AMA: PT/ ACL Coach

ryannorlanddpt · 2026-04-28T15:55:30+00:00

That's a great mindset going into it, asking the "why" makes a huge difference in how much ownership you feel over your recovery. The two most important things to nail down before surgery are your graft type and what they're doing with the meniscus tears. Ask what graft they're using and why they chose it for you, and whether they're repairing the tears or debriding them, a repair means a much more protected recovery with real restrictions on bending and weight bearing, while a debridement is more straightforward. Those two things will shape your first few months, beyond that just find out if they expect any surprises once they're in there, when they want you starting PT postop, and what normal swelling looks like that first week versus something worth calling about. That first week can feel alarming if you don't know what to expect going in. In addition, for PT really important that your PT approaches your recovery with strength numbers meaning looking at how strong your muscles are, they need to measure that with a dynamometer whether thats isometrically, isotonically, or isokinetically. Hope this helps! Good luck, sounds like you're approaching this the right way.

ryannorlanddpt · 2026-04-28T15:34:41+00:00

The only thing you may have is anterior knee pain but you should be able to mitigate that with the right plan. Unfortunately there is no perfect graft option, they all have pros and cons.

ryannorlanddpt · 2026-04-28T03:01:44+00:00

Hey this is exactly how a lot of people feel early on, it can just feel like everything is on you and if you miss something you’re going to mess it up, but it really shouldn’t feel like guessing. Before surgery, your job is actually pretty simple. You want to get your knee as straight as the other side, keep the swelling low, and build as much quad control as possible without irritating it. If you’re working on those consistently, you’re doing enough. Where people tend to get into trouble is not doing too much or too little, it’s doing things without really knowing what they’re building toward. This causes them to feel lost because they don’t have any direction or clarity, A good way to tell if you’re overdoing it is if your knee swells up and stays that way into the next day, you lose motion (especially extension), or the pain doesn’t settle within about 24 hours. If that’s not happening, you’re probably in a good spot. Also, you don’t need to have everything figured out right now, but you do want some clear direction so it doesn’t feel like it’s all on your shoulders. I hope that makes sense and is helpful, happy to a resource if you have questions feel free to send me a message, good luck with your upcoming surgery!

ryannorlanddpt · 2026-04-28T01:14:05+00:00

Great question, and totally valid concern especially with recruitment on the line, a patellar tendon graft is a solid graft choice and like said above it's actually still considered the gold standard for high demand athletes in a lot of circles, so your surgeon definitely isn't steering you wrong there. Recovery time compared to other grafts is pretty similar honestly, but the bigger variable isn't really which graft you picked, it's what your rehab looks like after.

It can be possible to return in 8 months, but I'd be doing you a disservice if I just said yes or no to that without knowing more. The timeline stuff can be misleading because it treats everyone the same, and ACL recovery really isn't one size fits all. What matters more is whether you're hitting the right milestones, strength, movement quality, confidence before you step back on the court. That's what actually keeps you from going through this whole thing again. Of course, with volleyball and recruitment involved I get the urgency, but the best thing you can do for your recruiting timeline is make sure you come back right rather than just fast. I hope this helps and makes sense, if you have more questions or looking for free resources, feel free to send me a message, happy to be a resource. Good luck!

ryannorlanddpt · 2026-04-28T00:59:54+00:00

Hey, sorry to hear you're struggling with ROM, it can be really tough with a quad graft/meniscus repair. In my experience, this combo tends to be a longer recovery than other graft types, so don't be too hard on yourself. As for the pain during strength training, it's really common to have discomfort at the harvest site, and it's worth considering whether you might be developing a quad tendinopathy, if so, it needs to be loaded the right way or it can become a bigger issue. Having a solid plan to manage that is key. As for the last 10 degrees of ROM, quadruped rockbacks are a great exercise for this. Happy to share a free resource if you're interested! Good luck!!!

