Episode 91 | When Can You Return to the Gym after ACLR?

What is up guys? Today, we are diving into the question: When can you return to the gym after ACL reconstruction? This is a question that I’ve gotten recently from an athlete, and I’ll actually get this quite often. People are approaching their surgery or maybe it is right after the injury and they’re like, hey, I want to get back into the gym. What does that look like? Do I need to worry about anything? Today, we’re going to tackle this question. And I totally get it. You’re itching to get back into the gym to move. And you also might be scared of losing any of those gains or the strength you’ve worked really hard to build. I totally that. And it always seems like when you take time off from the gym, it just takes a few days for you to feel like you are losing everything versus you got to stay steady and keep that strength up. I totally feel that. There have been times in my life, especially after my two ACL injuries of working on that.

Let’s talk about how you can maintain your strength and be able to get into the gym right after this happens. And is going to overlap with someone who is post-injury or post-surgery. The one thing I will say with post-surgery that you need to worry about, is basically if you are immediately post-op, you’re going to have wounds. And those are going to be open and hopefully, they’re going to be protected and wrapped up. But you want to just make sure you protect that and you do not risk any type of infection. Gyms can obviously be disgusting, so you just want to make sure you’re smart about what you’re touching, what your knee is touching, and ultimately being clean, protecting the site.

Let’s talk through some factors that are going to influence your decision to get into the gym. A lot of this is basically you assessing your risk versus reward, and what makes the most sense for your situation. First off is going to be straightforward, it’s going to be your weight-bearing status and the time from surgery. Your weight-bearing status is going to be how much weight can you put on that operated leg. Usually, it falls into three buckets: your non-weight bearing, your partial weight-bearing, or your full weight-bearing. And this is usually the continuum of non-weight bearing all the way to partial to full. This will coincide with also typically the time from surgery and what’s done. But obviously, if you’re a non-weight bearing, then that means you can’t put your foot on the ground. So that is going to impact your stability, as well as your ability to move around and stabilize on that leg. And so that is going to dictate the movements you can do. 

Also, if you’re weightlifting, depending on dumbbells, or trying to rack weights, that’s going to be pretty hard. You want to be smart about this. Full weight-bearing, you want to be pretty far into this in order to really move some weights around and not be silly about it. The timepiece is going to be important because the further away, obviously the more healing is hopefully better, as well as hopefully you are more weight-bearing. But if you’re a few days post-op, then that’s going to factor into, okay, maybe I should not pick movements that are going to be super challenging or that could put me at risk. These are some factors that will play into this decision. 

Next up is safety. Just don’t mess up your surgery or your knee and compromise it. Be smart. This means don’t do some movements that you could lose balance or potentially a high exertion, like don’t go and do a barbell single-leg squat or something. This is something to just be mindful of. Think of it as more of a maintenance mode, or something where your body is fixed or seated and you’re working primarily on upper body stuff. I will say that, especially in high school, I remember that for the longest time, I couldn’t really lift my lower body. And that was because of just the restrictions that I had gotten from the surgeon and the physical therapist and the environment that I was in. I just worked on my upper body all the freaking time. It was the strongest my upper body had ever been because I had so much dedicated time to my upper body, which was pretty sweet. But I had assistance from my coaches and my teammates. If you don’t have that assistance, then that will impact what you can do. So that might mean not being able to load up certain things as much as you want. And that’s okay for that time period, it’s not forever. It’s just enough to be able to keep moving and to be safe. 

Next up is your environment. This is where the important question is, what is what you define gym? Where is it? Is it at your home? Do you have a home gym or is it just a few weights? Is it at your apartment complex and you guys have a gym set up there? Is it somewhere where you need to drive? Like Crunch Fitness or Planet Fitness or anything like that where you’re going to have to think about the logistics of where you need to consider going from your home, your point A to whatever your gym is, your point B. That will factor into when you can get in the gym. If you have to drive, but you can’t drive yet, and your right leg is the one that has the surgery on it, well, you’re going to be limited. Those are things to factor in is, if my home is my home base, then where is the gym that I want to go to? And what are the logistics and the steps to get there? And that’s where you need to have a plan for this and understand, I got to get out of my house into a car, go to a parking deck, get into the gym. And then also thinking about navigating the gym space with people. Usually, if you’re on crutches, people will stay away from you or give you some space, so at least that’s good.

And one thing I recommend is to see if you can have a friend or whoever is helping you to assess. You guys can have a scheduled time to either go to the gym or pick you up and they come to assist you at the gym. And that’s something that could be their time as well. See if that’s a possibility, which can help a ton. Almost like your own bodyguard or protector, someone who’s there to assist. 

Next up is driving. Let’s assume the friend can’t drive you. Can you drive? Is it your right leg? Is this something where you can truly and safely do that? If not, then maybe get an Uber. Or this might be something where you have to revert to home until you can drive to your gym. 

Next one up is medicine. The medicine you’re taking post-op or post-injury is going to be important. You want to make sure you are with it, especially if you’re operating weights or anything like that. Or if you’re operating a car, you just want to be smart. If you’re on meds, don’t go driving, and don’t go dropping weights on your head. 

