40+ Tips to Prepare for ACL Knee Surgery and Recovery (Home & Self)

Tips to prepare your home and yourself for recovery pre & post ACL Knee Surgery.
by Updated November 2, 2018

If you ski long enough, chances are pretty high that you or someone you know will end up tearing an ACL in their knee. All it takes is one freak ski accident, a bad crash or a ski binding not pre-releasing when it should have, to do some real damage to your knee and tear an ACL or other ligaments in your knee.

This past winter I was on the losing end of a bad ski racing crash that ended up tearing the ACL in my left knee. The cause of the crash was due to a number of different factors (which I may write about in another post). But essentially, my lower back gave out in the middle of a GS race course, I hit a cross rut, which jolted my body forward, and I simultaneously hit my head on the snow in front of me, as my left leg got hyperextended underneath me. With all that going on my ski binding never released. At 37 years old, after skiing for 30 years, unfortunately I became a member of the torn ACL club.

I'm currently at the 10 week mark, post ACL surgery (allograft), after pre-habbing for 3 months prior to surgery. I still have a long way to go until I'm fully recovered and back out skiing again, but I've learned a lot in these last 5 months and thought I'd share some of the things I did and recommend to others who might be going through the same thing. So if you're about to have ACL reconstruction surgery, hopefully these tips will help you out to get better prepared for after surgery and make your recovery at home a little smoother and less painful.

Here are the 40+ tips you can use to prepare your home and yourself before having ACL Reconstruction Knee Surgery:

Walking Devices

1) Crutches - Must have... don't think you can get by the first 2 weeks with just a walker or a cane (as I almost did). You really need a set of crutches to get around those first few weeks after surgery. Do your best to get them before surgery, especially if you've never used crutches before or if you have poor balance, you're older, weak or have to go up or down steps to get into your house. That way you can practice how to use them prior to surgery to get a better feel and balance for how to use them properly, as well as to make sure the crutches are adjusted to the proper height for you. After surgery you'll still be woozy, so figuring out how to use crutches for the first time (like I did) isn't such a good idea. Typically if you aren't able to get crutches before surgery, the hospital or surgery center should issue them to you (your insurance will pay for them).

Two types of crutches that you may use after ACL surgery are Walking underarm crutches or Forearm crutches.  Walking underarm crutches may be a little clumsy to use at first, but they give you the ability to offset some of your body weight onto your armpits (even if this isn't always a good idea), which can take pressure off your hands and allow you to rest when standing. Forearm crutches may be a little less clumsy to use than standard crutches, but they tend to put more pressure on your hands and can take more forearm, wrist and tricep arm strength to use while getting around. 

Note: Make sure to crutch proof your house by removing any slippery rugs / mats, and move furniture so there are wide enough lanes to get around your house on crutches.

2) Cane - While a cane is not necessary, it can be helpful once you start bearing weight while walking without using two underarm crutches. A walking cane can make it easier to start transitioning to full weight bearing walking.  At two weeks, your physical therapist may have you transition from using two crutches to using only one crutch when you're walking outside the home. I found using just one under arm crutch to be really awkward and a bit cumbersome. This is the time when a cane can come in handy and be less clumsy to use rather than trying to use just one underarm crutch. Just remember, that a cane is used on the opposite side of your injured knee.

In my opinion, a cane is way easier and safer to use when going up and down stairs rather than using crutches. It's also a little less discreet (than under arm crutches) and can be easier to throw in your car and take along with you places.


Bed & Pillows

3) Move Bed to Ground floor - If your bed is on the second floor of your two story house, have some family or friends help move the bed to the first floor, preferably near the kitchen and bathroom. If you can't move your bed, consider renting a hospital bed. The simple fact is that for at least the first 2 to 3 weeks, you will not want (or be able) to go up and down stairs regularly (it can be painful, physically exhausting, and dangerous for your new ACL graft). In the first two weeks when you're still not fully weight bearing, you should only go up and down stairs sitting down on your butt (one step at a time). But if you need to go upstairs, make sure to put a chair at the top of the stairs, so you can get up from the top step floor easier (and safer) or to get down onto the floor to your butt. Also you'll really want to wait until you're weight bearing and off crutches before attempting to go up or down a flight of stairs while standing up (at that point you can use a cane to help you, along with using the railing).  While you can certainly get by sleeping on your couch (not recommended), after that first night post-surgery of sleeping on your couch you'll probably regret not having moved your much more comfortable bed to the first floor when you had the chance.

If you do move your bed to the ground floor, be sure to bring the following to the first floor as well:

  • Clothes - Move any clothes you may need for the first 2 weeks near your bed, so you don't have to go up stairs to fetch what you need to wear (socks, underwear, pants, shirts, etc.).  You may also want to move your laundry basket for your dirty clothes.

  • Extra Bed Sheets - So you can easily change your sheets in the first week, without having to go upstairs.

  • Toiletry bag - So you have all your needed bathroom supplies in your downstairs bathroom to brush your teeth, shave, brush your hair, put in contact lenses, etc.

  • Shampoo - Usually the first 7-10 days you'll be advised not to take a full shower, so your wounds can fully heal.  However, you may still want to shampoo your hair in the kitchen sink in the first week (in case you don't have a bathroom shower on the first floor).
  • Towels - Wash cloths, hand towels and bath towels.

On a side note, if you have surgery during the colder months, you'll want to keep heavy blankets / comforters off of your foot, as this will put undue pressure on your knee. You can try putting on a really warm wool sock and putting your foot outside of blankets, or get an adjustable blanket support. I actually used this InteVision Knee Pillow placed vertically to hold up blankets around my feet, which worked pretty well (It's also really great for its intended purpose when you start sleeping on your side to take pressure off your knee).

4) Memory Foam Topper / Mattress - For those who may already have lower back pain (like myself) or your current mattress is worn out; I highly recommend getting either a memory foam topper for your current mattress or a full memory foam mattress like a Casper Mattress. Unfortunately, after surgery you will literally spend a ton of time lying flat on your back for 3 to 6+ weeks with your leg locked out in your post-op brace and elevated on pillows. Most likely you will be sleeping on your back the majority of the time without the ability to be move around much, as sleeping on your side will remain uncomfortable with your leg in a locked out brace and your knee sensitive to pressure for the first 4+ weeks.

The longer you sleep on your back with your leg elevated and locked out in the post-op brace, the better off your knee swelling and leg extension will be (I wore the post-op brace locked out for 8 weeks while sleeping to help retain full leg extension). If your mattress is uncomfortable or causes you to wake up with lower back pain and stiffness before surgery, you will be much more miserable than you need to be during your recovery without a good comfortable mattress. If you are uncomfortable in your current (worn out 8+ year old) mattress, do yourself a favor and invest in a memory foam topper or a new memory foam mattress (which can literally be shipped to your house in a small box.  For myself, buying this 3" memory foam topper from amazon was one of the best purchases I've made in recent years, and I did this soon after tearing my ACL. Having a comfortable bed while recovering from an ACL injury and/ or ACL surgery should not be underestimated, especially for those with existing lower back pain.

5) Pillows to Elevate Legs / Head - You'll need at least a few pillows to elevate your leg(s) in the weeks following surgery to help reduce swelling and avoid blood clots. I used this Conforma memory foam pillow on the bottom as it is fairly dense, and a really soft pillow on top of the memory foam pillow to keep my knee / leg elevated and comfortable.

Also underneath my good UN-Injured knee I used this memory foam knee pillow (just DO NOT use it under your surgically repaired knee). Keep in mind you need to keep your surgically repaired knee/ leg totally straight (locked out in post-op knee brace) while sleeping for 4 to 8 weeks after surgery.  Initially, I did NOT put the knee pillow underneath my good knee and began getting some lower back pain. Two days later I started using the knee pillow under my good un-injured knee and my lower back pain virtually went away for the weeks following surgery.

UPDATE: 2-10-16 Since October I've been using an InterVision Foam Wedge Bed Pillow (7.5" High) to elevate my legs / feet. I initially got it for my lower back, but it didn't work very well as I had intended to use it until I decided to put the wedge under my feet/legs, which then helped take pressure off my lower back while sleeping. In doing so, it made me realize that this triangle pillow wedge is the perfect solution to use after ACL knee surgery to prop your leg/knee/foot up with, rather than stacking multiple pillows up for your leg to rest on.  Essentially, you can just stick the pillow wedge on top of your mattress or underneath your mattress (or just underneath a memory foam topper) at the end of your bed.  I think using the wedge this way is actually a much better solution to stacking pillows up because it seems to prop your leg up in a straight line/angle which should help with extension, while also helping to reduce swelling.  Note: I would stick to the 7.5" high pillow wedge (not the 12" high wedge, as I think that 12" would be a bit too tall to sleep comfortably). Also keep in mind, if you're taller than 6 foot, the longer version may be better InteVision Extra-Large Foam Wedge Bed Pillow (33" x 30.5" x 7.5").

6) Bed Tray Table - So for the first two weeks you'll probably be much more comfortable eating in bed with your knee straight out in front of you, rather than sitting with your knee bent in a chair around a table. If you're lucky enough to have someone serve you breakfast, lunch or dinner in bed, a breakfast serving tray will come in handy and make eating food in bed much more enjoyable. Alternatively, a bed tray can also serve as a laptop tray, in case you need to do work or want to watch a movie from your laptop in bed.


Bathroom & Shower

7) Raised Toilet Seat - If you're tall, one of the best things you can do, (besides moving your bed to the ground floor) that will make your life easier after knee surgery in the first few weeks is getting a raised toilet seat, especially if you're a taller person. This is because every time you sit down to go to the bathroom in the first few weeks with your post-op brace on you essentially have to do a single legged squat (pistol squat), using your good leg to squat down to the toilet (or stand up), as your injured leg will be in a post-op brace. So having a raised toilet seat will make sitting down and getting up from the toilet that much easier and less painful especially for individuals 5' 9" or taller, since the distance you have to squat down will be smaller.

Keep in mind, if you have 1' (foot) or more of empty space on either side of your toilet, you should consider getting a raised toilet seat with handles so you have something stable to grab onto when you sit or stand up. Just make sure you secure the raised toilet seat properly before surgery. You can also just get handle rails that go around a toilet. Having handle rails to grab onto to help you sit down or get up from the toilet will make your life much better in the weeks after surgery.

Note: Shorter individuals may also benefit from a raised seat, but it's possible that the extra height of the raised seat could end up being more awkward for someone with shorter legs while wearing the post-op brace in the locked out position.

8) Miralax for constipation - Surgery, anesthesia, and the pain medication taken after ACL surgery can all cause constipation for a variety of reasons. So just in case you start getting constipated after the first day or two, you'll want to at least have a laxative like  MiraLAX at the ready.

9) Toilet paper - Make sure you stock up on toilet paper and place it in an easily accessible bathroom location. You won't want to go up or down stairs searching for toilet paper when you really need it!

10) Baby wipes - Since you won't be able to shower for the first week or so, baby wipes can be a nice alternative for staying fresh.

11) Shower seat - Once you are allowed to begin taking showers, you'll be much safer sitting down on a non-slip shower seat or bench while showering. The last thing you want to have happen is to slip and fall in the shower. Standing for a short period of time in the first two to three weeks can often cause your knee to swell, so being able to sit down while showering is recommended. Also keep in mind, if you don't have a walk in shower and only have a bathtub shower in your house, it will be very difficult to get your involved leg over the side of the bathtub in the first few weeks, so having non-slip seat in the bathtub may allow you to sit down to get over the side of the bathtub easier.

12) Sticky non-slip bath rug / mat - A wet floor can be super slippery and very dangerous on a leg that can't support itself very well in the first 3 weeks after surgery. And you really don't want a slippery bath mat or rug to slip out from under your already unstable feet. So make sure when showering you use a non-slip bath rug that you can step onto when getting out of the shower, that won't move around. Otherwise you may find yourself crawling out of the shower the first time you shower because you're scared you might slip and fall. Also, a non-slip bathtub mat or shower mat to use inside your shower or bathtub should also be considered, especially if you don't use a shower seat.


Groceries, Food & Drink

13) Groceries - Stock up your fridge, freezer and kitchen cabinets with plenty of groceries before surgery. The last thing you'll want (or be able) to do is go grocery shopping in the first couple weeks after surgery. Hopefully, you'll a have a family member or good friend helping you pick up groceries in the first few weeks after surgery. If not, you should really stock up on food so you can get by for 2-3 weeks without needing to go to the grocery store. If you will need to go to the grocery store early on, then make sure you get your doctor to issue you a handicap parking permit for your car, which will make getting to work, or going to the grocery store a whole lot easier. Otherwise, use a grocery delivery service in your area with the help of Instacart, or alternatively use Amazon Prime Pantry to get some needed grocery supplies.

