Your ACL reconstruction is scheduled. So what should you be doing between now and surgery?

If you have several weeks between your injury and surgery, you do not have to spend that time simply waiting. A 4–6 week ACL prehab period gives you an opportunity to improve the knee you are bringing into surgery and build a foundation for the rehabilitation that follows.

Start by Getting the Knee Quiet

Before focusing on harder exercises or heavier strength work, start with the basics.

The priorities are to:

• Reduce swelling

• Restore full knee extension

• Improve knee flexion

• Get the quadriceps working

• Normalize your walking

A swollen, stiff knee is not the best place to start aggressive strengthening. First, focus on calming the knee down and restoring basic function.

Build as Much Strength as Your Knee Allows

Once your knee is tolerating more load, you can begin progressing your lower-body strength.

Depending on your injury, symptoms, and how your knee responds, exercises may include:

• Squat or leg press variations

• Direct quadriceps strengthening

• Hamstring strengthening

• Hip and posterior-chain exercises

• Step and split-stance exercises

• Calf strengthening

There is no single perfect list of ACL prehab exercises.

The goal is to safely build as much strength and capacity as your knee and surgical timeline allow.

Progress Toward Single-Leg Control

As your strength improves and your knee tolerates more activity, your rehab may progress toward more single-leg work.

This can include single-leg strengthening, balance exercises, and movement-control work.

Higher-level activities such as landing, hopping, perturbation, or reactive exercises may also be appropriate for some athletes. These should only be introduced when the knee is ready, and not everyone needs to reach this stage before surgery.

Pay Attention to How Your Knee Feels the Next Morning

One of the most useful ways to judge your exercise program is to see how your knee responds afterward, especially the next morning.

If you notice more swelling, warmth, stiffness, or difficulty fully straightening the knee, the previous session may have been too much.

Your physical therapist can adjust things like resistance, range of motion, volume, speed, or exercise complexity based on that response.

Progress should be based on what your knee demonstrates, not simply how many weeks have passed.

Establish Your Pre-Surgery Baseline

ACL prehab is also an opportunity to collect objective measurements before surgery.

Your physical therapist may measure:

• Range of motion

• Swelling

• Quadriceps strength

• Hamstring strength

• Single-leg performance

• Functional testing when appropriate

• Patient-reported knee function

• Strength and performance of the uninvolved leg

These measurements can give you and your physical therapist useful reference points as you move through postoperative rehabilitation.

At Petroski Physio, this helps us look beyond simply completing exercises. We can track how your knee is functioning and use objective information to guide your rehab as you progress.

What If I Can't Accomplish Everything Before Surgery?

That is not the goal.

Four to six weeks of prehab is not about building a perfect knee before surgery. Your priorities are much simpler:

Get the knee calm. Get it straight. Get the quad working. Build strength. Measure your baseline.

How far you progress will depend on your knee, your symptoms, and how much time you have before surgery.

Whatever capacity you can safely build becomes part of your starting point for the next phase.

Instead of thinking of the month before ACL reconstruction as waiting for surgery, think of it as the first phase of your rehabilitation.