Why Physical Therapy Before ACL Surgery Is Important

Should I go to physical therapy before my ACL reconstruction surgery? This is a question I have been asked a lot. When we have torn our ACLs and are preparing for surgery we wonder if it would be beneficial to go to physical therapy before the knee surgery. Common sense may lead us to believe that there is no ACL surgery rehab that can be done if we are yet to have the surgery. For me, I did go to physio and am glad that I did, here is why…

The simple answer is that the stronger your leg is before surgery the stronger your leg will be after surgery and the quicker your recovery will be. I believe the work I put in before at physio and the gym certainly helped in my recovery so far.

There are several knee exercises you can start doing before surgery which will limit the amount of quad atrophy you experience. The exercises I focused on included…

1. Leg Extensions

2. Squats(body weight and weighted)

3. Hamstring Curls(especially important if you will be using your hamstring as a graft)

4. Biking – I did a lot of biking because it was easy on my knees and helped me build strength in my leg and maintain a reasonable(not exactly ideal) level of fitness.

The Most Important Physical Therapy Exercise Before ACL Surgery…


Balance exercises before ACL surgery are the most important to your ACL surgery rehab since you have likely been favouring your injured knee for awhile now. By favouring your injured knee you will have limited the amount of balance work it has needed to be doing and therefore the small muscles responsible for fine tuning balance will have already started to atrophy.

Some balance exercises you can be doing include

a. Standing on one leg. If this is too easy shut your eyes and hold for 30 seconds.

b. 747’s You do these by standing on your injured leg and bending over with your arms out, back flat and holding a “flying” position like a 747. Dont worry I didn’t make the name up.

Pre ACL Surgery 747 Balance Exercise

Pre ACL Surgery 747 Balance Exercise

c. Balance boards. Standing on any surface that requires you to put effort in to remain balance will help improve your ability to balance before the surgery.

d. Yoga? I have never done yoga but I would imagine any yoga exercises you can do before surgery that involve strength/balance around the knee would be helpful. Some people have told me that yoga can help prevent knee pain as well. I am yet to try it out.

Any balance exercises that can be done before surgery will help to improve your recovery time.

In my opinion don’t wait until surgery to start your recovery. Focus on strengthening all muscles around your knee without forgetting your hamstrings and the smaller muscles used for balance.

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, thanks for doing this blog. It is a really helpful resource.

    I tore my ACL playing soccer a week ago (first time I’ve had this injury), and I’m in the pre-hab stage right now getting swelling down and ROM up.

    Looking forward to following your progress.

  2. Sorry to hear about you injury, good luck with the surgery. Have you decided on a surgeon or what graft you will have?

  3. I’m meeting a surgeon in 8 days, and I’m doing my homework in the meantime (research, etc). My preference would be autograft patella, will be interesting if he thinks that is a good choice given my desire to return to things like Olympic lifting (clean and jerk, etc).

  4. Jen Smith says:

    WHat about a level three tear in the MCL which is not operable and just needs to heal.
    Do you think I can cycle before my ACL surgery?
    I tried today and noticed pain in MCL uphills.

  5. Jon Haver says:

    Depending on how stable your knee is before surgery you can do a lot of things. You can definitely cycle…if you felt like there was pain(not just discomfort) going up hills take it easy on the hills.

  6. Debbie C says:

    Yoga has been good for me since I tore apart my ACL a month ago. I’ve not been practicing yoga much since the injury, but what I had was un upper hand on strength and flexibility. I haven’t lost much muscle mass and almost no strength despite hobbling around and still not having complete flexion/extension (one end of my ACL flung itself into my knee joint acting like an meniscus tear). I’m a complete Yoga advocate!!!

  7. Thanks for all the great info!

    I tore my ACL last Sunday (so its been just over a week) and I am scheduled to go in for surgery in a few weeks. I have been having incredible calf cramps on my injured leg. Did anyone else experience this? Its so painful and now the muscles are so sore that I cant even really extend and flex my foot, let alone try to walk normally or even bike.

    I see that I am supposed to be strengthening but I cant even walk. Help! I do have the advantage of being a marathoner (in fact I finished a marathon about a week before this ski accident) and practiced yoga a few times a week. So, I am pretty strong and fit going into this and want to be able to maintain some semblance of fitness during this ordeal.

    Also, am I supposed to still be elevating and icing? I have been and I am wondering if that could be the problem.

    Thanks for any info you can give me.

  8. Jon Haver says:

    Ilana…stop working out you are making us all look bad…marathon etc!…joking. I never had surgery so quickly after my tears so I cant say from experience but I would imagine in your case getting the swelling down will be more important than getting your already very in shape legs into better shape. Once you get the swelling under control any kind of movement and weight bearing you can do on the leg may help minimize quad atrophy before the surgery and make for a speedier recovery.

