When can I return to run after an ACL reconstruction?

One of, if not the most common question we get asked when regarding Anterior Cruciate Ligament (ACL) rehabilitation is:

“When will I be able to run again?”

If you’ve had an ACL reconstruction, you have probably been asked this countless times by friends, family and teammates. The simple answer is for most people, around 3-4 months after your operation is a reasonable estimate. However, this is not a concrete timeframe, and there is no magical physiological response that happens at 3 months that allows you to run again without the proper rehabilitation.

Returning to run is one of the most critical and exciting parts of the rehab process. And as such, it deserves a thorough plan, and we will outline below some of the key metrics we use here at Instinct Health to determine if you are ready and able to get back to running safely.

Objective measurements and testing

• Strength testing using some any/all of:
  • A hand-held dynamometer to establish specific muscle group strength (quads, hamstrings, calves, gluteal muscles)
• VALD Force Plates to measure shock absorption capacity, balance, and jump and land capability
• Jumping and hopping tests

We use these objective measures to explain WHY you are safe to run, and they tell us if your muscles are ready to support the load required for running.

Fun fact: when we run, we load around 3-5 x our body weight with each step as it hits the ground!

Graded exposure

Once that we are happy an athlete is getting close to running, we can begin the fun stuff. A graded exposure to running helps to provide your muscles and joints with a little “preview” or what the demands of running will be. This process involves:

• Breaking down each part of the running cycle to ensure you have the correct technique and good symmetry
• Gradually building the runner to ensure their body is able to tolerate the pure impact and repetitive nature of running

Remember, your body hasn’t done this for more than 3 months, so we need to give it some time to adjust!

Set realistic expectations

Like a snowflake, every person’s ACL rehab is different, which is what makes it so fascinating and, at times, challenging. From the very first appointment it is important to recognise the type of surgery that has been undertaken, which other structures were involved (ie meniscus or other ligaments) and the ability to weight bear and move post-operatively as a result.

All of these factors can change the trajectory of rehab vastly, and is the main reason why giving everyone a set timeline of 3 months is setting up for failure. Furthermore, every person reacts differently to surgery, and again when we reintroduce load. The main takeaway from this is that if you are behind your team-mate or friend in rehab, then that is both okay, and very normal.

Now as mentioned previously there are many more criteria we follow to allow return to running. At the very least, we need our athletes to be able to complete the following:

• >25 single leg calf raises
• >10 single leg sit-to-stands from a standard chair
• >20 single leg bridges
• 1x barbell squat at your body weight

Once you have been initially cleared by your physiotherapist to resume running, they will then work with you to establish exactly what your return to running plan will look like. This will be specific to your rehab goals and progress towards greater distance run, adding speed, and where appropriate, a return to change of direction and contact with other athletes.