Physio Bangkok/Conditions
ACL Injury and Reconstruction Rehab in Bangkok
An ACL injury is a tear of the anterior cruciate ligament, the band inside your knee that stops your shin bone sliding forward and steadies it when you twist. At Aspire Physio Bangkok we run ACL rehab with or without surgery: prehab before reconstruction, then strength, running, jumping and return-to-sport testing, progressed by criteria on our gym floor. The clinic is on the 2nd floor of Jasmine Building, Sukhumvit Soi 23, a short walk from Asok BTS and Sukhumvit MRT, and your first consultation is free. Book through our contact page or call 082-281-8009.
- Free first consultation
- Licensed physiotherapists
- English and Thai
- Sukhumvit 23, near Asok BTS
Your physio team
Licensed physiotherapists who assess and treat you themselves, in English or Thai, from treatment through to the gym floor.
At a glance
| What it is | A tear of the ligament that stops the shin sliding forward, usually from a twist, sudden stop or bad landing |
|---|---|
| Surgery or not | Rehab first is reasonable for many people; in the KANON trial outcomes at 2 and 5 years were similar either way |
| Running after surgery | Usually from around 12 weeks, once strength and swelling criteria are met |
| Return to pivoting sport | Not before about 9 months after reconstruction, and only after passing strength and hop tests |
| Total rehab after surgery | Typically 9 to 12 months |
| First consultation | Free |
What an ACL injury is
Your anterior cruciate ligament (ACL) runs diagonally through the middle of the knee. It stops your shin bone sliding forward under your thigh bone and gives the knee rotational stability [1].
Most ACL injuries happen without any direct hit to the knee [1]. The usual moments are a sharp change of direction, a sudden stop, slowing down from a run or landing badly from a jump [1]. The typical pattern is a quick deceleration or acceleration while the knee buckles inward [2].
It mostly affects young, active people, often during sport [2]. Female athletes tear their ACL at 2 to 8 times the rate of male athletes [1]. The ACL rarely tears alone. Injuries to the medial collateral ligament and the meniscus are common at the same time, seen in about 30% and 42% of cases respectively, and these extra injuries shape both the surgical decision and the rehab plan [2].
If your knee pain came on gradually with no clear injury, our knee pain physiotherapy page covers the more common causes.
Symptoms
Typical signs of an ACL tear are:
- A pop. Hearing or feeling a pop at the moment of injury is a classic sign [2].
- Fast swelling. Swelling from bleeding inside the joint within about 2 hours is a strong reason to suspect an ACL tear [2]. Most knees are swollen within 24 hours [1].
- Giving way. The knee buckles or feels like it will slip when you turn or change direction [1][3].
- Pain and stiffness. You may lose full movement, feel tender along the joint line and find walking uncomfortable [1].
The pain and swelling often settle by themselves, which is why many people assume it was a sprain. Going back to normal activity on an unstable knee tends to make the giving way worse and risks damage to the cartilage and meniscus [1][2]. In one orthopaedic emergency unit, half of acute ACL tears were first misdiagnosed as a simple knee sprain [2].
A hands-on stability test called the Lachman test is the most accurate clinical check. An MRI helps when the diagnosis is unclear, and to look for meniscus and cartilage damage [2].
When to see a doctor first
Some knee injuries need a doctor before physio. Get medical help first if:
- You can’t put weight on the leg or can’t move the knee [3].
- The knee is badly swollen or has changed shape [3]. After a big knee injury, a fracture or a dislocated kneecap needs ruling out [2].
- The knee locks or won’t straighten [3].
- You have a high temperature, or feel hot, cold or shivery, with redness or heat around the knee. This can be a sign of infection [3].
After ACL surgery, contact your surgeon or a doctor straight away if you notice:
- Throbbing or cramping pain in your leg, which can be a sign of a blood clot [4].
- Leg pain and swelling together with difficulty breathing or chest pain. Get emergency help (call 1669 in Thailand) [4].
