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Returning to Running after ACL reconstruction Surgery

Have you torn your anterior cruciate ligament (ACL)? Have you had reconstructive surgery on it?  When is the BEST time for you to return to a jogging/running program?

When you have ACL surgery, running might not be the first thing you want to do right after the surgery.   But, as you progress with your rehabilitation, you might begin to ask yourself (and your physical therapist), “when can I start running?”

Orthopedic surgeons typically have protocols or timelines for rehab specialists to follow with regards to specific surgeries that they are performing.  These timelines are nice for us to reference in order to validate when a patient may progress to the next phase of rehab.  BUT, the progression forward isn’t just about time or how far out you are from your surgery.  It’s about whether you are ready in regards to your strength, range of motion, ambulatory gait mechanics, endurance, balance, loading mechanics, control and stability, pain, swelling/effusion, and confidence.  This is where the skill of your physical therapist comes into play.

When reviewing the research, there is no specific criteria that proves someone is ready to return to running.  However, there are several areas that need to be addressed and assessed in order to determine if a patient is ready. Again, this is not a one size fits all plan but here are some suggestions based off of research that was published in 2018 in the British Journal of Sports Medicine.

  • MD clearance- Your surgeon needs to clear you to run
  • 8-16 weeks post-operation
  • Normal walking gait
  • <2/10 pain on VAS (lower pain levels)
  • 95% knee flexion on surgical limb versus non-surgical limb
  • Full knee extension on surgical limb
  • Trace joint effusion (minimal swelling in the knee)
  • 70% quadriceps isometric strength (on surgical limb versus non-surgical limb)
  • 70% forward and side hop test (on surgical limb versus non-surgical limb)
  • 70% quadriceps rate of force development and hamstring strength (on surgical limb versus non-surgical limb)
  • Tolerates jogging in place 5+ minutes
  • LOADING MECHANICS (assessing quality of movement and neuromuscular control): single leg and double leg squatting, hopping, multidirectional lunging, etc.
  • Confidence- Your physical therapist may use several different ways of measuring this

The return to running component occurs at different time frames for different patients based off the above criteria.  The main take home point is understanding that your return to running is not about a timeline or how far out you are from your surgery but rather if your body is ready for that next step.  Work hard, listen to your physical therapist, and do your home exercises and you should be able to progress through the different stages of ACL reconstruction rehabilitation in a timely manner.

If you have had an ACL injury and/or surgery, call Omaha Physical Therapy Institute today for specialized ACL rehabilitation!

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Contributors to this blog:  Braden Swanson, PT, Katie Cordery, PT, Brent Cordery, PT, Sara Palinski, PT, Marc Hunley, PT, Matt Vetter, PT, Ally Brown, ATC

Your Comeback Story Starts Here!

Rambaud AJM, Ardern CL, Thoreus P, et al. Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review. British Journal of Sports Medicine 2018; 52:1437-1444