8 Best Exercises to Rehab a Torn ACL Without Surgery

What is the Anterior Cruciate Ligament (ACL)?

The ACL is a ligament that resides deep inside the knee joint. Along with the Posterior Cruciate Ligament (PCL), the Lateral Collateral Ligament (LCL), and the Medial Collateral Ligament (MCL), the ACL helps to provide stability to the knee when walking, running, and jumping.

How is the ACL injured?

ACL injuries can occur in one of three ways:

1. ACL Sprain

   • An ACL sprain occurs when the ACL is overstretched to the point where it becomes damaged. Inflammation (swelling), stiffness, and knee pain will occur as the repair process begins. Once the ligament is excessively stretched, it will permanently stay stretched out. It will not retract back to its original length, which can lead to knee instability for some. However, with the right ACL tear/sprain exercises, most people can successfully rehabilitate back to high-level function without further issue.

2. ACL Tear

   • An ACL tear occurs when the force that is placed upon the ACL is too great for it to handle that it fully or partially ruptures. A full-thickness ACL tear is usually accompanied by an audible popping sound and/or sensation within the knee along with instantaneous knee pain. ACL tears usually result in a large amount of knee swelling and stiffness soon after the injury. The individual may or may not be able to walk immediately after this type of knee injury.

3. Multi-Ligamentous Injury

   • Multi-ligamentous injuries in the knee joint are usually related to high impacts. These types of injuries are often witnessed in American Football and skiing.

What Activities Increase the Risk of Suffering an ACL Injury?

To be frank, participating in most sports increases your risk of suffering an ACL injury. This is due to the common occurrence of cutting maneuvers (fast changes in direction when planting on one leg) and jumping when playing sports. However, that being said there are some sports that rate higher than all others in the rates of ACL tears and ACL sprains.

1. American Football
2. Soccer
3. Basketball
4. Skiing
5. Lacrosse

Though, don’t be fooled that the only way to suffer an ACL tear is by playing sports. I have seen patients who have torn their ACLs jumping up to give someone a high five, trip and fall while out walking their dog, and even slipping and falling on ice.

Yes, the vast majority of ACL injuries occur in active individuals that participate in sports and other higher-intensity activities, though honestly, ACL injuries can occur to all of us if the situation parameters are just right.

First Steps – Initial Treatment After an ACL Tear

Depending on the severity of the injury (i.e. speed of the injury or collision, other potential bodily injuries, ability to immediately walk after the injury, etc.), an injury to the ACL should be treated as a serious injury until you know that no bone fractures also occurred during the injury. For this, you should visit your doctor or hospital’s emergency room to get an x-ray and an evaluation from the doctor.

Then follow the steps below:

1. Get a pair of crutches to use for walking assistance as it will help to take weight off of the injured leg until you can return to a normal walking pattern.
2. Perform RICE
   • Rest
   • Ice – Use a cold pack for 15-20 mins several times per day. I highly recommend using a high-quality gel pack like Chattanooga ColPac.

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• • Compression – Use an elastic knee sleeve or elastic bandage to help prevent swelling by gently wrapping it around the knee.

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• • Elevation – Elevate the leg frequently to allow gravity to help prevent a buildup of swelling in the leg.

1.  
2.  Perform early mobilization exercises to re-engage muscle coordination and improve knee joint mobility.

Safest Early Mobilization ACL Tear Exercises to Start

Early mobilization ACL rehab exercises can safely start soon after the ACL tear as long as there are no other additional injuries (fractures, multiple ligamentous injuries, etc.) that were also sustained.

• Heel Slides

  1. Start this exercise by lying on your back with both legs straight.
  2. Slowly begin to actively bend your injured knee by sliding your heel towards you.
  3. Pause at the point of pain or stiffness in the knee, then return to the starting position.
  4. Perform 10-15 repetitions several times per day.
  5. Initially, moving the knee will be difficult because of swelling and stiffness though this will improve gradually.