    Good luck with your recovery and I hope you are back to running shortly!

  9. Turns out it was a blood clot causing my calf cramps. Just a warning to all you ACL patients, incredible calf cramping is not normal! I called my on-call doc when they first started over a week ago and he told me it was normal and to just fight through the pain.

    Well, 4 or 5 days and immense amount of pain later, I had trouble breathing and side pain. We went to the ER and they did an ultrasound and sure enough, a blood clot had formed in the lower leg and then a piece broke off and traveled up to my lungs.

    I dont mean to be freaking people out but go get checked out if something doesnt seem right. I wish I would have gone in several days before I did.

    Now, I am on blood thinners, havent moved off my couch in three days, have dreaded getting up to use the bathroom and my surgery will most likely be postponed.

    Yuck! Dont let this happen to you!

    Thanks again for your support and encouragement!

  10. i am 1 month before getting surgery. i have been playing tennis and it fels great. it has been over a month since i have injured it so i am anxious to get it done. they will be using the hamstring graft. i am going in for physio next week so we shall see whats up then 😀

  11. hey guys just a couple of quick questions… i am a raft guide and ski patroller who has just completely torn my ACL MCL and medical meniscus. I was hoping to push surgery along as I want to be able to ski this winter but things are not looking good.

    Although it is great to hear that people are up and able to do things athletic much like ILANA I am just hobbling around mostly. I am just trying to get up to 120 degrees of rotation (I am currently at 30 degrees) I am searching for distinct exercises that increase knee rotation for people who have very little currently. Any help would be greatly appreciated

    Also.. if anyone can settle my fears and tell me how long after their surgery they where on skis again that would be great!!

  12. Jon Haver says:

    Meg…on my first surgery I tore my ACL in September and skied all winter then had surgery the next Aug(very end) and skied all winter. My motivators for the timing was 1. university and 2. Skiing. However, on my second surgery I had it early December and decided to pass on skiing all winter, even at the 4 month mark because of the amount of slush that I would experience spring skiing.

    To help with the range of motion here are some good exercises…http://www.aclsurgeryrecovery.net/23/top-5-knee-range-of-motion-exercises-to-do-during-acl-surgery-recovery/

  13. I do regret not doing hamstring curls before surgery. In fact, I wasnt doing much exercise at all the year prior to the surgery thanks to the acl tear. Now i always wonder if i could have had a stronger graft. I think many were not well informed about this. Nice article, cheers.

  14. I was told I tore my Left ACL on July 22 2011 and saw the doc that Tues. and my MRI is scheduled for Aug. 23 so hopefully that is really the problem. Right now the swelling has gone down alot, and there is like a band of swelling around the kneecap still, i can sit on the couch fine with my knee bent and still have a lot of pain at night. My calf muscle is no longer as tight as it was so I can put weight on my leg and I tried walking on it yesterday but my knee still felt weak like buckling. And I may have created more pain doing it. i wear no knee brace, Im still on crutches but should I be walking by now? I start college on the 22nd, I would really love to be walking by then I don’t wanna crutch it all around campus. My husband wants me to take it easy I dont wann force it and reinjure anything that is there, but I feel like my recovery is slow. I just want to know if I should be walking by now.

  15. My surgery is in 11 days. I have put it off for 23 years. If you can longer, do it! I had my knee scoped 23 years ago and it helped a lot! I have been on ski patrol, water skiing every summer, hiking, completing triatholons. “Keep your hamstring and quads strong” thats what my doctor said and he was right. Last summer it finally dislocated while doing box jump-ups and it now hurts to kick swimming. I still have not made up my mind about the graft, any suggestions?

  16. I injured my knee almost two months ago. I am in the army, so the ‘doc’ that I saw said he thought it was a minor meniscus tear, gave me motrin and told me to take it easy. After a few weeks of severe pain I went to see a physical therapist, who pretty much agreed with the first guy, meniscus tear. He gave me some exercises to do and told me to ‘drive on’. Now two months later I am still in pain, he decides to have an MRI done. Turns out I shredded my meniscus, completely tore my ACL and have severe bone bruising. I have a surgery consult scheduled at the end of Oct, so I guess we will see what happens. I have been biking as much as I can tolerate and do other exercises such as the leg extensions and squats. I am hoping that my recovery will be a little easier.

  17. Jason, I went through the same as you! 6 consultants and 2 physios told me that my ligaments were fine and that it was probably my cartlidge causing the pain. The mri showed the real problem – total rupture of the ACL.

    I am going in for surgery in 2 weeks and really dreading it. I am having the hamgstring graft. I don’t really know what to expect when I wake up and I aren’t looking forward to being imobile. Any info about surgery and rehab is much appreciated!

