Anterior Cruciate Ligament (ACL) Tear

See Case Study below, but first – What is an ACL tear?

An anterior cruciate ligament (ACL) tear is a specific kind of knee injury that happens when the ACL is torn. One of the four main ligaments in the knee, the ACL joins the shinbone to the thigh bone (femur and tibia). It aids in stabilising the knee joint and limits the tibia’s excessive forward movement.

ACL tears can result through sudden knee twisting or hyperextension, direct knee trauma, or an awkward landing after jumping or pivoting. ACL tears can cause swelling, discomfort, and instability in the knee joint, as well as a popping sound or sensation in the knee.

ACL tears are significant injuries that may necessitate surgery and prolonged recovery. A knee brace or the use of crutches may be required during treatment, and physiotherapy should be used to regain the knee’s strength, stability, and range of motion. 

If you think you may have torn your ACL, it’s critical to consult a clinician right away because timely treatment can assist to protect the knee and improve outcomes.


Whether the condition is treated conservatively or surgically, physical therapy is essential to the rehabilitation process after an ACL tear. Physiotherapy for an ACL tear is to help the patient get back to their pre-injury level of activity by restoring the knee joint’s range of motion, strength, and stability.

An initial evaluation by a physiotherapist, who will assess the severity of the injury and develop a specialised treatment plan based on the patient’s unique needs and objectives, is usually the first step in the rehabilitation protocol for an ACL rupture. We can give guidance regarding the surgical options also.

The Physiotherapy Rehabilitation Regimen


Acute Healing Phase: Managing pain and swelling, regaining range of motion, and gradually resuming weight-bearing activities are the main goals of the acute period. We will always offer hands on treatment at this stage to improve tissue condition and healing times.

Strengthening Phase: Strengthening activities: In the second stage, the emphasis is shifted to activities that will strengthen the muscles that surround the knee joint and enhance its stability. Exercises to strengthen the quadriceps and hamstrings as well as those that concentrate on the hip and core muscles fall under this category.

Proprioception, Plyometric, Balance and Agility Training: To enhance neuromuscular control and lower the risk of reinjury, proprioception and balance and agility training are the main focus of the third phase of the rehabilitation programme. Exercises like single-leg balancing, agility drills, jumping and twisting may be a part of this.

Sport-Specific Training: To prepare the patient for a safe return to their pre-injury level of activity, sport-specific training is the last step in the rehabilitation process. Exercises that mimic the demands of their sport and gradually get harder over time might be a part of this.

The physiotherapist will continuously assess the patient’s progress throughout the rehabilitation process and modify the treatment plan as necessary to provide the best possible recovery. After an ACL tear, physiotherapy can aid in the reduction of discomfort and oedema, enhancement of range of motion and strength, and promotion of a secure and successful return to exercise.

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Case Study: Liam's ACL Journey

Liam, a 25-year-old avid soccer player, faced a sudden ACL tear during a match. Having been to Achieve Health in the past, he knew to turn to us to guide her recovery.

Liam had an ACL reconstruction using his hamstring tendon.

Pre-Op Physio? Yes!

Focus on reducing swelling, increasing range of movement (ROM) and increasing strength – particularly of the quads. All this will aid his post op recovery time.


From 1 week after op: patient started physiotherapy again.

Treatment: Hands on treatment into scar portals, scar tissue massage, swelling flushing, deep soft tissue massage and gentle mobilisations.

Exercises: Static Quads, Inner range quads, Heel slides, patella mobilisations, heel to toe walking with crutches, ankle inversion and eversion with resistance band and glute exercises.


Continued hands on treatment throughout. This is a key stage to regain normal tissue quality and ensure swelling, inflammation, scar tissue and tightness is not limiting recovery. 

Exercises: Proprioception work, Hydrotherapy work (such as squatting in water and walking lap), biking sessions (2-3x a week), quad progression – including leg extension machine. Also hamstring bridges and curls, glute complex exercises and  reduced ROM air squats.


Continued soft tissue work through the muscles being rehabbed – hamstrings, calf, quads and scar portals to improve tissue quality, healing and tightness.

Exercises: Bench bridges, deadlifting, squatting and Bulgarian split squats.


Exercises: Weights and resistance increasing on all exercises. Bulgarian deadlifting, side steps downs, weighted step ups and step downs. Running in water. Glute needing a lot of focus to support knee control.

Continued soft tissue release.


Strength testing completed to progress to next stage of rehab (20 weeks post op).

Strength testing comparing single leg strength (operated vs good leg). This included: calf raises, single leg press, single leg gym ball squat, single leg hip thrusts, side step downs and Bulgarian split squats with weights.

Start of plyometric training – jumping.


Review with surgeon – no concerns.

Start running and SAQ work (speed and agility) such as ladder drills. Dribbling straight line with ball.

Progressed on box jumps and Single leg landing/jumping work.

Sports massage and hands on treatment to aid level of training recovery and keep muscle quality high.


Cutting (Speed turning) – sprint and speed work.

Introduction of goal keeper training. More kicking work/power work with ball.

Reviewed strength again – stronger than pre injury.


Back playing matches at full intensity and training as normal.


Discharged by surgeon at 9-month review.

We are here for continued support as needed.

Also Alongside Throughout:

  • Nutrition advice
  • Programming, can work hand in hand with PT also
  • Education on gait and orthotics for correction and prevention of injuries
  • Sports massage
  • Stretching and mobility routines

After several months of dedicated physiotherapy, Liam not only regained his pre-injury level of performance but also developed a heightened awareness of his body’s capabilities. His success story is a testament to the power of tailored physiotherapy in ACL injury recovery.

At Achieve Health, we’re committed to guiding individuals like Liam towards a full recovery and a return to the activities they love. If you or a loved one are facing a similar challenge, don’t hesitate to reach out. Together, we can rewrite your recovery story.