Simplifying Performance Rehab Part 8: ACL Reconstruction

Presented by Phil Plisky and Nate Denning

Video Runtime: 51 Minutes; Learning Assessment Time: 38 Minutes

This course is part of a series designed to be taken sequentially. It is recommended that learners view the series in the following course order:

An ACL reconstruction sidelines an athlete for the better part of a year, and clinicians often narrow the plan to knee-focused rehabilitation while whole-athlete performance quietly erodes. This course applies performance programming to a real postsurgical case: a 15-year-old soccer and basketball player recovering from ACL reconstruction who wants to return to sport as soon as possible. It defines the clinical goals and progression criteria for each phase of healing and builds a comprehensive training regimen around them, with particular focus on lower body strength. Learners see how bilateral and unilateral lower body push and pull are progressed from phase 2 to return to sport; how power, speed, agility, and metabolic conditioning are modified by phase; and how evidence-based prevention programs fit into return-to-sport planning. Throughout, it reinforces that isolated joint rehabilitation—early hyperextension, quad strength, blood flow restriction, and open-chain work—continues alongside performance training and that programming begins with the return-to-sport end in mind. That programming begins with the return-to-sport end in mind. Physical therapists, athletic trainers, and other clinicians managing postsurgical athletes will be able to plan phase-specific goals and progress a complete, lower body–focused program from early rehab through sport return.

Learning Outcomes
  • Plan phase-specific clinical goals and progression criteria based on the physiological stages of healing following an ACL reconstruction
  • Implement core rehabilitation essentials necessary to protect and support adequate tissue healing of the ACL graft
  • Apply lower body strength training progressions and coaching strategies across all phases of postsurgical ACL recovery
  • Modify power training and rate-of-force-development variables to safely match the athlete’s current healing phase
  • Prioritize speed, agility, and metabolic conditioning pathways throughout the ACL rehabilitation process to prepare the athlete for return to sport

Meet your instructors

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Phil Plisky

Dr. Phil Plisky is a professor in the University of Evansville’s Doctor of Physical Therapy and PhD in Health Professions Education programs. He is the host of the Medbridge Rehab and Performance Lab podcast and founder of the Coaches Club at

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Smiling man with short hair in a red polo shirt, standing against a white background.

Nate Denning

Dr. Nathan Denning is the founder of Integrated Performance and a partner at Athlete Development Solutions. His mission is to revolutionize human performance and rehabilitation through the integration of physical, mental, and educational support. Nate believes that peak performance—whether for an athlete or a clinician—is the…

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Chapters & learning objectives

ACL Reconditioning: The Essentials

1. ACL Reconditioning: The Essentials

This chapter introduces the recurring case — a 15-year-old soccer and basketball player recovering from ACL reconstruction — and establishes the rehabilitation essentials that continue throughout: early hyperextension, restoring quad strength, blood flow restriction, and open kinetic chain work, with a return to the gym once the athlete ambulates without an assistive device. It defines the initial-phase goals (reducing pain and inflammation, full hyperextension ROM, quad strength, and hypertrophy) and the progression criteria for each phase, all framed by beginning with the return-to-sport end in mind. Because isolated joint rehab remains essential throughout, anchoring the plan to phase goals keeps performance work aligned with graft healing.

Movement and Lower Body Push Progressions

2. Movement and Lower Body Push Progressions

This chapter details how lower body push strength is advanced from phase 2 to return to sport, using bilateral push progressions from the goblet squat through kettlebell rack squats to the barbell front and back squat, and unilateral push progressions built on split squats and lunges, alongside movement screening and early prevention activities. The chapter emphasizes coaching the athlete through each stage. Programming targets strength comprehensively across both unilateral and bilateral patterns, rebuilding lower body capacity for performance and injury prevention while respecting the healing graft.

Lower Body Pull Progressions

3. Lower Body Pull Progressions

This chapter modifies power, speed, agility, and metabolic conditioning across the phases of ACL recovery, with phase-specific examples and ground-contact guidelines, and situates evidence-based prevention programs such as the FIFA 11+ and Sportsmetrics within return-to-sport planning. Because these qualities can begin in early rehab, progressing them with respect to healing, developing them by phase, and adding metabolic work to replace the missed practice load returns the athlete not only healed but also sport-ready and at lower reinjury risk.

Power, Speed, Agility, and Metabolic Training

4. Power, Speed, Agility, and Metabolic Training

This chapter modifies power, speed, agility, and metabolic conditioning across the phases of ACL recovery, with phase-specific examples and ground-contact guidelines and situates evidence-based prevention programs such as the 11+ and Sportsmetrics within return-to-sport planning. Because these qualities can begin in early rehab, progressing them with respect to healing, developing them by phase, and adding metabolic work to replace the missed practice load returns the athlete not only healed but also sport-ready and at lower reinjury risk.

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