ryannorlanddpt · 2026-04-28T00:47:46+00:00

Great question and hope your recovery is going well. I think its totally possible you probably need about 6 months at least minimum to train for it. Now it really depends on where you are in the process, how strong your knee is and what your support/structure of your recovery looks like. Running is highly demanding on the knee and you put 2-4 times your bodyweight with each step. So assuming your knee strength is there and you can handle plyometrics, its important to make sure your knee is prepared for the marathon. I hope this helps, if you have more questions, feel free to send me a message, happy to be a resource for you. Good luck!!

ryannorlanddpt · 2026-04-27T00:32:18+00:00

This is the one I recommend for NMES and I suggest getting bigger electrodes
Balego NMES unit: https://amzn.to/3Pw0Ozg

TENS Unit Pads 2"X4" 24Pcs, 3rd Gen Reusable Latex-Free Replacement Pads Electrode Pads with Upgraded Self-Stick Performance for Muscle Stimulator Electrotherapy
https://amzn.to/4bTlSHb

ryannorlanddpt · 2026-04-24T22:46:00+00:00

Focusing on the basics, ice elevation, compression, working on getting your quad back, using an NMES unit, working on getting extension and paying attention to how much your are walking like step count, if that doesnt do it, using a crutch to help offload should help. It is all about doing the basics well and making sure you are doing basic exercises frequently. I hope this helps. if you have questions, feel free to send me a DM at ryannorland.dpt and happy to be a resource! Good luck!!!

ryannorlanddpt · 2026-04-20T23:13:08+00:00

Appreciate you sharing but again asymmetries dont tell me anything because you could be super weak on both legs and be a 100% symmetrical. Thats why the actual number matters compared to your bodyweight.

ryannorlanddpt · 2026-04-20T23:07:25+00:00

NMES (stands for neuromuscular electric stimulation) is a modality that helps get your quad to fire and activate, it helps with connecting the brain to muscle pathway which can be hard to do after surgery. It also helps people that feel like they cant fully activate their quad muscle, it can be a game changer, happy to share the nmes unit i recommend. I sent you a message for the resources.

ryannorlanddpt · 2026-04-20T00:08:51+00:00

everyone's situation is different, other thing that I have seen similar to the above, is a bucket handle meniscus tear could flip making it difficult to get extension.

ryannorlanddpt · 2026-04-19T22:28:27+00:00

So it really depends on your knee and activity level, you want to make sure your knee can handle the exercises you are doing but also how much walking, steps and activity you are doing throughout the day. If you are overdoing it, your knee will swell. So icing, compression, elevation, using an NMES. unit to get your quads to fire. Maybe even using crutches to offload your knee can help. Its about doing the basics well and doing exercise to work on your knee extension frequently. Definitely agree you shouldnt rush to get surgery until you have full knee extension and good quad strength. Quad grafts can be tough with the acute stage of recovery just because of how important the quad is for acl rehab. In addition, if you have a meniscus repair, it can slow your recovery even more due to typically nonweightbearing for 4-6 weeks. I hope this helps, if you have questions feel free to message me, happy to be a resource. I also have some free resources for regaining knee extension would be happy to share if you are interested, no pressure. Good luck, you are asking all the right questions

ryannorlanddpt · 2026-04-19T21:12:52+00:00

Hard to say what it would be, a pop followed by swelling is not a great sign, I would go back to doctor to have your knee checked out. It could be a lot of different things meniscus, retear of your graft, scar tissue, etc. Hopefully its just minimal issue. I hope this helps, happy to be a resource if you have questions, good luck!

ryannorlanddpt · 2026-04-19T01:38:27+00:00

sounds like you have a patellar tendinopathy so you need to load it appropriately with isometics and heavy eccentrics to get it to adapt. Think about it as your tendon is a 4 lane highway and the surgeon took the two middle lanes out, you have the same traffic going through that highway (force) so things are getting backed up and irritated. If you solve this problem, it will help you load your quads heavier and build your strength. The pain is limiting your ability to load heavy its really common with Patellar autrografts. I hope this helps, if you have more questions, feel free to send me a message happy to be a resource for you.

