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5 Reasons To Load the Uninvolved Leg After ACLR

aclr atlanta brookhaven decatur dr. mike knee pain physical therapy rehab strength training Apr 25, 2024

A common question I’ve gotten during ACLR rehab is, “Should I do these exercises on my other leg too?” A quick answer: ABSOLUTELY. 


Now, to clarify, every single exercise targeting the surgical leg after ACLR isn’t needed, especially during the early phase where a large focus is placed on restoration of motion and quad activation. The uninvolved leg doesn’t have these issues (hopefully). Although you likely feel “injured” overall after surgery, it’s important to remember that the uninvolved leg is just that - uninvolved. With that said, it should be treated as such. 


  1. Neglecting strength/power training on the uninvolved side will lead to a deconditioned leg. 
  2. A deconditioned leg is much more prone to injury, of any kind, and is specifically associated with an increased risk of another ACL injury
  3. The uninvolved leg is handling more loads than usual while the surgical leg is healing. Let’s call it overuse. Overuse + weak quads = spiked increased likelihood of knee pain. 
  4. When progressing through ACLR rehab, the involved leg is compared to the uninvolved leg to gauge strength asymmetries. Comparing the surgical leg to a deconditioned uninvolved leg could be viewed as a “false positive”. A 90% LSI isn’t nearly as helpful as a 90% LSI when we know the uninvolved leg has gotten stronger since surgery.
  5. When cleared for return to sport, the challenge of restoring peak performance capacity will be much steeper than it would be had that leg been trained during the rehab process. 


The last thing anyone involved wants is another injury to deal with, especially another ACL tear. Your time away from the sport while rehabbing is a unique opportunity to address any detected strength asymmetries and improve your preinjury strength as much as possible without the physical/mental stress associated with play. This may require a bit of creativity if there are positional intolerances or weight-bearing restrictions on the surgical leg.  


How you should be loading the uninvolved leg will vary on an individual basis. 

Key points of area to focus on: 

  • Strength and hypertrophy - glutes, quads, hamstrings, calves (gastroc AND soleus) 
  • Proximal neuromuscular control - trunk, pelvis, hip


These are very simple recommendations, however, I think when navigating muddy waters such as ACLR rehab, simplicity can be very beneficial. If you only take one thing away from this, let it be this: after surgery isn’t a time to rest the uninvolved leg, it’s a time to work it! 

Referencing back to point #4: every strength assessment of the surgical leg is compared to the uninvolved leg. To put our best foot forward, the uninvolved leg needs to be a reliable comparison to ensure progression between phases and activity is truly warranted. 


If you or someone you know is seeking guidance after ACLR, call us at 470-355-2106 or fill out the contact form in the link below.


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Thanks for reading,

Dr. Mike, PT, DPT, CSCS, PES

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