14) Cooking - In the first 2 weeks, you will not want to stand around cooking for any length of time while using crutches with a swollen knee. So if you don't have anyone cooking for you in that time frame, then you'll really want to have a lot of food dishes already prepared (microwave ready) that you can take out of your refrigerator or freezer and quickly heat up in the microwave if needed. Cold foods that you don't have to heat up also work really well. Be sure to have fruit at the ready like bananas, clementines, blueberries, strawberries or fruit salad.  Hopefully, you'll at least have someone around for the first 3 to 4 critical days after surgery that can help with cooking your meals and serving food to you in bed while you're still hopped up on pain medication.  You'll really want someone cooking / serving meals to you those first few days. I had a family member around for the first 4 days, but due to a family emegency, after that I was pretty much on my own for the most part (other than groceries and being driven to PT in the first two weeks). So if you don't have someone close to you, you can always hire a person to come in for a few hours a day to cook meals and help out (or even go grocery shopping for you)... similiar to home care services that come in for the day to help out seniors/elderly.

15) Snacks - It's good to have some of your favorite snacks by your bedside for those times when you get hungry in the middle of the night or during the day, but don't want to get up. My personal favorites are Honey Stringer Organic Energy Chews, and Blue Diamond Smokehouse Almonds. I had both of these snacks, along with a bottle of water, clementines and bananas within an arms reach at all times, but any healthy (or somewhat healthy) snacks will do.

16) Drinks (bottled) - Stock up on bottled drinks.... because trying to carry a glass of water or milk while using two crutches to get around doesn't work well. So while you're on crutches you'll want to have drinks that are in bottles or cans, and can be carried in a bag while walking with crutches. Drinks such as bottle water, bottled Gatorade, bottled juice or even cans of soda. Keep in mind, sugary drinks like soda and gatorade will make you have to pee more often and can cause inflammation, so you should try to avoid sugary drinks (or sugar in general). A small refridgerator or cooler next to your bed can make your life a little easier, as well as help keep drinks, food and ice cool.

17) Plastic food containers - If you won't be having anyone help you with meals and are not being served meals in bed, then be sure to have a bunch of plastic food containers w/ tops that you can put your hot food / meals into. This will allow you to carry food in a plastic bag while on crutches to wherever you eat your meals. In the first week or so, you'll probably feel much more comfortable eating in bed with your leg off the ground, rather than around a dinner table.

18) Backpack and/ or Plastic grocery bags - While on crutches you'll need some sort of bag to carry your meals/ drinks/ silverware to and from the kitchen to your bed. Plastic grocery bags or a backpack can work well for this. To carry smaller things, a fanny pack may also come in handy for times when you are not wearing pants with pockets or you could use a hands free crutch carry bag that attaches to the side of a crutch.


Medical & Physical Therapy Aids

19) Rolled Gauze & Sterile non-stick pads - Hopefully, you will have set up a Physical Therapist appointment 2 to 3 days after your surgery, at which time the PT should change your blood soaked gauze pad for you that's wrapped around your knee. If not, you will need to change the gauze / pad yourself within 3 days post-surgery and probably a few more times within the 2 weeks after surgery. So make sure you have some Rolled Gauze and Sterile non-stick pads (3" x 4") on hand that you can use.

20) Ice Gel Packs / Ice Bags / Ice cubes - If you aren't lucky enough to be issued a Knee Cyro Cuff ice machine by your doctor, then you'll certainly want to have a number of ice packs and bags that you can alternate as you use them (and freeze them). I'd recommend having at least two Ice Gel Packs (6" x 10") and one or two Ice Bags with plenty of ice cubes you can use so you can alternate use throughout day and night. You may also want to try the O2 Cold and Compression Knee Wrap which comes with a really nice ice pack that fits around your knee.  Along with the ice packs, it's a good idea to have a thinner towel on hand when using the Ice Gel Packs as it's not recommended to place gel packs directly on your skin for a long period of time. You could also keep a personal cooler next to your bed, so you don't have to get up during the night for cold ice packs (or cold bottled water).

21) STIM Tens unit - An electronic stimulation pulse massager is highly recommended to help reduce swelling around your knee (or get muscle activation after initial injury) and can be a great complement to icing. The truMedic TENS unit electronic massager works really well and in my opinion felt just the same as the larger STIM unit used at my Physical Therapist office.

You just need to be aware that after surgery your goal will be to reduce swelling, so you want to make sure you DO NOT put the Tens unit up on a setting too high where you start getting muscle contraction in your quad. You only want to see muscle contraction while using the Tens unit if you're trying to get the quad muscle to fire after injury and get it working again, not to reduce swelling. Instead, using the truMedic TENS unit, you'll want to use the "Knead" setting (which will feel more like mini pins and needles) and only set it on a power intensity that is comfortable enough for you to handle, but not to the point of being painful. 

22) Foam Roller - A foam roller is really great to use whether you had ACL surgery or not. It's typically used to massage stiff muscles, break down scar tissue and improve your range of motion by rolling out or putting pressure on targeted areas of the body, such as on tight hamstrings, calf muscles, quads or back. But a foam roller can also come in especially handy after ACL surgery for performing Heel Prop exercises in order to loosen up your hamstring and get your leg extension past 0 degrees.

23) Stretch Out Strap - While you can certainly use a large bath towel for stretching out hamstrings and other muscles after surgery, a Stretch Out Strap makes it much easier to get a proper stretch. The stretch out strap has multiple loops on the strap allowing you to grip it better and perform various stretches that you wouldn't be able to with an ordinary bath towel. The green stretch out strap is also the same strap you will use at Phyiscal Therapy.

24) Compression Knee Sleeve - A compression knee sleeve like the CEP Ortho+ Compression Knee Sleeve can be really beneficial to help reduce swelling in the weeks after surgery and beyond. It can also add more stabilization to your knee when you start walking around without the functional sports knee brace. If the functional sports knee brace you get is sized a bit larger when you first get it due to having lost lots of muscle in your quad and calf muscles after surgery, you could wear the compression knee sleeve underneath the brace to give you a tighter fitting and more stable knee brace, but it will make it harder to bend your knee.

When you get your functional sports knee brace, ask the fitter for a neoprene undersleeve, as this can also make a knee brace fit slightly tighter and is also helpful if you're leg is between knee brace sizes. It can also help keep the knee brace feeling more comfortable, as well as keep your leg warmer.

25) Ankle Weights - 2lb or 5lb pound ankle weights can be helpful for at-home rehab once your leg starts getting stronger.  You can use the 2lb ankle weights to add extra pressure when doing heel props or prone leg hangs for working on leg hyperextension. You can also use ankle weights to add extra weight when performing exercises like straight leg raises, leg extensions, hamstring curls or hip abductions.

26) Resistance Bands - A Resistance Band Loop set can add extra levels of resistance to your at-home leg exercises. You can use resistance band loops for exercises such as lateral band monster walks, clam exercises, squats, bridges, hip abductions, high steps, and many other proprioceptive exercises. Once you gain back more strength, a 40 to 80lb Pull-up Resistance band can be helpful for doing standing terminal knee extensions.

27) Spin / Recumbent Bike / Rowing machine - Cycling (or rowing) before or after ACL knee surgery can be one of the safest exercises for your knee to help it regain knee flexion. However, in the first 6-8 weeks after surgery you should avoid biking too much as it can place too much repetitive stress on your graft as it is healing, especially if you have an allograft. After the first 4 weeks you may feel like you can cycle for up to an hour or more a day, so talk to your physical therapist as to whether or not you should be cycling that much. As a general rule try not to do more than 15 to 20 minutes of cycling per day. 

Biking is good for endurance and regaining flexion in the early days after knee surgery, but in my opinion I have not found it great at regaining optimal leg strength, proprioception or regaining back the critical VMO muscle. You will have to put in some seriously long, hard, uphill miles on the bike to get real lasting strength back that you will have lost after surgery through biking alone. For the most part, biking is an aerobic exercise and only when you start sprinting or doing more up hill riding does it start becoming an anaerobic exercise. But to regain the muscle you lost after surgery, you'll really need to focus a lot of your attention on anabolic leg exercises, which means strength training in the gym.

Once you can start walking after the first few weeks, start to do it progressively as much as possible, as this will help a lot with reducing pain, regaining proprioception, and also help with strengthening the leg muscles in the first few months after surgery. Just make sure you have full leg extension, and walk with proper form or else you'll elevate your risk of re-injury. You can substitute biking when walking / hiking / jogging does not feel good or as a 10 minute warm-up.  I would NOT worry about trying to run until you get the "OK" from your PT or doctor and your leg muscles have the proper strength to support proper running form.

NOTE: I found standing pedaling (stand-up) on a spin bike or standing pedaling on a mountain bike (w/ a short stem) to be really helpful when transitioning my knee/leg into jogging or running.

28) Suspension StrapsTRX Suspension straps can be really helpful in gradually regaining stability and strength in your leg post-op.  There's a number of different knee rehab exercises you can do using suspension straps to progressively get your knee stronger after surgery.  Just a few supported suspension strap exercises include: squats, front squats, lunges, reverse lunges, bulgarian split squats or single leg pistol squats.  I really wish I had bought a set of suspension straps to help with rehab in the first few months after surgery and beyond. But I've since picked up a pair of Nayoya Gymnastic Rings, which I can setup and use in a similiar fashion to TRX suspension straps.


Clothes & Shoes

29) Slip-on shoes - A pair of slip-on shoes can be really convenient to wear in the first few weeks after surgery in my opinion because they don't have shoe laces to tie and can be slipped on more easily.  You will not want to wiggly your foot into shoes or bend over to tie shoe laces, so slip-on shoes can make life a little easier and less painful following knee surgery. I wore a pair of Merrell slip-on shoes that I already had as they are comfortable, lightweight and can be worn during the early phases of physical therapy. In general, I think zero drop shoes or slip-ons (that do not raise your heel up) are the best to wear for recovery/rehab/walking around, as the zero drop shoe platform is more natural and seems to put less stress on the knee.

If you have high arches or want better foot support you may also want to consider getting a pair of moldable insoles like the Sole Softec Footbed. I've started using Sole Insoles in all my footwear and ski boots and highly recommend them if you have high arches and want a more comfortable shoe support for your foot. Alternatively, if you have low arches, a wide foot or want a more natural feeling shoe, you may prefer a Zero Drop shoe like the Altra Instinct Walk Shoe or the Altra Provision 2.0 shoe, as they can give you a more stable feeling while walking due to a wide toe box and zero drop shoe platform.

Once you get back in the gym and start performing more weight lifting type exercises like high bar squats, deadlifts, leg presses, split squats, etc. a good pair of crossfit or weight lifting shoes can be beneficial and help with stability and power while performing many leg exercises.  For a great all-round crossift shoe that can be worn during PT or weight training, consider the Reebok Crossift Nano 6.0.  For a more specific weight lifting shoe that offers great stability when performing compound leg exercises like deadlifts consider the Reebok Crossfit Lite TR 2.0. The Crossift Lite TR 2.0 may not look like the coolest shoe, but after ACL surgery it has many of the characteristics in a shoe that can really offer some advantages while performing stationary leg exercises, like a wide forefoot, stable heel and flat sole, while also being really comfortable. However you would not want to do any prolonged walking, jogging or running with it. Alternatively, a shoe like the Converse Chuck Taylor is another good option to use. Eventually, you may want a more Squat specific olympic weight lifting shoe with a wedged heel and extremely hard sole, like the Reebok Legacy Lifter.

30) Shoe Horn - Essentially, you will NOT want to wiggle your heel into your shoes, as this side to side wiggling will not feel very good on your knee. A shoe horn will allow you to slip straight into just about any shoe, without the side to side movement that occurs when you wiggle into shoes. If you can't borrow an old shoe horn from your parents or grandparents, then it's definitely worth picking up your own. Note: A flexible longer shoe horn (16" or above) will make it easier to use without having to bend over.

31) Breakaway Pants and/ or ShortsTear away warm-up pants, loose fitting sweat pants, or shorts that will fit easily over the top of your bulky post-op brace can come in handy to wear after surgery and for physical therapy sessions.


Books & Entertainment

32) Books & Magazines: It's good to have some books and / or magazines to read while you're recovering. I highly recommend reading Kelly Starrett's best-selling book Becoming a Supple Leopard 2nd Edition as it is a great reference book to "Improve your athletic performance, extend your athletic career, treat stiffness and achy joints, and prevent and rehabilitate injuries—all without having to seek out a coach, doctor, chiropractor, physical therapist, or masseur."

33) Laptop / iPad - You'll definitely want some sort of laptop, tablet device or smart phone for mindless entertainment, especially if you don't have a TV near your bed.  You also may need an extension cord to plug in your laptop and/or smart phone for charging. Having access to Netflix or Amazon Instant Video can also help keep you entertained, as you'll have plenty of time on your hands while lying in bed to catch up on some episodes of your favorite TV shows and/ or movies. An inspiring movie to rent on amazon that I highly recommend is Meru with renowned alpinists Conrad Anker, Jimmy Chin and Renan Ozturk.


