Physical Therapy for an ACL Injury

In the eyes of many young athletes, no situation can be more hopeless than a knee injury that requires surgical repair. It may feel career-ending to some athletes, even those who have multiple sports seasons left on the horizon.

Luckily, in most cases, this does not have to be the case. With timely intervention, and teamwork between a surgeon, physical therapist, and athletic trainer, many athletes are able to safely return to sports within six to nine months.

What to Expect Before Surgery

Immediately before surgery most patients will be visited by a physical therapist in their room. The therapist will teach them how to walk with crutches, how much weight they can put through their leg, and how to use their knee brace.

Additionally, the physical therapist will review a handful of exercises that can be started the day after surgery! This is surprising to most patients, but it is safe and often strongly recommended to begin working on gentle range of motion and quadriceps muscle activation exercises almost immediately.

What to Expect After Surgery

Anywhere from 10 to 14 days after surgery, patients will begin formal physical therapy which will continue at two times per week for, at least, the next three months. In these beginning stages, patients will be weaned from their crutches and brace, utilize electrical stimulation for re-educating their muscles, and perform range of motion and strengthening exercises in order to perform typical school and home activities.

Because ACL protocol is a combination of time-based and criteria-based progressions, it is crucial during these early stages for each patient to work on their home exercise program in order to avoid falling behind.

What to Expect Long-Term

Three months after surgery patients become candidates to transition into Functional Rehabilitation. Whether that is formal Functional Rehab with Sports Medicine athletic trainer, or continued physical therapy, this phase will mark the beginning of sports specific training. At this point, in a controlled environment, the athlete can begin to work on running, cutting, and jumping activities that are specific to their chosen activity. This phase is very important for athletes planning to return to sport, as it allows them to get comfortable with higher level activities while they continue to heal.

Once a patient is released to return to sport by their surgeon, they must also pass a series of tests by their physical therapist or athletic trainer. One of these tests is the hop test, which takes the athlete through a series of three jumping tasks which get progressively harder with each level. In order to be discharged, a patient must achieve a certain level of limb symmetry when comparing their operative limb with their healthy limb.

Our team has successfully returned athletes to nearly any sport imaginable, from horseback riding, to competitive cheer-leading, and even football and other contact sports! For more information on Nationwide Children’s Sports Medicine Physical Therapy download our free Parent’s Guide to Knee Injuries.


Mindy Galleher, PT, DPT
Mindy Galleher, PT, DPT, graduated from the University of Cincinnati DPT program in 2015. Immediately following graduate school, she began a one-year Sports and Orthopedic Physical Therapy Residency here at Nationwide Children’s. Following the completion of the residency, she plans to sit for, and obtain, her Orthopedic Specialist Certification.

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