ACL Recovery: When to Start Training After Surgery
One of the most common questions we hear from parents and athletes recovering from an ACL injury is:
“When can I start training again?”
It’s a fair question—and an important one. But before diving into timelines, it’s crucial to understand that full recovery from ACL surgery is a long, non-linear process. Progress can be frustrating at times. There may be setbacks, plateaus, and moments of doubt. That’s completely normal. The good news? With consistent, high-quality training and guidance, recovery is not only possible—it can often lead to a stronger, more resilient athlete.
ACL Surgery: A Second Injury
Athletes who undergo ACL surgery must understand that they’re essentially experiencing a second injury—one from the initial ligament tear and another from the surgical repair. This naturally extends the timeline for recovery. However, it also sets the stage for better long-term outcomes.
The human body is an incredibly adaptable organism. It often “remembers” the high levels of coordination, mobility, and athleticism it once had. With the correct inputs, the body regains those capabilities.
Early-Stage Rehab: The Role of Physical Therapy
In the first few weeks post-surgery, care is typically directed by a physical therapist. Their main goals during this phase are to:
● Reduce pain and swelling
● Restore normal knee range of motion (flexion and extension)
● Re-establish proper gait (learning to walk normally again)
This initial recovery window is vital. But contrary to common belief, the return-to-play protocol doesn’t have to wait for months. In fact, one of the keys to successful rehabilitation is to begin training before surgery and return to training as early as safely possible afterward.
When Can You Start Training?
Simple rule:
Once you can walk without crutches and bear weight evenly on both legs, you’re ready. There are safe training methods that you can perform to stay fit and accelerate the recovery process.
Here’s how:
Safe Training Options After ACL Surgery
1. Static Lower Body Strength Training w/ Restricted Range of Motion
Examples include exercises like RDLs, kettlebell swings, and high box squats. These exercises are safe because they are executed with both feet on the ground and within ranges of motion that safely load the muscle tissue without placing the injury site at risk. They also groove movement patterns that will be heavily loaded later in the rehab process.
2. Upper Body Weight Training
Since the lower body cannot be loaded heavily at this point, it is necessary to maintain a strength stimulus through upper body exercises. Strength training—even targeted upper body training—causes hormonal adaptations in the body, such as increased growth hormone and testosterone levels, which promote recovery, injury healing, and the maintenance of athletic qualities through neuromuscular stimulation. The exercise menu includes staple bodybuilding movements like overhead presses, bench presses, rows, pulldowns, and other arm and torso training. As a coach, it is necessary and important to lift from standing positions if tolerable, but ensure there is no risk of excessive weight bearing or falling onto the surgically repaired leg.
3. Plyometric Activities on the Healthy Leg
Jumping and plyometric exercises are fair game on the healthy leg. Early training and restoration of athletic qualities are necessary in the healthy leg to prevent detraining and to prime the nervous system for skill acquisition later in the rehab process, when both legs can be used equally. In our experience, some athletes perform so much targeted rehab and strength training on the injured leg that the healthy leg falls behind in strength and reactivity. As coaches, we must implement plyometrics early and often to keep the body primed for explosive activities. The same rules as upper body lifting apply—ensure the athlete can safely perform jumps and hops without accidentally falling or placing excessive force through the surgically repaired leg. Some example exercises include two legged vertical jumps and hop variations.
4. Assisted or Low-Intensity Plyometric Activities on the Surgically Repaired Leg
This is an incredibly important option and should be carefully applied under the watchful eye of an experienced coach. One of the overarching objectives and key milestones in ACL rehab is return to running. Running forms the basis for most sport-specific actions, and exercises like pogo jumps, assisted hops, and skipping are critical to restore the natural elastic qualities of the foot, ankle, knee, and hip in preparation for running. These movements are safe and necessary to deploy in a controlled environment as long as techniques and loads are monitored closely. Constant communication between the coach and athlete is vital to make adjustments if the athlete is responding well—or poorly. This element of the program is one of the most important, as static lifts and low-intensity physical therapy exercises are insufficient to mimic the forces and contraction speeds of sprinting, jumping, and changing direction that characterize sport.
5. Isometrics
Isometrics are exercises that require intense muscular contractions without producing movement. Because the knee (or leg in general) will not be moving through a range of motion, these exercises are relatively safe. Isometric exercises like split squat, calf raise, and hamstring bridges build tissue tolerance through longer duration holds in specific positions that help prepare the athlete’s body for more intense stressors later in the program. They are also effective for training co-contractions, which integrate the foot, calf, quad, and hamstring musculature in patterns that apply directly to walking, running, and sprinting. Lastly, isometrics build tendon strength and resilience—just as important as muscular strength—and may reduce the risk of developing Achilles or patellar tendon pain as a result of increased training demands.
Final Thoughts
Recovery from ACL surgery is long and tough—but it’s also an opportunity to overcome adversity. The early stage of ACL reconditioning is about restoring function to get back to intense training. The middle and late stages of ACL recovery are about training intelligently at intensities that prepare you to sprint, jump, land, and change direction. Ultimately, what we are able to do in training is what we will be able to do in competition. With a strategic approach that targets speed, plyometrics, strength and movement quality, athletes can continuously progress performance and build momentum for the next phase of their comeback.
