Reza Jazayeri, MD | DOCS Health
Dr. Reza Jazayeri is a double board-certified orthopedic surgeon and sports medicine physician and Director of Longevity & Optimization at DOCS Health. He completed his orthopedic surgery residency at NYU-Hospital for Joint Diseases and his sports medicine fellowship at Kerlan-Jobe Orthopaedic Clinic. Learn more about Dr. Jazayeri’s training and approach.
About this guide
Stay in the gym, protect the graft. This guide gives athletes and bodybuilders a muscle-group-by-muscle-group timeline for returning to lifting after ACL reconstruction. It covers two surgeries side by side:
- ACL reconstruction alone
- ACL reconstruction with meniscus repair
Your upper body, core, and other leg can keep training almost from the start. Your own timeline may differ based on your graft, what was found at surgery, and how your knee responds. Your surgical report and Dr. Jazayeri’s instructions always come first.
Your surgery: what each one protects
The ACL graft sets the overall pace in both surgeries. A meniscus repair adds early limits on weight-bearing and knee bending, so the repaired cartilage can heal.
On a phone, swipe horizontally to view all table columns.
| Consideration | ACL alone | ACL + meniscus repair |
|---|---|---|
| Weight-bearing | As tolerated from day 1, with brace and crutches | None for the first 2 weeks, then gradually increased |
| Knee bending | Regain motion as tolerated; full straightening is the first priority | Limited to 90° for the first 4 weeks |
| Deep loaded squats | Progress from month 3 | Not below parallel with load until about month 4 |
| Hamstring curls | Early with patellar or quad tendon graft; week 6 to 8 with hamstring graft | Week 8 to 12 (curls stress the repaired meniscus) |
| Return to sport | Month 9+, after testing | Month 9 to 12, after testing |
Your graft matters. A hamstring graft delays resisted hamstring curls. A patellar tendon graft can make kneeling sore for several months.
At a glance: what you can train, and when
Your upper body, core, and other leg can train from week 1. Running, jumping, and sport come back last.
Upper body and core train from week 1; running and sport come last. Earliest start after ACL reconstruction. Meniscus repair changes the quad row most.
| Body part | Weeks 0 to 2 | Weeks 2 to 6 | Weeks 6 to 12 | Months 3 to 6 | Month 6+ |
|---|---|---|---|---|---|
| Cardio | Light/limited: Arm bike | Light/limited: Stationary bike | Light/limited: Elliptical | Training/progressing: Jogging | Training/progressing: Full training |
| Upper body | Training/progressing: Seated lifts | Training/progressing: Standing lifts | Training/progressing: Full training | Training/progressing: Full training | Training/progressing: Full training |
| Core | Training/progressing: Floor core | Training/progressing: Planks | Training/progressing: Hanging raises | Training/progressing: Full training | Training/progressing: Full training |
| Non-surgical leg | Training/progressing: Machines | Training/progressing: Train freely | Training/progressing: Train freely | Training/progressing: Train freely | Training/progressing: Train freely |
| Quads: ACL alone | Light/limited: Quad sets, SLR | Light/limited: Mini squats | Light/limited: Leg press | Training/progressing: Squats | Training/progressing: Heavy squats |
| Quads: + meniscus | Not yet/protected: No weight | Light/limited: Flexion to 90° | Light/limited: Leg press | Light/limited: Light squats | Training/progressing: Heavy squats |
| Hamstrings | Not yet/protected: Not yet | Light/limited: By graft type | Light/limited: Light curls | Training/progressing: Curls, RDLs | Training/progressing: Full training |
| Hips and glutes | Light/limited: Bridges | Light/limited: Hip machines | Training/progressing: Hip thrust | Training/progressing: Full training | Training/progressing: Full training |
| Calves | Not yet/protected: Not yet | Light/limited: Seated raises | Training/progressing: Standing raises | Training/progressing: Full training | Training/progressing: Full training |
| Running and sport | Not yet/protected: Not yet | Not yet/protected: Not yet | Not yet/protected: Not yet | Light/limited: Jog, then jump | Light/limited: Cutting; sport 9+ |
Meniscus repair: no weight-bearing for 2 weeks, and knee bending limited to 90° for 4 weeks.
Exercise timeline by body part
Times are from the day of surgery. Each one is the earliest start, if your knee is quiet (little swelling, no pain) and you have met the milestones below.
Cardio and conditioning
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Arm bike (seated) | Week 1 | Week 1 |
| Stationary bike, rocking then full turns | Week 2 to 3 | Week 4 to 5 |
| Pool walking (incisions healed) | Week 3 to 4 | Week 4 to 6 |
| Elliptical | Week 6 to 8 | Week 8 |
| Swimming, flutter kick only | Week 6 to 8 | Week 8 |
| Stair climber | Week 8 | Week 10 |
| Rowing machine (deep knee bend) | Week 8 to 10 | Week 10 to 12 |
| Straight-line jogging | Month 3 to 4 | Month 4 |
| Breaststroke kick | Month 5 | Month 5 to 6 |
Upper body
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Seated machines and dumbbells: chest press, rows, pulldowns, shoulder press, curls, triceps | Week 1 | Week 1 |
| Flat bench press (feet on the bench) | Week 1 to 2 | Week 2 |
| Standing upper-body lifts | Week 4 to 6 (off crutches) | Week 6 |
| Pull-ups (step down, never drop) | Week 4 | Week 6 |
Core
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Crunches, dead bugs, side planks from the knees | Week 1 to 2 | Week 1 to 2 |
| Front plank | Week 3 to 4 | Week 4 to 6 |
| Hanging leg raises, standing cable core | Week 6 | Week 8 |
Non-surgical leg
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Single-leg extension, curl, and leg press | Week 1 to 2 | Week 1 to 2 |
Training the healthy leg helps the surgical leg keep strength through the “cross-education” effect.
