Best exercises for Anterior cruciate ligament (ACL) Rehabilitation
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Which Exercises are Best for Anterior Cruciate Ligament Injury?
There is no "best" or "worst" exercise for every single person rehabilitating an Anterior Cruciate Ligament (ACL) injury.
The exercises given to you during your ACL rehabilitation should match your own specific needs and help you to bridge the gaps between where you are now, based on a comprehensive assessment, and where you want to go – back to performing at your best. If you plan to work with a professional for your rehab, such as a Physiotherapist, Accredited Exercise Physiologist, or Strength and Conditioning Coach, they should first conduct a criteria-based assessment to identify your specific gaps in function and performance. From there, the "best" exercises for you can be prescribed.
Let's start with the typical needs that can be identified based on the criteria in the Melbourne ACL Guide, a key resource during your ACL rehab journey, and then discus some exercises that meet these needs.
NB: While it is helpful to know what these exercises achieve, If you just want to see the good exercises – skip the next section
ACL Rehabilitation – Function and Performance Gaps
Every person's knee will feel different; some are more unstable than others, some feel more weak than others, some even feel stiff or locked. This is because everyone's injury is different depending on factors including pre injury function, presence or absence of other injuries (EG: Meniscus, MCL, Bony Bruising), and amount of swelling.
Despite these differences, there are key criteria that all ACL rehab participants should be required to pass before a return to training, then return to play.
These can include:
Full Knee Joint Range of Movement
Symmetrical Muscle Strength and Bulk
Excellent Lower Body Force Output Strength and Endurance
Excellent Hop Testing Performance (Power, Stability, Endurance)
Excellent Stability (Balance, Proprioception)
Full Confidence in your Knee and its Function (Questionnaire/Interview)
Ensuring that these tests are passed improves your likelihood of returning to pre-injury levels and significantly reduce your risk of re-injury. Without it, your knee can continue to re-swell, remain unstable, and perform inadequately leading to reduced confidence and capability.
Exercises to Match
Now that we know the outcomes we are trying to achieve, here are some exercises that we can use to achieve particular criteria in the Melbourne ACL Guide.
Knee Extension (Symmetrical Muscle Strength and Bulk)
Wasting of the quads muscle is a common issue. This is due to inhibition of the quads from pain, swelling, and reduced use.
Use of a machine or banded knee extension is a great way to isolate the quadriceps to get your muscle symmetry back. This exercise is considered a little controversial in early ACL rehab, but is absolutely essential at the right time in your rehab process.
This exercise is typically prescribed for 3-4 sets of 6-15 repetitions
Single Leg Exercises (Symmetrical Muscle Strength, Muscular Endurance and Stability/Balance)
In double leg exercises it's possible that the injured/detrained side can "hide". Therefore, to restore symmetry, and conveniently also develop some balance and stability, single leg exercises are great exercises to include.
Single leg glute bridges, squats, calf raises, and all of their variations are staples in ACL rehabilitation, especially early on.
These exercises may be challenging in the early stages, and you may only be able to complete 6-8 repetitions before fatigue. However, building up to 2-3 sets of 15-20+ repetitions can be helpful to develop strength, endurance, and stability in the early stages.
Plyometrics and Jumps (Power, Stability, Endurance)
To return to high level sports activities such as running, jumping, and agility, you will need excellent power, stability and endurance in the legs.
Plyometric exercises can vary in so many ways including their amplitude (how high you jump), direction (which way you jump), whether they are extensive (low impact for higher repetitions) or intensive (high impact for fewer repetitions), and whether they are a true plyometric (repeated efforts/jumps with shorter ground contact time) or jump training (singular or fewer efforts/jumps with longer ground contact and/or rest between jumps).
Dosages vary widely depending on the goal and specific exercise. If you're looking for a starting point, some landing drills for 2-3 sets of 5-8 repetitions, single jumps for 2-3 sets of 3-6 repetitions, and repeated jumps such as pogo hop varieties for 2-3 sets of 20-30 seconds are good places to start.
Lower Body Resistance Training (Strength)
Bodyweight exercises, isolation exercises, and plyometrics are all key ingredients, but there is one thing we haven't covered yet – getting as physically strong as possible. This will help you build and maintain muscle mass, improve connective tissue strength, increase bone density and develop the foundational strength that supports all of the other activities previously mentioned. Strength training doesn't solve all of the problems that come with an ACL injury – but it definitely helps.
Free weight exercises such as squats and deadlifts are usually highly recommended by exercise professionals and strength and conditioning coaches. However, for general strengthening purposes you may be able to achieve sufficient results with only machines. A combination of both is likely the best choice depending on your circumstances.
Typical linear periodisation (3-4 sets of 12-15 repetitions, adding weight and progressing down to 3-6 repetitions) or maximum strength training (3-5 sets of 3-5 repetitions) guidelines can be used for these exercises depending on your experience and ability.
Remember, the key is not just to do these exercises because they seem "good" - it's to match the exercise to your own injury, specific needs, skill level, and available equipment. Ensuring that you have both the right exercises and the right dosage will be the most effective way to help you regain confidence and function.
Including Exercise in Your Rehabilitation Journey
Rehabilitating an ACL injury can feel overwhelming, especially when your knee feels weak, unstable, or painful. By including a high quality, exercise-based rehabilitation plan you can overcome these challenges and get your strength and stability back, so you can go back to doing what you want to do.
The journey
begins with identifying your unique needs through a comprehensive assessment,
progresses with tailored exercises to rebuild strength, stability, and confidence,
and culminates in meeting key milestones that prepare you for a safe return to activity.
Along the way, you’ll experience ups and downs as your knee regains its function and your trust in it improves. With dedication and the right guidance, you can move from frustration and uncertainty to feeling strong, stable, and ready to take on life—or your sport—with confidence. Let’s take the first step together toward your recovery.