Reconstructive ACL surgery: Postop physical therapy day 1

Posted on July 20, 2018

(Last Updated On: July 20, 2018)

It took me about 8 hours after waking up from the surgery until I felt good enough to really start moving around. Below is how my first day looked. Note this is the day of surgery. None of that waiting a week to do anything crap.

This is half-written for somebody looking for what to do after their surgery and half-written specifically for me. In other words, while below is specifically tailored for me, I think it’s a good starting point for most people too. The biggest factor in my surgery was an accompanying meniscus tear that was repaired. Whether the tear is cut off or repaired alters the rehab. As I’ve mentioned though, we’re talking pretty small differences in the overall rehab.

With that said, EVERYTHING here is subject to change based on the person.


Post-op Day 1


-Stocking compression sock provided by hospital ->Already on me when I woke up.

-Manual massage quads, hamstrings, adductors -> Just some simple rubbing of my leg by me.



-No weight bearing allowed the first day. This is due to your pain medications and the nerve block not wearing off yet. Therefore, you don’t know how weight bearing actually feels yet. It might feel great the first day…and horrendous day 2.

-> I definitely could have put a lot of my weight on my leg the first day -the nerve block was kicking for about 15 hours- but not something you want to do. You’ll feel it day 2!



-Locked at 0 degrees at all times. My leg was straight the entire day.



-If wanted for pain.

–>For reasons here, I didn’t bother with icing the first day. I didn’t need it pain wise, and it just stiffens me up. The last thing I want. Please read the link before you tell me it helps with swelling, range of motion, etc. And then read this one  regarding icing specifically for reconstructive ACL surgery. Or this one,

Should you ice your knee after reconstructive ACL surgery?

Hint: it doesn’t do anything but numb the pain. Why am I going to numb pain I don’t have?


Range of motion exercises (15 reps each exercise. Should be done often enough throughout day to accomplish goals! There is no magic number.)

-Passive extension: To 0 degrees or 5-7 degrees of hyperextension. This should be accomplished  Day 1!

Reconstructive acl surgery exercises


Quad sets

You can see some difficulty here:


And then much better activation here:


Flexion: No flexion allowed. Remember the brace prevents all flexion.

–> This was surprising to me. The amount of flexion is something that varies widely amongst ACL rehab protocols. Typically, from what I’ve seen, passive flexion is allowed the first 10 days. However, if you have a concomitant meniscal tear this can be all over the map. Based on my meniscus tear and repair, my doctor recommended no flexion, at all, for the first 10 days. Something I’m complying with.


Patellar mobilizations


Sitting hamstring stretch

Plantarflexion / dorsiflexion (Pull foot up towards shin, then push foot down away from shin. Back and forth.)


Strengthening (4 x10r each)

Glute Bridges

–> Lying down with both legs straight, squeeze glutes and slightly elevate hips


Straight leg raise


Calf strengthening with band/towel

Toe grabs

–> Like grabbing marbles with toes



Ibuprofen after surgery

–> I go with over the counter meds over the hard stuff as much as I can. I barely had any pain day 1 so I didn’t bother with the percocet. This allowed me to be able to move around without being dizzy and distorted from something like percocet. I also don’t have to worry about taking a header with my crutches due to balance issues.



 (I’ll have a whole post about surgery and nutrition in the future.)

Calories = (Bodyweight x 15) x 1.20

-> For example:

I’m 190 pounds.

190 x 15 = 2850.

2850 x 1.20 = 3420.

This might not happen, and didn’t happen for me, day 1 due to the nausea after the anesthesia. It’s a good number to strive for though.

Protein = Bodyweight x 1 = MINIMUM (190 x 1 = 190 grams of protein.)

Supplements: Glucosamine and chondroitin, vitamin D, fish oil.

For a comprehensive look at ACL rehab, check out The most important phase of ACL rehab


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