ACL rehab is its own thing
Generic post-surgical rehab won't get an ACL patient back to cutting sports safely. The graft has a biological maturation timeline you can't shortcut. The strength and neuromuscular control needed for change-of-direction is highly specific. And the re-injury risk if you rush back is brutal, re-rupture rates are reported around 6-8% within 2 years of surgery, climbing higher if return-to-sport criteria aren't met.
What you need is a 9-month rehab program structured around the graft healing timeline, with objective testing at every milestone. That's what we do.
The two paths into ACL rehab
You haven't had surgery yet, prehab
Pre-surgical conditioning is one of the strongest predictors of post-op outcomes. Patients who enter ACL surgery with full knee extension, good quad activation and minimal swelling reach return-to-sport benchmarks 1-2 months earlier than patients who didn't prehab. The research on this is consistent and the cost is low, typically 4-6 weeks of focused work.
What we do in prehab:
- Restore full range of motion (especially terminal knee extension, which most patients lose after the initial injury)
- Quad activation work to prevent the post-op arthrogenic muscle inhibition that delays recovery
- Manage swelling so the knee enters surgery in the best possible state
- Cardiovascular conditioning via low-impact work (bike, swim, upper-body strength) so you don't deconditioned during the immediate post-op weeks
- Education, set realistic expectations for the 9 months ahead, plan crutches/transport/work, prep the home
You've already had surgery, post-op rehab
If you've had your reconstruction, we pick up wherever you are in the timeline. We've taken patients on at week 1, week 6, month 3 and month 7, each phase needs different work.
The 9-month structured program
Weeks 0-2, Protect the graft, reduce swelling
The graft is at its most vulnerable in this window. Focus is on swelling management, restoring full knee extension, gentle range of motion progression, gait retraining on crutches, and quad activation (the quad shuts off after surgery, getting it firing again is critical).
Weeks 2-6, Full weight-bearing, range of motion goals
Off crutches per your surgeon's protocol, full knee extension restored, working towards 120° of flexion. Begin closed-chain strength work (mini squats, leg press, step-ups), continue quad and glute strengthening, start hip and core conditioning. Stationary bike from week 4.
Months 2-3, Strength phase begins
Real loading begins. Progressive squats, deadlifts, single-leg strength work. Pool jogging from month 2 (if available). Begin lateral movement progressions (sidesteps, lateral lunges, low-intensity agility).
Months 3-5, Running progression
Straight-line running typically returns around month 4 once strength benchmarks are hit. We start with treadmill running on a graded protocol (timing, speed, surface). Continue heavy strength work, at this stage gym strength should be approaching or exceeding pre-injury levels.
Months 5-7, Plyometrics and change of direction
Once running is established, we layer in jumping and landing mechanics, deceleration training, planned change-of-direction drills, sport-specific movements. This phase is where most patients want to rush, and where reinjury risk is highest if you do.
Months 7-9, Return-to-sport testing and clearance
Objective testing battery before sport clearance:
- Handheld dynamometer strength testing, quad and hamstring symmetry between operated and non-operated leg (target: 90%+)
- Single-leg hop tests (single hop, triple hop, crossover hop, 6m timed hop), symmetry to non-operated leg
- Y-balance test, dynamic balance and neuromuscular control
- Sport-specific movement screen, actual cuts, jumps, pivots at game-realistic intensity
If you meet the criteria, you get clearance. If you don't, we extend rehab until you do. Most patients hit the criteria between months 9-12, some take longer, and that's fine. The data is what matters, not the calendar.
"Pain-free at rest" is not the same as "ready to compete". The objective testing is what separates a confident return-to-sport from a re-rupture.
Working with your orthopaedic surgeon
ACL rehab is a team sport. We communicate with your surgeon throughout, sending progress reports at key milestones (6 weeks, 3 months, 6 months, 9 months), flagging concerns early, and following the specific post-op protocol your surgeon prefers based on graft type (patellar tendon, hamstring, quad tendon, allograft) and any concurrent surgeries (meniscus repair, MCL, etc.).
If you don't have a surgeon yet, we can recommend orthopaedic surgeons we work with regularly across Sydney. Your GP can write the referral.
What we treat under "ACL"
- ACL reconstruction post-op (all graft types)
- ACL injury awaiting surgery (prehab)
- ACL injury managed non-surgically (rare but valid in specific cases)
- Multi-ligament knee injuries (ACL + MCL, ACL + meniscus, ACL + PCL)
- Revision ACL reconstruction (second-time ACLs)
- Contralateral ACL injury (the other knee, after a previous ACL)
What it costs
ACL rehab is covered by private health insurance physiotherapy extras (we run HICAPS on the spot so you only pay the gap), Medicare CDM plans (with a GP referral), workers compensation if the injury was work-related, and CTP insurance if it was a motor vehicle accident.
Out-of-pocket gap depends on your fund. Total session count varies but typically falls in the 30-50 session range across the 9 months, front-loaded in the first 12 weeks, spreading to fortnightly and then monthly as you progress.
Areas we serve
Our clinic is on Hume Highway in Liverpool, NSW 2170. We see ACL rehab patients from Liverpool, Casula, Holsworthy, Moorebank, Chipping Norton, Cabramatta, Gregory Hills, Narellan, Hoxton Park, Green Valley, and the wider South-West Sydney region.
Common questions
I haven't had surgery yet, can you help?
Absolutely. Prehab is one of the best things you can do for your post-op outcome. Start as soon as the initial swelling settles, typically 2-3 weeks after the injury.
My surgeon gave me a generic exercise sheet. Do I still need physio?
Yes. Exercise sheets cover the basics but don't progress your loading, can't test your strength symmetry, and can't decide when you're ready for the next phase. ACL rehab needs progression decisions made on objective data, every few weeks.
What if I miss a phase milestone?
We extend that phase until you meet it. Skipping ahead is the single most common cause of re-rupture. Your surgeon will back this up.
Can I still play sport during rehab?
Not your usual sport. But there's almost always something, straight-line running from month 4, swimming much earlier, cycling, gym work, upper-body strength training. We'll help you stay active without compromising the knee.
Book your ACL assessment in Liverpool
Whether you're pre-surgery, just out of theatre, or stuck mid-rehab elsewhere, we'll meet you wherever you are. Initial 60-minute assessment to map your timeline, set objective targets, and build the plan. Same-week availability.