- A high temperature, pus or oozing from the wound, or redness, swelling or pain in the knee that keeps getting worse [4].
- A new knee injury, repeated giving way, or a knee that won’t fully straighten as rehab goes on [2].
Our physiotherapists screen for these at your first visit and will tell you if you need to see a doctor. We can recommend clinics nearby.
Your first consultation is free. A physiotherapist will assess you properly and explain what’s going on, with no pressure to book more.
The phases of ACL rehab
Rehab first or reconstruction?
A torn ACL doesn’t automatically mean surgery. In the KANON trial, 121 young, active adults with a fresh ACL tear had either structured rehab plus early reconstruction, or structured rehab with the option of surgery later if needed [5]. At two years, knee scores were no better with early surgery [5]. At five years there was still no difference, and 30 of the 59 people in the rehab-first group (51%) had gone on to reconstruction [6]. Results were similar whether knees were reconstructed early, late or not at all [6].
For most people, current recommendations suggest a period of rehab before deciding on surgery, and reconstruction is likely to help if the knee keeps giving way after that rehab [2]. Other injuries, your sport, your goals and your timeline also count [2]. The decision is yours to make with your orthopaedic surgeon. Our job is to get your knee as strong and stable as possible whichever route you take. If you go rehab-first, the same principles apply, usually on a shorter timeline [2].
The phases after reconstruction
Modern ACL rehab is criteria-based. You move on when you hit clear milestones, and timeframes are a guide [2]. The ranges below are typical figures from guidelines and studies. Your own pace depends on your graft, any meniscus repair and how your knee responds.
| Phase | Typical timeframe | Goals | What rehab focuses on | We move on when you can |
|---|---|---|---|---|
| Before surgery (prehab) | Typically 3 to 6 weeks in studies [7] | A quiet knee that straightens fully, with strong quadriceps | Swelling control, range of motion, quadriceps strengthening and balance work [8] | Straighten the knee fully with little or no swelling, lift a straight leg without it sagging, and ideally reach quadriceps strength over 90% of your other leg [8] |
| Early recovery | Typically the first 2 to 4 weeks after surgery [7][8] | Settle the swelling, get the knee fully straight, get the quadriceps firing again | Quadriceps tightening and straight-leg raises from the first days, early walking and weight-bearing, ice, gentle bending [7] | Walk without crutches on a straight knee, bend past 110 degrees and lift the straight leg without a lag [8] |
| Strength and control | Typically from about week 3 to month 3 [7][9] | Rebuild quadriceps and hamstring strength, single-leg balance and control | Leg press from around 3 weeks and seated knee extension in a limited range from week 4 [7], step-ups and balance work [8], with precautions for your graft type [2] | Bend to about 95% of your other knee and straighten fully, with trace swelling at most, quadriceps strength over 80% of the other side and pain-free repeated hops on the spot [7][9] |
| Running | Usually from around 12 weeks; studies range from 5 to 39 weeks [9] | Run continuously with good mechanics and no flare-ups | A graded walk-jog programme alongside continued strength work [8] | Progress your running without extra pain or swelling, and show good jumping and landing technique under supervision [8] |
| Jumping, landing and agility | Typically starts between 3 and 6 months [8] | Absorb force, slow down and change direction with control | Hop and landing drills, plyometrics, change of direction and sport-specific drills, combined with ongoing strength work [7][8] | Pass a return-to-sport test battery: quadriceps strength and four single-leg hop tests at 90% or more of the other leg, plus scores of 90 or more on knee function questionnaires [2][10], and complete sport-specific training [7] |
| Return to sport | Not before about 9 months for pivoting sports [2][10] | Train fully, then compete, with confidence in the knee | A graded build-up from restricted to full training, then match play, plus an ongoing injury-prevention programme [2][7] | Move from full training to competition once you’re at least 9 months post surgery, handling full training without pain or swelling, and psychologically ready on a scale such as the ACL-RSI [2][8] |
Why time and criteria both matter
The Delaware-Oslo cohort followed 106 people from pivoting sports for two years after reconstruction [10]. Those who went back to pivoting sport before 9 months re-injured their knee in 39.5% of cases, against 19.4% of those who waited longer [10]. Up to 9 months, each month of delay cut the re-injury rate by 51% [10]. Strength mattered too. Every extra percentage point of quadriceps symmetry lowered the re-injury rate by 3%, and 33.3% of people who returned with quadriceps strength under 90% of the other leg were re-injured, compared with 12.5% of those above it [10].
