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The Phases of ACL Injury Recovery

Anterior Cruciate Ligament (ACL) tears are one of the most common knee injuries among the young athletic population, with the highest incidence affecting males and females ages 14-25. ACL injuries occur most in physically demanding sports, such as soccer, football, basketball, and lacrosse. The ACL has an important role in keeping the tibia (shin bone) from moving anterior or forward in relation to the femur (thigh bone). In other words, the ACL is an extremely important ligament that keeps the knee stabilized while doing anything athletic such as running, jumping, cutting, and changing directions.

When someone goes under ACL reconstruction to repair a torn ACL, Physical Therapy is always necessary to restore range of motion & mobility, muscular strength & endurance, neuromuscular control, balance, and stability of the leg. Typically, ACL recovery takes six months to over a year, depending on the person’s age, health status, previous level of fitness, and the sport(s) they plan to get back into. Needless to say, it is a long recovery process that takes a lot of time, effort, and dedication on both the athlete and physical therapist.

There are many phases of ACL recovery, with each one taking different amounts of time depending on the individual. The early phases are focused on getting range of motion back, restoring and normalizing gait patterns, improving strength, balance, and proprioception. Once the athlete has restored full range of motion and has good strength and stability, they can be transitioned to the sports specific phase of recovery. This phase is usually the longest phase, as it requires a lot of time practicing on sports specific skills that are both difficult and challenging to the athlete recovering from ACL surgery. The exercises in this phase can include running/sprinting, plyometrics, agility, dynamic balancing exercises, change of direction drills, cutting drills, and exercises focusing on power and speed production.

The video below highlights an athlete recovering from ACL reconstruction performing some of the early phase sports specific exercises. The athlete in the video is four months post-surgery, and working towards a return to competitive high school and club lacrosse. The drills he is performing are designed to promote hip and knee stabilization as well as optimal loading and landing mechanics, which are all important in his sport. They also create a strong foundation for future exercises and drills as the athlete becomes stronger, faster, and closer to return to full sports participation.

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