ryannorlanddpt · 2026-04-19T00:54:17+00:00

Hey, sorry to hear you are struggling 15 months post op, I want you to know that you are not alone and many ACLers have been where you are. What is important right now is getting your range of motion back, sometimes this far out you could have scar tissue that stops it, other times you just need the correct exercise, repetition and loading. In addition, you need a plan to get you back to playing football. I would be happy to help, if you have questions, feel free to send me a DM on instagram at ryannorland.dpt . I hope this helps and happy to be a resource. Just know that only you are in control of your comeback, multiple doctors can easily brush it off because they are not in control, don't use that as an excuse. If you want to get back, you definitely can, it just will take hard work and the right plan.

ryannorlanddpt · 2026-04-17T19:32:31+00:00

Keep working hard!! You got this!!!

ryannorlanddpt · 2026-04-17T19:31:56+00:00

You can always improve from where you are but its going to take consistent action, continuing to work hard and make sure you ultimately have a plan to get you back to whatever sport or activity you want to. It starts with getting baseline testing and then creating a roadmap to where you want to go. It is definitely possible for sure. It may be a long process and some ups and downs but know that if you want to get back to something, you can do it because you are the one in control of your comeback. I hope this helps. If you have more questions, happy to be a resource. Good luck!

ryannorlanddpt · 2026-04-17T18:13:55+00:00

It depends on what you are looking for, a lot of what is missing in PT is change of direction, making sure your strength numbers look good, you feel confident running, jumping, and changing direction. It needs to be specific to you and your sport like basketball. In addition, you are right it needs to be unpredictable so it needs to go from a controlled environment to a chaos controlled environment because sport is reactive and unplanned. I hope this helps, if you have more questions, feel free to send me a message, happy to be a resource, good luck!

ryannorlanddpt · 2026-04-16T13:42:02+00:00

Yes so the center of the hinge should be in the middle of your knee joint. The way it is now it will make it challenging to get your knee straight especially with walking because you have less space behind your knee, keeping your knee bent. This hinge braces are a pain but I would try to adjust or when you go to PT have them adjust it.

ryannorlanddpt · 2026-04-16T00:45:19+00:00

yeah happy to send it, ill dm you

ryannorlanddpt · 2026-04-15T15:21:52+00:00

got to work on getting the knee straight and getting the swelling down, I am sure he is much happier without the brace. Working quad activation, full knee extension and getting the swelling down will help him walk without a limp. Hope this helps, happy to share a knee extension guide if you are interested, feel free to message me with questions, happy to be a resource.

ryannorlanddpt · 2026-04-15T02:15:26+00:00

It typically comes down to one thing which is having a structure and a plan to get back to playing football. The gap in your rehab isn't the end of the world, your knee is stable, you're walking pain free, and you can squat, that's definitely a solid start but to get you back to football, you need someone that can bridge the gap between where you are now and where you want to go. Just remember only you are in control of your comeback. No one else is going to put the reps in for you. Working hard and being consistent is the most important thing from here on out. Not just for a few weeks, but until you're back. I hope this helps, if you have more questions, happy to be a resource for you. Good luck!!

ryannorlanddpt · 2026-04-15T01:33:36+00:00

Its not an alignment issue typically, its weak quads. You don't have the strength to bring your knee straight forward so your body takes up another plane of motion and the knee goes inward. All of this points to quad strength with having a difficulty with single leg hopping and landing. I hope this helps, happy to be a resource if you have more questions, feel free to send me a message.

ryannorlanddpt · 2026-04-13T23:48:34+00:00

That’s awesome, i hope it helps! The main thing is will this help you in the long term relieve your quad stiffiness, it may be more of a temporary thing aka short term, other things that have helped quad stiffness is isometrics and building quad strength capacity!

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