Early Stage ACL Rehab (0–6 Weeks): What to Expect and How to Recover Properly
Understanding Your ACL Injury: What Actually Happened
The anterior cruciate ligament (ACL) is one of the key stabilisers of your knee. It prevents excessive forward movement and rotation of the shin bone, something vital for anyone who runs, cuts, or lands at speed.
Most ACL tears don’t happen from a big collision, they happen in a split second when the body’s movement and position overload the knee. Around 70–80% of ACL injuries are non-contact, meaning there’s no tackle or direct hit at all.
It usually happens when the foot is planted, the knee collapses inward (valgus position), and the body twists or changes direction sharply. This combination drives the shin bone (tibia) forward under the thigh bone (femur), putting huge strain on the ACL. if this strain is to high, the ACL tears.
You’ll often hear a “pop”, followed by swelling within a few minutes and a feeling that the knee is unstable or “gives way.”
In contact-based injuries (roughly 20–30%), a direct blow to the front or side of the knee can push the shin bone forward or force the knee inward, again overstretching the ACL.
Certain factors can make someone more at risk, like weaker hamstrings, poor landing mechanics, or in females, a slightly wider hip angle and hormonal effects on ligament laxity. Understanding this mechanism is key. It’s why ACL rehab focuses on retraining movement patterns, improving hip and trunk control, and building strength to stop these forces from overloading the knee again.
The early stages after injury, or after surgery, are crucial. What you do (and don’t do) now sets the tone for how well your knee recovers later.
Gazza made the ACL (Anterior Cruciate Ligament) the most talked about thing in football with this tackle.
Why the First 6 Weeks Are the Most Important
The early stage of rehab isn’t about performance or getting you back onto the pitch. we want to reduce swelling as fast as we can to then regain quadriceps function (muscle on the front of the thigh). without removing swelling we can’t regain range of motion, and therefore we can’t restore function, which within the first few weeks directly influence long-term success.
Skipping or mismanaging this phase is one of the biggest reasons people end up with stiffness, ongoing swelling, or delayed return to sport.
Pre-Op and Non-Operative ACL Rehab — Setting the Foundation
While youre sitting waiting the op, you must start your Prehab. strengthen the surrounding areas, Hamstrings, quads, calfs and gluts. get as cardiovascular fit as you can. Size, strength and fitness will drop massively post op. the high base we have going into the op, the better outcomes you will have. stronger graph, more control, quicker return to full range of motion. People who go into surgery with a strong, mobile, calm knee recover faster and with fewer complications. For those choosing not to have surgery, early loading and controlled movement help the knee adapt and stabilise naturally.
Your goals before surgery (pre-hab) are to:
Reduce swelling and inflammation
Restore full knee extension
Regain good quadriceps activation
Build hip and core stability
Maintain cardiovascular fitness
This isn’t just about exercises it’s about getting confident with your knee again and building the base for long-term strength.
Early Post-Op Goals: Reduce Swelling, Regain Motion, Rebuild Confidence
The first six weeks after ACL reconstruction (or injury) can feel frustrating. You’re dealing with swelling, tightness, and a knee that doesn’t feel like yours. But this stage is where real progress happens.
Your key aims are:
Swelling control: Ice, compression, elevation, and regular gentle movement.
Extension restoration: Getting the knee fully straight is priority number one.
Quadriceps activation: The sooner your thigh muscles “switch back on,” the better your stability and walking pattern will be.
Gradual flexion: Controlled bending helps reduce stiffness without overloading the graft.
Walking normally: Re-establishing your gait pattern early reduces long-term compensations.
Avoid pushing too hard too soon pain and swelling are feedback. The goal is consistent progress, not rushing milestones.
Common Mistakes People Make After an ACL Injury
Even with the best intentions, these mistakes slow recovery more than the injury itself:
Resting too much: The knee stiffens quickly without movement.
Skipping early strength work: The quadriceps weaken fast, and it’s much harder to rebuild later.
Ignoring full extension: A small loss of straightening early on can cause big issues long term.
Comparing to others: Every surgery, graft type, and person recovers differently.
Avoiding professional guidance: Generic online rehab plans can’t adjust for your pain, swelling, or graft type.
A tailored program, remotely or in-person ensures your rehab stays on track week by week.
What a Proper ACL Rehab Should Include (and What to Avoid)
In this phase, every exercise should have a purpose: restore motion, rebuild control, and prepare for load.
Good programs will combine:
Targeted range-of-motion work
Early quadriceps and hamstring activation
Balance and proprioception drills
Hip and core strengthening
Progressive load exposure (not avoiding movement but respecting healing timelines)
Avoid aggressive open-chain knee extensions early on, deep weighted squats, or twisting movements unless cleared. A progressive, evidence-based plan will move you from gentle control work to weight-bearing, then to loaded patterns, all while protecting the graft.
Transitioning Into Later Phases of Rehab
By six weeks, swelling should be minimal, range of motion close to full, and walking comfortable. This is where strength, control, and return-to-performance work start.
Later phases will introduce:
Heavier gym-based loading
Plyometrics and change of direction
Speed and sport-specific conditioning
Return to sprinting
Return to practice
Return-to-play testing
This is where an integrated rehab and performance model matters. At Josh Ricketts Coaching, rehab isn’t just about getting pain-free, it’s about getting you back to your sport, job, or active life stronger than before.
When to Get Professional Help (and Why It Matters)
If you’re not sure whether your knee is progressing, or if swelling and pain keep returning, it’s time to get it assessed.
Working with a Sports Therapist or S&C Coach experienced in ACL rehab gives you:
Personalised progressions based on your graft type, pain, and goals
A structured weekly plan that adapts to how your knee responds
Confidence that every stage builds towards sport-ready performance
Even a single session can help you reset your approach and avoid months of wasted effort.
At Josh Ricketts Coaching & Injury Clinic, Swindon
I specialise in ACL rehab, combining hands-on therapy, strength and conditioning, and performance-based progression. Whether you’re just starting after surgery or managing your recovery non-operatively, we’ll create a clear, evidence-driven plan to get you back stronger.
📍 Based at Blunsdon House Hotel, Swindon and Jd Gyms, Swindon. Also available online for remote ACL rehab coaching.
If you’re serious about recovering properly, not just getting by, book your ACL Rehab Consultation today or message me directly to start your online program.