• Emma B

Rehabilitation phases to expect whilst dealing with an ACL injury

Anterior Cruciate Ligament (ACL) tears are one of the most common injuries to occur whilst playing sports or during daily life. There is reason to believe that females are more prone to this injury than males, which you can read more about through the link to a previous blog. Typically, a weak muscular structure to the hamstrings and gluteal muscles are a factor into why people can get an ACL injury.

The most common cause of an ACL injury:

- Stopping suddenly

- Change of directions suddenly

- Landing incorrectly from a jump

- Having a collision, like a football tackle



What are the types of tears?


You should always seek medical advice if you believe you have torn your ACL, to discover which one you may have an MRI will be able to do this easily and quickly. There are three grades to a ligament injury:

Grade one: A mild ligament tear

Grade two: A moderate ligament tear

Grade three: A complete tear or a full rupture

A medical professional will be able to differentiate between these grades based on your weight-bearing abilities and pain levels. If a grade three rupture occurs surgery will be needed to repair the damaged ligament, in which MSKdoctors will be able to see you through each stage of surgery and rehabilitation with the skilled team of staff available.


Acute phase


When the injury has occurred the protocol to follow is the POLICE procedure. This is an updated version of RICE which includes added steps which can progress and improve your rehabilitation time when the injury has occurred.

- Protection: avoid further damage by using crutches while still trying to engage in daily tasks. This can also mean completing the appropriate amount of rest to heal the injury.

- Optimal Loading: this will stimulate the healing processes. Using crutches or help, start to put weight through the injured ankle, but not too much to re-injure. The right amount of activity will reduce swelling.

- Ice: applying ice to the injured ankle can help reduce swelling and pain. Ice should be applied for 15-20 minutes at a time, several times a day.

- Compression: wrapping the ankle with an elastic bandage can help reduce swelling.

- Elevation: keeping the injured ankle elevated above the level of the heart can also help reduce swelling.

If a full rupture has occurred, typically wait time before surgery commences is two to three weeks to allow for any swelling to reduce and for pre-rehabilitation to occur, such as optimal loading and small movements. This means there is a higher likelihood of successful surgery and easy rehabilitation afterwards.


Sub-acute phase


Next, is the subacute phase, which is once swelling, and pain levels have reduced where more movement can occur. It usually lasts for 4-6 weeks and involves a variety of different therapies and exercises.

These include trying to increase the joint range of motion and focusing on muscle conditioning. For example, isometric exercises (contraction of the muscle, no movement) which may be performed and submaximal isometric exercises to maintain neuromuscular function at a low enough intensity where the collagen fibres are not disrupted.

Isotonic exercises (movement that requires the muscles to resist weight), this could include weight bearing exercises, resistance bands or weight-stack machines.

There also may be exercises to help neuromuscular control involved. These are exercises performed on unstable surfaces like wobble boards or trampolines.

Some examples:

- Knee hangs

- Heel slides

- Wall slide


Late-stage rehabilitation


Late-stage rehabilitation for an ACL injury usually includes a combination of exercises to improve balance, proprioception, and coordination. The goal of this phase is to help patients regain confidence in their ankle and prepare them for a safe return to their previous level of activity. Some examples of exercises:

- Single leg squat

- Step down

- Double leg squat

- Proprioception exercises


To conclude, an ACL injury is once that can occur very often due to factors that many of the population suffer with, such as weak glutes and hamstrings, joint laxity and over-dominant quadriceps. There are three phases to be aware of when going though rehabilitation and is important to work through each stage reaching the goals that are set out for you.

If you need surgery or are unsure about the pain you may be experiencing in your knees, contact MSKdoctors for an appointment or MRI scan.

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