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Rehabbing an ACL Tear

ACL tears are career-changing, but don’t have to be career-ending. You can (and will) bounce back with the right rehab!

No doubt, an ACL tear is a major injury that changes things. But it doesn’t have to be the end of your career, and it doesn’t mean your best days as an athlete are behind you. With the right rehab, you can (and will) get back to where you were before the injury.

Heck, there’s no reason why you can’t become a better athlete than you were before the injury.

But that all depends on having a great rehab process and the right combination of factors: the right therapist, with the right tools to evaluate you, and the right equipment to rehab you with.

ACL rehab happens in stages, and if your rehab team doesn’t have access to the best equipment or the best rehab approach, then you’re leaving yourself exposed to the worst case scenario…another ACL tear. 

That’s why we spared no expense in getting the best equipment in the industry.

We invested over $1,000,000 in our facility to give our patients the best that physical therapy has to offer—the same stuff the pros use. We know that using the best technology available gives you the best results possible, so we went out and got the best.

Hopefully by now you’re seeing that all therapy is not created equal. The best outcomes are the product of the best environments. If you’re interested in seeing how our specialists at the RE_Building bring athletes back to 100% after an ACL tear, read on…

ACL rehab at the RE_Building happens in four stages: 1) Immediate Care and Mobility, 2) Strengthening and Balancing, 3) Plyometrics and Explosiveness, and 4) Game-readiness Testing.

Stage 1: Immediate Care and Mobility

After surgery there’s a lot of swelling, and that’s a good thing–swelling is your body’s way of healing. The downside of swelling is that hurts and makes it harder to bend your knee. If left unchecked, it can linger around too long, causing more pain and making the long-term healing process more difficult.

Our therapists are trained in managing swelling to make sure it does it’s job but doesn’t stick around longer than needed. That way, pain goes down and mobility starts to come back. 

Getting mobility back is important because after an ACL surgery your knee loses the ability to bend well. Most knees won’t straighten all the way out or bend past 90° after surgery. Using your knee is obviously important, so being able to fully bend it is a big part of getting you back to your normal life and sport.

Teaching your knee to move well again is step one, but just because it bends well doesn’t mean it’s ready to do everything it needs to. That brings us to stage two of ACL rehab…

Stage 2: Strengthening and Balancing

It’s no surprise that leg muscles get weaker in the leg that had the ACL tear, but you might be surprised to hear the other leg also gets weaker. After an ACL tear, neither leg is able to do the same amount of exercise you could before the injury. You can’t run, squat, deadlift, or do much of any exercise, and that affects both legs.

Because you can’t exercise the same way, the muscles in both legs get smaller and weaker. The side with the ACL tear will have bigger losses than the other, but they both get worse. 

An athlete using the Biodex to measure leg strength during ACL rehab.

Having strong leg muscles is an important part of stabilizing and protecting your knee from pain and re-injury down the road, but you have to be careful how you exercise your knee after an ACL surgery. Doing the wrong exercises (or the right ones at the wrong time) can do more harm than good and set you back even further.

An important part of knowing when to progress is measuring muscle strength. As you get stronger, you graduate to more advanced exercises.

Plus, measuring strength tracks your improvements. 

But accurately measuring strength is tough to do without the right equipment. The traditional way to measure strength is to push into your therapist’s hand while he or she feels how hard you’re pushing, but that’s not a very accurate way to measure. You and the therapist might feel like you’re pushing harder than last week, but that doesn’t tell you how much better you’re actually getting (or if you’re even getting better at all, if you’re both wrong about how the push feels!). 

We measure strength with a Biodex, the gold standard for strength measurement. It shows exactly how much strength your body produces and presents it in an easily understandable way, allowing you (and your doctor, coach, parent, or physical therapist) to know exactly how strong you are at any given point.

This is critical, because we know how much strength it takes to control your knee during activities like running, jumping, and cutting, and if you don’t have enough then you’re at risk for another ACL tear.


Having enough strength is one thing, but having balanced, or symmetric, strength is another key factor in ACL rehab. 

Symmetric strength refers to both legs being equally strong. 

You don’t want one strong leg and one weak leg because that creates an imbalance that makes you more likely to tear your ACL again. 

Plus, you’ll play better if you have two strong legs instead of one strong leg and one weak one.

Take a look at the picture below, which is an example of Biodex strength test results.

Look at the numbers the green arrows are pointing at. Those numbers are how much strength the left and right leg produced in this test.

The next number over, 35.4, is the percent difference in strength from leg to leg. 

One of these athlete’s legs was 35.4% stronger than the other! 

That puts this athlete at a high risk for another injury.

The goal is for your leg strength to be as close as possible, and with the Biodex we directly measure how strong your legs are until they are equal. That’s the “balancing” part of stage 2 in the rehab process: balancing out your leg muscle strength.

Force plates are another tool we use to make sure your strength becomes even.

Force plates tell you exactly how much weight you’re putting on each side. Our force plates are hooked up to a TV, so when your surgeon tells you it’s OK to put 25% of your body weight on the injured side, you can see exactly how much that is.

Check out the picture below. The red and green arrows and numbers represent how much weight you’re putting on each leg.

