14/05/2026
Most ACL rehab covers the basics. Here are 5 things I see missed most often.
1️⃣ QUAD EXTENSIONS
For years patients have been told that using a quad extension machine — or any other “open kinetic chain” exercise — is terrible for your graft.
“It will stretch it and make the graft loose.”
Science has proven this wrong, time and time again. You actually generate 2–3× more force on your ACL just by walking than you do during a quad extension (Englander et al. 2020).
There’s also no difference in graft laxity between patients who completed open-chain vs closed-chain exercises after ACL surgery (Perriman et al. 2018).
Start quad extensions early, progress slowly, and gradually work into full range — under the guidance of your rehab professional.
2️⃣ PLYOMETRICS
“Why do I need to practice jumping? I’m not a jumping athlete.”
Plyos are so much more than just jumping. They teach the body how to take off and land safely, improve reactive ability, and generate power and explosiveness.
As we get more dynamic and explosive, the force the knee absorbs from the ground increases. To prepare for the demands of mountain sports, I like to train for “impact” — the ability of the body to accept increased force, use it effectively, and protect structures sensitive to injury.
3️⃣ RANGE OF MOTION
Restore the knee’s range of motion, make it as flexible as it was before — pretty simple, right?
Wrong. The majority of patients I see with ongoing knee issues have some range restriction.
Achieving full knee extension is essential for walking, running, and pivoting sports — and should be a major early rehab goal. Missing it leads to compensations through the lower limb, pelvis, and back.
Knee flexion deficits are also really common, especially after ACLR + meniscus repair. Avoiding end-range flexion during rehab is a sure way for an active person to injure their knee in the future.
Think about how often you need end-range flexion — crouching into a crawl space, deep compression on skis, a big step-up on a hike. If you don’t train it, you’re not prepared for it.