Knee injuries are (unfortunately) quite common, and ACL injuries in particular are a major concern, with about one in 3,500 people experiencing an ACL injury each year. In the U.S. alone, about 400,000 ACL reconstruction surgeries are performed to address such injuries. Pro athletes aren’t the only ones who face ACL injuries, either. It can happen rather quickly on a ski trip or during a recreational soccer league. Rehabbing an injured knee is no walk in the park, but making a proper recovery ultimately comes down to doing the right exercises. One exercise, however, that has developed a questionable reputation is the classic leg extension.
“Leg extensions can be a great exercise for improving quadriceps strength, which is important for many daily activities that require you to push through the leg, such as climbing stairs, getting in and out of a car, and getting up from a chair or toilet,” says Jimmy Pajuheshfar, PT, DPT, Clinical Director at FYZICAL Therapy & Balance Centers. “Other exercises like RDLs and single-leg squats are excellent for lower extremity strength and stability, but they recruit multiple muscle groups rather than isolating the quadriceps as effectively as a leg extension.”
The outdated advice is to avoid leg extensions altogether, but current research suggests that properly prescribed leg extensions can be safe, effective, and an important part of rebuilding quad strength, which is one of the biggest areas of weakness following ACL reconstruction.
When Can I Do Leg Extensions After ACL Surgery?
After ACL surgery, leg extensions can be introduced relatively early under the guidance of a physical therapist, but initial caution is important, as intensity and range of motion should progress gradually. Everything will depend on the individual: their diagnosis, surgical procedure, stage of recovery, and symptoms.
“A common progression may begin with isometric loading, where the quadriceps contracts without significant knee movement, often around 60 to 90 degrees of knee flexion,” Pajuheshfar says. “From there, light resistance through a limited range of motion can be introduced, followed by progression toward full range, progressively loaded leg extensions as healing and strength allow.”
As far as a potential timeline goes, isometric quad loading may begin as early as the first couple of weeks. Around week four post-op, light resistance and controlled range of motion work may be introduced. By the two- to three-month mark, many patients can begin working toward full range of motion and progressive resistance.
Leg extensions might be avoided during certain stages of recovery after surgery, or if the exercise causes significant pain, swelling, instability, or other concerning symptoms. Otherwise, there are very few situations in which leg extensions should be considered permanently off limits.
How to Do Leg Extensions
- Sit on the leg-extension machine with your back against the pad. Adjust the seat and ankle pad so your knees align with the machine’s pivot point and the pad rests just above your ankles.
- Grip the handles and extend your legs until they’re nearly straight, squeezing your quads at the top.
- Bend your knees to lower the weight back to the starting position, maintaining control throughout the movement.
Experts
- Jimmy Pajuheshfar, PT, DPT, Clinical Director at FYZICAL Therapy & Balance Centers
Sources
- ACL Injuries by the Numbers, Panorama Orthopedics & Spine Center
- Considerations with Open Kinetic Chain Knee Extension Exercise Following ACL Reconstruction. International Journal of Sports Physical Therapy, 2021
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