The physical therapy practice guidelines for a torn ACL typically involve a multi-phase approach with progressive rehabilitation. The following is a general outline of the different phases and timelines based on the American Physical Therapy Association’s (APTA) guidelines (1):
Phase 1: Acute Phase (0-2 weeks)
- Goals: Control swelling and pain, restore range of motion, maintain quadriceps activation.
- Exercises: Ankle pumps, quad sets, straight leg raises, heel slides, gentle knee range of motion exercises
- Dosing: 3-5 sets of 10-15 reps, 2-3 times per day
Phase 2: Subacute Phase (2-6 weeks)
- Goals: Restore full range of motion, improve muscle strength and neuromuscular control, normalize gait, improve cardiovascular endurance
- Exercises: Weight-bearing exercises such as squats, lunges, step-ups, single-leg balance exercises, and mini-squats; progressive resistance exercises for hip and thigh muscles; treadmill walking or stationary bike for cardiovascular endurance
- Dosing: 3-4 sets of 8-12 reps, 2-3 times per week; cardiovascular exercise 3-4 times per week for 20-30 minutes
Phase 3: Intermediate Phase (6-12 weeks)
- Goals: Restore normal gait pattern, improve balance, improve proprioception, improve neuromuscular control, improve cardiovascular endurance
- Exercises: Plyometric exercises such as jumping and hopping, dynamic balance exercises on unstable surfaces, resistance exercises with increased weight or resistance bands, agility drills
- Dosing: 3-4 sets of 8-12 reps, 2-3 times per week; cardiovascular exercise 3-4 times per week for 30-45 minutes
Phase 4: Advanced Phase (12-16 weeks)
- Goals: Return to sports-specific activities and full functional activities, improve neuromuscular control, improve cardiovascular endurance
- Exercises: Sports-specific drills and activities, multidirectional plyometric exercises, advanced resistance exercises, interval training
- Dosing: 3-4 sets of 8-12 reps, 2-3 times per week; cardiovascular exercise 3-4 times per week for 45-60 minutes
It is important to note that each patient’s rehabilitation program may vary based on their individual needs and the severity of their injury. Additionally, surgery may be required for some ACL tears before beginning physical therapy.
Sources:
American Physical Therapy Association. (2016). Knee ligament sprains and tears: Clinical practice guidelines. https://www.apta.org/apta-and-you/news-publications/podcasts/clinical-practice-guidelines-for-the-knee
Logerstedt, D. S., Snyder-Mackler, L., Ritter, R. C., Axe, M. J., & Godges, J. J. (2010). Knee stability and movement coordination impairments: knee ligament sprain. Journal of Orthopaedic & Sports Physical Therapy, 40(4), A1-37.
