Exercises After ACL Surgery: Week-by-Week Rehab Programme

Exercises after ACL surgery start on day one and progress in phases: regaining full straightening and controlling swelling, then bending and normal walking, then strength and balance, then running, and finally sport-specific training. Moving between phases depends on criteria — range of motion, swelling and strength — not on time alone. The timings below are approximate and are adjusted by your surgeon and physiotherapist.

Bandaged knee after ACL surgery at the start of the exercise programme — The first days: full straightening and swelling control come first.

ACL rehabilitation phases at a glance

Phase	Approximate timing	Goals	Example exercises
1. Protection	Weeks 0–2	Full straightening, less swelling, quadriceps activation	Quad sets, straight-leg raises, ankle pumps, heel slides
2. Motion and walking	Weeks 2–6	Normal gait, bending to about 120°	Stationary bike, partial squats, calf raises, single-leg stance
3. Strengthening	Weeks 6–12	Strength, balance and control	Leg press, step-ups, bridges, partial lunges
4. Running	Months 3–6	Start running safely	Graded running programme, light two-leg hops
5. Return to sport	Month 9 or later	Pass return-to-sport tests	Cutting drills, single-leg hops, sport-specific training

Table 1: Phased rehabilitation after ACL reconstruction (approximate timings).

Exercises for the first week

Quad sets: sit with the leg straight, press the back of the knee into the bed and tighten the thigh for 5 seconds; repeat 10 times, several times a day.
Straight-leg raise: tighten the quadriceps first, lift the straight leg 20–30 cm and lower it slowly.
Ankle pumps: move the foot up and down continuously to help circulation and reduce clot risk.
Heel slides: slide the heel toward you to bend the knee gradually within the allowed range.
Knee extension: place a small roll under the ankle — never under the knee — to let the knee straighten fully for a few minutes each day.

Video: the ACL and training in the gym

Prof. Dr. Ibrahim Shaarawi on what to know before training in the gym to protect the ACL — the basis of a safe return to training after surgery (in Arabic).

Phase 2 and 3 exercises

Once the knee straightens fully and you walk without a limp, the focus moves to bending and strengthening with closed-chain exercises (foot on the ground), which are safer for the new graft at this stage:

Stationary bike with light, then increasing, resistance.
Partial squats to 60°, keeping the knee over the foot.
Step-ups and step-downs on a low step.
Bridges for the hips and hamstrings.
Single-leg balance, progressing to an unstable surface.

Common mistakes

Putting a pillow under the knee, which stops it straightening fully.
Running or jumping before strength has recovered.
Neglecting the healthy leg and balance work.
Stopping exercises once the pain settles.
Returning to sport based on time alone, without testing.

When to stop and call your doctor

Pain or swelling in the calf (possible blood clot).
Fever or discharge from the wound.
Sudden loss of knee straightening after you had regained it.
Increasing swelling with severe pain that does not settle with rest and ice.

Return-to-sport criteria

Full range of motion without swelling.
Strength of the operated leg at least 90% of the other leg.
Single-leg hop tests at a similar level.
Psychological readiness and confidence in the knee.
Sport-specific drills completed without pain or instability — usually not before 9 months after surgery.

Frequently asked questions about exercises after ACL surgery

When do exercises start after ACL surgery?

On day one: quad sets, ankle pumps and knee straightening, progressing as your surgeon and physiotherapist advise.

When can I walk without crutches?

Usually within 2–6 weeks, once you can walk without a limp and the knee straightens fully; it takes longer if the meniscus was repaired.

When can I go back to the gym?

The stationary bike and upper-body training can start early; heavier leg work progresses from about week 6 depending on strength and follow-up.

When can I run after ACL surgery?

Usually between months 3 and 6, after passing strength and balance tests — not simply after a set time.

Can I do the exercises at home without a physiotherapist?

Early exercises can be done at home, but physiotherapy follow-up matters for judging progress and timing each phase.

To have your knee assessed, book a consultation, call +20 155 240 4488 or message us on WhatsApp at +20 155 554 7181.

Medically reviewed by Prof. Dr. Ibrahim Shaarawi, Professor of Orthopaedic Surgery. This article is general medical education and does not replace an examination or the plan your surgeon sets for you. See our medical disclaimer.

Related ACL guides

Exercise is one part of recovery after ACL reconstruction surgery. Read also:

Exercises After ACL Surgery: A Phased Programme From Day One to Return to Sport