Everyone loves to talk about ACL injuries, and truly, we as physical therapists unfortunately see a lot of them. But if you’ve had knee surgery for a different kind of injury of the knee, (like a MCL or PCL injury), your recovery matters just as much. These injuries come with their own challenges, and the process of returning to your sport still requires structure, patience, and a plan.
So, let’s talk about what sets these injuries apart and what it really takes to get back on the field, mat, or court after surgery.
Not All Knee Injuries Are the Same
MCL and PCL injuries don’t always follow the same pattern as an ACL.
MCL injuries tend to happen with a hit from the side, (like what you’d see with a linebacker getting hit at the knee). Sometimes the MCL is injured along with the ACL, but it can also be injured on its own. If it’s a small enough tear, it might heal without surgery. But if you’re recovering from surgery, chances are it was more severe.
It’s also one of those injuries that really hurts. There are lots of nerve endings in that area!
PCL injuries are different. You usually see them when someone falls directly on their knee or takes a blow to the front of the shin. Either way, if you’ve had surgery to repair one, the recovery still needs to be just as intentional.
Your Strength Needs to Be Measured!
After surgery, one of the biggest mistakes I see is when athletes start to feel “normal” and assume they’re ready. You might walk fine, you might even be able to jog! But if we’re not measuring your strength objectively, we don’t really know what’s safe to try.
We use tools in the clinic to test your isometric strength (basically, how hard your muscles can push or pull). We’re looking at how your surgical leg compares to your other leg, and whether your numbers match what your body needs based on your size and sport.
Because looking or feeling good isn’t enough. If the numbers aren’t there, you’re not ready.
You Can’t Skip the Milestones
No matter which ligament you’ve had repaired, every return-to-sport plan follows a tiered progression. You don’t jump from surgery straight into competition. We have to hit our goals and criteria one phase at a time.
Early on, I’m watching for:
- Full knee extension: Can your leg get completely straight?
- Quad control: Can you do a straight leg raise without compensation?
- Range of motion: Is the injured leg equal to the other leg?
- Strength: Is it quantifiably ready? It can’t be just average, it has to be measurable, consistent, and symmetrically excellent
- Planes of motion use: Can you do sports-specific movement in multiple planes of motion?
We don’t move forward until you meet the criteria. You hit this milestone, then you get to get off your crutches. You do that, we get to start jogging. Then we talk about changing direction, adding in cutting, or sport-specific drills. So that everything you do keeps building one piece at a time. You don’t just go from surgery to suddenly playing in a game. You hit each checkpoint, and by the time you’re back at full practice, it’s because you’ve done everything right to get there.
It’s Not Just About the Knee Bend
I hear it all the time: “I just need to get my bend back.”
And yes, you will get it. But that’s not the first priority after surgery. What really matters in the early phases is knee extension, which means getting your leg all the way straight.
If you don’t get extension early, you risk scar tissue, gait problems, or even another surgery. So, we always start with extension and quad control. Bending will come as we go, and it usually does without too much work.
That foundation, a strong, straight leg , sets up everything else.
Building Confidence Alongside Strength
Returning to sport isn’t just physical. If you’re post-op, your brain is going through this process too. I see a lot of athletes who physically look ready, but mentally, they’re holding back. They’re unsure. They don’t trust the knee.
We use some outcome measures to check for fear or anxiety, especially if it’s showing up in movement. Sometimes you’ll tell us directly, and sometimes it shows up in the way you move.
A big part of my job is to build your trust in the process with tangible results, but also emotional support and encouragement. Your physical therapist will not send you back before you are ready. If we’ve done our job right, then by the time you return to play, you’ve already done every component: cutting, sprinting, and reacting a hundred times in rehab. And if you’re still feeling unsure, that’s a great time to bring in a sports psychologist. That support can make a huge difference.
Staying in the Game (Even When You’re Not Playing Yet)
The hardest part of being post-op is feeling like you’ve lost your identity as an athlete. That’s why I try to keep my patients active in any way I can.
Not ready to run? No worries! We’ll work on core or upper body until you hate me. Still restricted from side-to-side motion? You can work on ball touches or drills in a straight line.
We’ll find something. Because keeping that “athlete” mindset, even while recovering, is one of the biggest factors in long-term success.
And when you do get back to practice? We layer it in just like we do in the clinic so it is controlled progression.
- Start with individual work.
- Add in non-contact practice.
- Scrimmage with teammates you trust.
- Then, finally, return to full contact or competition.
We don’t go from 0 to 100, and we will never send you back until we know you’re ready.
You’ve Earned It
There’s a reason we set clear expectations and use objective measures. We’re not guessing. We’re not hoping you’ll be okay. If you’re back to sport after a knee surgery, it’s because you’ve earned it. Session by session, exercise by exercise, and milestone by milestone.
So when in doubt, remember: your recovery is a series of small wins that build up to that big one. You’ll get there. And when you do, you’ll be stronger, smarter, and ready for it.
Looking for help in your recovery to return back to sport or daily life after a knee injury? Schedule an appointment with a Spooner physical therapist today!