13 Feb Navigating the Road Back: A Step-by-Step Guide to Returning to Running After ACL Reconstruction
Embarking on the path to return to running after ACL reconstruction surgery is a journey that demands precision, patience and a comprehensive plan. Whether you’re an athlete eager to hit the track or someone seeking the joy of a morning jog, the process requires careful consideration and diligent effort.
In this step-by-step guide, we navigate the nuanced stages of post ACL reconstruction recovery, providing a roadmap for success. However, it must be noted that every individual with an ACL injury is different and certain concomitant injuries and post-surgical regimes will mean changes to the post-operative plan in terms of timeframes and goals.
Step 1: Have a Structured Plan in Place
Embarking on the journey to return to running after ACL reconstruction demands a well-thought-out plan. Understanding your current status and setting clear goals is the first crucial step. Establish where you are in your rehabilitation journey and define the milestones you aim to achieve. A structured plan provides the roadmap for success, guiding you through each phase of recovery.
Step 2: Nail the First Six Weeks Post-Op
The initial six weeks post-op lay the foundation for a successful return to running and performance. To pass this critical phase, ensure you have minimal to no swelling, full knee range of motion, good quadriceps activation, normal walking mechanics, and minimal to no pain. These early achievements set the stage for a smooth progression into the subsequent stages of rehabilitation and beyond!
Remember, in this stage, swelling is the enemy!
Step 3: Wait at least 12 Weeks (or longer) before Considering a Return to Run
Despite the surgeon’s optimistic projections around the 12-week mark, a prudent approach involves waiting even longer before contemplating a return to running. The reality is that sufficient strength and capacity around the knee takes time to develop. Patience during this phase is key to avoid setbacks and ensure a robust foundation for the challenges ahead.
Step 4: Have a Set Criteria for Return to Run
Before lacing up your running shoes, establish a set of criteria that must be met and tracked over time. These criteria go beyond the initial phase and include:
- Achieving 80% symmetry in quadriceps and hamstring strength
- Performing over 15 single-leg sit-to-stands
- Demonstrating good lower limb control on a step-down test
- Exhibiting strong balance and proprioception
- Successfully completing over 20 single-leg calf raises and glute bridges
- Performing over 10 pain-free vertical hops and forward hops
- Demonstrating sufficient core strength in the side bridge endurance test
Fulfilling ALL these criteria is essential; anything less indicates that you may not be ready for a return to running. Remember studies have shown that the loads through the knee during running can be up to 7.5 times your bodyweight! We want to ensure that your knee is prepared to tolerate and flourish under such demands.
Step 5: Trial Running on an Anti-Gravity Treadmill First
Before hitting the pavement, consider trial running on an anti-gravity treadmill. This innovative tool allows you to gradually introduce the impact of running while minimising the load on your joints. It serves as an effective litmus test, providing valuable insights into your body’s tolerance for running. Utilise this controlled environment to gauge your comfort, monitor any signs of discomfort, and make necessary adjustments to your plan.
We are fortunate enough here at SportsFit to have access to the Alter-G treadmill, meaning that we can get you going quicker than most, without the increased risk associated with it!
Step 6: Build Up Your Lower Limb Strength with Particular Emphasis on your Quadriceps
As you transition into more dynamic activities, focus on building overall leg strength with special attention to your quadriceps. Incorporate targeted exercises such as knee extensions, leg presses, squats, and lunges into your routine. Strengthening your quadriceps is pivotal for providing the necessary support to your knee during the impact of running. Quadriceps strength as a whole is a massive treatment target during the rehab process. It is also vital to focus on hamstring strength, calf strength, glute and core strength.
Step 7: Become Proficient in your Early Plyometric Capacity and Work
Plyometric exercises play a crucial role in enhancing your capacity for dynamic movements. Plyometric exercise teaches your body to absorb, store and release energy – essentially to act like a spring. This is awfully similar to what you are trying to do whilst running. Integrate controlled and progressive plyometric exercises into your rehab as guided by your physiotherapist. If all goes according to plan, you may be surprised just how quickly you can integrate some lower level plyometrics intro your program. Plyometrics are one of our best exercise modalities to truly prepare your body for running, whilst improving your athletic performance and decreasing your re-injury risk.
Step 8: Be Patient! It’s Not a Race and Everybody’s Journey will be Different
Patience is the cornerstone of a successful return to running. Understand that everyone’s journey is unique, and progress may vary. Embrace the gradual nature of rehabilitation, and resist the urge to rush the process. Listen to your body, celebrate small victories and acknowledge that each step forward, no matter how small, is a testament to your dedication and resilience.
By seamlessly incorporating these additional steps in your recovery plan, you’ll enhance the thoroughness of your approach and set the stage for a more confident and sustainable return to running. Remember, this process is much about the journey as it is about the destination.
Todd Grbac
Physiotherapist