ACL reconstruction rehabilitation is lengthy and challenging, and every phase in returning to play is essential.
The goal of rehabilitation isn’t simply to get you back on the pitch.
It’s to prepare your knee, your body, and your mind for the demands of football.
How long does it take?
You’ll often hear that ACL reconstruction takes 9–12 months to recover from. While this is a good rule of thumb, there shouldn’t be a specific date when you’re automatically considered ready to play.
A better approach is criteria-based rehabilitation.
This entails proving:
- That the injured knee is very close to the uninjured knee when it comes to strength, force output, and generation of power.
- That the injured knee can tolerate the movements and speeds required to play competitive football.
- That the athlete is psychologically prepared to return to the sport.
What needs to be rebuilt?
Strength
Quadriceps weakness is extremely common after ACL reconstruction, but the focus shouldn’t stop there.
Your quadriceps, hamstrings, glutes and calf all need to produce and control force effectively.
Single-leg strength is particularly important because football involves constantly accelerating, braking, jumping and changing direction from one leg.
Running and power
Rehabilitation requires progressive development from walking without crutches, to running in a straight line, to jumping and landing, and then finally sprinting.
An athlete needs to be able to repeatedly produce and absorb force without significant pain, swelling or loss of control.
Change of direction
Football involves unpredictable sprinting, braking, changing of direction and accelerating again, often within seconds.
Your rehabilitation should therefore progress from planned movements to faster and increasingly reactive movements.
Football fitness
You may be able to perform one hard sprint without difficulty, but struggle to repeat that effort throughout a training session, when fatigue builds.
I expose my athletes to high-speed running, repeated sprints, changes of direction and eventually full training, to appropriately prepare them for the physical demands of the sport.
Confidence
Physical recovery is only part of the process, and I see the psychological side of rehab frequently neglected. Hesitation when returning to play is common for any injury, but is magnified in the context of a major operation such as an ACL reconstruction.
Learning the strategies to react instinctively, rather than protectively, takes mental fitness and repetition in the same way any other physical rehabilitation requires.
When are you ready?
There isn’t one test that determines if an athlete is ready for high-intensity play.
I like to look at the bigger picture:
- Knee range of motion and swelling
- Quadriceps and hamstring strength
- Jumping and hopping ability
- Sprinting and change-of-direction capacity
- Football-specific conditioning
- Exposure to full training
- Confidence in the knee
The ultimate question is:
Can my knee, my body, and my mind handle what football is going to ask of me?
If the answer to any of those questions is no, then we need to look at what exactly the athlete is struggling with, and orient our rehabilitation around that.
This is a fluid and non-linear process. Recovery from ACL reconstruction can be confusing, with symptoms occurring when trying a new movement pattern, a new speed, or any new demand on the knee.
Sometimes that is just a normal part of rehab, and can be worked through with coaching and appropriate integration of strength work, balance exercises, soft tissue release, etc.
Other times, it means we have to go back a step or two, and perhaps not progress as quickly as we were initially hoping for. This alone can be very frustrating and upsetting for the athlete, who wants more than anything to be back on the pitch with their friends, doing what they love.
Not to mention the concerns surrounding what this might mean for their long-term health. All too often, I’m asked: “Will my knee ever be the same again?”, “I could do xyz last week, but it’s sore this week, have I damaged something else?”, “What if I’m not healing properly?”, and more.
All of these concerns are valid, and athletes need reassurance from their entire support system that the long-term outlook is very strong.
This makes ACL rehabilitation a collaborative effort between the athlete, parents, coaching staff, medical team, and everyone in between, to ensure the individual can return ready and confident.