As you move side to side, the red and green arrows move with you. The higher the arrow, the more weight you’re putting on that side.

Their great for all movements, not just standing. For example, the video below shows an athlete learning how to squat symmetrically after an ACL surgery.

[embedyt] https://www.youtube.com/watch?v=5tjLdnQ84JA[/embedyt]


Based on the height of the arrows (which tell you how much weight is on each leg), can you guess which knee this athlete injured?

Once your legs are strong enough and balanced in strength, you move on to stage three of ACL rehab.

Stage 3: Plyometrics and Explosiveness

Up until this point in rehab, you haven’t done any jumps or explosive movements.

That changes now.

You’ve got basic strength, body awareness, and knee control back, so it’s time to start using them to improve your explosiveness and ability to move quickly.

Step one is back to the basics: learning how to land safely and under control. Exercises like stepping or hopping off of a small box are starting points.

The reACT trainer is great tool for building the muscle strength back up to wear you can handle catching yourself at the end of a jump. The video below shows how it works.

As the board moves up towards your body, you have to use your legs to absorb it. In it’s typical setting the reACT does 54 revolutions in just one minute. How long would it take to do 54 jumps? And how long would your joints be able to handle that impact?

With sixty seconds on the reACT your muscles get the benefits of doing 54 jumps but your joints don’t deal with the impact that comes with 54 jumps. It’s a safe and effective way to train your muscles and joints to be ready to play.

After mastering landings, jumping and all-around explosiveness becomes the focus.

The specific exercises you do depend on your sport, but, in general, all athletes need to run, jump, and cut on one foot. Those are primary focuses of rehab.

And adding resistance to running, jumping, and cutting is a great way to teach your body to excel in these movements.

You can use bands to add resistance, but that’s hard to do and limits how far you can go (since the bands are usually anchored to a wall). You could pull a sled, but that’s clunky and doesn’t work well for all movements, like jumping. 

The 1080 Sprint solves these problems.

The 1080 allows us to dial in exactly how much resistance to give you, from as little as a quarter of a pound up to 66 pounds—for up to 90 yards of movement. Check out the short video below to see how it works.

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Change of direction skill is critical for just about every athlete. Definitely a key athletic factor for field and court sports, like football, soccer, volleyball, and basketball. If you can’t slow down and change directions quickly, you can’t juke anybody, you can’t guard anybody, you’re gonna get juked, and you’re more likely to get hurt. ACL injuries are linked to change of direction ability, for instance. Yesterday was a change of direction day with my man @justin_scoggin of @westsalemboysbasketball. We did a ton of deceleration and explosion work, all against extra resistance using the @1080motion. Adding resistance to deceleration and change of direction exercises is a great way to overload the system and make your muscles better at absorbing shock and being more explosive. That’s why we love loading agility / change of direction drills and making our athletes work! Justin has been working hard and after only our first few sessions he and his parents both have already noticed a difference. Justin is doing big things this year. This kid has a great attitude and a great work ethic. Can’t wait to see how much better of an athlete you become Justin! #hoops #basketball #westsalem #westsalembasketball #1080 #speed #agility #changeofdirection #athlete #salemor #salemoregon #keizer #keizeroregon #southsalem #soccer #football #whatsyourRE

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The 1080 also measures your performance and tells you exactly how strong, fast, and powerful each rep was. 

Not only does this tool make you more athletic and bring you closer to game-ready, but it measures the whole process so you know exactly how much you’re progressing from session to session. 

Once you and your therapist feel you’ve gotten your explosiveness back, it’s on to stage four of the rehab process.

Stage 4: Game-readiness Testing

At this point in rehab, you and your therapist both suspect you might be ready to get back to playing your sport. The only way to know for sure is to test and find out.

We use the Biodex again to determine how strong each leg is. We’re looking for two things:

  1. Are your legs strong enough to keep you safe and play well?
  2. Are your legs balanced in strength, or do you have one strong and one weak one?

Once we know how strong your legs are, we look at how you actually use your legs during athletic movements. The force plates tell us if you favor one leg during exercises like squats and jumps. If you do, that could mean you aren’t 100% ready to get back to your sport yet. 

We’ll also look at functional movements like squats, jumps, cuts, and shuffles to make sure your have great technique and are able to handle those explosive movements during high-stress game time moments. After all, being strong is important, but you still have to have good technique to play safely.

Last, but not least, we analyze an often overlooked part of returning to your sport again: how you feel about it.

Are you confident that you can go play again without getting hurt?

Do you feel scared or nervous about doing the same move you did when you got injured?

Do you feel ready, or do you feel like you need more time?

Just because your knee is moving well and you pass all the physical tests doesn’t necessarily mean you’re mentally ready, and being mentally ready is a critical part of playing again successfully.

Once you pass these tests, you’ve officially proven you’re mind and body are ready to go and you get fully cleared to return to your sport!

Abby Forsyth playing against the University of Oregon after successfully rehabbing her ACL at the RE_Building.


Do you need help?

Are you or someone you know in need of rehabilitating a knee injury or preventing one from happening in the first place? Contact us by filling out the form below or by calling our main hub at 503-371-0779 to schedule your first appointment today.