Waiting alone isn’t enough, since nearly 1 in 5 of those who returned after 9 months still re-injured [10]. In professional male athletes, those who didn’t meet all six discharge criteria before returning had four times the risk of graft rupture [11]. Reviews disagree on how much passing a test battery lowers risk, and a contact injury likely can’t be predicted by any test [7]. That’s why we use time and testing together.
How we treat ACL injuries
Assess the whole knee
At your first visit your physiotherapist takes a full history of the injury, checks swelling, range of motion, quadriceps activation and knee stability, and screens for red flags. If you haven’t had a diagnosis and an ACL tear looks likely, we’ll tell you and recommend a clinic nearby for a medical review and imaging. If you’ve already seen a surgeon, bring the notes. Graft type and any meniscus repair change what’s safe in the early months [2][8]. For other operations, see our post-surgery rehab page.
Prehab before surgery
If you’re heading for reconstruction, the weeks before surgery count. A quadriceps strength deficit of 20% or more before surgery predicts a strength deficit up to 2 years afterwards, and prehab is linked to better self-reported knee function up to 2 years after surgery [12]. Prehab can also improve early range of motion and quadriceps strength at 3 months [7]. We work to get the knee quiet and fully straight, and your quadriceps as strong as possible, before the operation.
Settle the knee after surgery
Early on, the work is simple and frequent: quadriceps activation, getting the knee fully straight, walking well and keeping swelling down. Ice is cheap and rarely causes problems, so it’s reasonable in the early weeks, and compression may add to its effect [7]. Hands-on treatment plays a small supporting role here. We may use soft tissue work around the thigh and knee to help you move more comfortably, but the Aspetar guideline names exercise as the mainstay of rehab after reconstruction [7]. The same guideline advises against dry needling into the inner quadriceps in the first weeks after surgery because of a bleeding risk [7].
Build the strength
Getting your quadriceps strength back is a core goal after an ACL tear, and heavy resistance training is how you get there [2]. Quadriceps weakness can still exceed 20% at 6 months and 10 to 15% at a year after reconstruction [8], so this phase gets a lot of attention. Open chain work such as seated knee extension and closed chain work such as leg press and squats both help, with load and range adjusted to your graft [7]. Our physiotherapists work on the gym floor, and two are also qualified strength and conditioning specialists. You move from the treatment room to loaded training in the same building, often in the same session when it’s appropriate.
Run, jump and change direction
Once you meet the running criteria, we build a walk-jog programme, then add hopping, landing and agility drills. Strength work and movement control training run side by side the whole way, because one can’t replace the other [7]. We coach landing, stopping and cutting technique, since these are the movements that most often injure the ACL [1]. Our sports injury rehab page covers how we bring athletes back to training more generally.
Test before you return
Before you go back to pivoting sport, we check strength and single-leg hop performance on each leg and compare them as a percentage, called the limb symmetry index. We also use questionnaires on knee function and confidence, because fear of re-injury is one of the most common reasons people don’t return to sport [2]. Once you’re back, neuromuscular training should continue as part of your routine [2].
How long it takes and how many sessions
After reconstruction, plan for the long haul. Guidelines suggest rehab continues for 9 to 12 months [12]. Most people are back at work after about 4 to 6 weeks [13]. Running usually starts around 12 weeks [9], and a return to pivoting sport shouldn’t come before about 9 months [2]. The NHS notes it can take up to a year to play sport again [13], and the graft itself may still be maturing beyond 12 months [2].
