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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).
Information:

If you have increased knee pain or swelling after these exercises please use rest, ice, compression and elevation (R.I.C.E.), and contact your physiotherapist.

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.

Photograph of person sat on the floor with their legs outstretched and with their upper body upright

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.

Photograph of person laid on the floor with their elbows to the floor. One is leg bent with their foot on the floor, and the other foot raised keeping their leg straight.

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.

Photograph of person laid on the floor with their knees raised and their feet to the floor. They have a football between their knees and are holding it in place.

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.

Photograph of view of person from behind raised up onto their 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.

Photograph of side view of person raised up onto their 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.

Photograph of side view of person laid on their back, with their knees raised, and feet on the floor. Their arms are to the floor, pushing their bottom into the air to make a straight line between their knees, bottom, and shoulders.

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.

Photograph of side view of person sat on a chair, with a resistance band around their ankle, and is attached to a piece of furniture in front of them.

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.

Photograph of person with hands on their waist squatting down to bend the knee a little

Photograph of side view of person with hands on their waist squatting down to bend the knee a little

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.

Photograph of person with hands on their waist keeping one leg straight and raising the other at the knee

Photograph of side view of person with hands on their waist keeping one leg straight and raising the other at the knee

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.

Photograph of person stood with one leg on an unstable surface, and their other leg raised with their arms out for balance

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.

Photograph of person stood with one leg on a trampette, and their other leg raised with their arms out for balance

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.

Photograph of side view of person with their hands on their waist gently squatting on a 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.

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.

Photograph of side view of person on one knee, with their other leg up in a lunge, and their foot on an unstable surface

Photograph of person on one knee, with their other leg up in a lunge, and their foot on 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.

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.

Photograph of side view of person laid on their back, with their legs raised on a gym ball, keeping their ankles, bottom and shoulders in a straight line

Photograph of side view of person laid on their feet raised on a gym ball, keeping their knees above their hips

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.

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Disclaimer

Please note this is a generic information sheet relating to care at Sheffield Children’s. The details in this resource may not necessarily reflect treatment at other hospitals. This information is not intended as a substitute for professional medical care. Always follow your healthcare professionals’ instructions. If this resource relates to medicines, please read it alongside the medicine manufacturer’s patient information leaflet. If you have specific questions about how this resource relates to your child, please ask your doctor.

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United Kingdom

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