Work & Bills

34) Take Time off from Work - Take at a minimum of 3 weeks off from work and focus primarily on rehab, but preferably take at least 4 to 6 weeks off, even if you work a computer / desk job. If you need to work, do it from your bed at home using a laptop. If you go back to work earlier than 3 or 4 weeks, you'll just be very uncomfortable at work and probably very unproductive as concentration will be lacking. Typically, at around 3 weeks you will get your functional sports knee brace, so having at least a week to rehab and get used to getting around with the functional knee brace will be beneficial for your recovery. Also sitting in an office chair for any prolonged period of time with your leg bent in those first six critical weeks, without your knee elevated will lead to swelling, worse leg extension and a longer recovery time.  Getting full leg extension and keeping it, is critical in the first few weeks and months after surgery, so do everything you can to avoid sitting at a computer desk with your leg bent for extended periods of time, as this can be detrimental to your long-term recovery. So the longer you can take off work, or work from bed on your laptop, the better off your knee will be in the long run.

35) Pay Bills - Pay any monthly bills you have for the month following surgery. That way you won't have to worry about writing checks for the upcoming month.



36) Pet Food - Don't forget about feeding your pet! Make sure you have at least a few weeks of cat or dog food on hand.  

37) Litter Box - If you have a cat, be sure to have plenty of kitty litter.  If you're the person who will be cleaning the litter box, make sure it's in a easy to reach location on the first floor.

38) Dog Walker - If you have a dog, and don't have a fenced in yard, then you will absolutely need to have someone walk your dog for you, for at least the first 4 to 6 weeks (and possibly many more weeks depending on how big or active your dog is). If you have a dog that pulls while on leash, then definitely consider getting a dog harness to use once you’re physically able to start walking your dog again. It’s much easy to control a dog on a walk and keep them from pulling when using a harness rather than a simple dog collar. In the early stages of recovery you will not appreciate being jerked or pulled around by a dog with pent up energy.


Pre & Post Op Tips

39) Shave Inner/ Upper Thigh Leg Hair - Before surgery, for guys especially, I recommend shaving or buzzing off your inner and upper thigh leg hair (even if you don't have too much). For myself, about a week after surgery I found the post-op brace foam irritating the heck out of my inner thigh, due in part to some upper/inner thigh leg hair (which I don't even have a lot of) and possibly due to the nerve block I received prior to surgery. Two and half weeks after surgery, I finally took an electric hair clipper and shaved the hair around my upper/inner thigh and after doing so the sensitivity and irritation on my leg from the post-op brace started going away. I just wish I had shaved it off before surgery as this irritation became super annoying especially while trying to sleep with the post-op brace on. In all honesty, it almost became more annoying than any knee pain I dealt with after surgery. Alternatively, I've heard that some people wrapped up their thigh with ace bandages to keep the foam brace from itching and iratiating their leg.

Keep in mind, for those who have yet to have ACL surgery, on the day of your surgery, a nurse will use an electric hair clipper to buzz off any leg hair that is right around the top portion of your knee, but they typically do not shave the hair off your entire leg.

40) Set Alarm to take Pain Medication - After surgery, stay ahead of pain by setting your alarm every 4-6 hours (and throughout the night) to take your pain medication. I was given Oxycodone to take and would wake up throughout the night to take the medication when my iPhone alarm went off every 4-6 hours. I feel this totally helped keep my pain level really low. If you don't do this, you'll most likely end up waking up anyway due to pain and be in much worse shape. It's much better to stay ahead of your pain, than trying to suppress pain after it really starts hurting. I took oxycodone regularly every 4-6 hours for the first 4 days, then only 1 oxycodone just before sleeping for 3 days, and after that I never had to take any more prescribed pain medication or over-the-counter medication.

41) Pain from Blood Rushing to Leg - To help avoid or lessen pain from blood rushing to your leg when standing up in the first few weeks after surgery, try to always take off the post-op brace and do leg exercises / stretches for at least 5-10 minutes to get the blood flowing before standing up (especially in the morning after just waking up). I wish I had done more of this in the first 2-3 weeks after surgery.

Overall, the most pain I ever experienced after surgery was when I started weight bearing walking, but the pain never got much higher than a 2 or 3. However, the pain might have been even less if I had taken more time beforehand to warm up my leg and get the blood flowing each time I needed to I stand up from bed in the first few weeks. Once I started putting weight on my leg while walking (2-6 weeks after surgery), I would get some medial knee pain, but I eventually figured out that if I tightened my core while walking, I would get virtually NO medial knee pain.

Everyone is different as far as how much pain each person experiences after surgery. You may experience very little pain, like myself, or you might experience a world of hurt. Either way, the pain will go away and you will begin to get better. You just need to stay vigilant and continue to do your exercises and stretches daily (multiple times per day), and you will continue to progress day by day, week by week.

42) Self Doubt & Strength - Even with minor setbacks or feelings of doubt, just keep at it... You'll have good days and some bad days (and possibly a few times you're going think you re-tore your ACL). Just make sure to keep active and stay consistent while working out 6-7 days a week. If I stopped working out for a day or two, my knee typically felt worse off, especially the following day. 

Try not to worry too much if you're not healing faster than someone else you know did or read about on an internet forum. Everybody heals differently, everyone goes into surgery with their legs and body in different states of physical condition, and everyone loses muscle mass differently before and after surgery.

But with that said... do your absolute best to get your injured leg as STRONG as you can before surgery. And after surgery work as hard as you can to progressively rebuild the strength in your quads, hamstrings, glutes, hips, calves, adductors, abductors and core, and get them STRONGER than they have ever been! Your recovery will depend greatly on the strength in your leg.

So make sure you focus primarily on single-leg exercises that strengthen your involved knee / leg.  Otherwise it's very easy to unconsciously strengthen your good leg more than your bad leg, while putting more stress on your good knee. For instance, don't start doing HEAVY weighted back squats until both leg muscles are in balance, otherwise you will just unconciously stress your good knee and risk getting patellar tendinitis in your good knee...  this can also lead to a huge muscle imbalance in your opposite leg (as well as knee pain in your good knee).  So make sure you start with primarily incorporating single-leg exercises into your PT routine in order to get your involved leg quad/ VMO muscles as strong as your good leg (for example: single-leg press, physio lunges, single leg lunges, bulgarian split squats, stagger stance split squats, step-ups (without pushing off w/ good leg), reverse step-ups, Poliquin Step-ups, Petersen Step-Ups, single-leg hamstring curls, etc.).

UPDATE 12-29-2016 A huge mistake I made in my rehab and in my training over the years was not really focusing enough on the ECCENTRIC portion of any given exercise. The quadriceps muscle group in particular contracts eccentrically when you descend stairs, hike down a hill, put the brakes on to stop or while skiing down a mountain. Eccentric strength absorbs force. Concentric strength on the other hand will help with walking up stairs or hiking up a hill. To put this in perspective, I could walk up stairs relatively well in the weeks following surgery (in part because I was pushing off my good leg when stepping-up), but still to this day have not been walking down stairs all that well (still a little wobbly at times).  So when rehabbing your leg after surgery make sure you focus more of your time on the eccentric contraction when performing any given exercise rather than the concentric. For many exercises when rehabbing you can use a slow controlled tempo of 3 or 4 seconds on the eccentric contraction of the exercise (i.e. when lowering weight or lowering your body when you squat) and usually around 1 second on the concentric contraction. Keep in mind, fast eccentric training (plyometrics) should typically be reserved for the competitive time period once you're leg is back to full strength. Leg exercises that you should really focus on the eccentric contraction when rehabbing include: body weight squats, cyclist squat, slant board squats (double or single leg),  eccentric leg presses (single leg), lunges (forward, side).  To read more about the benefits of Eccentric training check out this article from strength coach Charles R. Poliquin: The Role of Eccentric Training in Building Maximal Strength. Also see this Mountain Athlete article on Training "Fast" Eccentric Leg Strength for Alpine Skiing. END UPDATE

Overall, the stronger your leg muscles are going into surgery (and in the weeks following surgery), the faster you'll be able to make a full recovery after surgery. Just don't forget, you break down muscle in the gym, but you grow muscle and get stronger by eating enough healthy food in the kitchen and getting plenty of sleep every night.

Recovering from ACL surgery is a marathon, not a sprint. It takes time, just stay consistent, take it step by step, and you'll get your knee back to full health and back to doing the things you love to do.


IMPORTANT UPDATE 4-5-2016: One thing I didn't note in my post above, but is probably one of the most important, is to make sure you pick a really good / highly recommended "sports" Orthopedic Surgeon to perform your ACL surgery. You want a doctor who specializes in knee surgery and performs ACL surgery often (daily/weekly).

If you're not sure who the best knee doctors are in your city, then try to find out what sports knee doctors your Minor League or Major League sports teams use in your area. You can also ask just about any adult ski racer or ski coach and they will probably know who the best ACL knee doctors are in your town. I found out it's often hard to get in to see a second doctor after you've already consulted with a first doctor... It took me 5 weeks to finally be able to get in to see a second Orthopedic surgeon, after initially going to a different doctor whom I did like, but I knew far more friends and ski racers who had successful operations with the second Othopedic surgeon who I choose for my surgery. However, because I decided to switch doctors, it set me back a bit and I didn't have surgery for 3 months after my injury.

If I could do things over, here's what I would do in that first week, just after tearing my ACL:

  1. Find out the best Orthopedic surgeon(s) in your area by talking to friends, family, phyiscal therapists, other atheletes and coaches and make an appointment with him/her.
  2. I would have started formal Physical Therapy (PT), right away (first week) after initially tearing my ACL. Get a prescription for Physical Therapy from your doctor.  Do NOT wait or try to do PT on your own. You start losing critical muscle mass very quickly after injury, as your muscle begins wasting away.  The key to a fast, successful recovery is keeping as much muscle mass in your leg as possible before and after surgery.  Focus on getting the swelling down, and getting in to see a Physical Therapist to receive the proper treatment.
  3. If I could have looking back, I would have had surgery ASAP...within the first 2 weeks, especially since I had very little swelling. That being said I wasn't mentally ready for surgery at that point. Unfortunately, I was diagnosed with a partial tear based on my MRI, which to be frank is kinda of a mind-fuck. I struggled back and forth with the idea of having surgery on my knee... I wasn't totally sure if I needed surgery due to it being diagnosed as a "partial" tear and the fact that I was starting to feel better. The lack of laterally stability in my knee, and it buckling randomly while hiking finally made it clear to me in my mind that I needed surgery... It did take a lot of back and forth for me though. Once I had surgery, the ACL was shown to be pretty much fully torn and just hanging by a couple threads, so there's no doubt I would have done more damage to my knee if I hadn't gone through with surgery.
  4. Professional atheletes don't wait months for surgery to fix a torn ACL, why... besides the fact that their livelyhood depends on being healthy as soon as possible, one critical reason is because you lose way too much muscle in your leg the longer you wait for surgery even with a good prehab. In Europe, doctors seem to do things a little differently... Aksel Lund Svindal (one of the best ski racers in the world), had surgery 2 days after tearing his right ACL at the downhill in Kitzbuehel this year... 9 weeks after surgery his quads looked nearly identical (https://www.instagram.com/p/BDjHmWVts5I/?taken-by=asvindal). Ted Ligety (also one of the best ski racers in the world), tore his ACL this year, flew home and had surgery in the U.S. two weeks after injury (but he did debate whether to have surgery in Europe soon after his injury). Here's his quad 6 days after surgery (https://www.instagram.com/p/BB0skGCpSzm/?taken-by=ted_ligety).
  5. The more muscle you lose around your leg/knee prior to surgery, the harder and longer it will take to make a full recovery after ACL surgery. It's critical you do everything you can to not lose your quad / VMO muscles. Make PT and strength training an absolute priority before and after surgery! I can't stress this enough...


Hopefully, the tips above will help make the recovery process a little bit easier for those of you who are about to go through an ACL reconstruction or some other type of knee surgery.  If you have any other tips, questions or suggestions that might help out others, feel free to share them in the comments below... I still have a long way to go in my recovery process, so I'd love to hear them!




anonymous by Mich on 3/13/2016
Thanks. I'm post-13 days and my first few days were so medicated, i felt great! Then the meds weaned off and getting back to weight bearing is showing its good and bad days. I know this is the process..but it helps to read blogs like this.
anonymous by Angela on 3/14/2016
Wow, Doug!
Thank you for taking the time to share! The details were amazing. I am contemplating having the surgery and found your post while looking for an ice machine. Hope your recovery goes well.
doug by doug on 3/17/2016

Hey guys,

I'm glad to hear you found the post helpful.

