How to Return to Running After ACL Reconstruction

After an ACL reconstruction surgery, getting back to running is likely at the top of your priority list. However, it is very important to take it slow. Recovery from a major surgery can take months and even years, and it’s important to work with a professional to make it easier for your body to return to pre-injury levels of performance.

First, let’s look at a study to determine how many athletes fully return to their sport after surgery.

In a study of 5770 subjects (48 studies) with mean follow-up of 41.5 months post-op., this is what was found:

• 63% returned to preinjury level of participation

• 82% returned to some level of sport participation 

• 90% had normal knee function (strength/laxity) 

• 85% had normal IKDC scores 

• Fear of re-injury was most commonly cited reason for reduction or cessation of sport

They fact that they saw a low rate of return to competitive sport despite the high rates of successful impairment-based function suggests other factors need to be considered (Arden et al. (2011) Br J Sports Med).

Why is So Hard to Return to Running Post ACL Surgery?

Sagittal plane deficits during running are common, can be substantial, and often persist for several years. It’s not enough to just re-strengthen and get back to running. Quadriceps strength, rate of activation, and rate of force development are important factors to consider early in rehabilitation process. It is extremely important to work with a physical therapist to reconsider appropriate time to return to running post ACL reconstruction.

A common side-effect of ACL surgery is asymmetrical running,. where runners favor the healthy leg. While this may not cause injury in the short term, in the long-term, abnormal lower extremity biomechanics may contribute to development of post‐traumatic osteoarthritis. This suggestions that it is important to resolve any potentially modifiable biomechanical asymmetries to 1) optimize quality of life, 2) promote long term knee joint health, 3) restore athletic performance.

Return to Running Program after ACL Reconstruction

When seeking a return to running program after ACL reconstruction, it’s important to take it slow. Remember to listen to your body and start with strength/power training before hitting the trail. Quadriceps performance is a primary factor in determining if you are strong enough to get back to running.

Start with isolating quad strengtheners, including:

• Single leg lifts

• Seated knee extension

The goal is to increase demand on knee extensors to promote quadriceps utilization. Remember to respect anterior knee pain with BPTB graft . Post ACL reconstruction,hip compensations are secondary to knee 

Once your body is strong enough, still go slow when you get back to running and reintroduce your body to the mechanics.

1 Walking

Try exaggerated stride lengths, squat walking (aka Groucho walking) to get back into the mechanics

2. Jogging 

Continue to use exaggerated stride lengths, and when comfortable, try slight bounding. Remember to think about driving through push-off.

3. Running

When running, use speed to manipulate mechanics. Contrary to what you may think, faster running may improve form. Remember to drive through push-off and lift heels during early swing.

Get Help Returning to Running Post ACL Reconstruction

If you need assistance as you get back to your running routine after ACL surgery, it is encouraged that you work with a licensed physical therapist – particularly one that specializes in runners. Schedule a consultation with Oregon Running Clinic and learn more about your recovery options.