Good performance does not mean low injury risk. Recovering from a volleyball ACL injury requires full knee ROM and true landing control.
【Case Background】
She’s a college volleyball player, around 20 years old, who had left knee ACL reconstruction along with a lateral meniscus repair.
Her orthopedic surgeon gave clear direction from the start: knee extension ROM needed to be pushed early, right after surgery.
Her surgeon prioritized full knee extension early post-op, while holding off on aggressive flexion ROM work for the first 3–4 weeks.
Surgery being successful is only half the story — the recovery and training afterward matter just as much.
With her surgeon’s approval, we started as early as we safely could.
This was a genuinely proactive surgeon, not one to let her sit still for long.
So where did her training go from there?
【Movement Training Progression Notes】
She started training with me about one month after surgery, and kept up with her regular follow-ups with the surgeon throughout.
I’ll walk through her progress in two parts: joint range of motion, and movement function.
Knee Joint Range of Motion
The main numbers we track for knee ROM are the maximum angles for extension and flexion.
One thing that worked in her favor — once she learned proper stretching and self-massage, she took care of this part on her own, really well.
Extension came along mostly through her own stretching; I just checked in quickly each session to confirm progress.
Flexion also kept improving with her stretching alone, so I didn’t need to assist.
Whenever progress slowed down, a small adjustment to her stretching approach was enough to get it moving again.
Weekly progress: 112°→122°→120°→128°→130°→136°.
Being an athlete, her leg muscles were already strong, so once she hit 136°, I stopped tracking the angle itself.
Partly because measuring it accurately needs a second pair of hands, and I didn’t want to eat into training time.
But more importantly, I care more about the functional side of ROM.
Things like: can she fully kneel-sit? Can she fully stretch out her quadriceps? That kind of thing.
At that point, numbers matter less than getting a real sense of whether it affects her daily life and her volleyball performance.
She later moved back to school out of town and trained with another coach near campus, so I didn’t see her for about two months.
Then summer break came around. When she came back to train with me, her knee ROM still wasn’t fully open — not yet matching her healthy leg.
This was already about 5 months post-op, so we needed to catch up on that missing range quickly.
It ended up creating real problems for her during summer training.
Unfortunately, the number of sessions I could give her over the summer was limited, and strength and stability needed urgent attention too — I was worried about her injury risk once summer training started.
So all I could do was have her keep stretching on her own; we had bigger problems to deal with.
Movement Function
Going back to when she started training with me at 1 month post-op.
She did great keeping up with independent stretching, which freed up more of our session time to focus on neuromuscular control and strength.
For balance, we progressed step by step from bodyweight drills to unstable surfaces like the Bosu ball.
Functional training: open kinetic chain exercises, hip hinge, single leg deadlift, split squat, and more.
Over those roughly two months from 1 to 3 months post-op, she even started adding some light weight training.
But we hadn’t built up to running or jumping intensity yet before she headed back to school.
She was proactive about it too — while at school out of town, she found a coach near campus to keep training with.
Then summer break came, around 5 months post-op.
When she came back, I noticed something: some discomfort around the patellar tendon.
It tracked back to those two months without enough strength training, where she’d instead been learning how to jump.
That training sequence carried real risk — the tendon issue was a sign the load had exceeded what the tendon could handle.
On top of that, she showed clear knee valgus during movement, which needed correcting first.
I gave her some corrective work and had her hold off until the knee felt better.
A few weeks later, the patellar tendon had recovered well, but with only two weeks left before she went back to school.
We focused on single leg squats and the key techniques for plyometric training.
Teaching her how to keep the knee stable through dynamic movement, along with jump mechanics and landing control.
I didn’t have time left to fine-tune her lifting technique or her sport performance — the priority was bringing her sport risk down first.
At the same time, we started jogging and some basic volleyball movements.
But with her ROM still not fully open and the knee valgus tendency still there.
Both jogging and these basic movements were giving her some trouble — and her knee was also showing signs of unusual warmth.
But time was up, and I could only teach her how to monitor and manage her training load before she went back to the team for summer training.
By this point it was about 6 months post-op.
Given where her movement function actually was, regular volleyball training wasn’t going to make it easy for her to keep her injury risk under control.
Hoping it goes well for her.
Looking back at the whole process — it started smoothly, stalled in the middle, then turned into a rush to catch up.
She could eventually jump onto a 40cm box, but her landing control still wasn’t there.
Good performance doesn’t mean low risk.
I hope she doesn’t overestimate where she’s at and rush back into competitive play too soon.
Keep building the fundamentals step by step, and she can absolutely get stronger than she was before.
Note from the Author:
This category features “Training Case” documenting the process of clients progressively optimizing their physical functions through systematic training under professional athletic training guidance.“Train after injury.” While many believe that rest is the only option after an injury, true recovery often requires rebuilding motor control and strength under appropriate loading.
This involves more than just movement optimization and strategies for balancing muscle groups; it is about preparing the body to handle higher-intensity challenges and returning to the sports and lifestyle you love.
These case studies are intended to share training perspectives and do not function as medical diagnosis, treatment, or clinical prescriptions.
Training results vary depending on individual participation frequency, physical baseline, and recovery status; please do not attempt to replicate movements without a professional assessment.
If you experience acute pain or have concerns regarding an injury, please consult your primary physician for a medical diagnosis.
This article was originally composed in Chinese and translated to share these clinical insights with the global athletic training community. Our goal is to bridge the gap between movement science and practical application across languages.
About the Author｜Andy Hsu, MS, Athletic Trainer
Train Smarter After Injury.
Precision Movement Optimization & Return to Play (RTP)
- Former Athletic Trainer, Landseed Sports Medicine Center
- Former Athletic Trainer, National Sports Training Center (Taiwan)
- Former Athletic Trainer for National Teams (Table Tennis, Volleyball)