  18. I tore my ACL completely on September 19th. After 2 visits to the orthopedic doctor, I was never told to exercise. I have been told to keep using the immobilizer. My injured leg has atrophied from lack of use and my good knee is now a little sore. I have been on crutches since the injury. Recently, before I read this article, I started experimenting by bearing weight and then just trying to stand on both legs. However, I am unable to bend my knee without pain, for which I thought was do to the initial injury and not due to the lack of movement. I was lead to believe that I shouldn’t and/or couldn’t move my knee. Now it is stiff beyond belief. I have also shed the immobilizer because it continues to fall down and gets in the way. I did have some bone bruising and a very tiny patella chip that the doctor was not worried about. Due to other circumstances, I have not been able to see the surgeon just yet, but should be within the next week. Any advice on home pre-surgery rehab? I hope to have the surger within the next two -three weeks.

  19. thanks a lot, this helped a lot! i’m a dancer and this is my first and hopefully last ACL injury and had a lot of questions that I didn’t get to ask my doctor because i was too busy grieving! what you say makes sense!

  20. Hello all, Thank you so much for sharing. I tore my ACL and MCL 3 weeks ago and have had many questions. You’re comments have answered many of them. However I do have couple more.

    1) I do not feel pain when I stand on my leg, or bend it or move it around. In fact the brace doctor that I went to today did some pretty severe movements on my knee and I only felt slight discomfort. Is this normal? I surmise it is good but from what I read, it seems a bit unusual.

    2) I am a hefty guy and after looking at some of those exercises I feel that my knee will buckle when attempting them. Should I wait for my brace to come in before doing the exercises? Or should I just try and do them as much as possible?

    3) I have slight swelling still in my knee and it gets a tad painful when I try to bend my leg completely back (Heal to butt style) Will this go away?

    4) I play a lot of sports and work outside. I am hoping to have my surgery within the month, my doctor wouldn’t comment so it’s a bit up in the air. How long is the typical recovery time? (assuming I do PT prior to the surgery?

    5) The doctor told me that I will never be 100% again. Is this fairly common or is he being conservative with my assessment?

    6) After I get my brace, should I ditch the crutches so as to strengthen my leg as much as possible?

    I know these are questions I should ask him but as he was walking out before he came into my room I didn’t get a chance and am left with a lot of unanswered questions. Thank you for any help you can offer.

  21. Hey guys,

    Tore my ACL playing cricket (weekend cricket!) a year ago, but only found out after a MRI when I twisted my right knee, once again playing cricket, a few months back. I was on bed rest for a week, then started to walk normal in three to four weeks. After discussion with my Physio, I decided to go for the ACL reconstruction surgery. I am from India and live in Brazil where this surgery is super common, but for insurance and family reasons I moved back to India and will undergo it here. I have been working out strengthening my muscles for about 40 days now. Having been doing a lot of stationary biking, Leg extensions, Leg curls, Leg press, inner and outer thigh strengthening, EFX ehlipticals and swimming (with less intense breast stoke since i feel my knee finding it difficult) three times a week. I have marked my surgery for the 2nd of April and hope things will go well!

    1) I would like to know the type of crutches that is recommend for use post surgery.

    2) My Doc will use the hamstring tendon, how long does it take to stand on feet? I heard people say that it is just a day or two…and to start walking slowly with crutches will take 5 to 7 days, can any one help me out with this?

    3) Is there any thing else apart from the topics discusses here in this page that I need to take care off Pre-ACL surgery?

  22. ACL tear is a very funny one, the discomfort and pain it depends on each person and each time you tear it. So with decent rest and care I think it is normal not to feel the pain in 3 or 4 weeks post tear. Do not force yourself into any exercise until you are confident of that exercise…your Ortho or physio may recommend various exercises to you, but it depends on you…if you feel something is painful or if your knee is giving up..then you should stop that right there. recuperation and back to sports should be only after minimum of 8 months.

  23. I tore my ACL in February skiing. My Orthopedic knew about my love for the mountains and physical activity. She gave me a month of PT & ordered me a custom sports brace (CTI). She said normally she wouldn’t recomend surgery for someone my age (47) but she knows how active I am. She also knew that I wanted to finish out the season before considering surgery. I was back on the slopes after a month with the sports brace and PT. I felt so much better that I was considering not having the surgery at all. Over the last couple months my knee has given out on me several times while walking. I was not doing anything strenuous or out of the ordinary. I made an appt with my surgeon to discuss surgery. After reading all this stuff on the web I am wondering if I should put it off until the end of next ski season. My custom sports brace will get me through the season but I’m thinking it might be too late to schedule surgery and be able to be back on the slopes by end of December – January. If I am physically fit and very strong and determined, do you think I could be on the slopes in late December – January if she can get me in to surgery by end of July – August?