I'm now about 10 months post-op and things are continuing to steadily progress. For me, the worst part of tearing my ACL and ACL Surgery itself is the amount of muscle loss that's occurred in my leg. I literally lost my entire quad muscles (VMO / tear drop muscle disappeared into less than nothing), and it's been extremely hard to get it to come back from practically no muscle at all (yet I never lost too much strength in my hamstring).

I did start skiing again just before the 7 month mark post-op with a Berg XT Fusion knee brace... Although I wouldn't recommend skiing that soon unless you are an expert skier/racer or you have near-full strength back in your leg. I was extremely careful, as well as very lucky, and just skied easy groomed Green circle runs for about a month (very slow, short turns on short 165cm length slalom skis). That being said, my very first run on my first day back skiing I nearly had an out of control skier barrel right into my involved knee, luckily she fell down about 10 feet from me. If that wasn't enough, then on my second day skiing, on my second run, I nearly had my involved knee taken out by another out of control skier, who crashed 10 feet above me while I was stopped off the side of the trail. Needless to say I got pretty damn lucky, and I didn't ski a third run on my third day of skiing. 

Looking back I really shouldn't have been skiing that soon due to the poor condition of my leg. But with that said, I needed to get back out skiing for my mental and physical well-being and I do feel like skiing was beneficial in my recovery. I was able to get in 30+ days of skiing in (without falling) before hanging up the skis for the season at the beginning of March. At that point, I was starting to ski harder and just felt like it wasn't worth pushing my knee through un-groomed east coast spring skiing conditions that left much to be desired this year.  So I just decided to get back to working out more heavily and getting my knee/ leg much stronger for next season. Even with all the skiing, hiking, biking and gym workouts, my involved leg is still much weaker than my good leg, so I still have a lot of work to do in the gym to fully bring my quad muscles back in my involved leg. I have a feeling this will be more like a 2 to 3 year recovery for me, (due to all the muscle I lost pre and post surgery) until I really feel like my knee is back closer to normal with full strength.

Good luck to those of you who are about to have surgery or are still recovering... You are definitely not alone in the torn ACL club. I probably talked to at least 15 to 20 different people this season while riding up the chairlift at my local mountain that had also torn their ACLs or had knee surgery.

Hey Doug,

Great article and thanks for sharing the details of your experience. I'm 53 and after 48 years of skiing, I had my first "freak" accident on a heli-skiing trip. Not even that terrible of a fall but my bindings didn't release and well... I joined the club! I was training very heavily for the ski trip and I have no idea how I would be dealing with this recovery if I wasn't in shape. I find that my core strength is a major contributor to my ability to get around and not feel completely helpless. Balance on one leg while moving makes things much easier.

After surgery my worst pain was actually muscle spasms from where they took out my hamstring graft. Valium helped the muscle spasms subside and they went away completely a couple days after surgery. My biggest frustration right now is really bad pain in my shin when standing up (I had surgery 10 days ago). The pain comes on after about 15 seconds and peaks at 1 minute after standing up. On a scale of 1-10 I would rate it at least a 7 but it goes away immediately after raising my leg again. I will try your stretching/flexing recommendation before getting up to see if that helps. Still having issues getting my quad to fire but I'm getting there.

Good luck to all of you facing this issue and thanks Doug for the great article. I've found lot's of posts on medical blogs and doctor sites but none from a fellow skier. I'm planning to return to complete my heli-skiing trip in late February (they gave me a credit!) so any follow-on articles regarding rehab techniques that worked for you would be a great compliment to this article.

doug by doug on 4/12/2016

Hi Rahlstrom,

Sorry to hear you joined the club... but glad to hear you found my post useful. That's really awesome that the heli-skiing operation gave you credit to come back next year. That's definitely some extra incentive to get back to skiing strong next year... you just need to work extra hard at phyiscal therapy so you can get back skiing. I probably experienced the most pain while starting to walk again between the 1st week and 3rd week, so just know that the pain will begin to decrease in the weeks ahead once you get moving about on your feet more.

I'm probably not the best person to give advice regarding rehab, as I lost over 3 inches off my quad/leg after initial injury/surgery by the time I was fitted with my sports knee brace 3 weeks after surgery. I had thought I was in pretty good shape, before my injury... I had skied 45+ days, was ski racing, backcountry skiing, and running a few miles after skiing to get ready for an upcoming ski mountaineering race, so like you I can't imagine how much worse off I would have been if my legs weren't in fairly good condition. I certainly made some mistakes in pre-hab and rehab, but was diligent about pre-habbing and rehabbing after surgery... it's just crazy how fast you lose your muscle when your knee/leg stops working correctly.

In the days and weeks after surgery, just make sure to do exercises/stretches throughout the day and I would say plan for 2 hours a day of rehab for at least the next 6 months. Also make sure you constantly work on getting proper leg extension throughout the day.

Here are some notes I took on my iPhone regarding PT in the early days after my surgery:


5-18-15 (6 days after surgery) Took 1 oxycodone for sleep. Second PT appointment. Flexion stiffened up a bit. Did Prone hangs, straight leg lifts, quad sets, heel pulls, seated leg flexion. Got full rotation pedaling backwards on recumbent bike. Started 30% weight bearing crutch walking w/ brace locked (heel touch down first). Probably had the most pain today, since surgery (at most 3 out 10), due to starting partial weight bearing. Note: Pain is the worst when you first stand up and all the blood rushes to it.

5-21-15 At PT today did hamstring stretch, TOWEL pulls 5x a day, seated no weight leg extension, standing leg bend back hamstring curl, weight bearing standing on left knee, squats, calf raises. Started 60% weight bearing crutch walking w/ brace unlocked (quad tight, leg straight, and crutches touch down first, and heel). Bending leg back while moving. Had electro stim with ice... Learned tens-unit should not be set to cause muscle contraction in order to reduce swelling. Instead use the knead setting on truMedic tens unit, at a comfortable setting. If u wanted to get quad firing again after initial injury, that's when u'd want to use tens unit with muscle contraction.

5-26-15 (2 weeks since surgery) woke up with heel pain, had worn compression sock to sleep. But read a blog comment that heal pain may b from pressure placed on heel digging into pillow/ bed with brace on (what worked was to let foot /heel dangle freely over pillow), blanket on top of foot may also have caused downward pressure). Note: For the last two weeks I had NOT slept with a blanket over foot of injured knee, but may have last night, may also hv had pillow pushing up on heel.

Swelling in knee is down a little bit more. Knee still feels a bit unstable/ loose while crutch walking at times.

Drove car today for first time, was totally fine since it is a left knee injury.

PT today: heel props w/ weight on quad, prone hangs, quad sets (focus on pulling knee towards u), squats, calf raises, one leg standing balance, straight leg deadlift, single leg extension, weighted leg extension (only go to 60 degrees), hamstring curl. Started walking without crutches (w/ brace on). As well as w/ one crutch. Was told to now start walking w/out crutches at home, and one crutch when out of home. Got extension to -5, flexion to 105. Not very much pain discomfort when walking.


I will say just continue to focus a lot on single-leg muscle building exercises to get your involved leg as strong as your other leg.  Also make sure you really focus on the Eccentric contraction of all leg exercises to get your legs ready for skiing strong and confident.  To read just how IMPORTANT eccentric strength is for skiing, be sure to read Mountain Athlete's article here: Train Eccentric Leg Strength for Alpine Skiing. I'd also do Cyclist Squats and One and a 1/4 squats

A month before you hope to beginning skiing again, I'd recommend putting on your ski boots in your living room and start pressuring the front of the ski boot with your shin (like you do when making turns on your downhill ski)... this will give you an idea of how much pain you'll feel in the front of your knee / cap while skiing and turning on your downhill ski. The more muscle you have in your leg, the less pain you should feel.  You can probably come up with some alternative exercises in ski boots in your living room (like holding a downhill tuck for 1 minute, etc.)

Even with all the skiing I did this past season, I still was never confidently pressuring the front of my ski boot while turning and putting pressure on the downhill ski of my bad knee / leg. So instead I was skiing really tentatively all season, which just isn't how I typically ski... That's why I think it would be a good idea to do some "dry land" training in your living room with your ski boots on, to work out some of the pain beforehand that you'll likely experience in the front of your knee during those first few weeks back of actual skiing.

Hope that helps!

anonymous by Rashmi on 10/6/2016
Thanks Doug for a great n helpful article. tore my acl n meniscus (bucket handle tear) in the gym (step too high) 14 mths ago n wish had it operated way earlier. Waiting for my surgery date now. Thanks for your article, will get onto some of those logistics pronto. Best wishes for ur full recovery. Greetings from a balmy London!
doug by doug on 10/6/2016

Hey Rashmi,

Sorry to hear you joined the club... but best of luck w/ your surgery and recovery. I definitely agree, the sooner you have surgery the better (in most cases). Hopefully, you've been able to get in the gym and build up your quad/leg muscles in the meantime while you wait for surgery. From my experience, the more muscle you lose pre-and-post surgery the longer it will take to recover. In total I lost 3+ inches off my quad (I lost 2 inches off quad before surgery & an additional 1+ inches after surgery), and have a feeling it will be around the 36 month mark until I'll really feel confident in my knee and have near full strength back in my leg. The people who lose 1 inch or less of muscle off their quad/leg seem to be the people who have the quickest recovery (6 to 12 months) and are back to playing sports sooner. On average, I believe around the 18 to 24 month mark is when most people's knee will feel good overall and they won't be thinking about it too much.

Appreciate the kind words from across the pond... All the best!

anonymous by Amber on 11/21/2016
Thank you for this article. I'm having surgery in two weeks and very nervous of the pain. Been doing pt for about a month and will continue until surgery. Bought the pillows you recommended.

Hi Amber,

Best wishes on your upcoming surgery... Don't worry too much about the pain, it will suck for about 2 weeks and begin getting better as you become more mobile. For my surgery, I had an allograft, so the pain wasn't too bad. I'm guessing if I were to have had an autograft (hamstring tendon or the patella tendon), I would have had a bit more pain to deal with. But overall, looking back... as far as I'm concerned the scariest part of ACL surgery is not the pain you have to deal with, or the surgery itself, it's actually the muscle loss that occurs pre and post surgery in your leg and surrounding area and the confidence you lose in your leg because of it.

That's great to hear you've been in PT for a month prior to surgery. One of my biggest mistakes I made was not getting into (official) PT the first week after injury, instead I did far too much R.I.C.E (Rest, ice, compression and elevation) in the first two weeks after my initial injury, which I feel helped to contribute a lot to the muscle loss I experienced.

Glad to hear you ordered the pillows I recommended... I'm still continuing to use pretty much all the pillows I talked about in my post above in some form or fashion on a nightly basis and highly recommend them, especially the InterVision Foam Wedge Bed Pillow (7.5" High) and the InteVision Knee Pillow.

- Doug

anonymous by Amber on 11/27/2016
Thank you, I think I bought a dozen items you recommended above! I'm also having an allograft. My surgery is Friday. I'm very nervous! I think it's the unknown that makes it worse, some say it's the worst pain ever and others said it's a bit rough, but manageable. I had a kidney transplant 3 years ago so I understand discomfort. This article has been so helpful thank you!
anonymous by Amber on 12/2/2016

Had acl and meniscus and cartilage repair surgery. Still numb from blocker, nervous for when it wears off

doug by doug on 12/3/2016

Hi Amber,

Hope you're doing well after surgery... I just looked at my notes that I took after my surgery that I'll share with you below:
I had ACL Allograft surgery @ 8:30 AM on 5/12/15. I was home by noon after surgery (I live 30+ minutes away from surgery center). Took 1st oxycodone (pain pill) around 9 PM. Then I would set iPhone alarm and take an oxycodone every 4-6 hours for next 4 days (and throughout the nite)... I would literally wake up to to take a pill, otherwise you'll just end up waking up anyway in pain. You want to stay ahead of the pain, so take a pain pill before you really start to feel pain, so at first this may be every 4 hours.

The nerve block partially wore off by 3 AM on 5-13-15... Pain was never that bad, but was worse while sleeping / not moving.

So to answer your question, the nerve block didn't really last 24 hours for me.

Hope that helps.
- Doug

BTW, in case you haven't come across the Reddit ACL page here: https://www.reddit.com/r/ACL/ It has lots of questions and answers from other people going through ACL surgery / recovery, and is updated constantly. I've continued to follow the page over the last year and half, so you may want to check it out for any additional questions you may have. 

All the best to you over the next few days and weeks with your recovery.

anonymous by Amber on 12/3/2016
i cannot thank you enough!
anonymous by Gary on 12/9/2016
Hi Doug, it is great to see someone so dedicated to helping people with this issue. Thank you so much. I had ACL allograft reconstruction surgery about 10 hours ago. 6 weeks prior, I had surgery to repair my meniscus, which had torn clear to the white matter. My muscle in the leg is already non-existent due to the last 6 weeks. Your tips are so helpful and appreciated. thank you
doug by doug on 12/9/2016

Hey Gary,

I can't imagine having back to back surgery like you did, so I hope you're doing alright and getting through post ACL surgery as best as you can so far. I'm glad to be of some help and share my experience/advice with others. Knee surgery is definitely a life altering experience on many levels, so the more you know going into it, the better off you'll be in the long run to make a full recovery.

