First, who leads your rehab
After an ACL injury or reconstruction, your surgeon and physiotherapist lead the early stages — and their protocol comes first. My role is to work alongside it: taking over or supporting the strength side once you’re cleared for gym work, and helping you bridge the gap between “discharged” and “back to what I love”. If you’re still early in recovery, follow your physio’s plan.
Why strength is the centre of it
After an ACL injury the muscles around the knee — especially the quads — lose a lot of strength, and they often stay weaker than the other leg long after the knee feels fine. That gap matters: returning to sport before strength has come back is linked with a higher risk of re-injury.
Progress by criteria, not the calendar
Research on return to sport after ACL reconstruction suggests that waiting until at least around nine months, and meeting strength and function targets before returning, lowers re-injury risk. In practice that means progressing when you’ve earned it — strength compared with your uninjured leg, hopping and landing quality, confidence — not because a date has arrived.
What the gym phase looks like
- Rebuilding the quads — progressively loaded squats, split squats, step-ups and leg extensions, within your physio’s guidance.
- Single-leg strength and control — so the injured side stops relying on the other one.
- Hips and calves — they share the load and control how the knee moves.
- Jumping and landing — introduced gradually, from simple landings to change of direction, once the basics are strong.
- Measuring the gap — comparing left and right so progress is visible, not guessed.
What a typical week can look like
Every plan depends on where you are and what your physio has set, but once you’re cleared for the gym a common shape is two or three strength sessions a week with a day between them:
- Two main strength days — the heavier work for quads, hamstrings, hips and calves, always with the injured leg worked on its own.
- One lighter day — control, balance, and, later on, landing and jumping practice.
- Your physio’s exercises — kept in, not replaced.
The week is adjusted by how the knee responds. A knee that’s more swollen or sore the next day is information, not failure.
Common mistakes on the way back
- Stopping strength work once running starts. Running feels like progress, but the strength gap is still there.
- Testing only on good days. Progress should hold on an ordinary day, not just your best one.
- Rushing change of direction. Cutting and pivoting come after landing is solid, not before.
- Comparing timelines. Someone else’s recovery tells you very little about yours.
Rebuilding confidence
The knee can be ready before the head is. Many people are hesitant to trust the leg again, and that’s normal. Seeing your numbers improve, and practising the movements your sport demands in a controlled way, is how that confidence comes back.
After you’re back playing
Returning to sport isn’t the finish line. Keeping one or two strength sessions a week helps protect the knee you worked hard to rebuild — and research on structured warm-up and strength programmes in team sports shows they reduce ACL injury rates. It’s far easier to keep strength than to rebuild it twice.
When to check back with your physio or surgeon
If the knee swells, gives way, locks, or pain increases rather than settles, stop and get it checked before continuing.
In-person coaching is the right fit when you’re returning from injury or surgery. I coach at Peterborough and King’s Cliffe. Book a free consultation and bring what your physio has given you.