Why won’t my quad tighten after ACL surgery?

Often it’s arthrogenic muscle inhibition: after an injury or surgery, the nervous system turns the quad down.

Can I go back on light duty right after ACL surgery?

One NHS physical therapy team says light duties may be possible after 2 weeks, though you’ll likely still be on crutches.

Can I drive while on pain pills after ACL surgery?

Not on narcotic pain medicine. MedlinePlus says not to drive while taking it, because it can make you too sleepy to drive safely.

ACL surgery · Weeks 0 to 2

ACL Surgery Recovery, Weeks 0 to 2: What’s Normal

You tell your thigh to tighten on the couch. The other leg goes hard. This thigh barely moves, and the crutches lean by the door.

A quad that won’t switch on is common: after surgery, your nervous system turns it down, and swelling and pain add to it. One NHS team says light duties may be possible after 2 weeks, likely still on crutches.

What’s normal now

If your quad won’t answer, you’re not lazy. Your nervous system is holding it back. Source
In lab studies, swelling and pain each turned the quad down, even in healthy knees. Source
You’ll lose some muscle, but how much is more in your control than it feels right now. Source
Quad sets and straight-leg raises are the usual first step. Source
Staying off the road is expected: MedlinePlus says don’t drive while taking narcotic pain medicine. Source

Free milestone map

Where are you in recovery?

Pick your surgery and your week. Your map opens right here: what’s normal now, what usually comes next, and the guides for each stage. No email needed.

What usually comes next

One NHS physical therapy team says light duties may be possible after 2 weeks, though you’ll likely still be on crutches. Source
Seated work like takeoffs and cut lists has a guide range of 2 to 4 weeks, gated by your surgeon’s crutch and brace rules. Source

Questions to bring to your surgeon or PT

Is my quad fully firing? Can you test it against my other leg? Source
What can my operated leg do now, and when does that change? Source
What should make me call sooner instead of waiting for the follow-up? Source
Can you put the driving advice in writing for my boss or insurer? Source

Don’t wait for your next visit

A temperature higher than 101°F (38.3°C). Source
Redness, pain, swelling or yellowish discharge at an incision. Source
Bleeding that soaks through the dressing and won’t stop with pressure. Source
Pain that doesn’t ease after you take your pain medicine. Source
Pain or swelling in one calf or thigh. A clot can show up weeks after surgery; with chest pain or shortness of breath, call 911. Source

Chest pain or trouble breathing: call 911.

Questions men ask at this stage

Why won’t my quad tighten after ACL surgery?: Often it’s arthrogenic muscle inhibition: after an injury or surgery, the nervous system turns the quad down. Source
Can I go back on light duty right after ACL surgery?: One NHS physical therapy team says light duties may be possible after 2 weeks, though you’ll likely still be on crutches. Source
Can I drive while on pain pills after ACL surgery?: Not on narcotic pain medicine. MedlinePlus says not to drive while taking it, because it can make you too sleepy to drive safely. Source