4 Weeks After ACL Surgery – Quad Atrophy and Lost Weight

At the 1 month after ACL surgery mark I have finally been cleared to return to work. Although I felt like I could have returned much sooner and was walking after acl surgery the doctor/physio thought it best to wait the standard 4-6 week return to work time frame. Historically I generally return to things to quickly and hence why I had a second ACL surgery so I am glad I have listened to them this time. My quad atrophy has stopped and believe I am putting some density back into my thigh muscle and was surprised that I have lost weight after acl surgery.

Lose Weight After ACL Surgery

Lose Weight After ACL Surgery

Lose Weight After ACL Surgery

Since my range of motion is pretty much full there aren’t many easily measured recovery goals, however, I still feel like there has been good progress this week. One surprising piece of news was my weight, I figured with me not doing much and eating a lot of turkey I thought I would have packed on a few pounds, however I guess that was off set by my leg loosing some density and the net result is I am lost 5 pounds after ACL surgery.

I continue to be impressed with my physio who promotes some really great exercises which he always tries and ties balance into any strength exercise.

Quad Atrophy

Quad Atrophy

Quad Atrophy - Week 4

In hind-site I wish I had tracked my quad size each week, right now my circumference is a ½” smaller on my right leg. The difference is now less than what it was when it was at its most prominent approx weeks 1.5-2.5. Time to do some more quad sets and other quad exercises to close the gap.

4 Weeks After ACL Surgery

Goal – 0 degree,
Actual – 0 degrees

Goal – 120 degrees
Actual – Full Range of Motion approx. 140 degrees – quad is being stretched and not knee.

Driving after ACL SurgeryPain
Goal – Driving to work 15 minutes
Actual – successful – Drove 3hr home from family at the start of the week

Strength and Balance
Goal – Exercises continue to increase in intensity
Actual – actual – Physio has had me doing hamstring exercises on swiss ball which was definitely difficult and I feel the next day.

Areas for improvement…I can walk much faster when I limp then when I take my time and dont limp. At work it can be fast paced and I found myself cheating and limping to walk faster, I need to focus on walking without a limp at whatever speed is right for me.

Anyone have any good quad exercises or tips on improving walking speed without limping?

The Top 5 At Home Exercises
I did that helped get me walking 4 days after surgery

Click Here to see the exercises


  1. Jon Haver says:

    Anyone have any good quad exercises or tips on improving walking speed without limping?

  2. Hey dude it’s me again. It’s been a month after my surgery and I just started walking to school. Is it normal if it feels weird while I walk? And it’s still hard going up and down the stairs? And it feels wobbly when you walk?

  3. Jon Haver says:

    Migs…glad to hear you are walking…yah its normal for the knee to feel weird. Mine does. With the “wobbly” feel do some more balance exercises such as standing on your injured leg and shutting your eyes. Make sure to be close to something to help you balance yourself if you start to fall over. Keep us posted on your progress!

  4. I am having ACL reconstruction surgery on Feb 1st. My wife was offered a job in Ca and would require us to move cross country (we live in Va) less than 5 weeks later. Do you think a cross country trip will be difficult? I’m trying to decide how to get there and I’d love to do the drive, broken up into small segments, but if I had to I could fly

  5. Jon Haver says:

    Bill, as long as you arent doing any lifting I dont see it being a problem. You may have some difficulty with having to stop frequently so your leg doesn’t get too sore. At the 5 week mark the swelling should be at a minimum and you will be walking without too much of a problem. Again, no lifting though because the ACL ligament is actually at its weakest around the 6 week mark. After which it will finally start to get blood circulation through it.

    Hope the surgery went well and good luck with the move!

  6. Hi Jon!
    Thanks so much for posting all of this info, it has been very helpful for my recovery!
    I am 4 weeks post op acl/hamstring graft, and I’m wondering your opinion about using an elliptical cross trainer at this point. I have used one twice so far, adjusting the settings to not use the hamstrings…. any thoughts on this? I am anxious to resume activity, but weary of jumping the gun…
    Thanks again,

  7. Jon Haver says:

    Ellipticals are great…start slow and see if you have any pain. My wife has one in our basement and I have been using it occasionally for recovery. Can I ask a question though…why did you adjust it to not work your hamstring? You should be working your hamstring at this stage in your recovery it is one of the weakest muscles now and one of the most important in your recovery. Ask your physio but I recommend using the elliptical and working your hamstrings.

