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Program design for post-ACL rehab...


Was hoping to get some help here with my recovery from ACL reconstruction. I am a little over 6 months removed from a hamstring graft and also a meniscus repair, but I am fully functional and can perform any lift, run, jump, sprint, etc.

I have been participating in a study of post-ACL patients that includes several functional movements. I "passed" the test last week, but the Doctor of Physical Therapy that is conducting the study said that there is still a small amount of asymmetry in the balance on my surgery leg. He said I should focus a little more on that leg and double the number of sets that I do for that limb with my single-leg lifts.

FYI, my goals for recovery are to return to my previous level of lifting and be able to get back out on the basketball court. I enjoy the occasional HIIT session and hope to regain all of my speed.

Here is what I have been doing since my last test. This is 3x per week full body with the running and plyo stuff in between lifting sessions.

Box squat - 3x5 (slightly past parallel)
Weighted Pullups - 5x5
Single leg RDL - 3x5 left leg, 5x5 right leg (barbell)
Bulg. split squat - 3x5 left leg, 5x5 right leg (barbell on back)
DB bench press - 5x5
Single leg squat - 3x5 left leg, 5x5 right leg (no weight, ass to heel)
Core work

And for the lifting off-days:
Jog 1 mile for speed (fastest time of 6:06, always try to break it)
Box jumps - 3x5 (Box comes up to about my hip)
Single-leg platform jumps (front/back, side/side) - 3x10 (for speed)
Single-leg BOSU balance (I know it looks gay, but it's pretty important for knee stability post-surgery)
Side-to-side shuffles up and down BBall court
Suicide sprints up and down BBall court (have recently implemented cutting with these)

Thanks for any advice concerning this. I'm not really worried about building upper body strength at this point, just really focusing on my overall lower body strength and power while trying not to lose any mass up top.


At 6 months out post-op, I don't see a GREAT benefit to doing the single leg BOSU balance. For initial rehab, it can help, but that far along (unless you have lingering issues) you won't get too much benefit. It isn't going to hurt you to do them (unless you lose your balance and injure yourself), but I just see them as a waist of time and energy that could be focused towards better exercises with a better return of gains.

As far as your program, are you doing that same list of exercises 3x per week? Also, as a refresher to your situation, what type of graft did you get and where was the meniscal tear? How did you initially tear it? Do you have your full knee flexion and extension ROM back?


Thanks for the advice LH...I had a hamstring graft, and the meniscus repair was "pretty lengthy" in the words of my surgeon, but he repaired it anyway. Here is the language about it from the MRI, if this means anything to you:

"Complex peripheral tear in posterior horn of the medial meniscus"

I have stuck to the listed exercises pretty strictly for the past 4-5 weeks, though I have substituted deadlifts (sumo the last 2 weeks) for the squats once per week. For the running/plyo days, I have changed up the jumping exercises. I almost always perform the box jumps, but have also done broad jumps, one-leg broad jumps and something else (don't know what you'd call it) where I hop over platforms of various height in succession.

I initially tore the ACL and meniscus playing basketball. I took a step toward a loose ball and I'm not really sure exactly sure what happened, but looking back I believe it was a hyperextension of the leg that i used to step to the ball. I will say that I had a very intense leg workout the day before (within 24 hours), so that could have played a big part in the injury.

I have full extension and, though it feels more stiff than my other knee, I've been measured at full flexion.

I should probably note that this ACL tear is my second as I tore the ligament in my other knee in 2004. That one, I landed on one leg from a jump playing flag football and hyperextended it. I also had a meniscectomy on that knee in high school from a wrestling injury (2000).


Best of luck with it all. From the sounds of your injury (and past ones as well), they have all been non-contact based, which generally shows a muscular imbalance issue. As you stated before your most current ACL injury, you performed an intense leg workout within 24 hours of playing, which may have a part in the injury, but also may just show a lack of recovery on your body's part (could be nutrition based, program strategy, exercise selection, etc).

Regardless, I think it would best benefit you to figure out where you were lacking, what biomechanical and overall S&C issues may be present, and how to better structure your programs to address those issues. I personally feel you would be better off with some more variety in your program. Especially now that you have followed that same program for 4-5 weeks and have (hopefully) built a good base to work off of. You could even keep it as simple as keeping the current total body workout as a Day 1 program and just develop another Day 2 program and rotate between them on a 3 day per week cycle. I think some more hip extension and hamstring based work would be greatly beneficial to you. Also, form the sounds of what you are doing on your running/plyo days, it sounds good. The biggest thing I can advise would be to make sure you are not slipping into any kind of knee valgum during the landing, and making sure you are achieving program landing mechanics (take more of the stress into your glutes and off of your knees, reach adequate ankle dorsiflexion, maintain proper thoracic positioning and lumbar bracing, etc).

Again best of luck and keep us updated.


Thanks for that...what would you recommend for hip extension? I would have no problem changing the exercises for each session, I'm just not sure what I should replace.


Hip Extension - Deadlift variations, Hip Thrusters, BB Glute bridges, Pull Throughs, Clean/Snatch (BB, DB, KB variations), KB swings, SB Bridge and curls, GHR, OH med ball tosses.

That is just a list off the top of my head and I'm sure there are tons more. I'm just suggesting that you put more variety into your program and include more hip extension based exercises in. It seems you already have a good understanding of the need at this point for single leg work, so continue with that as well.