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ACL Reconstruction: The Ultimate Self-Test for Optimal Knee Alignment Following Surgery

     Recovering from ACL-Reconstruction surgery is a crucial journey that involves various exercises and tests to ensure proper rehabilitation. One key test is the Heel Pop, which becomes especially relevant around two months post-ACL-Reconstruction surgery. In this blog, we’ll delve into the importance of the Heel Pop. Furthermore, we’ll discuss its significance in achieving optimal knee extension, and practical exercises to enhance mobility and strength.

The Significance of the Heel Pop Test:

     The Heel Pop is a test designed to assess your ability to achieve hyperextension in the knee. This is done by squeezing the quad, pushing the knee down, and observing the upward movement of the heel. This motion is essential post-ACL-Reconstruction surgery as it plays a pivotal role in activating the quadriceps muscles and ensuring normal walking patterns. Moreover, the Heel Pop helps in assessing your ability to control and hold hyperextension, facilitating fluid knee movements, and assessing your progress. In summary, the heel prop test is used as an isolated test to figure out if you are able to achieve terminal knee extension. We’ll dissect this even further.

Importance of Terminal Knee Extension:

     The Heel Pop is directly linked to achieving terminal knee extension, a critical aspect of the rehabilitation process. Without proper knee extension, you will face challenges through your rehab. Therefore, it is a priority in the early stages of rehab. This poses a challenge on your ability to fully activate, squeeze and strengthen your quadriceps muscle. 

     Furthermore, with a lack of full knee extension, poor quadriceps activation and strength, this will directly affect your walking mechanics. For example, you may notice that when you walk your knee will be slightly bent and feel a bit unstable when you’re on the leg. This improper walking style will further enforce problems you and your physical therapist are trying hard to correct. These include inadequate knee extension range of motion, weak and poor quadriceps contraction, and excessive contraction of the hamstring. As an illustration, imagine about how many steps you take through the day, and each step you take incorrectly will reinforce those problems. 

Factors Affecting the Heel Pop Test and Terminal Knee Extension:

     Two primary factors influence achieving Terminal Knee Extension and the Heel Pop Test are mobility and strength. Lack of mobility limits your ability to reach the desired position, while insufficient strength hinders your ability to maintain the hyperextension. To address these issues, specific exercises targeting mobility and strength are essential components of an effective rehabilitation plan.

How to Perform the Test & Discover Your Limitations

It is always recommended to seek a health care professional first to help determine the greatest limiting factor for you.

Improve Your Mobility With a Foam Roller

     For those struggling with mobility, a foam roller can be a valuable tool. Placing the leg on the foam roller and using hands to push down on the thigh helps stretch the knee, particularly the back of the knee, aiding in achieving terminal knee extension. This stretch should be held for 6 to 10 minutes to enhance mobility gradually. 

     If it is too uncomfortable early on, start with more sets at less minutes held and gradually work your way up to lower sets and longer minutes held. For example, start off with 3-5 sets of 2-3 minutes, progress to 2 sets of 5-7 minutes, and then 1 set of 10 minutes.

Watch The Video Above

Build Strength with Just a Strap

     If you can passively get to full knee extension/hyperextension, but you are able to get there on your own, then you need to address your quadriceps muscle activation and strength. To address this deficiency, a strap can be used to assist you. Place the strap around the foot, squeeze the quad, and straighten your knee as much as possible while using the strap with your hand to lift for a bit of assistance. Lifting the leg helps activate the quadriceps muscle and promote controlling that hyperextension. Over time, you should aim to reduce your dependence on hands, allowing your quadriceps to take on more of the workload.

Watch Video Above

Bonus Exercise: Prone Knee Extension

     For an extra strengthening exercise after you master the other exercises, try out this prone knee extension. Start by lying on your stomach, place your toes flat on the ground with your knee bent, and squeeze your quadriceps to straighten the knee up towards the sky/ceiling. This exercise aids in further strengthening the quadriceps and promoting muscle activation.

Watch Video Above


     To summarize, the Heel Pop test is a crucial checkpoint in the early stages of ACL-Reconstruction rehabilitation, to make sure you are achieving and maintaining full knee extension. By understanding the importance of this assessment, significance of full terminal knee extension, and incorporating these targeted exercises for both mobility and strength, you can navigate your rehab journey more effectively. Remember, consistent effort and adherence to a well-rounded rehabilitation plan contribute to successful outcomes.

The Basketball Doctors - Gabriel Ignacio Physical Therapist

Dr. Gabriel Ignacio PT, DPT, OCS, TPI

The Basketball Doctors - Marco Lopez Physical Therapist

Dr. Marco Lopez PT, DPT, CSCS

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