If you manage your ACL tear with rehab alone, the principles are the same and the timeline is usually shorter [2]. Some people who start this way go on to need surgery later, as about half did over five years in the KANON trial [6].
How often you come in depends on your phase and your goals. One expert review suggests visits at least every two weeks may be needed to keep your programme progressing, with exercises done anywhere from daily to two or three times a week [2]. A well-designed programme you do on your own can work as well as supervised sessions, as long as it’s individually prescribed and monitored [7]. It varies a lot from person to person, and your physiotherapist will give you a plan after the first session.
What you can do at home
- Let swelling and soreness guide you. If your knee is more swollen or sore after an activity, it hasn’t tolerated that load yet. Ease back and tell your physio. Clinicians use these signs to judge when to progress [2].
- Get the knee straight early. Even a small loss of straightening, 3 to 5 degrees, can affect results after reconstruction [8]. Your physio will show you how to work on it.
- Ice safely. Ice helps with pain in the early weeks after surgery. Ask your physio how to apply it, because ice used carelessly can injure the skin [7].
- Do your quadriceps exercises. Quadriceps tightening and straight-leg raises can be started in the first 2 weeks after surgery [7]. Do them as often as your physio prescribes, within your surgeon’s instructions.
- Hold off on pivoting sport. Avoid football, basketball and other cutting or pivoting sports until you’ve passed return-to-sport testing [10].
- Keep your prevention routine. Once you’re back playing, keep doing an injury-prevention warm-up [2].
Your physiotherapist sets the specific exercises, loads and progressions after assessing your knee.
Cost and insurance
Your first consultation is free. Treatment sessions start from ฿1,600. If you have health insurance, you can claim with your insurer, and we’ll supply the documents your provider asks for. It’s worth checking your policy’s physiotherapy cover before you start. See our insurance claims page for how claiming works.
Your physiotherapists
Your knee is treated by one of our licensed physiotherapists: Boom Namsak, who is both a physiotherapist and a strength coach, Gino Udomthanakij, or Som Benjaprasertsri. They all work in English and Thai, and they all coach the gym-floor part of your rehab themselves.
Common questions
Do I need surgery for a torn ACL?
Not always. In the KANON trial of young, active adults, starting with structured rehab and only operating if needed gave knee outcomes at two and five years that were no worse than early reconstruction, and about half of the rehab-first group never had surgery. Reconstruction is usually advised if your knee keeps giving way after a proper period of rehab. The final decision is yours to make with your orthopaedic surgeon.
What is ACL prehab and is it worth doing?
Prehab is rehab before your reconstruction, and the evidence supports it. It aims to settle swelling, get the knee fully straight and build quadriceps strength. A Dutch guideline found prehab is linked to better self-reported knee function up to two years after surgery. The Aspetar guideline recommends at least one visit before surgery to check that your quadriceps are working and the knee straightens fully.
When can I start running after ACL surgery?
Usually from around 12 weeks after surgery, once you meet clear criteria. A scoping review found the median time studies allowed running was 12 weeks, though it ranged widely. Before your first run we look for full straightening, a near-full bend, little or no swelling, quadriceps strength over 80% of your other leg and pain-free hopping on the spot.
When can I go back to football or other pivoting sports?
Not before about 9 months after reconstruction, and only once you pass return-to-sport testing. In the Delaware-Oslo cohort, each month of delay up to 9 months cut the re-injury rate by 51%, and people with weaker quadriceps on the operated side were re-injured more often. We look for strength and hop results of at least 90% of your other leg, good knee function scores and confidence in the knee.
Will I get back to my previous level of sport?
Many people do, but it isn’t guaranteed. One review reports that only 42% of non-professional athletes return to competitive sport after reconstruction, and fear of re-injury is a common reason people don’t go back. We ask about your confidence in the knee as well as checking strength and hops, and we build your confidence with graded exposure to the movements your sport demands.
