If you’re going through ACL surgery recovery, you know how overwhelming it can feel. When should you walk? When can you run again? Is swelling normal? Too many people are thrown into rehab with no clear ACL recovery plan. That’s where the HAMISH Protocol steps in.
Created by ACL specialist Tilly Milverton, the HAMISH Protocol is a 6-step ACL surgery recovery framework designed to guide your rehab safely from surgery to sport. It’s structured, evidence-led, and already transforming how both athletes and clinicians handle ACL rehabilitation.
What Is the HAMISH Protocol?
You’ve likely seen protocols like PEACE & LOVE for general injury rehab. But ACL surgery recovery demands its own specific roadmap. The HAMISH Protocol focuses on the key milestones that must be ticked off before progressing through ACL rehab.
Each letter in HAMISH stands for a critical stage of recovery:
H – Hit Goals Early
Establish full range of motion (ROM) and knee extension as soon as possible.
Early ROM gains are essential. Delays in achieving full extension can impact gait, muscle control, and long-term joint health.
A – Absorb Swelling
Swelling is a signal your knee isn’t ready to progress. Don’t ignore it.
Use elevation, compression, and movement to manage swelling early. A calm knee is one that’s ready for loading.
M – Muscle Activation
Get your quads firing again – both lying down and standing.
ACL surgery recovery starts with regaining neuromuscular control. Activate quads, hamstrings, calves, and core early.
I – Initiate Loading
Once swelling is down and ROM is restored, it’s time to load the knee.
Begin with bodyweight, then double-leg gym-based movements. Only start when the knee is ready – this protects your graft.
S – Single-Leg Progressions
Unilateral strength is key to return to sport.
When the knee tolerates loading well, progress to single-leg strength and balance. Don’t forget hip, ankle, and core control.
H – Hop Testing & Return to Sport
Don’t guess. Test.
You must pass strength and hop tests before running or returning to sport. Progression should be based on criteria, not just time.
Why This Protocol Matters for ACL Surgery Recovery
Every week, I meet patients who are months into ACL rehab but still struggling with swelling or extension. Many were cleared to run without passing a single test.
The HAMISH Protocol brings clarity to ACL surgery recovery. It doesn’t replace individual rehab, but it makes sure the foundations aren’t missed. It’s a roadmap both patients and therapists can follow.
Need the Full Plan?
The HAMISH Protocol shows you what to do. If you need the how – exercises, videos, rehab testing and gym plans – that’s all inside my step-by-step guide:
Outbound source: PEACE & LOVE protocol via BJSM: https://bjsm.bmj.com/content/54/2/72
Follow along on Instagram @specialistsportstherapy for updates or downloads.