As for me, I remember just two weeks after my initial injury, I started to see noticable muscle loss in my quad... then fast forward to two weeks after my surgery and my left leg VMO/ quad muscles were virtually non-existent concave looking, instead of looking convex like a health leg VMO muscle. It's been a slow process for me re-building back my quad muscle, and my operated leg is still no where near my good leg. But the muscle has started coming back to life more and more over the last couple months, and the knee has started to feel better overall lately because of it.

So just make sure you stay as consistent as possible with PT / strength training (at least 5 days week) and eat enough calories ("good" food/protein) to build back muscle. My knee will still feel worse if I stop working out for 2-3 days in a row, and I still have to work on stretching my hamstring out and getting extension every morning (and throughout the day).

I started mountain biking (using an oval chainring) with a brace on around 11 months post-op. Growing up I did a ton of BMX, dirt jumping, street riding, but I hadn't ridden a 'real' bike in about 20 yrs, so at first it was super dangerous learning to mtb ride with a leg/knee that was still pretty weak. But I can say, mountain biking has been really good for my knee/leg/full body in general, and it's been a great alternative to gym workouts and getting fresh air outside. However, I have found that you do lose 'gym' strength in your leg if that's all you do, but it will certainly be beneficial and improve your overall cardio and strength endurance in your legs.

Well all the best to you in your road to recovery... Cheers!

anonymous by Grayce on 12/21/2016
Hi Doug! I am a multi-sport Athlete, and unfortunately a couple weeks ago I tore my acl and my meniscus. I am devastated that I can't participate in my sports, but I am on the road to recovery. I'm going to have surgery in about a month and your tips make me feel just a little bit less stressed about the events that are going to occur soon! Thank you!

Hi Grayce,

I'm sorry to hear you joined the club, but I do know the feeling of being "torn up" about not being able to participate in sports at a high level while recovering from injury / surgery. How quickly you get back to sports will depend on a lot of things, but I can tell you that there were actually 2 women in my ski race league that tore their ACL's around the same time I did.... one women tore her ACL on the very same day, at the very same ski race I tore my ACL, and the other women did much more significant damage to her knee (I believe she had surgery two weeks after her injury). Both women were back ski racing last year (probably about 8 to 9 months after their surgery), which was just a few weeks after I had just started skiing again and feeling like I could barely ski beginner slopes.

So depending on your recovery and a very dedicated rehab, you can get back to sports sooner. In the meantime, you can always take some of the down time you'll have away from sports to learn some new skills (i.e. like learning to play guitar or piano) that you might not have had the time to learn or desire for while participating in your sports. For instance, I had never learned how to juggle before, so in the weeks following surgery I decided to teach myself how to juggle (which can help with coordination and translate back into sports). I also started teaching myself how to tie various knots to use for Climbing / Mountaineering / Ice Climbing. Then as my leg started feeling a little better, I began mountain biking for the first time, which I have a feeling that if I hadn't torn my ACL I may never have seriously started riding a bike again.

At any rate, stay positive, eat enough healthy food to re-build muscle, train smart and you'll be back to participating in your sports ...Good luck with your surgery and glad to hear I could ease some of your stress going into it. All the best.

doug by doug on 1/24/2017

Hey Guys,

I just wanted to pass along a few podcast episodes from the 'Low Pressure Podcast' that are really worth listening to for those of you dealing with a knee injury, knee surgery, recovery, prehab or rehab. There's a lot of good information and insight that you can get from listening to episodes #76.1 and #76.2 (especially if you're a skier). Also the SKIRAD Pro iPhone app that they talk about in these episodes is definitely worth purchasing ($0.99 in U.S.) if you're a skier. Here are the episodes I recommend you listen to:

#76.1 Kneehab with the Physios from Back in Action (Whistler), they work with Olympic Athletes, including the Canada Skier Cross Team.

#76.2 Kneehab with the Professional Skiers... In this episode we hear from the professional skiers who have gone through and are currently dealing with knee injuries. Angel Collinson, Dana Flahr, Dave Gheriani, Josh DaieK and Rory Bushfield all share their stories and experiences.

#67 – Ski Season Prehab w/ Mike Conway (Physio and co-owner of Back in Action) They talk a lot about the making of the SKIRAD PRO app...

SKIRAD PRO iPhone app - Are You fit for snow or will you just be another injury statistic? SKIRAD (ski ready and avoid damage) is a pre-habilitation fit for snow guide that aims to provide users with relevant risk assessment awareness, practical advice and exercises solutions to reduce risk.

anonymous by Michelle on 1/27/2017

Doug, thank you for your great info here. I am 42 and have been athletic my whole life. I played softball, soccer and even played basketball at the collegiate level. I have been a city letter carrier for the USPS for 23 yrs. I was used to getting exercise at work and was going to spinning classes and basketball with my boys. At the beginning of Nov I started play indoor soccer recreationally. While almost the oldest on my team I was still holding my own. On Dec 2nd the goalie slid into my right leg and completely tore my acl, mcl and partial tear to my meniscus. Initially for the 1st 2 weeks my Ortho did not do an MRI and told me it was a fraud 2 MCL tear and the Acl was fine. My leg was swollen all the way into my ankle and the pain was getting worse and he finally told me at the 2 week mark the results. From there I was unsure of surgery, but the bone bruising in the tibia and femur were very painful and I started physical therapy at the 6 week mark once the pain went down. I found a knee specialist who will do my surgery next Thursday using the allograft method and I am so anxious to get on to the recovery phase.

doug by doug on 1/29/2017

Hi Michelle,

Best of luck with your upcoming surgery and recovery. From what you described it seems like you sustained a pretty bad knee injury, so it sounds like you're doing the right thing by having surgery now, so you can get back to your active lifestyle going forward. I'm not too sure how I'd feel if someone else was the main culprit to tearing my ACL and meniscus, but I'm sure I wouldn't be too happy with that person. Hopefully it wasn't a malicious slide by the goalie.

During your rehab and recovery, do your best to stay away from foods and drinks that cause inflammation. I've found that taking Turmeric, especially before bed has helped my knee feel better in the morning. If I remember, I'll also take a Turmeric supplement at breakfast and lunch as well. Since you have meniscus damage, you may want to take Glucosamine, as that seems to be quite beneficial from people I've talked to who have torn their meniscus.

All the best in your recovery phase going forward...

anonymous by Deb on 2/15/2017

Doug, If I could, I would personally shake your hand and thank you for the information you provided here. I found it helpful and utilized most of the tips you offered. I blew my ACL in 2010, then fell on 27 Dec 2016 tearing my meniscus badly, with ACL reconstruction/major meniscus repair surgery on 27 January 2017. So I am 2.5 weeks into my recovery. I had a bit of a complication due to my shin bone being soft (I am in my 50s), so they had to use staples to anchor the graft instead of screws. This resulted in my PT starting at 2 weeks instead of 1 week. I made sure I continued to exercise and work the quads prior to surgery, and am at 112 degrees range of motion, can do stairs (carefully), and am feeling better each day. I am able to be without the brace when at home which is awesome as I am only 5'3" and the brace I was given is a "One Size Fits None!" It literally goes from the top of my leg to the ankle.

Your tips about having the bed ready, the stretch out strap, having people care for you, bills, pain meds, bathroom set up, etc were all instrumental in me being prepared logistically for this journey. I do have to say I had to cultivate a "mental patience," as I was literally on the couch for the first 2 weeks. Since I am not much of a TV person, I did puzzle books, on-line puzzles on my tablet, etc. I did enjoy some of the Netflix shows, too. I wasn't quite prepared for the mental patience aspect of this, but others who had been through major surgery provided me with the puzzles books to keep my brain occupied.

One thing to add to the clothing is non-slip socks. I couldn't find any locally, so I ordered some from Amazon. My feet were cold, and with the polar icing unit, I was really chilled most of the time. I also used a heated throw which allowed my body to relax and warm up from the 32 degree ice water flowing 24/7.

Another thing that is not necessary, but was pretty sweet. My hubby received a Google Home for his birthday 1 week prior to my surgery. We used it to set alarms for the pain meds, turn on the Netflix TV shows, play music, etc. Again, not necessary, but it was pretty helpful.

Thank you again for taking the time to present this information - you were a God-send! Your information helped me feel "in control" as much as I could be prior to the surgery. I was ready for the event! Blessings to you!

doug by doug on 2/16/2017

Hi Deb,

Thanks for the really nice comment... That's great to hear this post was helpful to you going into your surgery. The non-slip socks are a really good idea. Prior to my surgery (at surgery center) I was issued a one size fits all pair of non-slip socks to wear for surgery (which I continued to wear at home in the days after), but I do remember thinking that it would have been nice to have another full-length pair of non-slip socks that was better fitting.

The post-op brace is definitely not the most comfortable to wear around. I found sleeping with it on super uncomfortable and one of the worst parts about the surgery for me especially with the foam irritating the heck out of my inner thigh (my post-op brace also went from just above my ankle to the top of leg. I still wore it for 8 weeks locked out while sleeping (since my doctor said the longer I wear the brace while sleeping the better it is for keeping proper leg extension, and my leg felt better extension wise in the morning when I wore it). At 3 weeks, I was issued my sports knee brace to wear while walking, but was initially measured for and given a brace that was painfully too tight fitting for my leg and knee... I realized this after just an hour of wearing the brace, so the next day I had to go back to the office and get a new brace in the next size up, which I've been happy with to this day.

That's good to hear Google Home has come in handy for you. I recently got an Amazon Echo and have also found it to be pretty darn cool as well.

All the best to you going forward with your rehab and recovery... You've now gotten past some of the most painful parts of ACL surgery, but now the real hard work of PT and strength training begins. - Regards

anonymous by Deb on 2/17/2017

Just an interesting follow-up. Talked with the company that is handling my short-term disability. They said their metrics from surveyed doctors show the "return to work time" at 3 days to 35 days. I told the representative he needed to Google ACL reconstruction and see what the surgery entails as their 3 day metric is ridiculous especially when you consider you are laying flat with your foot above your heart for the first week and on an ice machine 24/7. I will be returning after 4 weeks, and my main concern is getting all the PT in each day. Your notes on the office chair and the leg not being elevated are good to know, too. I may take my posi-foam block in with me and use it to prop the leg up. Just thought you would find the work metrics fascinating. Gotta love the insurance companies - goodness going in too soon also exposes you to getting sick because you immune system is already compromised.

Hi Doug,

Thank you for this comprehensive post. It is super helpful for someone about to go into ACL surgery next week.

I joined 'the club' 1 year and 1 month ago playing soccer. After the first few months of pain and discomfort, I eventually returned to semi-fitness; 3 miles a day jogging (treadmill), cycling to work and weight training. I’ve hiked around 100 miles and have done 8-9 climbs above 5,000 ft (Cascades, NW volcanoes). At age 27 this is my first ever surgery so I'm a little anxious, but overall feeling excited.

I'm interested to see if a year of 'pre-hab' has any effect on recovery time. It seems that only around half of all athletes return to high intensity sports at the same level. Thanks for keeping us updated, glad to hear you got some skiing in this season.

How did you cope with the mental aspect of being away from previously regular activities during the grind of recovery?
doug by doug on 2/26/2017

Hi Adrianjf11,

Sorry I didn't respond sooner, just saw your post... If you've already had surgery, I hope it was successful and you are doing well.

It sounds like you are in pretty good shape going into surgery, so my guess is that you will do well in your recovery. In general, factors that seem to play a much bigger role in faster recover times are as follows: a top-notch surgeon, really good Physical Therapy/ Therapist, the younger you are, the more muscle mass in your leg / quad (VMO) going into surgery and how much muscle you retain after surgery, having surgery within 2 to 3 weeks after injury (or surgery a year or more after injury, once you've rebuilt full strength back in your leg), healthy nutrition of up to 5 to 7 meals per day every 3 hours to build back muscle (at least 20g of protein per meal to support heathly ligaments, tendons, bones and muscle growth...now is not the time to skimp on meals or go on a diet to lose weight), with that said try to avoid sugar and too much carbohydrates, as both have been known to cause inflammation and will make your knee feel stiff and achy. Note: avoid beer (if you're going to have an alcoholic drink, choose red wine it's anti-inflammatory and contains resveratrol, knee will feel better) and just being consistent with rehab / mobility / strength training / plyo.

In the early days (weeks) after surgery, getting full extension in your leg is critical and you'll need to work at it daily, multiple times per day. Flexion will generally come back over time, whether you work too hard at it or not (although there are some people that do have a difficult time regaining flexion).

