ACL Rehab Between Physio Appointments: How to Make Every Week Count

Your physio sees you for an hour a week, if you're lucky. The other 167 hours are on you, so most of your ACL rehab happens on your own. That's a lot of sessions where you have to decide what to do, how hard to go, and whether that ache is normal.

This is where many people drift. They do too much on a good day, too little on a bad one, or repeat the same printout of exercises for weeks. Here's how to make the time in between count.

The good news: rehab at home can work. A 2025 review of 12 studies (711 patients) found home-based programmes gave similar knee function to fully supervised rehab, although supervised groups gained a little more strength, especially in the hamstrings (Khubzan & Alhomayani, 2025). The lesson isn't to skip your physio. It's that the work between visits needs a plan, and a way to measure it.

I wish someone had told me that at 17. My own ACL rehab, as a young footballer in England, was poor and unstructured: no clear goals, no way of knowing which phase I was in or what came next. That's when I started to lose hope of ever playing again. It's also why I do this job.

1. Know what this phase is for

ACL rehab has stages, and each one has a different job. Early on, the job is a calm knee that straightens fully and lets you walk normally. Later, it's strength that matches on both sides. Later still, running, landing and change of direction. Ask your physio, "What is the one thing I'm working towards right now?" and write it down.

2. Plan the week, not just the session

Decide your training days in advance. A simple structure works well: strength on two or three days, with lighter days for range, balance or a bike in between. Once you start running or jumping, never do impact work on two days in a row early on.

3. Use the knee traffic light after every session

• Green: pain 0–3/10, settled by the next morning, no extra swelling. Carry on, or progress next time.
• Amber: pain 4–5/10, or the knee is stiffer or more swollen the next morning. Repeat the same level.
• Red: pain 6+/10, pain that changes how you move, or clearly more swelling. Drop back for 2–3 days, and tell your physio if it doesn't settle.

A little soreness after a new exercise is usually the knee adapting, not damage. The traffic light helps you tell the difference.

4. Test, don't guess

Every week or two, retest something simple: knee bend, swelling with a tape measure, single-leg bridge or calf raise reps on each side. Write the numbers down. They show progress you can't feel day to day, and they give your physio far more to work with at your next appointment.

5. Check in with your head too

Once a week, rate your mood, confidence in the knee, fear of re-injury, motivation and sleep out of 10. Bring the numbers to your physio along with your strength results.

Know the red flags

Get seen the same day if you have calf pain, swelling or warmth, sudden breathlessness or chest pain, fever or wound redness or discharge, a giving-way episode with fast swelling, or a knee that locks.

Want every week planned for you? ACL Comeback gives you one page per week for all 46 weeks, with sessions, effort, the week's Mind task and a check-in, built to use alongside your physio.

Sources

1. Khubzan WD, Alhomayani KM. (2025). Comparison between home-based and supervised rehabilitation protocols after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. EFORT Open Reviews, 10(9), 695–708.

This article is general education, not medical advice. Always follow your surgical team's instructions.