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How to Properly Recover from an ACL Repair

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Anterior cruciate ligament (ACL) repairs are a very common operation amongst sporting individuals. Most physiotherapists will likely be treating patients after ACL repairs at any given time. You would imagine that most patients would be treated in a similar way for the same injury, but this is not the case as there are many good and many bad ways to rehabilitate an ACL injury.

Strengthening is often addressed during rehabilitation, but in our experience it can all too often include plenty of quadriceps and hamstring strengthening work and not nearly enough focus is given to the hip and thigh muscles. Depending on your physio’s approach, you may have been instructed to do squats, single leg squats, bridging, theraband work and balance work. This will usually progress and be made more challenging over several months with slightly more intricate exercises before you are let loose again into the world of sport.

What our patients tell us more often than not is they have failed to improve as expected, or still they feel anxious about returning to playing sports, either due to perceived weakness and vulnerability or due to pain. What we have found useful to address and assess (because not every patient is the same and so a ‘one size fits all’ approach will not suffice,) is the rotational control on one leg or the strength and activation of the adductors. These are commonly under-evaluated points and it’s easy to appreciate when you take a look at the biomechanics, and also when you remember why the ACL failed in the first place. Knee joints are only supposed to bend and straighten. They are not supposed to twist or rotate. The ACL’s job was to prevent this once the muscles had done as much as they could to prevent it.

A good percentage of patients struggle with regaining adductor and abductor strength after sustaining an ACL injury but they can improve this if it is worked on. There is evidence emerging from football clubs and other sports where pre-injury prevention strategies try to identify what muscles might be weak in players and which ones, if weak, are linked to injuries. These results have hinted that adductor and abductor strength may play a part in the injury risk.



If you are recovering from an ACL repair, improving your adductor and abductor strength will mean you are likely to see an improvement in the rotational stability of your hip over your knee. You are also likely to see improvement in plyometric activities such as jumping and sprinting, as the limb is more efficient due to the increased stability. It’s also likely to help with future injury prevention, all good reasons to focus some time and effort on these other muscles and work to get them on track. Exercises that include single leg ‘running man’ style poses, sideways lunges, jumping and turning to land whilst maintaining a steady knee, as well as dip and deadlifts are all good examples of exercises you can do to improve your adductor and abductor strength.

If you’re recovering from an ACL repair and are looking to work with a physio, why not call us for a chat? Call us today on 020 7884 0374 or email