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Physical Therapy Treatment for ACL Injury or Tear

The Anterior Cruciate Ligament (ACL) is located in the middle of the knee and connects the thigh bone (Femur) to the shin bone (Tibia) and helps provide stability to the knee joint. Injury to the ACL can result in pain and instability in the knee. ACL injuries can occur from sudden pivoting or cutting movements with sports, work activities, and motor vehicle accidents. 

Upon ACL injury,  a “pop” or “snap” may be felt or heard followed by immediate swelling of the knee. This impacts knee mobility, strength, and stability. ACL tears can be detected with special tests performed by a trained Physical Therapist and further testing can be performed including an MRI to determine the severity of the tear and any additional tissue damage. 

Treatment Options:

Physical Therapy treatment without surgery: 

  • Not all ACL tears require surgery. Those who only injured the ACL and/or do not experience bouts of the knee “giving way” are in this category. These individuals can recover with a custom physical therapy treatment program based on specific tests performed by a trained Physical Therapist. Treatment programming may include mobility, muscle strengthening, balance training, and return to sport.

Physical Therapy treatment in conjunction with surgery: 

  • Pre-Operative Treatment: 
    • When surgery is warranted it is recommended to engage in Physical Therapy prior to surgery to improve strength and mobility as tolerated to improve post-operative recovery. 
  • Post-Operative Treatment: 
    • The Orthopedic Surgeon will provide a specific post-operative protocol that will help guide your Physical Therapist to create an appropriate treatment program based on your needs and goals. 

Physical Therapy treatment includes:

  • Gait training with crutches to unweight the knee
  • Bracing to limit knee mobility per Surgeon’s protocol
  • Mobility exercises to improve mobility of the affected knee within surgical parameters
  • Electrical stimulation to improve activation of  the quadriceps muscles
  • Strengthening exercises targeting quadricep and hamstrings of the knee
  • Balance training to improve weight bearing and proprioception of the affected knee
  • Return to sport training or higher level of activities


  • Duthon VB, Barea C, Abrassart S, Fasel JH, Fritschy D, Ménétrey J. Anatomy of the anterior cruciate ligament. Knee Surg Sports Traumatol Arthrosc. 2006 Mar;14(3):204-13. doi: 10.1007/s00167-005-0679-9. Epub 2005 Oct 19. PMID: 16235056.
  • Benjaminse A, Gokeler A, van der Schans CP. Clinical diagnosis of an anterior cruciate ligament rupture: a meta-analysis. J Orthop Sports Phys Ther. 2006 May;36(5):267-88. doi: 10.2519/jospt.2006.2011. PMID: 16715828.
  • Nyland J, Brand E, Fisher B. Update on rehabilitation following ACL reconstruction. Open Access J Sports Med. 2010 Sep 1;1:151-66. doi: 10.2147/oajsm.s9327. PMID: 24198553; PMCID: PMC3781865.

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