For me, the recovery and rehab has been slower and tougher than I thought it was going to be going into it. In my case, VMO quad / leg strength has been the biggest limiting factor in my recovery. Mentally, it's certainly been challenging, but being that I'm older... I think it's been a little easier to deal with as opposed to if my injury were to have happened when I was still in High School or College where there's sometimes more of a sense of FOMO (Fear Of Missing Out), especially when it comes to competitive sports. But don't get me wrong, tearing your ACL and having surgery sucks, no matter how old you are!

I think there's a number of factors at play with athletes returning to sport at a high level (and those that don't) after ACL surgery... Here are a few: 1) how well they rehabbed 2) how quickly they want to return to sport 3) how confident they are in their knee 4) how much risk they feel comfortable taking now...  If it's not your job, your risk assessment definitely changes as it relates to sports after such a major life changing injury (nobody wants to go through the ordeal a second time).  With that said, there are plenty of athletes who make a full recovery after ACL surgery and continue to compete at the highest levels in all sports... in a sense, it just comes down to how badly you want it.

As for skiing, this winter I've been gradually skiing much more aggressively as my leg has gotten stronger and stronger and more adapted to the rigors of skiing. I've been powder skiing, steep skiing and started backcountry skiing again last month. I'm still not ski racing and will probably give myself another full year to recover and build up the strength in my leg more before I decide whether or not I want to get back into Masters ski racing.

All the best in your recovery...

anonymous by Adrianjf11 on 3/5/2017
Doug, Thanks for the info and kind words. Surgery was 1.75 weeks ago and recovery has been difficult, but getting easier day by day. Almost at full straight extension and 90 degree bend. Interesting that between 1.5 and 1.75 weeks it totally changed, from lying in bed unable to move with night sweats (painkiller withdrawals) to being up and walking. No crutches now, and it feels like running around on the soccer field is only a few months away.

I would say the most difficult part was between week 1 and 1.5, when the meds ran out and I switched to tylenol and ice. Your advice on preparing the home was critical and super helpful. Good luck to you as well :)
anonymous by Jocelyn on 3/31/2017
Doug, Thank you for your tips, advice, and knowledge.
I'm going in on April 5th for a ACL reconstructive and lateral / medial meniscus repair surgery. I find your information so helpful! And thanks to all the people that responded to your post. It all helps. I just hope over the counter pain medication will be enough for me as I am not a big fan of medications I am fortunate I only take vitamins. Thanks again!
doug by doug on 4/1/2017

Hi Jocelyn,

Best of luck with your upcoming surgery. As for recovery, I'm not too sure I'd want to only rely on over-the-counter medication in the first few days after surgery. I'm sure it can and has been done, but I'd definitely talk to your surgeon first about doing so before you go this route. The first 3 to 4 days would not be much fun at all and you probably won't get much sleep. Either way, sleep will be hard to come by in the first few days after surgery even with the pain medication prescribed by your doctor.

I was given 3 medications to take after my ACL reconstruction surgery:

1) Oxycodone / Acetaminophen (5 /325 mg Tab Amneal): Take 1-2 tablets by mouth every 4-6 hours as needed for pain. Max daily dose of 8 tablets.
2) Ketorolac (10 mg Tab Mylan): Take 1 tablet by mouth three times a day with meals for 5 days.
3) Cephalexin (500 mg Cap Lupin): Take 1 capsule by mouth four times a day for three days.

As for vitamins and supplements, I've definitely become a bigger proponent of taking Vitamins since my surgery. Here's what I currently take:

- Vitamin C -- Purpose: Aids in connective tissue repair, antioxidant to fight free radicals, key to the formation of joint cartilage, and may help protect against arthritis.
- Vitamin D3 -- 5000iu
- Collagen -- Vital Proteins Collagen Peptides Powder (this is one thing I didn't take at the time, but wish I had known about... I take now, and it definitely helps with joint recovery)
- Turmeric Curcumin -- Fights inflammation, can help lower back pain. Can take up to 3 times per day in divided doses. Best time I've found to take turmeric is before bed.
- Multi-Vitamin -- General purpose vitamin and mineral supplementation.
- Glucosamine, Chondroitin & MSM -- Supports joint health and can help reduce knee pain.

- BCAA -- 5 to 10 grams
- Creatine - 3 to 5g - Purpose: Increases work output
- Magnesium Glycinate - Don't take more than 400mg per day (Don't get the standard Magnesium: Magnesium Oxide)

- Whey Protein Isolate -- up to 40g
- Carbs powder -- Post workout carb load - up to 100g post workout
- BCAA -- 5 to 10 grams
- Creatine - 3 to 5g - Post workout may be the best time for taking creatine.
- Vitamin C - 500 to 1000mg 
- Zinc - 30-50mg (zinc citrate)

anonymous by Deb W. on 4/7/2017
THANK YOU. On my birthday, I managed to inflict the Terrible Triad jumping on a trampoline. (Who knew?!) I'm facing surgery in exactly two weeks and am, honestly, pretty terrified. None of the information I found online was anywhere near as comprehensive as what you've provided. My Amazon.com basket is now full! I feel a little better having more "knowns" now than unknowns and that is all thanks to you. Also appreciated how honest you were about how it felt skiing 7 months after surgery. I'm a surfer and it is frustrating trying to explain to people who haven't experienced this type of injury the huge amount of time it takes to recover. Most people look at me like I'm surely exaggerating and will be totally fine in a few weeks. This is definitely one of those situations where the only way to go is through and I am so grateful you shared your experience so I could fully prepare. Lastly, have you had any experience or known someone who has done Cryotherapy? I've heard some people swear by it, but with the cost wondered if it was worth it? Thanks again!
doug by doug on 4/12/2017

Hi Deb W,

So sorry to hear you had such a bad injury occur on your birthday... major bummer! Trampolines are fun, but they seem to be great at causing injuries.  But it is good to hear you're feeling a little better about surgery after reading this post, even if it may still seem a bit scary.

Looking back, I really had no business starting to ski when I did at 7 months and feel really lucky I didn't do anything to screw up my knee. Without a sports knee brace, there's no way I could have skied that early. This season I definitely started feeling better and better and just last week I did a backcountry ski ascent and descent of Mount Marcy (highest mountain in NY). I'm still not close to 100%, but the knee is feeling a lot better than just 3 months ago.

Try not to worry about what other people think... until someone goes through a similar injury or a bad situation, it can often be hard for a person to fully relate to the experience. Since you're a surfer, I'd definitely look to get a prescription for a sports knee brace from your surgeon that is recommended for surfing. Here's a list of Surfing Knee braces at BetterBraces.com.

As for Cryotherapy, all I've really heard is that athletes will use it to recover from games, or it can also be used post-surgery for recovery. But I really don't know how well it works or the cost/ benefit of it. Personally, I'd probably stay away from the liquid nitrogen facilities and just stick to Cyrotherapy places that use ambient cold air. In any case, I'd ask your surgeon or Physical Therapist about it and see if they have any insight into it's benefits after surgery.

On the flipside there is evidence that the use of a sauna can have positive effects on: the endocrine system, hypertrophy, endurance, and the brain. So sauna use could prove to be very useful after injury or surgery for recovery. See Rhonda Patrick, Ph.D. post on Tim Ferriss' blog here: Are Saunas the Next Big Performance-Enhancing “Drug”?

All they best going forward,

doug by doug on 5/4/2017

Hey Guys,

Just wanted to share an article I just came across that's worth reading here: How to Treat Loss of Knee Extension after ACL reconstruction. It's a good read with tips, as well as points on the importance of regaining full leg/knee extension after surgery.

In a about a week, I'll be coming up on two years since my surgery and I still have to work on leg extension everyday, especially after waking up in the morning. Without proper leg extension, I believe it also hampers your ability to rebuild proper quad/VMO muscles (as stated in the article), so it's super important to constantly work on. As I mentioned in my post above, ankle weights (5 LB each) are really useful to help regain knee extension when doing heel props and prone hangs.

anonymous by Deb W. on 5/24/2017

Hello again, Doug!

Thank you so much for the kind words in your response and THANK YOU again for this post. I’m now nearing 5 weeks post-surgery and the tips you shared and I followed were a tremendous help…and tremendous is an understatement. I’m checking out all your post surgery tips too now! In addition to your advice on the comfy mattress topper, setting the timer on the phone to take the pain meds on schedule (lifesaver!), and the wedge pillow, here are a few of the things, some you already mentioned, that really helped me personally. Some of these I found better deals on at medical supply places or local stores, but added links for reference:

-Cast Protector
Will fit over the brace and forms a water tight seal...so much better than trying to tape a garbage bag on your leg.

-Raised Toilet Seat with Handles
Best. Thing. Ever. I'm embarrassed to admit that, but it really came in handy. Girls have the disadvantage of having to sit/stand EVERY single time we go to the bathroom, and that's not easy when you're balancing on only one leg and trying to stand back up again on crutches.

-Crutch Eaze Covers
A friend’s husband loaned me these cool, expensive ergonomic crutches...but the Crutcheaze covers slipped on standard crutches made them really comfortable. They also make a pocket you can slip on the crutches so you can carry your cards, phone, wallet, etc. and not have to wear a backpack.

-Cold Therapy System
Like a little ice chest with a pad that goes over the knee and continuously circulates ice cold water. They sent me home from the hospital with one of these and it made it easy to keep my knee iced and the swelling down.

-Steri Strips
Heard these are often used for plastic surgery and they do seem to be minimizing my scars (fingers crossed). After a shower, I spray with Betadine and put these on.

-Back Rest
Really helped along with the bed tray you'd recommended when trying to eat in bed.

-Tablift Stand
A friend of a friend’s invention that makes it easy to watch the iPad in bed.

-Dry Shampoo
It was a while before I could (or even wanted to) attempt a shower, so dry shampoo came in handy…especially when people came to visit.

Seconding your tip on loose shorts. I bought a few cheap pairs that would slip over brace and can also be worn to physical therapy/ortho appointments where they want to see the knee.

Again, so grateful you posted all this info to help people like me out! :)

doug by doug on 6/2/2017

Hi Deb W.

It's great to hear you're doing well. It's also really great to hear the tips shared here were such a big help to you. And thank you very much for sharing your additional tips. The Cold Therapy System or a Cryo Cuff is something I didn't have access to, but I've heard nothing but good things from people who were able to use one. I'm sure they are much better than just using ice packs. In addition to this, I didn't have access to a CPM machine for my recovery, but I've heard that using one can be really beneficial post-surgery. I definitely would have liked to have used both devices post-surgery as I'm sure they would have been quite helpful in reducing pain and swelling.

As for memory foam... I'm a huge fan and totally recommend getting either a topper or memory foam mattress, along with a memory foam pillow for your head. I had a really bad lower back injury, and attribute the memory foam topper, bed wedge (under my legs) and the Conforma memory foam pillow (mentioned previously) which I now use for my head as helping to get past such a bad back injury (it took many, many months for my back to finally feel really good). With that being said, I think mountain biking has also helped to keep it feeling good, along with not ski racing and barely running over the last two years (both combined put a huge strain on my lower back). For anyone going through a back injury like I did, Back Mechanic by Dr. Stuart McGill is well worth reading.

Well all the best in your recovery going forward. Just stay consistent with your rehab and you'll continue to see improvement...Cheers!

anonymous by searee on 7/16/2017
Dear Doug,

Thank you so much for putting this list together. I, like many of the other commenters, found it really useful to prepare before surgery -- my physical environment (and things that make life easier), my mental state, and my expectations. From my research into ACL reconstruction, it seemed as if people fell into two categories after the nerve block wore off on day three post-surgery: those who never took a pain pill, and those who wanted to die until about day 7. I'm currently two weeks post-op (patellar tendon autograft, no meniscus damage), and so far, things have been more like the first group than the second. I take daily inflammatories (meloxicam) and took hydrocone 3X the first day, then just before PT and bedtime days 2-7, and just before bedtime days 8-12. The worst pain I had was on days 6-7, when I started having terrible pain, bruising, and swelling from blood rush to my leg as I began moving around a bit more. Icing, elevation, and mild compression from an Ace bandage wrapped from mid-thigh to the ankle helped a good bit. I began driving automatic on day 8, and am waiting a few more days to see how I do with my injured left knee on the clutch of my manual transmission car.

Of the things on your amazon "shopping list", I definitely stocked up on books from the library, and purchased the cane, mattress topper, 2 of the wedge pillows (one for head, one for feet, or two under feet esp days 1-3), the shower seat, the ColPacs (2L, 2XL), the TENS unit, and the stretch out strap. It was the most pitiful amazon order EVER, but made a huge difference. The stretch out strap really helped with getting in and out of bed, lifting my leg with the nerve block while going up and down the stairs (15!) on my behind, move my foot at night, and getting in and out of the car to go to PT at first.