• Isometric Quad Sets

  1. Start this exercise by sitting on the floor with your injured leg straight out in front of you and your toes pointing towards the ceiling.
  2. Slowly engage your quadriceps muscles (thigh muscles) by actively pressing both knees down into the floor essentially straightening out both legs. In order to perform this movement, you should notice that your quadriceps muscles contract.
  3. Hold for 10 seconds
  4. Relax
  5. Perform 10 repetitions multiple times per day.

• Isometric Hamstring Sets

  1. Start this exercise by lying on your back on the floor.
  2. Gently bend the injured knee to approximately 45°-90°.
  3. Slowly begin to dig your heel into the floor as if you were trying to drag your body towards your foot, though do not allow any movement to occur (isometric exercise). This will activate the hamstring muscles (back of the thigh).
  4. Hold for 10 seconds
  5. Relax
  6. Perform 10 repetitions multiple times per day.

How to Identify “Copers” vs. “Non-Copers”

Research has helped to identify that some athletes can demonstrate excellent dynamic knee stability and neuromuscular control after an ACL tear without requiring ACL reconstruction surgery. We refer to these individuals as “Copers” as they can successfully return to prior levels of sports without knee instability after an ACL rupture. On the other hand, those who eventually require ACL rehabilitation to regain dynamic knee stability are referred to as “Non-Copers.”

Typical, non-athlete individuals can also be assigned to these groups as well as some people can function just fine without requiring ACL reconstruction surgery.

To determine if you may fit into the Coper category, answer the following two questions:

1. Have you had more than one episode of your knee “giving way?”
2. Do you trust your knee?

Copers will regain muscle strength, coordination, and knee stability. If you continue to experience periodic episodes of your knee giving out on you and you can not trust it, those are episodes of joint instability and you will likely require ACL reconstruction surgery to regain knee stability.

Additionally, I will state that if you are a high-level athlete, you will likely benefit from ACL reconstruction surgery because you will require a significantly higher level of dynamic knee stability than most, and the only way to truly get that back is to have the surgery along with a full physical therapy rehabilitation program afterward.

Wearing a good quality knee brace can provide improved knee joint stability during the rehabilitation phase and eventually return to sports. I highly recommend McDavid braces they are my go-to brand for quality and durability.

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Possible Downsides of Not Having ACL Reconstruction Surgery

If you have suffered a full-thickness ACL tear (you wouldn’t know this unless you have an MRI), without surgery the ACL will remain torn. The knee may heal as in the swelling and pain may stop, but a torn anterior cruciate ligament does not reattach or heal itself.

The possible downsides to not having ACL reconstruction surgery include:

1. Knee Instability
   • Without surgery, you may experience periodic episodes of knee shifting or giving way. These episodes can be reduced though by regularly performing ACL tear strengthening exercises that target the leg and hip muscles.
2. Early-Onset of Knee Arthritis
   • Without a functioning ACL, the knee will experience an increased amount of shifting and movement even if just minimally. However, over time this is likely to speed up the “wear and tear” within the joint leading to early-onset knee arthritis.
3. Reduced High-Level Activities
   • You may need to dial back participation in any higher-level activities that require a significant amount of jumping, cutting, or pivoting as this will likely cause excessive shifting in the knee.
4. Uncertainty
   • Let’s face it, no one can predict the future. By deciding not to have ACL reconstruction surgery after an ACL tear, you may or may not be able to return to your previous level of function before the injury. Either way, the following at-home ACL tear exercises without surgery are great to start to regain strength and mobility in the knee after an ACL injury.

Advanced Knee Exercises After an ACL Tear Without Surgery

Eventually, your knee swelling will be minimal and your leg muscles will be working like normal again. At this time point, you will be ready to progress to more advanced knee strengthening exercises. When this time comes, check out my “12 Best Exercises for Knee Pain Relief” article!