The Key to Returning to Sports after ACL Surgery: Get Strong on 1 Leg

Persistent quadriceps and hamstring weakness after ACL surgery delays an athlete’s return to sport.  Weakness of your injured leg will also predispose you to future injury.  To combat these problems you need to get strong on one leg.  This means your left and right legs are equally strong.  Also, to be at your best and reduce your risk for future injury, your quads and hamstring will have to be trained to work together.  The exercises in this article will get you strong and ready to return to your sport.

Quadriceps and Hamstring Weakness is a Big Problem 

A 2021 study out of New Zealand looked at athletes 2 to 10 years after ACL surgery. Compared to athletes without an ACL injury, the post-surgical athletes had lower activity levels, quality of life, and greater fear of re-injury.  Side-to-side thigh muscle (quads and hamstrings) differences were found in the post-surgical athletes.  Their quads were 11.9% weaker on the injured compared to their uninjured side.  Their hamstrings were 7.9% weaker on the injured compared to uninjured side.

This study shows a potential link between persistent thigh muscle weakness and quality of life up to 10 years after ACL surgery.  It is important to restore your quadriceps and hamstring strength within the first 9 to 12 months after your surgery.  The right ACL rehab program will get you strong enough to return to your sport and keep you healthy for years to come.

5 of the Best Single Leg Exercises after ACL Surgery

An estimated 70-90% of ACL injuries occur during rapid change of direction, landing, or decelerating on one leg. Decreased strength of your quadriceps and hamstring muscles increases your risk of sustaining these types of injuries.  Also, delayed hamstring activation during rapid change of direction contributes to this increase risk.  Therefore, exercises that activate and strengthen your quads and hamstrings together are ideal to protect your healing ACL graft after surgery.

Single leg exercises promote co-activation of your quads and hamstrings.  The 1-leg Romanian deadlift, band crossovers, and the single-leg squat all fit the bill. Perform these exercises with slow and controlled movements.  Maintaining a stationary trunk and avoiding knee collapse is important.  Do 3 to 4 sets of 8 to 12 reps.  Over time, increase the load and decrease the number of reps you do each set in order to maximize strength on one leg.

Sports are played in multiple planes.  This means you will be moving forward, backward, side to side, and in diagonal patterns. This requires reactive strength and stability on one leg. This is challenging to replicate during rehab.  Performing multi-plane lunges and hops are implemented before progressing to more challenging plyometrics.

Take the Next Step to Getting Strong After ACL Surgery

We have witnessed several athletes try to return to their sport before restoring all their strength.  Against our recommendations these athletes returned to their sport with poor results.  One young girl re-tore her ACL.  Another gentleman winded up tearing his other ACL.  Unfortunately this happens all too often.

You must commit yourself to getting strong.  This takes time.  Don’t rush back.  Some athletes don’t build up enough strength until well after 1 year from surgery.  Prehab, starting post-surgical rehab early, and taking your strength training seriously will set you up for success.  That is, an early and safe return to playing.  Call our office to schedule an appointment with your physical therapist and get started on your road to recovery.


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