I borrowed a walker, which was waaaay easier than crutches, and much more useful for getting around the house, especially to the bathroom. There are lots of walkers, shower seats, and other medical items available on craigslist for a good deal, and after use, can be resold or donated. I transitioned to a cane by day 7, but still used the walker in the middle of the night until day 9 or 10. Hooray for aprons and long-handled bags to carry things around the house, move ice upstairs/downstairs. I also second the recommendations for dry shampoo (I like Living Proof or Batiste) and stocking up on lightweight shorts that won't catch on the brace. Pillowcases were indispensable for icing -- both for wrapping my knee under my cryopressure sleeve and for holding the ColPacs (I prefer one of each size, the smaller under my kneecap and the larger wrapped around the top and down my shin).

The Game Ready has been very helpful. Keeping up with the ice is a bit of a chore, and we found that freezing big chunks of ice in plastic cups, solo cups, or inexpensive plastic containers helps keep the ice from melting too fast. I've also been keeping a good quality styrofoam cooler at the foot of my bed and loading up a second batch of ice to use when I wake up in the middle of the night. The styrofoam keeps the ice colder than regular coolers, with minimal melt on the ice chunks, even for 6-8 hours.

A heads-up for the ladies: ACL reconstruction was my first surgery, so I was surprised to learn that anesthesia and/or trauma of surgery can throw your menstrual cycle. The response probably varies from individual to individual, but it would have been good to know and prepare for in advance.

The last recommendation I'll pass along is the timing of surgery. My surgery was the day before the July 4th weekend, which certainly made it easier for family to help out, but it also made it harder to talk to somebody with questions after surgery. The pump for my nerve block malfunctioned on day 2, and it was difficult to reach the anesthesiologist to fix it. Similarly, my Game Ready rep was on vacation for the first whole week, and it took a while to switch out that unit. My physical therapists office doesn't normally open on Saturdays, and I would have had to wait until Monday after a Friday surgery for my first post-op PT visit. My therapist was amazing and opened up for me at 8am (!!), and I found it really reassuring to have that first PT visit the next day -- to get started with recovery, but also to make sure everything was okay and have the opportunity to ask follow up questions.

Again, thanks so much to you for the resource, and to others posting their stories and tips. Good luck to all!
doug by doug on 7/16/2017

Hi Searee,

Thanks very much for sharing your story and what worked well for you. It's always good to hear other perspectives, since everyone's experience may be a little different (while still similar).

It's interesting to hear you've been using a walker to get around. I actually borrowed one of my Grandma's walkers and was planning to use that to get around initially, but after surgery I was issued crutches (which I'm glad I was) and never really used the walker. I still don't know how I would of comfortably been able to get around with using just the walker during the first week or two (non-weight bearing). I just wasn't willing to put a lot of pressure on my surgically repaired leg at the time to feel comfortable using a walker. I think I just transitioned from using crutches to then using a cane...I don't remember if I ever really used the walker to move around.

I'm not sure what a "pump for my nerve block malfunctioned" means... You must have had a different kind of nerve block than me, as I was given a femoral nerve block prior to surgery (which was a shot near my groin), which wore off within 24 hours. I never had to use any kind of "pump" after my surgery.

At any rate, I'm glad to hear this post helped you out and you're doing well so far. Good luck with PT and getting your knee strong going forward.

anonymous by Emma-Lee on 7/26/2017
Thanks for this blog, it's really helped a lot!!!! I had surgery 6 days ago and off crutches, still a little wobbly but so far so good!!!! I feel a tightness in calf and quad from my muscles working when doing exercises, and pain is only about a 2-3 in the morning once I've woken up!!! I'm nearly fully straight with leg but the bending is the painful part!!! Anyone have any suggestions???? My surgeon said I should be back to physical intense activity in 6 months which is pretty exciting just going to steer away from pivioting movements and jumping, thanks again for your blog it's helped heaps :)
anonymous by Toneisha on 7/26/2017

How are you PTing before surgery??? I tore mine two days ago and get my MRI later this week and my surgeon is only having me do like small leg lifts and bending my knee and calf strength. I can't put weight on it at all but they think it's a total tear and mcl tear so there's no stability at all. Thanks!

doug by doug on 7/26/2017

Hi Emma-Lee,

I'm glad to hear things are going well for you post-surgery. As far as getting getting flexion (bending) back in your leg... Here are some things I did Post surgery at PT:

- Seated Knee flexion (sit on the edge of a table with legs hanging down, cross your ankles and then use your good leg to gently push back on your surgically repaired leg).
- Heel Slides a.k.a Towel or PT Strap Pulls (use a PT Strap to pull heel towards your bum)
- Pedal backwards on recumbent bike... just don't over do it. Go as far as you can comfortably pedal backwards. A recumbent bike is easier to use post-surgery, but you can also just use a regular bike trainer / spin bike, just make sure the seat is positioned correctly for your height on any bike you use (far enough back or high enough).

Also read my comments above about what I did at my initial PT appointments post surgery: https://www.backcountryplanet.com/how-to-prepare-yo...

All the best to you in your recovery.

doug by doug on 7/27/2017

Hi Toneisha,

I'm really sorry to hear you joined the club... As far as PTing before surgery, I would say the #1 thing to do is have your Surgeon write you a prescription for PT (if they haven't already) and get in to see a Physical Therapist as soon as possible. One of the biggest mistakes I made after my initial injury was not getting into PT until 5 or 6 weeks later (for a few reasons). Due to this, I limped and gimped around for probably 8 or 9 weeks. Thinking back on this, I can say limping around for as long as I did was probably one of the big reasons I lost so much muscle in my quad before surgery. Once I started official PT, I was walking without a limp within 2 to 3 weeks.  So it goes without saying, a Physical Therapist will be able to get you walking much more quickly than you'll be able to do on your own. I probably babied my knee too much thinking I was going to do more damage to it, but limping too much on it just creates bad movement patterns (along with nerve and muscle loss). The other reason to get into PT now, is that many of the exercises and stretches you will do in PT now to recover, will be the same ones you will do after surgery and you'll also have a familiarity with your therapist.

About a week after my ACL injury, I purchased this spin bike and used it quite a bit before and after surgery, which was helpful. But with that being said, I probably relied too much on the spin bike initially after my injury thinking it was helping to stave off muscle loss in my quads. But unfortunately, I've come to learn that the main driver of the pedal stroke is actually your hips and NOT your quads like many people seem to think, especially if you use a mid-foot position on the pedals.

As far as pre-hab strength exercises, I'm probably not the best person to give advice regarding the proper protocol for pre-hab, especially if you have an MCL tear. But here are a list of some of the basic exercises I was giving to do by my PT while pre-habbing my knee (typically 10 reps, 1-3 sets per day):

- Quad Sets
- Straight Leg Raise
- Chair Squats (hold onto the back of a chair for stability)
- Body Weight Squats
- Calf Raises -> Single Calf Raises
- Hamstring curl -> Single leg hamstring curl
- No weight Leg Extension / Squeeze Quad at Extension
- Step Back off 4" Step / touch toe
- Clock Steps Lunges (Lunge forward towards 12 o'clock position return to starting position. Lunge outwards at a 45-degree angle, return. Lunge out to the side towards the 3 o'clock position, return)

It's important to note, that the exercise progression (and reps/sets) you do will be best determined by a qualified PT...

Well, I hope that this info is helpful, and you don't make any of the mistakes I made. All the best.

anonymous by Toneisha on 7/27/2017

Thank you so much. My orthopedic surgeon is already having me do some things like calf raises and leg lifts (like lift my leg up off the bed) and bending my knee. My MRI is tomorrow so I am sure there will be more to come at my follow up next week I'm not even a week into my injury just yet. I will definitely ask about pre-PT, thank you so much for your input. This is my first real injury in my 34 years and I completely have no idea what to expect. Your tips have been helpful!

anonymous by Denise on 7/30/2017
I ruptured my ACL and have medial tear of meniscus. I am scheduled for surgery on Wednesday and very nervous. Initial injury was on 6/2 and I have not been able to walk thus far due to muscle loss and instability. I have been in prehab PT for the past 3 weeks which has helped tremendously with range of motion.

My surgeon's plan is to do an autograft from hamstring and possibly repair meniscus. Not sure what to expect but your experience has helped put me at ease a bit. I'm a single Mom of 2, live on a second floor apartment, have no family to speak of and am the sole financial provider for our household so I need to be back to mobile as quick as possible. Does returning to the office for at least a half day M-F just 4 days post op seem possible in your experience?

Best Regards,

doug by doug on 7/30/2017

Hi Denise,

Good luck with your upcoming surgery... as a single Mom of 2, I'm sure you'll be able to get through this experience just fine. With that said, I'd plan to take it easy and just recover for at least the first week or two after surgery. Returning to the office just 4 days post-op will be the last thing you're going to want or be able to do. Before surgery it's easy to underestimate just how physically draining this surgery (anesthesia and prescription meds) will make you feel in the initial weeks after surgery. Going up and down stairs will be extremely challenging as well as energy zapping after surgery, much more so than before surgery. Plus concentration levels are seriously lacking in the first few weeks after surgery, as you deal with a dull throbbing pain in your knee as it recovers, which makes it hard to think straight to get any productive work done.

If you can, I'd say take at least 2 weeks off from work to recover from surgery and just focus on your recovery and PT, and then at the end of 2 weeks determine if you're ready to go back to work. I have heard of some people going back to work in a week, but most of them only did so because they absolutely had to, and wouldn't recommend it. So it can be done, but it's not a great option, and I'd avoid doing so if you can. I'm sure that's probably not what you wanted to hear, but that's my honest advice.

All the best...

anonymous by searee on 8/9/2017

You asked about the nerve block. I had the femoral nerve block the day of surgery, and they sent me home with an ambulatory pump that boosted the block with regular doses over three days. The line near the groin was looped around to my stomach and connected to an IV style bag and pump that resembled a remote control, all carried around in a fanny pack. As I mentioned, the pump failed the first night and had to be switched out. The second one kept me nice and numb through day 3, thankfully.

Good luck, Emma-Lee, Toneisha, and Denise! Things definitely get easier down the road.
Denise, after my surgery (ACL only), I took one week off completely, a second working from home, and another week or two working from home 2-3 days per week. I work at a desk, so I probably could have returned after 2 weeks, but it was difficult to ice and elevate properly. I also found that everything took so much longer just after surgery. It took forever to get bathed, dressed, down the stairs, and out of the house, and I was fortunate enough to be able to work from home so I could spend more time working and less time just getting myself there. You'll know what's right for you. Good luck!
anonymous by Lou on 8/19/2017
Thanks for the tips. Blew my left ACL doing martial arts 4 years ago and finally taking time off to have the surgery.
anonymous by ADAM ACL on 9/24/2017
Hi Doug and all the folks going through/planning on an ACL surgery:

I am just under 6 months post surgery and wanted to say this article/list was by far the most helpful in my recovery. If you stick to the above I'm sure you will recover at an accelerated pace.

I'm currently jogging lightly and usually stop due to being out of shape haha, not my knee. Able to do mid height boxes jumps, one legged squats, mild cutting exercises, hiking pretty unrestricted etc.. but completely avoiding sports until at least 9 months.

Also wanted to share my experience and some insight to a speedy recovery.

I tore my ACL and damaged my meniscus almost 1 1/2 ago. Due to several reasons, mostly travel, work and insurance and waited almost a year until my surgery. One of the good parts about that was I regained strength in my leg and was functioning almost normal(day to day, no sports) with strong hamstring and quad strength that I focused on in the gym.

As I got closer to surgery day, I definitely benefited by some essential purchases:
Pre surgery vitamins: VitaMedica Recovery Support Program + VitaMedica Arnica Montana 30X HPUS
The Knee Pillow for my non-operation knee
The Wedge Pillow for my operation knee (This was key for keeping my knee fully extended and straight)

Post surgery:
I opted for the nerve block and I think it was my saving grace. It was creepy at first when you literally cant even feel your leg and it's like a dead log but that goes away. The key was I was able to immediately get on the home passive movement machine. This was essential as I was not in any pain for the first three days, avoided taking pain killers and I was able to fully extend my knee and keep it moving on the machine to prevent scar tissue buildup and ensure mobility. By day three I could fully extend my leg and bend to 110 degrees.

Month 1: I upfront told work I'd be taking time off for a week, and working from home for another 3-5 weeks.
First three days are keys to keep the leg mobile and at night completely straight. Per dougs notes, when resting keep it as straight as possible (see leg wedge)
I lived up stairs so had to to go slowly using one good leg and the other to stabilize and down on my ass.

After two weeks at home I started PT. I think the key is to get a PT relatively close to where you live to ensure you are consistent, make it as easy as possible to go. I set it up so I went two times a week.
The first month the only thing I focused on was mobility, I knew I'd eventually get to strength later. So all I did was focus on extension and flexion as that is the most critical time for scar tissue to build up. And it paid off.

