BookAfter ACL reconstruction, the operated quadriceps usually has the most strength to rebuild, and two-legged lifts let it work under heavier load early on. Your physiotherapist decides when single-leg work starts, and our coaches run it on the gym floor.
Single-leg exercises ask the knee to balance, control and produce force at once, so the load has to stay light. Two-legged exercises remove most of the balance demand, so the quadriceps can work against heavier load.
That is why early ACL rehab at Adapt leans on the leg press and squat patterns, within your surgeon's protocol.
Each step starts when your physiotherapist's review supports it, and the timing follows your knee.
Book an assessmentLeg press and other two-legged lifts, loaded heavier as your knee tolerates each block.
One foot steps forward, so the operated leg takes more of the work.
The operated leg lifts on its own once your physiotherapist's review supports it.
Faster single-leg work comes last, after slow, controlled loading is in place.
At each review, VALD ForceDecks and ForceFrame compare the operated side with the other, so your physiotherapist reads the gap in numbers rather than by feel.
More even quadriceps strength before return went with fewer knee reinjuries in the Delaware-Oslo ACL cohort (Grindem and colleagues, 2016), which is why strength testing tracks the gap.
It can, so coaches watch how the work is shared. If the uninjured side takes over, they change foot position, range or load, and your physiotherapist checks the block at the next gym-based assessment.
How each side is measuredYour physiotherapist sets each step and James Bowen's coaching team runs the sessions.
Runs the two-legged and single-leg strength blocks on the gym floor.
Sets when strength work moves from both legs to one.
Reviews the operated knee against the current strength block.
Single-leg work starts when your physiotherapist's review supports it, not on a set week. van Melick and colleagues (2016) recommend strength, hop and movement tests to guide it, the same mix used in sports physio. A physiotherapy appointment sets that review.
Book an assessment
Only when your surgeon's protocol allows it, usually in a limited range at first. Your physiotherapist decides whether it fits the current block. Contact Adapt if you want that checked before you book.
Book a physioThey can, because two-legged lifts are chosen so the operated quadriceps can work against a load that single-leg work cannot hold yet. The physiotherapist sets the starting load from the protocol and the first review, and coaches keep the movement inside that range.
Your physiotherapist's review decides it, not a set week. Single-leg work waits until the operated side is sharing the two-legged load and the protocol allows the stance. Coaches do not move that step on their own.
The order stays the same. Graft type and your surgeon's protocol change what range and load are allowed in each step, and the physiotherapist reads those limits at each review before coaches progress the block.
Tell your coach at the next session and your physiotherapist at the next review, so the current load and range can be checked. Some swelling can follow heavier two-legged work. The plan is then adjusted from that review.
Both. Your physiotherapist plans the steps and reviews the knee. Coaches run the strength work on the gym floor from that plan, so the same order is followed between reviews.
Yes, unless your physiotherapist asks you to change it. Two-legged lifts use both legs on purpose so the operated quadriceps can work under load, and reviews compare the two sides rather than guessing the next step from feel alone.
British Journal of Sports Medicine, 2016
British Journal of Sports Medicine, 2016
Sam and John are registered physiotherapists who plan ACL rehab at Adapt. Their AHPRA registration details are on their profiles.
Last updated on 21 October 2026