I love reading your website! I'm getting my Master's in Exercise Physiology, but I'd say the majority of the "real world" lifting information has come from your website and other coaches you recommend. I had ACL surgery Dec. 15th of last year with the patella tendon replacing the torn ACL. I was just wanting to know your protocol or favorite exercises that you've found to be beneficial for ACL rehabilitation. I would really value your insight and experience on this topic. Oh yea, thanks for the Super Strength DVD and the Defranco bars, absolutely amazing!
Thanks for your contribution to strength and conditioning,
I want to preface my answer by saying that I am NOT a physical therapist. My experience with ACL rehab has been during the “post” rehab phase and thereafter. By “post-rehab” I am referring to the initial stages of training after the surgeon and physical therapists have cleared the athlete to resume “normal” training. You should be in this phase right now, but I just wanted to make sure your doctor has cleared you.
O.K., now that I’m done with my little disclaimer, let me give you my “Fab 5” ACL “post-rehab” exercises. There are obviously a LOT more than 5 exercises that can help strengthen your knee, but these are my “best of the best.” I chose these exercises because I have seen them work in the real world time and time again after ACL surgery. Here ya’ go…
#1 – Terminal Knee Extensions (TKE’s)
It still baffles me that this exercise isn’t more “mainstream” in the rehab setting. This closed chain exercise is FAR superior to the much more popular leg extension.
To perform a TKE, you must first wrap a band around a power rack or another stable object at knee height. Wrap the other end of the band around your knee. Walk back so that the band is pulling at the back of your knee. With your heel on the floor, bend and flex your knee. When you flex, make sure to contract your quad as tight as you can for a one or two count. Perform 15-20 reps for 2-3 sets each leg. This is a GREAT warm-up exercise to perform on lower body days if your knees tend to bother you when squatting. It is amazing how this exercise almost magically reduces knee pain when you perform it before squatting. Give it a try whether you’re recovering from ACL surgery or not!
Foot remains flat on ground as the knee bends
Keep foot flat on ground as you straighten your leg and flex your quad hard
#2 – Box Squats
When performed properly, box squats place very little stress on the ACL and patella tendon and they are a great hamstring strengthener (which is important because the hamstrings help stabilize the knee).
I’ve recently started loading the box squat a little differently with my “post ACL” athletes. Once they are able to box squat an empty bar with no pain, I add chain weight before adding regular weight plates to the bar. This is because most athletes coming off of ACL surgery have a hard time “getting out of the hole” with regular weight on the bar when they are squatting. By starting with chain weight, the athlete is able to get off of the box easier because most of the chain is deloaded on the floor; then the chains unravel off of the floor and add more resistance at the top (where the athlete is much stronger and has less pain.) Using the chains in this manner is a great way to help overload the athlete in a safe way after surgery. As the athlete gets healthier and stronger, the goal is to decrease the chain weight and increase the bar weight.
#3 – Backward Sled Drags
This is one of the all-time great exercises for strengthening the vastus medialis and it places very little stress on the joints. It will also help get your ass back in shape! Simply face your sled, grab the rope, turn your toes slightly outward and walk backwards using short, quick steps.
#4 – Upright sled walks
Attach the rope from a sled around a weight belt and simply walk with an upright posture. This is a great hamstring and glute strengthener and it places almost no stress on your joints. Great when you’re recovering from surgery!
#5 – Step-ups
Anyone that reads my website knows that my 3 favorite unilateral movements are step-ups, Bulgarian split squats and reverse lunges. I start my ACL post-op athletes with step-ups because they tend to put the least amount of stress on their knee compared to the other 2 movements. We start with bodyweight then progress to a weighted vest. After step-ups become pain-free, we move onto Bulgarian split squats and then reverse lunges would be the final exercise in the progression.
**Just to clarify, the above exercises are my favorite strength exercises for post-op ACL athletes. Once you get your strength back, make sure to progress to more challenging tasks, i.e., landing drills, jumping drills, and most importantly, speed/”agility” drills that do not have a predetermined outcome.
Best of luck.