Are You Looking for the Best Exercises to Do in the First Week After ACL Surgery?
The first week after ACL reconstruction surgery is critical—but it doesn’t have to feel overwhelming. In fact, starting the right exercises early can reduce swelling, restore knee motion, and prevent quad shutdown, all while protecting your new graft.
This early rehab window sets the tone for your entire recovery. And while it’s normal to feel hesitant about moving your knee after surgery, gentle, PT-recommended exercises are not only safe—they’re necessary to regain full function.
As a Doctor of Physical Therapy, I’ve guided hundreds of patients through this exact stage. In this article, I’ll walk you through the exercises I most commonly prescribe for the first 7 days after ACL surgery. These are movements you can do from home with minimal equipment, designed to reduce pain, improve circulation, and begin reactivating your quadriceps.
In this post, you’ll learn how to:
- Reduce swelling and inflammation with simple movement strategies
- Restore full knee extension early (which is essential for long-term success)
- Begin quad activation without stressing the surgical repair
Before we begin: Always follow your surgeon’s specific post-op instructions. The exercises below are general recommendations based on clinical best practices, but your protocol may vary.
Let’s walk through the safest, most effective ACL exercises to begin during your first week of recovery.
Looking for a simple way to stay consistent?
👉 Download the free Week 1 ACL Surgery Exercise Program (PDF) + Exercise Tracker (PDF) to follow and log your daily progress.
Disclaimers and Disclosures: All information in this article is for informational and educational purposes only and should not be taken as individual medical advice. Additionally, this article contains affiliate links, meaning when you make a purchase, we make a small commission at no additional cost to you. For more information, see our full Disclaimers and Disclosures.
ACL Surgery Week 1 Exercises: Gentle Movements to Reduce Swelling and Reactivate the Quad
During the first week after ACL reconstruction, the focus is on reducing inflammation, protecting the graft, and gently reactivating the quadriceps muscle. Rest is important—but so is movement.
This early phase lays the foundation for everything that comes next. The goal is not to build strength just yet, but rather to:
- Regain full knee extension (straightening)
- Minimize swelling and stiffness
- Start recruiting your quad—even if it feels “asleep”
Below is a PT-approved routine designed specifically for Week 1 after ACL surgery. These exercises can be done from home, and many require nothing more than a towel, strap, or your post-op brace.
Aim to complete this routine 2–3 times per day, or as recommended by your physical therapist. Never push through sharp pain or swelling, and always follow your surgeon’s post-op precautions.
1. Calf Stretch with Strap
- Purpose: Gently lengthens the gastrocnemius muscle, which can become tight after surgery and restrict knee extension.
- Benefits: Improves flexibility and supports full straightening of the knee.
- How to Do It:
- Sit with your surgical leg straight and loop a strap around the ball of your foot.
- Gently pull your toes toward you until you feel a stretch in the calf.
- Hold for 20 seconds, repeat 5 times.
- Pro Tip: A stiff Stretching Strap helps you to keep effective tension.
2. Hamstring Stretch with Strap
- Purpose: Lengthens the hamstrings to reduce tension behind the knee.
- Benefits: Supports smoother knee extension and reduces post-op tightness.
- How to Do It:
- Lie on your back, loop a strap around your foot, and keep your leg straight.
- Lift your leg until you feel a stretch in the back of your thigh.
- Hold for 20 seconds, repeat 5 times.
- Pro Tip: Use a Stretching Strap with loops for better control and positioning.
3. Heel Prop
- Purpose: Passively improves knee extension (straightening), which is a priority in Week 1.
- Benefits: Prevents long-term stiffness and helps normalize gait mechanics.
- How to Do It:
- Prop your heel on a towel roll or foam roller.
- Place an ankle weight on your knee and allow the knee to relax and straighten.
- Hold for 5 minutes, build up to 10 minutes if restriction still exists.
- Pro Tip: Increase the Ankle Weight gradually to progress your stretch and extension gains.
4. Quad Set (Towel Under Knee)
- Purpose: Re-engages the quadriceps without bending the knee.
- Benefits: Reduces muscle shutdown and kickstarts recovery.
- How to Do It:
- Lie on your back with a towel roll under your knee.
- Tighten your thigh to press the knee down into the towel roll.
- Hold for 2 seconds, perform 30 reps.
