumping.  If they don’t, we have seen time and time again that the majority of jumping stress is delegate to the knee vs across the entire body.

So, what should you be doing to help strengthen your body?  Seek out a well-qualified strength and conditioning expert who has experience with ACL reconstructions.

Programming should consist of:

Single Leg Deadlifts

Lunging Variations

Squatting Variations

Deadlift Variations

As well as quadricep specific strengthening such as:

And also core strengthening exercises.

Before we have any of our athletes run or jump, we have them go through an extensive testing process.  One of our tests is a Single Leg Squat to a Box.

Single Leg Squat to a Box

3. “You need to learn to swim before you can join the swim team.”

This saying can apply to most anything new that is being performed.  One must learn the basics before learning and performing more complex things.

When it comes to ACL reconstructions and ACL rehab, an athlete must learn how to absorb force correctly prior to engaging in higher level plyometrics and jumping.

Not only is this important from learning a new movement, but also the knee, ACL, and the rest of the body must gradually adapt and learn how to absorb certain amounts of stress before absorbing higher levels of stress.  If not, then the athlete can experience pain, swelling, frustration, etc. as they are trying to progress in their rehab.

A few drills we like to use with our athletes are:

Drop Squat Progressions

Double Leg Forward and Lateral Line Hops

Forward Single Leg Hops

There are greater progressions from these drills.  We like to start with these to train the athlete to absorb force.  Once they have mastered these and have felt good doing them, then we will progress them to higher level movements.

If you are dealing with knee pain with jumping after an ACL reconstruction, make sure to optimize your mobility at your hip, knee, and ankle, have a sufficient strength base, and gradually introduce jumping and hopping into your program when you have been cleared by your PT to do so.

Andrew Millett