Simple Exercises to Improve Knee Extension After ACL Surgery

What can I do to get my extension back after ACL surgery? What are the best exercises for knee extension after ACL surgery?

This is are questions that I frequently asked my PT and doctor as I heavily struggled with my range of motion following my ACL and medial and lateral meniscus surgery in 2018.

Today, I’ll share the top exercises I used to get my extension back after ACL surgery.

Exercises for Knee Extension After ACL Surgery

Heel Raise

One of the best, most passive ways to work on extension is by sitting with your leg straight and elevating your heel. To do this, you put your leg as straight as possible and then put something like a pillow or foam roller under your ankle. Over time, the gravity will push your knee down, straightening the leg more.

Yes, this HURTS when you do it early on. You have to relax your quads and let gravity push it down. This is the first extension exercise I did 1-week post-op, but I continued to use it for several months.

Quad Squeeze with Heel Raise

Another great thing to do is a quad squeeze with a heel raise. For this one, I sit down and try to lay my leg flat. Wrap a towel or band around your heel. As you squeeze your quad, pull the towel up to help straighten your leg. Hold for a couple of seconds on the top and repeat 10-15 times.

Elevated Leg Extension on Chairs

The leg extension with chairs works similar to the leg extension with heel raise, except with even more gravity. Sit on one chair across from another chair of the same height. Straighten your leg so that your heel is on the heel across from you, and make sure there is no chair under your knee.

Gravity will pull your knee down, straightening your leg. For more aggressive extension, you can rest ankle weights above your knee or hang weights off of it. Sit in this position for as long as you can, then take a short break and return. This is one that is very effective because you can sit this way while working or doing other tasks for 30-60 minutes several times a day.

Prone Hang

The prone hang is another one I started doing within a week post-op. Lay on your stomach on a bed or table, with the end of the surface hitting the quad just above the knee. Relax and let your legs straighten. Again, gravity works with you to bring your foot down and straighten your leg. Once you are ready, you can wear an ankle weight.

Walking Technique

Your walking technique is really important for ROM. As you walk, push your leg all the way straight. Try walking backwards as well to straighten the leg with motion.

Terminal Knee Extension with Band

Terminal knee extension (TKE) is another great movement exercise for extension. Attach a band to something stationary. Step into the band, placing it on the hamstring just above your knee. Push your knee back against the band to straighten your leg as much as possible. Hold for a few seconds and slowly release. Repeat 10-15 times, 3 sets.

Slant Board

When you don’t have full extension, everything in the back of your leg tightens up. Use a slant board to help elongate your calves and push your knee straight as much as you can during the process. Hold for 30-60 seconds and repeat a couple of times. As you improve extension, select a more and more steep slant board.

Hamstring Stretch

To get your leg straight, you’ll also need to stretch your hamstrings. Put your heel up on a chair or bin, keep your leg straight, and try to reach your toes to stretch your hamstring. Do this for 30-60 seconds a couple of times per day at least.

Squats with Calf Raises

To help your extension, focus on how you complete your exercises. For example, you’ll do a lot of squats throughout recovery. Each time you do the squat, try to come up on your toes and go a calf raise while pushing your leg as straight as possible.

Tips for Improving Knee Extension After Surgery

• You must complete the exercises for knee extension after ACL surgery several times a day, especially at first.
• Listen to your body. Yes, it hurts to work on the extension, but immense pain after you’re done with the exercises is not normal. Don’t overstretch.
• Don’t neglect flexion. Work on both types of ROM each day.
• Don’t ice your knee while working on a range of motion or strength.

Extension After ACL Surgery FAQs

When did you get full range of motion?

I still don’t have full flexion 2 years post op, but I do have full extension. It took around 6 months for me to get full extension, but I was to 0 by 4 months.

Does working on range of motion hurt?

Yes, working on ROM is very painful and uncomfortable. It is sharp, shooting pain. It still hurt even when I was close, but it gets slightly easier over time. You have to push through pain. If you are concerned, you’ll need to contact a doctor to find out if it is normal pain.

How often do I need to work on extension?

You must work on ROM 2-3 times per day for the first months. You should do all exercises several times. Later one, you can scale back a bit, but to see results you must do it daily. The low load long duration exercises (prone hang, chair leg extension, etc) are the easiest to work on the most.

For more questions about my ACL and meniscus surgery, head to this FAQ.