Hips and glutes
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Side-lying hip raises, hip abductor/adductor machine (pad above the knee) | Week 2 | Week 2 |
| Glute bridges, both legs | Week 1 to 2 | Week 2 |
| Hip thrust | Week 6 | Week 6 to 8 |
Quads and hamstrings (surgical leg)
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Quad sets, straight-leg raises | Week 1 | Week 1 |
| Mini squats (0 to 45°), shallow wall sits | Week 2 to 4 | Week 4 to 6 |
| Leg press (0 to 90°) | Week 4 to 6 | Week 6 |
| Leg extension machine, protected arc (90 to 45°) | Week 6 | Week 6 to 8 |
| Leg extension, full range | Month 3 to 4 | Month 4 |
| Hamstring curls (patellar or quad tendon graft) | Week 2 to 4 | Week 8 to 12 |
| Hamstring curls (hamstring graft) | Week 6 to 8 | Week 8 to 12 |
| Bodyweight squats to 90° | Week 6 to 8 | Week 8 to 10 |
| Split squats, step-ups, lunges | Week 8 to 10 | Week 12 |
Squats and deadlifts
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Romanian deadlift, light | Week 8 | Week 10 to 12 |
| Goblet squat | Month 3 | Month 3 to 4 |
| Trap-bar deadlift | Month 3 | Month 4 |
| Barbell squat to parallel, light | Month 3 to 4 | Month 4 |
| Heavy or below-parallel squats | Month 6 | Month 6 |
Calves
| Exercise | ACL alone | ACL + meniscus repair |
|---|---|---|
| Seated calf raise | Week 2 | Week 3 |
| Standing calf raise | Week 4 | Week 6 |
Running, jumping, and sport
| Activity | ACL alone | ACL + meniscus repair |
|---|---|---|
| Straight-line running | Month 3 to 4 | Month 4 |
| Double-leg jumping, agility ladder | Month 4 to 5 | Month 5 |
| Cutting, pivoting, sport drills | Month 6 to 7 | Month 7 |
| Return to sport or competition | Month 9+, after testing | Month 9 to 12, after testing |
Training rules
- Swelling is your speedometer. If the knee is more swollen the next morning, drop back a step.
- Start every new leg exercise light, at about 30% of your old working weight, and add no more than about 10% per week.
- Full knee straightening comes first. Losing extension early is hard to get back.
- After meniscus repair, respect the 90° limit for the first 4 weeks, including on the bike and leg press.
- No twisting, pivoting, or jumping until you are cleared, even if the knee feels great.
- The graft is weakest between about weeks 6 and 12.
- Physical therapy comes first. Gym work adds to your therapy; it never replaces it.
Milestones, not just dates
- Before leaving crutches: walking without a limp, full straightening, quad control (no lag on a straight-leg raise)
- Before running: little or no swelling, quad strength at least 70% of your other side, good single-leg balance
- Before jumping and cutting: strength at least 80% of your other side, pain-free running
- Before sport: strength and hop testing at least 90% of your other side, and surgeon clearance
Call the office if you notice
- Calf pain, swelling, or tenderness in the lower leg
- Fever, redness, or drainage from an incision
- The knee giving way, or a new pop with swelling
- After meniscus repair: locking or catching, or new pain along the joint line
Your Surgical Athlete plan
Protecting your muscle starts before surgery, not after it.
- Before surgery: Metabolic Report Card labs check hormonal, metabolic and nutritional markers, so we can fix gaps before the operation. Targeted amino acid supplements start one week before surgery. We also discuss whether peptide therapeutics fit your recovery, and set up a muscle-centric diet to limit thigh muscle loss.
- In the operating room: orthobiologics such as PRP or bone marrow aspirate concentrate (BMAC) may be used to support healing, when appropriate.
- After surgery: you keep training everything the knee allows, using the timeline above.
Let’s talk openly about your training
I work with many athletes and bodybuilders, and I know anabolic steroids, peptides, and supplements are often part of the picture. That conversation is welcome in my office, without judgment. Being honest lets us plan timing, decide what to continue, taper or stop, and support healing. Please don’t stop or change anything on your own before we talk.
Related recovery resources
- Athlete’s Guide: Return to Training After Orthopedic Surgery
- ACL reconstruction
- Returning to sport after ACL reconstruction
- Download this recovery guide (PDF)
Your comeback starts before surgery
Ready to plan your recovery? Call 1-844-JAZ-0911 or email [email protected] to schedule a consultation with Dr. Jazayeri at DOCS Health in Beverly Hills or Westlake Village.
This guide is for education only and isn’t a substitute for personal medical advice. Timelines vary with each injury, graft, and patient. Always follow your surgeon’s and physical therapist’s specific instructions.
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