Anterior cruciate ligament (ACL) pre-surgery exercises

Introduction

After an anterior cruciate ligament (ACL) rupture it is especially important that you regain the strength in your leg before any reconstructive surgery.

What follows is an exercise program or ‘pre-habilitation’.

Regaining the strength and movement in your knee before surgery will significantly improve your recovery after ACL reconstruction surgery. This is vital and will likely give you a better outcome after your surgery. This exercise program has several important benefits:

• Return knee movement to normal and decrease the risk of post-operative stiffness
• Increase muscle strength in your legs and core
• Improve balance
• Maintain fitness in preparation for surgery

Ideally, these exercises should be performed daily, as recommended below and can be started once the swelling has settled in your knee once the physiotherapist has given you the go-ahead

General exercise

• 20 to 30 minutes of cardio exercises at least 3 times a week. They should all be low-impact, straight-line activities such as elliptical trainer, biking and walking.
• 15 to 20 minutes of strength training (we have included a set of exercises in this resource).

Strength exercises

Quadriceps contraction

Sitting with your knee straight and leg supported, tighten the thigh muscle to hold the knee straight. Avoid lifting your leg from the hip.

Do this 5 to 10 times holding each contraction for 5 seconds.

Progress to 20 times holding each contraction for 10 seconds, resting for 5 seconds in between reps.

Straight leg raises

In the position shown, tighten your thigh muscle while keeping your knee straight and lift your leg 3 to 5cm.

Do this 5 to 10 times holding each contraction for 5 seconds.

Progress to 30 times holding each contraction for 5 to 10 seconds.

Hip adduction

Lying down with your knees bent as shown, squeeze a soft ball or a pillow between your knees.

Do this 5 to 10 times holding each contraction for 5 seconds.

Progress to 30 times holding each contraction for 10 to 15 seconds, resting for 5 seconds between reps.

Calf raises

Both legs

Start with feet shoulder width apart feet flat on floor then slowly raise up onto your toes.

Start with 1 set of 10, holding each raise for a few seconds.

Increase the number of reps up to 30 with up to a 5 seconds hold. Start by using support at a wall or table and progress to no support as able.

Single leg

Start on 1 leg with toes pointed straight ahead, and raise up onto your toes.

Start with 1 set of 10, holding each raise for a few seconds.

Increase the number of reps up to 30 with up to a 5 seconds hold. Start by using support at a wall or table and progress to no support as able.

Glutes

Lying down on a firm surface with your knees bent and your arms by your sides, squeeze your bottom and lift up to create a bridge. Keep equal weight on each leg and straight alignment from your shoulders to your knees. Be careful not to push down on your neck or shoulders – use your bottom to do the work.

Start with 1 set of 10, holding each lift for 5 seconds.

Increase the number of reps as your strength increases. Once you can complete 20 reps holding for 10 seconds each, change to single leg bridges (your physiotherapist will show you this progression).

Hamstrings

In sitting place a resistance band around your ankle and also have it attached to a chair or table leg in from of you. Bend your knee backwards slowly against the resistance of the band using the muscles under your thigh.

Start with 1 set of 10 reps and increase to 3 sets of 15 reps.

Squats (quadriceps)

Slowly squat with equal weight on each leg. Bend your knees from 0 degrees angle to a maximum of 90 degrees angle of flexion, making sure your knees do not move beyond your toes.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Single leg squats

Standing on 1 leg, slowly squat bending your knee from 0 degrees angle to a maximum of 90 degrees angle, making sure your knee does not move beyond your toes.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Balance exercises

Double leg squats on an unstable surface

Using thick carpet, foam block, rolled up towel or camping mat to make an unstable surface.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Single leg stance on an unstable surface

Using thick carpet, foam block, rolled up towel or camping mat to make an unstable surface.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Single leg squats on trampette

On a trampette, stand on 1 leg, and slowly squat bending your knee from 0 degrees angle to a maximum of 90 degrees angle making sure your knee does not move beyond your toes.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Squats on a wobble cushion

Slowly squat with equal weight on each leg. Bend your knees from 0 degrees angle to a maximum of 90 degrees angle of flexion, making sure your knees do not move beyond your toes.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Lunges on a wobble cushion

Step forward or back and lunge as shown. Make sure your knee that is forward does not move beyond your toes.

Start with 1 set of 10, holding each squat for 5 seconds and increase the number of reps as your strength increases, up to 30 reps with a 15 seconds hold.

Bridging on a gym ball

Lying down on a firm surface with your knees bent and your arms by your sides, squeeze your bottom and lift up to create a bridge. Keep equal weight on each leg and straight alignment from your shoulders to your knees. Be careful not to push down on your neck or shoulders. Use your bottom to do the work. Slowly pull the ball in toward you keeping your pelvis off the floor.

Start with 1 set of 10, holding each lift for 5 seconds. Increase the number of reps as your strength increases.

Once you can complete 20 reps holding for 10 seconds each, change to single leg bridges.