Month 2:
Focus on controlled walking with support (cane or crutch) and muscle flexing.

Month 3: Goal was to walk without a limp and no support (cane or crutch) and started isolated workouts.

Month 4: Day to day is pretty much normal, continued leg exercises almost every day. Able to hike but take it super slow.

Month 5: Knee is functioning normal under controlled scenarios. One legged squats, light jogging, high stepping and calisthenics, and mid level box jumps, back and forth sprints.

Current as I approach my 6 month: Closing up last sessions with PT. Feeling great, flexion almost perfect, extension is perfect. Still feel tightness in my knee but that's expected. Stretch every day and foam roll. Relatively intensive leg workouts built into my daily excercise routine. Legs feelings strongest they've ever been, since it was a major focus (including my non-surgical leg).

I Hope the above helps and will update as I continue. Thanks Doug for the extensive list of pre/post ACL insight.
doug by doug on 9/26/2017

Hey Adam,

That's awesome to hear you're doing so well 6 months out from surgery. It sounds like you're much better off than I was at that point, so good on you. It's also great to hear the tips in this post were helpful preparing you for a solid recovery.

Keep it up and thanks for sharing your progress so far...

anonymous by Keli on 10/1/2017

Thank You Doug for the advice and tips! I am a Wildland fire fighter and got hurt fighting a fire almost two months ago now! Do to all the paperwork and requirements its taken a while to get everything approved to have surgery! But I am happy to say I have a date now and its on Halloween (10-31-17). Happy that its finally going to happen! I need to be ready for next fire season and be able to pass a physical fitness test! Which I am a little nervous about! I have never had surgery and its been a little stressful thinking about them cutting into my knee, but your post helped me get some prospective on what my reality will be!

Its awesome to hear how you and everyone on this blog are doing!

Hope everyday you get better and better!


doug by doug on 10/3/2017

Hi Keli,

Good luck on your upcoming surgery... I'm sure you'll do just fine, but I understand how worrisome it can be going into it, especially if it's your first surgery ever. Once the surgery is over, and the pain begins to reside, it's all on your shoulders to build back the muscle you lost and regain the confidence back in your knee / leg... This is the most challenging part of ACL surgery in my opinion, especially in the first few months after surgery. Just prepare yourself to be both mentally and physically challenged like you've never been before, and realize that'll you'll have to work consistently hard everyday to come back strong so you can get back out there next fire season. But I'm guessing if you're a Wildland fire fighter you're pretty darn tough.

For myself, it was hard / painful to hike down trails (even with hiking poles) in the first 6 months after surgery due to lack of VMO strength in my quad. Hiking up trails was usually not a problem, but that's because I was able to push off with my good leg. Around the 1 year mark after my surgery I did hike a pretty demanding Adirondack High Peak (Rocky Peak Ridge), and felt alright. But even to this day, walking down stairs is still a little awkward, as I still don't have full strength back. Because of this I still wear my knee brace when doing any activities where I could potentially trip or fall unexpectedly (skiing, mountain biking, or sometimes hiking, etc), as I have no interest in retearing my ACL. Keep in mind, I probably could have and should have done a much better job of consistently working out the leg with body/free weight type exercises (step-ups / downs, squats, split squats, leg presses, etc.), which would have strengthened my quad/leg faster, but sometimes life gets in the way (or I'd just rather go skiing or mountain biking instead).

That being said, this past weekend a few friends and I did a mountain biking trip up to the bike park at Killington, Vermont and I was able to ride some of the gnarlier double black diamond trails and hit some of the bigger jumps there and I only felt my knee once. Last year when I first started mountain biking, my knee could feel every little bump on a trail. So it really does take time and strength for your knee to fully recover from ACL surgery... Just remember time heals everything, give it time to heal and make the best of your time.

All the best to you going forward!

I just wanted to point out two podcasts (episodes), that I listened to recently and thought were really worth passing along...  there is a lot of good information contained in both episodes that I think can help you out to better understand ACL recovery / Back and Knee rehab.

1) Mountain Bike Radio - Apex Nutrition Podcast - "Get Ripped with Kelli" (Nov 9, 2017 #933).
Kelli talks about going through her own ACL recovery (8 months post-op), ways to reduce soreness, and gives a run down of training recovery tools. Including the benefits of Turmeric, as well as other supplements. Also why you should avoid taking ibuprofen.

2) Mark Bell's Powercast - Stan Efferding - My Hips, My Knees, My Elbows, and My Back | Rehab Yourself | #239 Released Nov 15, 2017
Stan Efferding stops in to celebrate his 50th birthday, and to share how he used his own experience, and research (including writings by Dr. Stuart McGill), to overcome tendonitis in his knees and a herniated disc in his back. -- There's a ton of really good information to take away from Stan Efferding in this podcast, that you can apply to rehabbing a knee or back injury.

So I highly recommend you listen to both episodes in full...

Also worth watching: Return to Training – Post-Surgery Planning w/ Kelly Starrett & Matt Vincent Part 1 (Watch Part 3)

anonymous by Andrew on 12/6/2017
As with many others on this comment thread, just want to send my sincere gratitude for this post. I found it just after I tore my ACL and sprained my MCL in a non-contact soccer injury and was feeling down. The post is comprehensive, specific, helpful, and doesn’t pull punches. That’s what I needed. I had reconstructive surgery yesterday (hamstring autograft) and I’m feeling pretty good today. I’ve been hammering supplements (arnica blend, turmeric extract (Gaia brand with pepper added in for bioabsorption), and Wobenzym N for joint pain). That has helped me reduce reliance on painkillers. Of course I also purchased the wedge pillow ahead of time and have had my leg on that since i got home.
Again, just wanted to say thanks. I’m passing this link on to a buddy who tore his ACL playing hockey. I can imagine how much time and effort it took to compile this post and update it — that’s amazing and much appreciated.
doug by doug on 12/7/2017

Hey Andrew,

I'm glad to hear this post has been helpful to you and you've passed it along to help out your friend who joined the torn ACL club (bummer). Hopefully, you're still feeling pretty good two to three days post-surgery. That's interesting to hear you've found some supplements that seem to be helping as well (I had never heard of Arnica or Wobenzym).

One thing that I probably should add to my tips above, is to really pay attention to what you eat (pre and) post surgery. In the days, weeks and months after surgery it's more important than ever to do your best to stay away from pro-inflammatory foods (junky carbs / sugar). I know this can be even harder to try to avoid after surgery when you're feeling down and out, but by avoiding inflammatory foods and drinks, it will help you to reduce swelling and inflammation in your knee, which will help your knee feel better and recover faster.

I think after surgery, a Ketogenic "style" diet (high-fat, adequate-protein, low-carbohydrate) is a good way to go, especially for those that are concerned about weight gain after surgery. This past summer I experimented with a Keto style diet, just to see what it was all about, and I felt really good while on it (you can also eat really tasty foods). That being said, it's not "typically" considered optimal for performance, but in the intital stages of recovery I think it can be really helpful. See the youtube link in my previous comment above to watch the Return to Training Part 1 video, around the 3 minute mark, Kelly and Matt talk about this.  Also Adrian Ballinger used a Keto style diet recently when he summited Mount Everest without oxygen.

All the best to you in your rehab going forward!

anonymous by Janeen on 3/25/2018

Hi Doug, Thanks for your detailed article. I was injured 1st day, 1st run at the base of a Bunny Slope! Yes I am a snow skier but was with a new skier trying to help. Skis got "hash-tagged" together and I fell. Fast forward. This happened 6 days ago. I've seen a sports surgeon that specializes in ACL tears (which to date 3 doctors have diagnosed. My MRI is scheduled tomorrow to confirm and see what other damage there is. He thinks the MCL is compromised as well. Surgery will be discussed on Wednesday. Doc says usually 2-3 weeks post accident day due to swelling. I have been in an 'Ace bandage' and Hinged knee brace since the fall, icing daily. I am now reading as much as possible to be prepared for the Arthroscopic Surgery I feel is in my future. Again, your words did help! Thank you

doug by doug on 6/24/2018

Hi Janeen,
I hope your surgery went well, and you're well on your way to recovery at this point. I'm fully onboard with having surgery as soon as possible after injury, and 2-3 weeks post injury seems like a pretty ideal time for surgery. Right around the 2 week mark was when I started to notice muscle loss in my leg, and at around 3 weeks post injury was when I started to move around a bit better and feel a little bit more normal.

For those who haven't gone through surgery yet, I highly recommend you listen the Gear Show w/ Lisa Gerber podcast, Episode #48 "Brian Harder on ACL Injury". Brian Harder is a ski mountaineer, former Exum mountain guide, who recently tore his ACL while backcountry skiing in the Alaska Chugach range. He's also an orthopedic assistant, so he's extremely knowledgeable on the subject of ACL surgery, treatment and recovery. Here's just a few things they talk about:

- Factors that can lead to ACL tears (in an Instagram world), and while backcountry skiing due to locking out the toe piece in a Dynafit / pin binding
- How to find the best Sports Orthopedic surgeon
- Types of ACL surgery, and which may be best for you: Patellar, Hamstring, Quad, Cadaver
- When is the best time to have surgery

Overall, this a really great podcast, and you'll be far more knowledgeable about the in's and out's of ACL surgery after listening to it. I definitely learned a few things that I had never quite known (like the fact that your surgeon actually takes bone out of your knee when you have a Patella tendon graft), which is why it's often painful to kneel after having ACL surgery using your patellar tendon . I fully agree with just about all his statements, like why it's often better to have surgery sooner, rather than later, due to muscle loss the longer you wait. Anyway, hope you learn a few things from this podcast...

anonymous by Derek on 10/31/2018

Hi, Doug. I just wanted to send a note of thanks for your blog. It was really helpful to me in my time leading up to surgery. Now I am 12 weeks post surgery and physically I am doing great. I am currently dealing with anxiety about what the future may hold, but also try to learn to live in the moment.


doug by doug on 6/5/2019

So I just wanted to give everybody reading this post a quick update... This past winter, I decided to ski in my first masters ski race since tearing my ACL. It was an early January race, and I decided to only ski the Slalom race for the day (I did not ski in the GS race). The race went well for the lack of training I've done in Slalom over the past two decades, and considering the snow conditions for racing weren't ideal that day. Then at the end of April, I capped off the ski season by doing an overnight backcountry ski trip (w/ 40+lb backpack) to Mt. Washington, NH, to ski Tuckerman Ravine. For those who aren't skiers and/or don't live on the East Coast, Tuckerman Ravine has some of the steepest and gnarliest terrain you'll find in the Northeast for backcountry skiing.

It's been a slow continuous process of building up my quad muscles and getting functional strength back, but over time things have been getting better and better.

With that said, I just wanted to note...I currently think the #1 exercise for building up functional strength back in the quad / VMO after you've gone through muscle loss associated with ACL surgery is the forward Step-Up exercise (performed strictly, in other words, without pushing off of your bottom foot). The Step-Up exercise can be performed anywhere, with or without weights and from heights of less than an inch when you just starting out, to over 20 inches or more when you regain back strength. Step-Ups also don't put a ton of stress on the knees, because after you step up, you step backwards to get down from the step, unlike when you walk down a hill which puts an enormous amount of stress on your knees. There's also tons of Step-Up variations, but I think the forward Step-Up is best, since it's the most functional and something you do everyday when walking up stairs. You also don't need any fancy exercise equipment to do Step-Ups (you can use books, wood blocks or 2x4s, or stairs in your house). I stacked together 3/4" Cap Exercise mats to create progressively higher steps. In the last few months, I ended up purchasing an adjustable Titan Step-Up Plyo box, which I'm really happy with.

Performing strict forward Step-ups are also a really good way to evaluate unilaterally how strong one leg is to the other (unlike squats or other two legged movements, where it's very easy to unconsciously cheat with your good leg and have it do most of the work). When performing a forward facing Step-Up, try your best not to push off using your bottom foot, and also try not to lean forward too much, and after stepping up, lower yourself back down slowly. Here's a Step-Up video with some good training tips for how to go about performing a proper step-up.  Keep in mind, make sure you talk to your PT before starting to perform forward Step-Ups... I know from my experience, that it may be many months after ACL surgery that you'll even have the proper strength to peform a step-up over a couple inches.

I also really like Band Assisted Single Leg Pistol Squats (using a Box or Chair, for fall back support). See the general idea of how to perform this here: Band Assisted Pistol Squat. I use the RitFit 41" long - #3 40-80lb band. The weaker your leg is, the thicker the band you'll want to get.

At any rate, let me know if you've done any other unilaterally exercises that really helped you to recover strength back in your leg/quad after ACL surgery... I'd definitely be interested to hear any alternative exercises that worked well for you, and I'm sure it would be a big help to others who come across this post... Cheers!

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