When can I drive after ACL surgery?
When you can brake hard in an emergency and your medical team says you’re fit to drive. Braking reaction time typically returns to normal around 4 to 6 weeks after surgery on the right knee and 2 to 3 weeks after surgery on the left. You brake with your right foot, so right knee surgery usually means a longer wait.
Does insurance cover ACL rehab, and do I need a referral?
We don’t bill insurers directly, but we give you what you need to claim. You pay at the clinic and claim back using the dated receipts, consultation report and treatment plan we provide. Some insurers require a doctor’s referral, so check your policy first. If you need one, we can recommend clinics nearby. Your first consultation with us is free.
I had my ACL surgery somewhere else. Can you take over my rehab?
Yes. Rehab after reconstruction follows the same criteria-based phases wherever the operation was done. Bring your operation notes and your surgeon’s rehab instructions, because the graft type and any meniscus repair change what’s safe in the early months. Our physiotherapists assess and treat you themselves, in English or Thai, and we work within your surgeon’s restrictions while progressing you by criteria.
References
Show 13 references
- American Academy of Orthopaedic Surgeons. Anterior cruciate ligament (ACL) injuries. OrthoInfo. Accessed October 2026. www.orthoinfo.org/diseases--conditions/anterior-cruciate-ligament-acl-
- Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019;33(1):33-47. doi.org/10.1016/j.berh.2019.01.018
- NHS. Knee pain. Page last reviewed 21 December 2023. www.nhs.uk/symptoms/knee-pain/
- NHS. Complications of ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery
- Frobell RB, Roos EM, Roos HP, Ranstam J, Lohmander LS. A randomized trial of treatment for acute anterior cruciate ligament tears. N Engl J Med. 2010;363(4):331-342. doi.org/10.1056/NEJMoa0907797
- Frobell RB, Roos HP, Roos EM, Roemer FW, Ranstam J, Lohmander LS. Treatment for acute anterior cruciate ligament tear: five year outcome of randomised trial. BMJ. 2013;346:f232. doi.org/10.1136/bmj.f232
- Kotsifaki R, Korakakis V, King E, et al. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med. 2023;57(9):500-514. doi.org/10.1136/bjsports-2022-106158
- Adams D, Logerstedt DS, Hunter-Giordano A, Axe MJ, Snyder-Mackler L. Current concepts for anterior cruciate ligament reconstruction: a criterion-based rehabilitation progression. J Orthop Sports Phys Ther. 2012;42(7):601-614. doi.org/10.2519/jospt.2012.3871
- Rambaud AJM, Ardern CL, Thoreux P, Regnaux JP, Edouard P. Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review. Br J Sports Med. 2018;52(22):1437-1444. doi.org/10.1136/bjsports-2017-098602
- Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA. Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med. 2016;50(13):804-808. doi.org/10.1136/bjsports-2016-096031
- Kyritsis P, Bahr R, Landreau P, Miladi R, Witvrouw E. Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Br J Sports Med. 2016;50(15):946-951. doi.org/10.1136/bjsports-2015-095908
- van Melick N, van Cingel RE, Brooijmans F, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50(24):1506-1515. doi.org/10.1136/bjsports-2015-095898
- NHS. Recovering from ACL (anterior cruciate ligament) surgery. Page last reviewed 17 July 2025. www.nhs.uk/tests-and-treatments/acl-anterior-cruciate-ligament-surgery
Free first consultation
Book a knee assessment
Aspire Physio Bangkok is at Jasmine Building, 2nd Floor, Sukhumvit Road, Soi 23, a short walk from Asok BTS and Sukhumvit MRT. We’re open Monday to Friday 7am to 8pm, and Saturday and Sunday 8am to 4pm. Bookings are required in advance. Book your free first consultation through our contact page or call 082-281-8009.