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Why Accessory Training is Crucial During ACL Rehabilitation

acl acl injury acl rehab acl rehabilitation acl return to sport acl surgery acl tear fairport ny knee injury knee pain knee surgery performance physical therapy physical therapy return to play rochester ny sports performance Jan 03, 2022

The Problem With ACL Rehabilitation

Re-tear rates continue to be at an alarming rate with those who go through an ACL reconstruction and then return to sport. While there are a number of factors to consider, one thing that continues to stand out is the lack of a robust strength and conditioning program in the mid-to-late stages of ACL rehabilitation. This stage of ACL rehabilitation coincides with return to running and return to jumping/agility when appropriate. There are various buckets of training that need to be addressed that range from strength, conditioning, spatial awareness drills, and a number of other considerations we take into account. We are going to go over a few key areas in the body that have a tendency to get overlooked when going through the ACL reconstruction process. 

Hamstring Training

Hamstring training is one of the more overlooked muscle groups as ACL clients start to progress in their rehab. While the main focus during ACL rehab is to get the quadriceps stronger, the hamstrings are key because in addition to the quadriceps, they help with control of the knee as you start to ramp up activity. Being able to slow your body down when having to change direction, jump, land, or when moving quickly is an underrated quality that again gets overlooked in most recovery protocols. Below is a hamstring exercise that we like to use to sufficiently challenge stability and control throughout a full range of motion as the leg fully bends and straightens. 


Calf Training

What most people don't know about the calf is that actually originates above the knee joint and contributes to dynamic stability of the knee with activity. The calf muscle is also important when it comes to generating force for jumping and creating stability when we land as the foot is the first thing to make contact with the ground. Unfortunately what we see is that many will return to running without any formal assessment of the calf and that could delay the recovery process or could potential create a setback. Being consistent with some form of calf training as you go through the ACL recovery process must be a staple.

Core Training

While we immediately think of the core in ACL rehab, it is important because it is the cornerstone of where strength, stability and athletic movements come from. This training becomes important as ACL clients return to higher dynamic movements such as cutting and jumping. The core needs to be able to transfer the appropriate amount of forces to the lower body so that strength and stability can all be coordinated properly. 

The MANA Difference

At MANA Performance Therapy we blend all of the above training for these muscle groups into all of our sessions when working with ACL clients. We truly believe incorporating full body training and challenging the body to meet the demands of what the athlete will go back to is massively underutilized in rehab as clients return to sport. We could utilize a number of different exercises to check a lot of boxes that hit multiple muscle groups so that we don't neglect any of the areas that need to be built back up during this process.


The issue with ACL rehab is that not enough focus is placed on strength training in the early and later stages of the recovery process. Clinicians, clients, parents, coaches all want to do the higher level work but not putting enough effort into the basics can be a shortcoming in the ACL rehab process. Training all the above mentioned regions in addition to a well rounded program is imperative to create a durable athlete who is prepared to return to the rigors of sport. The benefits of working with us is that in addition to sports rehab, we understand strength and conditioning and the implication it has for our clients that are struggling or not getting the care they should be getting when recovering from an ACL reconstruction. Are you frustrated with your care? Do you feel like you're not where you need to be in your recovery? Don't let your recovery be derailed by not getting the adequate care you need to get back to the activities that you want to do. Have questions? Please reach out and let us know how we can help! 

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