ACL Recovery: More Than Just Your Knee

By CArien Boshoff Osteopath

Recovering from an ACL injury can feel overwhelming. Whether you tore your ACL playing sport, had an

accident, managed it surgically or conservatively, the path back to movement, strength, and confidence is more than just doing exercises; it’s about how your body and mind work together to heal.

Following my own skiing-related ACL injury, I experienced how far-reaching an injury like this can be. At the

time, it didn’t just affect my knee, but also how I worked, slept, drove, and socially interacted with people. Like

many people, I found myself moving differently to protect my knee, because navigating uneven ground,

stairs, or even standing for long periods felt overwhelming. That experience deepened my understanding of

how an ACL injury impacts the whole person, not just the joint.

What Happens After an ACL Injury

The anterior cruciate ligament (ACL) is a key stabilising structure in your knee. After injury, people commonly

experience:

• Pain, swelling and stiffness

• Reduced strength in surrounding muscles

• Altered movement patterns

• Reduced confidence with loading or change of direction

These changes are not just physical. They influence your mood, motivation, and overall wellbeing.

How Osteopathy May Support Recovery

Osteopathy looks at the whole body system, not just the injured knee.

Management can include:

• Hands on techniques aimed to improve joint mobility and circulation

• Treatment of discomfort from compensatory muscles and joints

• Assessment of movement patterns

• Individualised exercise guidance

• Advice to support load management and function

  
  

This combined approach offers physical support, guidance, and education through rehabilitation, keeping in mind each individual’s presentation, goals, and stage of healing. As each person is different, so are their recovery journeys - it is NOT a one-size-fits-all approach.

Why Mindset Matters

Something we notice again and again is that the psychosocial side of recovery is often overlooked. This can present as patients who worry constantly about re-injury, compare themselves to pre-injury levels, or feel frustrated by slow progress. These deep concerns of fear and frustration can unconsciously tighten muscles, make movements more cautious, and even result in poor sleep. In turn, this may slow tissue healing and increase perceived pain.

Research has shown that simple strategies like goal setting, mindfulness, and guided breathing can make a measurable difference.

Just like cold plunges can train your nervous system to handle stress, controlled movement and mindful recovery can teach your body and brain to trust your knee again.

Practical Recovery Tips

1. Move Early, Move Often (Safely): Following an ACL injury, it is completely normal to experience a

range of emotions. Acknowledging how you are feeling is part of the recovery process. From a

rehabilitation perspective, appropriate and guided early movement is beneficial for both physical

and mental wellbeing. Gentle, progressive mobility exercises for the knee, hip, and ankle can assist

in maintaining circulation, reducing stiffness, and supporting joint health.

2. Look Beyond the Knee: After an ACL injury, it is common for people to focus solely on the knee.

The glutes, hamstrings, quadriceps and calf muscles all contribute to knee support. A structured

strengthening program should consider the entire lower limb. It can also be helpful to shift your

focus toward what you can do during rehabilitation. Maintaining general health, where appropriate

and guided, may support overall wellbeing and recovery. For example, swimming with a pool buoy

to minimise leg load, or continuing upper body and core strengthening exercises, can help maintain

cardiovascular fitness and strength while the knee progresses through its rehabilitation stages.

3. Support Your Sleep: Sleep is essential for tissue repair, healing, and overall recovery after an ACL

injury. If sleep disturbance is affecting your recovery, your osteopath can provide guidance on

strategies to support better rest and, where appropriate, recommend seeking additional support.

Good sleep complements treatment and is an important part of it.

4. Recovery is not a Race: ACL recovery timelines vary, and it’s natural to compare yourself to others.

However, rehabilitation does not follow a strict calendar. The most effective plan is one you can

realistically achieve alongside work, family, and daily life. Open communication with your healthcare

team ensures you feel heard, supported, and actively involved in creating a program that works for you.

References

1. Christino, M. A., Fleming, B. C., Machan, J. T., & Shalvoy, R. M. (2016). Psychological factors associated

with anterior cruciate ligament reconstruction recovery. Orthopaedic Journal of Sports Medicine, 4(3),

2325967116638341. https://doi.org/10.1177/2325967116638341

2. Kaur, M., Vela, L., Chmielewski, T., Saliba, S., Callanan, E., & Hart, J. (2026). Knee‐related function and

psychological aspects after ACL reconstruction among individuals with and without kinesiophobia: A

mixed‐methods study. International Journal of Sports Physical Therapy, 21(1), 41–55. https://doi.org/

10.26603/001c.153963

3. Longo, U. G., De Salvatore, S., D’Orrico, F., Bella, M., & Denaro, V. (2023). The impact of psychological

factors on return to sports after anterior cruciate ligament reconstruction: A systematic review. Osteology,

3(3), 78–93. https://doi.org/10.3390/osteology3030009

4. Momaya, A. M., Wood, A. S., Benson, E. M., & Kwapisz, A. L. (2024). The influence of psychosocial

factors on patients undergoing anterior cruciate ligament reconstruction. Sports Health: A Multidisciplinary

Approach, 16(2), 230–238. https://doi.org/10.1177/19417381231223560

5. Nedder, V. J., Raju, A. G., Moyal, A. J., Calcei, J. G., & Voos, J. E. (2025). Impact of psychological factors

on rehabilitation after anterior cruciate ligament reconstruction: A systematic review. Sports Health, 17(2),

291–298. https://doi.org/10.1177/19417381241256930

6. Slater, D., Kvist, J., & Ardern, C. L. (2023). Biopsychosocial factors associated with return to preinjury

sport after ACL injury treated without reconstruction: NACOX cohort study 12‐month follow‐up. Sports

Health, 15(2), 176–184. https://doi.org/10.1177/19417381221094780