This clinical blueprint is designed for the post-operative ACL patient, specifically starting at Week 2 post-surgery. The primary objectives are swelling management, restoration of full passive knee extension, and re-establishing quadriceps recruitment. The first four weeks focus on graft protection and gentle range of motion (0-90 degrees). Progression is milestone-based: full terminal extension before significant load, pain at or below 3/10, and no post-session effusion increase.
Phase 1 (Weeks 2-3) - Protection and Extension
Target: Quads, Hamstrings, Calves, Core
Exercises: Ankle Pumps, Quad Sets (Isometric), Heel Slides (Assisted), Straight Leg Raises (Braced), Glute Bridges (Double Leg), Seated Calf Pumps, Abdominal Bracing
Notes: Progress if no quad lag and pain is at or below 3/10; regress if extension drops or swelling rises.
Phase 1 (Weeks 3-4) - Early Activation
Target: Quads, Glutes, Hamstrings, Core
Exercises: Quad Sets with Towel Roll, Heel Slides (Active), 4-Way Straight Leg Raises, Standing Hip Abduction, Glute Bridges, Shallow Wall Slides (0-30 deg), Seated Hamstring Sets
Notes: Progress at 90-degree active knee flexion; regress if joint line pain appears in wall slides.
Phase 2 (Weeks 4-6) - Weight Bearing and ROM
Target: Quads, Glutes, Calves, Core
Exercises: Quad Sets, Heel Slides, Straight Leg Raises (Unweighted), Mini Squats (0-30 deg), Standing Calf Raises, Side-lying Hip Abduction, Bird-Dog
Notes: Progress only with normalized gait and no limp; regress if swelling lasts more than 2 hours after training.
Phase 2 (Weeks 6-8) - Strength Foundation
Target: Quads, Hamstrings, Glutes, Calves
Exercises: Mini Squats (0-45 deg), Step-ups (Low Box), Standing Calf Raises, Terminal Knee Extension (TKE), Single Leg Stance Balance, Glute Bridges, Prone Hamstring Curls (Unweighted)
Notes: Progress if single-leg balance exceeds 20 seconds; regress with any giving-way sensation.
Phase 3 (Weeks 8-10) - Neuromuscular Control
Target: Quads, Hamstrings, Glutes, Core
Exercises: Bodyweight Squats (0-60 deg), Step-ups (Medium Box), Single Leg Stance on Yoga Mat, Side-lying Clamshells, Dead Bug, Standing Hamstring Curls, TKE
Notes: Keep knee tracking over second toe; regress if valgus collapse appears.
Phase 3 (Weeks 10-12) - Functional Loading
Target: Quads, Hamstrings, Glutes, Calves
Exercises: Bodyweight Squats (0-90 deg), Static Forward Lunges, Lateral Monster Walks, Single Leg Glute Bridges, Calf Raises, Single Leg Deadlifts (Unweighted), Plank
Notes: Progress to lunges only with controlled squat depth; regress if anterior knee pain rises.
Phase 4 (Weeks 12+) - Return to Function
Target: Quads, Hamstrings, Glutes, Full Body
Exercises: Goblet Squat (Bodyweight), Reverse Lunges, Single Leg Squats (Partial Depth), Calf Raises, Bird-Dog, Side Plank, Hamstring Bridges
Notes: Move into impact and running only after medical clearance and strength testing.