Ask Beth: How can I knee-paddle again after ACL replacement surgery?

QUESTION: How can I knee-paddle again after ACL replacement surgery?

Hey Beth,

I had ACL replacement surgery in February, and am almost ready to be released, but cannot sit on my heels without excruciating pain. This means no knee-paddling!

Can you suggest guidelines to break up these adhesions? I currently cycle daily, and will begin roller skiing and inline skating next month. I’m also a competitive x-c skier.



Hi Jerry,

Below is the info from Lance, the kick ass surfer/PT master. Very helpful info. My input is to just make sure that your muscles surrounding that joint stay super strong and you are not compensating once you get back into your regular activities. You are going to have to be on top of this injury for awhile even when you start to feel better. Especially in keeping everything nice and open.

Best of luck. I agree with the knee-paddling….No big deal as long as you are able to surf!!


Hello Jerry,

Breaking up scar tissue can be difficult, you have to keep on it. I’m assuming that “almost ready to be released” means that you are working with a physical therapist, so you most likely have a program for working on the end range flexion. If not, then find a PT who will work with you to show you a program and do some manual therapy. There are no magical techniques, it just takes time and persistence. Sitting on your knees is one of the last things to return after this type of surgery. You have to keep stretching, slow and gentle. If you push too hard, you are going to irritate the tissue and cause further inflammation, possibly leading to more scar tissue. Hopefully, the limit is anteriorly and superficial secondary to adhesions from the incisions or patella tendon (patella tendon repair). This type of limitation will stretch out easier than limitations deep in the joint.

For now, you will have to paddle prone, this is better than not surfing. Make sure you are ready for a return to surfing by asking your rehab team because you are only six months out. At six months you feel strong and ready, but you have to be careful because the graft is still gaining stability. The other sports you are doing do not require deep knee flexion like knee-paddling. You should be okay there. Good luck!

Lance Harriman, MSPT
Potrero Physical Therapy

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