Now, the next thing I want to tackle is some practical options. Let’s say you can’t get to the gym or maybe at home you have a good setup or at the apartment, then let’s talk about practical options. When we are talking about training your upper body, the goal that is going to help you with being able to do this is to find a position where your ACL operated side, your leg isn’t moving and is fixed to the ground. And you could just pop that thing out, prop it up. That could be anything like a bench press, a seated shoulder press, a seated cable row, a dumbbell curl while you’re seated, seated overhead tricep extension, you could even do seated dumbbell flies. You can hit a ton of upper body work. And rotate these things through while you’re seated. That’s going to be the biggest key here. There’s no point in really doing standing-up work for the upper body. It’s not going to be worth the risk or reward of compromising your knee. Instead, just sit down, prop your leg up, and be able to knock some of this stuff out. And that way you can still train your upper body. And that’s what we do with a lot of our athletes if they want to hit the upper body and be incorporated into this. This is the way that we will program it out for them.

For core, again, the same principle applies. Do something where you are not manipulating your leg too much. You could do a Russian twist where your foot is still propped on the ground, you could do a front plank, you could do something like a Pallof press, seated side bands, it could be seated band rotations. There are a lot of options that exist here, even a seated cable curl. The goal, again, is to have the leg fixated so that way you can still attack some of the things that you want to without compromising the knee.

Now, here is my ultimate favorite machines. Machines are really underrated, and underused; whether it’s in the ACL rehab process itself. And especially when we’re looking at the post-injury or post-op, whenever we need that stability, or we need a machine that’s kind of fixated and it controls for that stability issue and focuses purely on strength and forced production and tissue capacity. I love using machines. You could get a solid pump. You don’t have to worry about slinging weights around or racking them. Usually, they’re just the pin weights where you adjust those little cables in the weight machine. So that is awesome. And the way that you could do this is easily like a machine bench press, a machine shoulder press, a machine lap pull down, a single-leg press where could just insert the little cable into the adjustable weights, a knee extension machine on the unoperated side. As you get further into your rehab based on what your rehab program is and what your PT has you doing, you could start building this into your regimen as well, which is really cool.

Now, if you’re looking for some very simple rep schemes for these machines or movements, a great rule of thumb is to hit two to three sets of 8 to 12 reps with only two to three reps left in the tank to help best pick your weight. We call that an RPE of seven or eight, or an RIR (reps in reserve) of two to three. Basically, if you’re aiming for eight reps and you want to leave two to three in the tank, then you want to pick a weight. You could do 10 to 11 times roughly. And that’ll help you to make sure you’re working on strength. It also helps with hypertrophy in size. This is just a very good rule of thumb. Overall, we can get into the nitty-gritty, but if you want to keep it simple and you’re an ACLer listening and you’re like, hey, I just want to get to the gym. I’m going to hit some of these machines. What’s a good sequence for me to hit? Two to three sets of 8 to 12 reps in the RPE of seven to eight. You will be golden. 

Now, lastly, what does conditioning look like? Do not, do not, do not use the bike for conditioning, especially if you’re post-op or post-injury. The bike is not meant for conditioning, and it is going to be a means for you to be able to work on your range of motion. At some point, it will turn into another mode of conditioning, but early on it’s not. And that’s one thing that’ll be important to stress because you can end up stressing your knee out. It’s just not worth it for the early phase. You want to make sure you build the foundation well. Don’t make the knee grumpy by just doing too much conditioning with a bike post-op. 

One caveat, I will add is that if you have an air bike and you have the handles that you can move as well as the pedals, then you could just prop up that ACL side on the resting pedal that’s up front by the wheel. And then you could use your arms and your unoperated side leg and you can go to town with that, rock and roll with it. That is actually a really great method and we use that with our athletes as well. And if you’re looking for a deeper dive on this, check out episode 44, early conditioning options after ACLR where we do break down more of off-feet type conditioning where you don’t stress the knee. But you can still get that metabolic, that workout-type feel that you’re looking for, especially after an injury or after surgery. There are also lots of at-home options as well. This will depend on your equipment and you can even do bodyweight-type work. The world is basically your oyster or something like that.

In review, the main thing I want you to assess is your risk-reward. Basically, how are you going to plan this, and what is going to look like? The ultimate goal and your number one priority is to protect the knee and facilitate that healing environment. Don’t compromise that by forcing yourself with certain movements at the gym. Make sure to choose your environment carefully. Choose your movements carefully. Plan ahead. If you know you’re going to want to do this, figure out a schedule with a friend or whoever is helping you. Get some weights for your home if you need some. This will be especially important for people who are non-weight-bearing for longer than just a week or two. For people who are maybe meniscus repair or have multiple things going on. And they’re off their feet for four to six weeks. These people and if you’re one of them, will be likely less to move just because you’re on crutches. And the last thing you want to do is just move around and about on crutches all the time. The duration of your recovery in that initial stint is longer. Make sure you’re planning and that will be even more important for you who is non-weightbearing for four to six weeks. 

The last point here is to use this as an opportunity to get away from home, to change your environment, to do your ACL rehab, and to throw in some upper body, some core work, and some conditioning work, one to two times per week. This will help your mindset and will help you to just kind of get out of the typical environment of recovery at your home. And to basically keep at bay that lethargic feeling or that feeling of not moving nearly as much as before. 

And to answer this question: When can you return to the gym after ACLR or maybe after ACL injury? This is really going to depend. This podcast episode was basically to highlight some factors you need to consider, as well as some practical options you can use. There are some people who we have doing stuff the day after. It’s pretty easy to get a band and maybe some lighter weights and be able to do just some seated shoulder press and some band pulls apart or rows, some core-related work. And it might just be a few days after, and that’s totally fine. These other factors are going to be more and more important depending on how much of the gym you want to utilize, as well as your readiness to get there. 

All right, team, that is going to do it for today. Thank you all so much for listening. This is your host, Ravi Patel, signing off.