Back to sports after ACL reconstruction: what to maintain and Why |

Back to sports after ACL reconstruction: what to maintain and Why

by Madelyn Ludwig
Ask a Vail Sports Doc
An injured ACL requiring a reconstuctive procedure.
Special to the Daily | iStockphoto

A year has passed since you underwent ACL reconstruction and you’re ready to return to sports. Whether you are a skier or runner or a soccer player, you will want to take good care in maintaining the quality of both your knee and the surrounding muscles and tissues — all to help in preventing further injury and chronic knee pain. To maintain optimal performance in your individual sports, make strengthening and stretching specific muscle groups a part of your lifestyle. Programming can be as creative as you want, but always focus on improving flexibility, balance, agility and strength.


Strength is the most important tool for maintaining a healthy knee and performing at peak level in sports. Strength deficits have been shown to exist up to three years post-ACL reconstruction. This is an important fact to take home, as most athletes return to sports at nine to 12 months post-surgery. Strengthening other muscle groups will give your knee the stability it needs and help with restoring the movement patterns and neuromuscular control needed for sports. Special attention should be taken to ensure proper squat mechanics. You also want to prioritize gluteal strengthening as many athletes concentrate only on quad strengthening, and hip musculature is very important to protect the knee from injury.


Flexibility helps joints move correctly and also helps prevent further injury. After ACL reconstruction, your body goes through a change in mechanics from walking on crutches to being in a knee brace and limping. One year after surgery, you will have full range of motion; you will also have addressed poor mechanics adapted from surgery during formal physical therapy. Maintaining good flexibility is crucial for your body to perform and to decrease compensatory movement patterns that increase stress on the surrounding soft tissue. Focus on hamstrings, quadriceps and gluteal musculature as well as lengthening or rolling out your iliotibial bands.

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Balance and agility

Balance and agility are the final ingredients to maintaining your knee after returning to your favorite sports. Exercises specific to balance and agility increase your reaction time and improve the way you land, which if done incorrectly, can put you in a compromising position for reinjuring your ACL. Reliable neuromuscular control in a fatigued state is crucial for performing in your individual sports and for preventing reinjury. This is accomplished through a long-term conditioning program that includes movement pattern repetitions and neuromuscular control training.

Strengthening your affected limb and the surrounding muscles is important if you want to continue to participate in the sports and activities you love. Be sure to continue a conditioning program that focuses on strength, flexibility, balance, neuromuscular control and agility long after ACL surgery.

Madelyn Ludwig is an athletic trainer with Dr. Rick Cunningham’s office. Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a Physician for the U.S. Ski Team. Visit his website at For more information about Vail-Summit Orthopaedics, visit

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