ACL Rehabilitation: What to Do in the First 12 Weeks After Surgery

ACL reconstruction surgery is just the beginning. What comes next-your rehabilitation-has a far greater influence on how well your knee recovers, how fast you return to sport or daily activity, and whether your knee remains strong long term.

At Perfect Balance Clinic in St John’s Wood, near Lord’s Cricket Ground, we offer structured, expert-led ACL rehabilitation programmes tailored to each phase of recovery. From day one post-surgery to full return to movement, our physiotherapists, osteopaths, and sports therapists provide personalised care based on your needs, goals, and surgical outcome.

If you’ve recently had ACL surgery, don’t delay. Get expert support from the start-book your consultation today and let us guide you through the safest and most effective route to recovery.

Why the First 12 Weeks Matter

Early on in ACL recovery, following the right steps matters most. Recovery needs to go in order-skipping parts may cause trouble.

The first few days often come with pain, swelling, and uncertainty about how much to move. But this is also when the groundwork for full recovery is laid. Small gains in movement, control, and confidence in these early stages lead to better results later on.

Without early intervention, complications such as poor quadriceps activation, joint stiffness (especially with extension), and abnormal gait patterns can delay healing and reduce your future performance.

That’s why our team at Perfect Balance works closely with you right from the beginning.

Phase 1 (Week 0-2): Protection, Pain Management, and Restoring Basics

Your knee needs care and safety first to start recovery well. At this point, the graft is still vulnerable, and your knee is likely swollen and painful. Activities like walking, getting in and out of chairs, or standing for long periods can feel difficult or even risky.

Here’s how we support recovery during Phase 1:

• Use of cold therapy, elevation, and compression to reduce swelling

• Passive stretches and heel prop techniques to regain full knee extension

• Early muscle activation work using isometric quad sets and leg raises

• Gait re-education with or without walking aids, depending on tolerance

• Advice on posture, sleep position, and managing day-to-day tasks safely

We also provide tailored guidance based on your surgical notes and consultant’s protocols. The emphasis is always on restoring safe movement without overloading the graft.

Phase 2 (Week 2-6): Building Strength and Confidence

By now, pain and swelling should have reduced, and many patients are beginning to walk more comfortably. The focus of Phase 2 is restoring full movement, improving strength, and helping you regain confidence in your knee’s ability to support your weight.

We often see patients become overly cautious at this stage, afraid to move too much. Others may push too far, too fast. Our therapists help you find the right balance between progression and protection.

What we focus on in Phase 2:

• Achieving full range of motion (especially flexion beyond 120°)

• Normalising walking patterns and gradually phasing out crutches

• Introducing bodyweight and resistance exercises for the quadriceps, hamstrings, hips, and glutes

• Starting closed-chain movements such as wall squats and mini lunges

• Early cycling and cross-trainer activity, if cleared

We also begin working on balance and neuromuscular control to support joint stability as you start moving more.

Phase 3 (Week 6-12): Functional Strength and Movement Control

As you transition into Phase 3, the knee should have full movement, minimal swelling, and improving strength. Now it’s time to prepare for more complex tasks that mimic daily life and sporting movements-such as stairs, lifting, turning, and changes of direction.

That said, this is still a critical phase. Many patients start to feel good physically, but the graft has not yet fully matured. Our therapists help you continue to build capacity while minimising risk.

Key areas we address in this phase:

• Symmetry in strength between legs (particularly in the quadriceps)

• Single-leg control during tasks such as step-downs and balance drills

• Functional strength development through controlled lunges, bridging, and squat patterns

• Return-to-movement training such as agility ladders and light plyometric prep

We assess your technique continuously to prevent compensatory movements, and we adjust exercises to match your progress and goals.

A Structured, Safe Progression-No Guesswork

Many ACL rehab programmes rely too heavily on a timeline. At Perfect Balance Clinic, we rely on milestones.

That means you only move to the next phase when your knee is ready. We track things like:

• Knee extension and flexion

• Muscle strength and endurance

• Gait and posture

• Pain levels and joint swelling

• Movement quality during functional tasks

Each patient progresses at their own pace-but always with structure, safety, and long-term results in mind.

How We Prevent Setbacks During Rehab

ACL recovery is rarely smooth from start to finish. There can be weeks where progress slows or pain increases slightly. What matters is how these challenges are handled.

We help reduce the risk of re-injury or plateau by:

• Closely monitoring your physical progress and adjusting your plan

• Educating you on what’s safe to do at home and what to avoid

• Providing constant feedback on technique, control, and posture

• Liaising with your orthopaedic consultant if concerns arise

When Should You Start Physiotherapy?

Ideally, you should begin physiotherapy within 5 to 7 days of surgery. This allows early mobilisation, pain control, and muscle activation to begin before stiffness or poor habits take hold.

But even if you’re further along in recovery and unsure if you’re on track, it’s not too late. Our team frequently works with patients who feel they’ve plateaued or are unsure how to progress. We reassess and restart the process with a focused plan.

Book a Consultation Today

Whether you’re in week one or week ten of your recovery, we’re here to help you move forward with confidence.

At Perfect Balance Clinic, we provide structured ACL rehabilitation programmes built around your specific surgery, goals, and physical needs. With expert care at every stage-from early recovery to full function-you’re never left guessing.

Start strong. Stay supported. Recover right.

Book your consultation today and take the next step towards full movement.

Patient Feedback and Results

Our patients are at the heart of everything we do. From the first post-operative steps to returning to full activity, we’re committed to providing expert care, clear guidance, and personalised support every step of the way.

Don’t wait-get in touch if you’ve had ACL surgery or need help getting back on your feet.

You can start your recovery with the team at Perfect Balance Clinic in St John’s Wood, near the iconic Lord’s Cricket Ground. Whether you’re in the early phase or progressing through rehab, we’re here to support every step.

St John’s Wood Clinic: Location: Lord’s Cricket Ground, London

Parking: Limited pre-booked parking is available for those with accessibility needs. Please let Reception know at least 48 hours before your visit.

We also have clinics available in Moorgate, Harley Street, Cambridge, Hatfield, and St Albans-so you can choose the location that works for you.

Phone: 0800 0724 012 Email: [email protected]

It’s easy to begin-just use the form below. Our team will be in touch to help you start your recovery with confidence.