  8. Hillary says:

    Thanks for the quick reply and the advice Jon! It seems I am gathering all of my recovery advice mostly from the internet and my physical therapist. I keep finding over and over that since I used my own hamstring, that I shouldn’t be doing any hamstring stretching or strengthening for 6 weeks. I do find this discouraging, but don’t want to damage or set back my recovery. I’m also thinking of discontinuing PT (due to finances) and doing my own therapy at this point…any thoughts on that?

  9. Hi All

    I had my op about 6 weeks ago and still have massive swelling above not below the knee is this normal …. no how long til i can play football !!!!!!!

  10. Having ACL, MCL, Meniscus repair in 2 weeks. Wondering what the recovery will be like/how fast it will be before I can walk/drive and return to work. I am a first grade teacher and on my feet pretty much 99% of my day…also have kids of my own. Very nervous also about pain management post-op. I need some advice. Hope someone can offer some. Thanks!

  11. Hi Jon,
    Thanks again for your excellent blog. Not only is the information very helpful, it’s emotionally helpful to read about what other people are going through. We all know how frustrating it is to not be able to do the activities we love to do. Anyway, I was wondering if you or your readers were still experiencing pain at the four week mark? During the day I feel fine, but at night I always wake up with pain. Also, in the morning it takes about an hour after waking for the pain to subside. Can anyone else share their experience?
    P.S. Like you, I had the hamstring graft.

  12. Rene,

    I am post 5 weeks from my acl surgery. I can relate to your problems usually at night my knee aches and in the morning it’s really tight and sore for the first few hours. Do you experience sharp pains at all in your knee? I’ve been busy with pt but not sure if my pains from the workouts or if something is wrong. My pt says my new Acl is bulletproof, but something doesn’t feel quite right.

  13. Hi! I am in my 5th week post ACL recovery too. It does feel weird walking, I need to think about it! But each day there is more improvement. I ride my trainer bike for 40-50 minutes a day with resistance and do all the exercises prescribed by PT. it’s been quite the journey since I am an avid cyclist and runner, and now I am reduced to the trainer and floor exercises for awhile. I suggest stretching a lot, I forgot to do that and it was really painful!!! Good luck to everyone!

  14. I had an ACL surgery on 18th of December 2011 near New Delhi, India. Consulted a number of Surgeons/Hospitals and finalized a surgeon who had a reasonable experience (~ 100 surgeries) & exuded the confidence I was looking for. One month down the line, I am quite satisfied with my decision. I visited his clinic daily for the first three weeks post surgery. (Physiotherapy started on the fourth day itself)

    Surgery details:
    Date:18th Dec’11
    Duration: 3 Hrs
    Graft: Auto graft, Hamstring
    Surgery type: Arthroscopic.
    Post surgery: After crap bandaging, braces+ Walker.(bed rest for 2 days)
    Cost: 1500 USD cumulative. (In India, costs of the surgery + hospitalization + Physiotherapy range from 1300 USD -4500 USD)

    Today’s update(19th Jan’12):
    Knee extension: 0%
    Knee flexion: ~150 degrees
    Quad strength ~ 75%
    Hamstring strength~ 50% (Working on developing strength through isometric exercises)
    I feel like I can walk without support. However, waiting for the docs clearance (Might get in a week) before getting adventurous.
    Since yesterday, I am able to drive upto 2 hours in a day(45 mins continuously). Might be able to stretch more.

    Key Takeout from my experience: Physiotherapy is as important as the Surgery!!! I started strengthening my knee even a month before my surgery.

    For more details, you can contact me personally on my e-mail ID : ajaynair_virgo@yahoo.com

  15. I find it interesting that 5 days post-op you are walking around without your knee immobilizer on. All the rehab protocols that I am aware of have the patient wearing their knee immobilizer at all times (except when lying in bed or showering) for the first 6-8 weeks. This includes sleeping in it. Why are you taking unnecessary risks especially considering this was your 2nd ACL repair.