Dr Mak Protocol™

COMPLETE ACL RECONSTRUCTION REHABILITATION PROTOCOL

Phase 1 : Protection & Activation ( Week 0-2 )

Phase 2 : Range of Motion & Strength ( Week 2-6 )

Phase 3 : Functional Strength ( Week 6-12 )

Phase 4 : Return to Sport ( Month 3-6 )

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Phase 1: Protection Phase

Week 0–2

Goals

• Protect graft

• Reduce swelling

• Achieve full extension

• Activate quadriceps

• Restore independent ambulation

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Range of Motion Goals

Extension: 0°

Flexion: up to 90°

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Exercises

1. Ankle Pumps

3 × 20 reps

Improve circulation, reduce DVT risk

2. Quadriceps Sets

3 × 15 reps

Hold 5 seconds

3. Heel Slides

3 × 15 reps

Within pain-free range

4. Straight Leg Raise

3 × 10 reps

Only if no extension lag

5. Passive Knee Extension (heel support)

5 × 30 seconds

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Weight Bearing

Partial → progress to full as tolerated

Brace if prescribed

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Avoid

• Active knee extension with resistance

• Pivoting

• Sudden movements

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Phase 2: Early Strength Phase

Week 2–6

Goals

• Full extension

• Flexion to 135°

• Improve quad strength

• Normalize gait

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Exercises

1. Wall Squat (0–45°)

3 × 12 reps

2. Step-Ups (10–20 cm)

3 × 10 reps

3. Stationary Bike

10–15 minutes

4. Hamstring Stretch

3 × 30 sec

5. Single Leg Balance

3 × 30 sec

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Manual Therapy (Dr Mak Protocol)

• Patellar mobilization

• Soft tissue release

• Fascial release

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Phase 3: Strength and Control Phase

Week 6–12

Goals

• Restore muscle strength

• Improve neuromuscular control

• Prepare for dynamic activity

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Exercises

1. Leg Press (0–60°)

3 × 12 reps

2. Split Squat

3 × 10 reps

3. Romanian Deadlift (light)

3 × 10 reps

4. Single-Leg Balance Progression

unstable surface

5. Core strengthening

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Cardiovascular

Bike: 20 minutes

Elliptical allowed

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Phase 4: Advanced Strength Phase

Month 3–5

Goals

• Restore 80–90% strength

• Prepare for running

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Exercises

1. Squat progression

3 × 10 reps

2. Lunges

3 × 10 reps

3. Step-down drills

4. Controlled plyometric preparation

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Start jogging if:

• No swelling

• Full ROM

• Good quad strength

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Phase 5: Return to Running and Plyometric Phase

Month 5–6

Goals

• Prepare for sport

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Exercises

1. Jogging progression

2. Plyometrics

• small jumps

• controlled landing

3. Agility drills (linear first)

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Phase 6: Return to Sport Phase

Month 6–9

Goals

• Full return to sport

• Restore explosive strength

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Exercises

1. Sprint drills

2. Direction change drills

3. Sport-specific drills

4. Jump and landing training

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Return to Sport Criteria (Critical)

Patient must have:

• ≥90–95% quad strength symmetry

• No swelling

• Full ROM

• Excellent neuromuscular control

• Pass functional tests

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Functional Tests

• Single-leg hop test

• Triple hop test

• Y balance test

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Dr Mak Clinical Insight (Unique Signature)

The most critical factor in ACL rehabilitation is restoring quadriceps strength and neuromuscular control before introducing high-load dynamic activity. Premature return to sport significantly increases reinjury risk.

A progressive, criteria-based approach ensures optimal graft protection and long-term joint stability.

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Recovery Timeline Summary

Walking normally: 6–8 weeks

Running: 3–4 months

Sport training: 5–6 months

Full return to sport: 6–9 months

Elite athletes: 9–12 months preferred