- Pro Tip: Use a Thick Yoga Mat to lie on for more comfort and support.
5. Quad Set (Towel Under Ankle)
- Purpose: A variation that helps encourage full knee extension.
- Benefits: Keeps the quad active while allowing the knee to stay straight.
- How to Do It:
- Lie on your back with a towel roll under your ankle.
- Tighten your thigh to press the knee down.
- Hold for 2 seconds, perform 30 reps.
- Pro Tip: Do your exercises on a portable Massage Table for even more ease and support.
6. Straight Leg Raise
- Purpose: Builds quad strength without moving the knee joint.
- Benefits: Supports knee stability and improves muscle control following ACL surgery.
- How to Do It:
- Lie on your back with one leg bent and the other straight.
- Tighten your thigh and lift the straight leg to the height of your bent knee, then lower slowly.
- Repeat for 10 reps and complete 2 sets..
- Pro Tip: If you can’t lift the leg yet, wear you brace locked in extension, and have a helper assist the movement gently.
7. Short Arc Quad
- Purpose: Isolates quad activation through a small range of motion.
- Benefits: Helps improve strength while protecting the graft.
- How to Do It:
- Rest your knee over a foam roll while lying on your back.
- Straighten the knee by lifting your heel off the surface, pause briefly at the top.
- Lower slowly and repeat 20 times for 2 sets.
- Pro Tip: Use a Foam Roll behind the knee for proper support.
8. Heel Slides
- Purpose: Improves knee bending range of motion safely in early recovery.
- Benefits: Reduces stiffness and prevents scar tissue buildup.
- How to Do It:
- Loop a strap around your foot.
- Slide your heel slowly toward your buttocks, keeping your foot on the surface.
- Hold for 10 seconds and repeat 10 times.
- Pro Tip: Use a Stretching Strap with loops for ease and for the best results.
Bonus: Ice Pack and TENS for ACL Injury Pain and Swelling
- Purpose: Reduce pain, inflammation, and muscle inhibition during early recovery.
- Benefits: Enhances comfort and reduces swelling, especially after exercise.
- How to Use:
- Place TENS pads just over the painful area of the knee.
- Apply ice for 10–15 minutes post-exercise.
- Pro Tip: Use the Ice Pack and the TENS Unit at the same time for maximum efficiency.
Week 1 ACL Surgery Exercises: Final Thoughts
The first week after ACL reconstruction can be both physically and emotionally challenging—but having a clear, structured exercise plan can make a world of difference. By focusing on gentle movements that reduce swelling, restore knee extension, and re-engage the quadriceps, you’re setting the stage for a smoother and more successful recovery.
This routine is based on the same post-op program I use with patients in the clinic every day. The goal isn’t to push through pain or get back to sports right away—but to re-establish a strong foundation that allows for safe progress in the weeks and months ahead.
Stay consistent, give your body time to heal, and listen to your surgeon or physical therapist for guidance. You may be surprised at how much progress you can make in just a few days with the right plan in place.
If you’re looking for more guidance throughout your ACL journey, we’ve got you covered. Whether you’re prepping for surgery, recovering from a meniscus tear, or dealing with long-term joint issues, be sure to check out our related guides on exercises before ACL reconstruction, exercises for meniscus tear, and exercises for knee OA—each designed to support your recovery at home with expert-backed routines.
Why Trust Physical Therapy Simplified for Early-Stage ACL Recovery Guidance?
At Physical Therapy Simplified, our mission is to provide an accessible, trustworthy source of physical therapy guidance that anyone can understand, follow, and benefit from. We want you to feel confident that you’re getting evidence-based advice and the best exercises in the first week after an ACL tear—all designed to reduce pain and restore your highest functional potential.
This article was written by Andrew Harkins, PT, DPT, OCS, a licensed physical therapist with over twelve years of clinical experience. He is certified by the American Board of Physical Therapy Specialties as an Orthopedic Clinical Specialist and has worked with hundreds of ACL patients—from early post-op care to full return-to-sport rehab.
Andrew has also served as a teaching assistant at the University of Pittsburgh’s Doctor of Physical Therapy Program, where he contributed to musculoskeletal coursework with a special focus on knee rehabilitation and surgical treatment recovery strategies. His knowledge and hands-on experience ensure that the information you’re reading is not only accurate but clinically proven to help.
