Do You Need Physio Before ACL Surgery?

Tearing your ACL can feel like a massive curveball. One moment you're in the middle of a game or training session, and with a sudden twist, landing, or change in direction, your knee suddenly gives way—leaving you in considerable pain, with significant swelling, and wondering what just happened and what comes next. Here is my take on what to expect, where physio fits into the picture, and how to give yourself the best shot at bouncing back.

Written in consultation with Kelly Henry, Senior Physio and MSK Clinical Lead, Habit Health

How Do People End Up Needing ACL Surgery? 

Your anterior cruciate (KROO-she-ate) ligament (ACL) is one of the key ligaments in your knee that helps keep things stable. It is one of the strong bands of tissue that help connect your thigh bone (femur) to your shinbone (tibia). 

An injury to this ligament typically involves either a strain (a mild injury) or a tear. A tear can range from a partial tear, to a full rupture. When an ACL rupture occurs, it’s usually obvious pain, swelling, and a feeling of instability or that you can’t trust your knee, are common symptoms. It is the full rupture injuries that often lead to surgical repair. 

Surprisingly, a lot of ACL injuries happen without contact from anyone around you, landing awkwardly or twisting suddenly is often all it takes. Any sport where there are a lot of quick direction changes, jumping, or sudden stops are common culprits. Netball, basketball, rugby and football are good examples here. Of course any impact such as a tackle in rugby, crash off your mountain bike, or contact like in wrestling can lead to an ACL injury too. 

People often wonder who the best person is to go and see after sustaining a major knee injury. Your physiotherapist is a great option. They can assess your knee and refer your onwards for knee imaging to confirm your diagnosis. Depending on the result, you would then see an orthopaedic surgeon to help you figure out if surgery is the right option. 

Some people can manage this injury with rehab alone, but others, especially younger people or anyone keen to get back to high-impact sport, will likely need surgery to stabilise the knee. 

Do You Need Physio Before ACL Surgery? 

If you want the best possible outcome, the answer is yes. 

Getting support from a physio before surgery to guide your pre-surgery rehabilitation (also known as prehab) can make a huge difference to your recovery. 

Prehab is all about getting your knee in the best shape possible before your operation. That means reducing swelling, improving movement, and building strength in the muscles that support your knee. 

A lot of people think, "Well, I need surgery anyway, so I will just wait." But showing up for surgery with a weak, stiff, swollen knee often means your recovery is slower. Many surgeons will delay surgery if your knee is not ready. 

One of the other key benefits of having physiotherapy before surgery is that it builds a trusted relationship early on. Your physio gets to know you, your body, and your rehab goals during prehab, which means your post-op recovery can feel more personal, efficient, and supported. 

When Do You Start Physio After ACL Surgery? 

Depending on the type of surgery you have had, you will usually see your physio around two weeks after surgery. If you have had other knee structures surgically repaired as well, this could alter your post-operative timeframes.

What Do the First Couple of Physio Sessions Look Like? 

It starts simple. There is a focus on reducing swelling, regaining full knee extension, and reactivating your leg muscles, especially your quadriceps which are often very weak after surgery. 

Your first session might include: 

•  Swelling management techniques 
•  Walking retraining (usually with crutches) 
•  Range of motion exercises and muscle activation exercises 
•  Focus on restoring full knee extension 

The second session builds on that with: 

• Progressed strengthening to include weight-bearing exercises such as mini squats + step-ups 
• Introduction to stationary cycling 
• Balance exercises 

The goal is to get your knee moving and build strength to help your body heal properly and prevent stiffness or weakness down the line. 

What Does ACL Recovery Look Like? 

Recovery after surgery is a long journey. At times, progress will feel steady and encouraging; other times, it may be slow and challenging. What matters most is having the right support around you to help keep you moving forward. 

First 6 Months 

• Regain movement and full range of motion 
• Reduce swelling and inflammation 
• Rebuild strength and control, especially in the quads 
• Return to daily activities (walking, stairs, uneven ground) 
• Gradually reintroduce running 

6 to 9+ Months (up to 12) 

• Progress to higher-level, impact-based activities 
• Running, jumping, changing direction (agility work) 
• Introduce contact drills (if the sport requires) 
• Begin sport-specific or physically demanding work tasks 

Whether you are a seasoned or weekend athlete, or just want to get back to everyday life, your rehab will be tailored to your goals. The first chunk of recovery looks pretty similar for everyone, as it is all about building a solid foundation. 

Common Mistakes to Avoid 

ACL recovery is long, and motivation can come and go. Some of the most common mistakes I see include:

• Getting impatient and rushing back into dynamic activities too soon 
• Easing off on rehab when things start to feel “pretty good”
• Skipping key stages in your rehab plan which can lead to setbacks later 

We all want to get back to normal quickly, but cutting corners often leads to setbacks. Staying consistent, even when it is challenging, and trusting the process gives you the best chance of success. 

Can You Re-Injure Your ACL? 

Yes, this can happen if returning to sport too early or jumping back into activity with inadequate rehab. 

Your body needs time to heal, and your muscles need to be strong enough to support your knee properly. That is why strength and agility tests and other checks should be completed with your physio prior to returning to physical work or sport to ensure you are truly ready. 

Even after you are cleared, keeping up with exercises helps protect your knee long term. Think of it as ongoing maintenance. Your future self will thank you for it. 

Just Tore Your ACL? Feeling Gutted? 

Totally understandable. ACL injuries can feel like a huge setback, but it is not the end of your sporting career, active lifestyle, or fitness goals. 

Plenty of people come back stronger than ever. With the right rehab plan, good support, and a bit of patience, you can get back to doing what you love. 

It is your chance to reset, get stronger, and work on the areas we often overlook when life is busy. 

How Habit Health Can Help 

At Habit Health, we support people through every stage of the ACL journey. Whether you need help deciding on your rehab plan, preparing for surgery or working through post op rehab, we are here to guide you. 

We are also part of the Integrated Care Pathway (ICP), an ACC-funded multi-disciplinary treatment pathway that helps cover the cost of rehab for significant injuries like ACL ruptures. 

That means you can access specialist care, imaging, and ongoing physio support without the stress of paying for every appointment along the way. If your physio suspects an ACL injury, ask about ICP and whether you are eligible. 

Physiotherapy is a key part of ACL recovery, both before and after surgery. The sooner you start, the better your chance of getting back to full strength and avoiding re-injury. 

Whether you have just injured your knee, have surgery coming up, or need support with rehab, the team at Habit Health is ready to help.

Torn your ACL? Need advice?  Book an appointment online with one of our experienced physios today.