"Can I start running again 12 weeks after surgery?" Ah... returning to run after ACL surgery. A HOT topic. Whether you are trying to get back to soccer, basketball, or skiing, running is a MAJOR milestone in the journey to full recovery and returning to sport. In this 3 part series, we'll outline how WE at Made 2 Move approach returning to run!
The Made 2 Move Return to Running Approach
We aren’t the PTs who are going to tell you that you can never run again. BUT, we are going to give you realistic benchmarks, tests, and measures that you MUST meet before you start running again.
We have to make sure that your knee is fully prepared for the demands of running BEFORE we actually start running.
If you start running before you're ready, you're going to run (🤪) into some road blocks and may prolong your rehab process overall.
With all of our athletes, we look at a combination of measures before we start introducing running/jogging intervals.
⏰ We start working on preparing for running demands WEEKS in advance. What does this preparation entail?
The 4 key Benchmarks
First step in returning to run after ACL surgery? Our Made 2 Move therapists are going to make sure you have a solid baseline. This solid baseline includes checking off 4 key boxes before we start programming run/walk intervals into an athlete’s program. Buckle up as we dive into these 4 key benchmarks an athlete must meet before they return to running with their Made 2 Move therapist!
1. At least 12 weeks post op (healing times)
Now hold on- JUST because you're 12 weeks out doesn’t mean you’re ready. The time-based approach in ACL rehab is not a good enough indicator that you’re set to run because of how varied every individual’s ACL recovery is. What one athlete’s walking looks like at 12 weeks may look wildly different from another athlete. This is where we have to remind athletes to not compare themselves to where their friend, that professional athlete, or the internet told them they “should” be at the 12 week mark in their rehab.
A recent review by Rambaud et al. in 2018 aimed to assess current criteria in the literature that clinicians utilize when deciding if an athlete is ready to return to running. 201 studies were reviewed and 99% of these studies used time as a variable to RTR (ie: you’re 12 weeks out so you can run now) while only 18% of these studies utilized additional parameters (let’s look at your knee strength, gait, mobility, psychological readiness, rate of force development, etc).
This is simply not enough- is this the reason re-tear rates are so high? A fault of the rehab rather than the graft, sport, or individual?
Where did this 12 week time point as a “go ahead’ for running after ACL reconstruction come from? This was likely included in one surgeon’s protocol somewhere and based off of traditional healing times for bones and ligaments. In a recent commentary, researchers noted, “In terms of graft healing and maturation, the often cited reason for determining this time frame [12 weeks], this is an irrelevant date” (Buckthorpe et al. 2020).
Researchers went on to clarify a better way to base our return to sport rehab off of: function (rather than time), as they outline, “The ability though, to perform specific tasks like running is not related to healing times, but more specifically to functional return” (Buckthorpe et al. 2020).
2. Aren't experiencing swelling (aka their knee isn't being overloaded)
This one is pretty self-explanatory. There’s no sense in loading (yes, running IS loading) an already overloaded (as seen by the swelling) knee.
3. Demonstrating FULL KNEE range of motion (ROM)
Full knee ROM means that you are able to fully flex (bend) and fully extend (straighten) your knee. Gaining full extension is usually the more stubborn range after ACL surgery, so your Made 2 Move PT will work with you to ensure mobility through that joint is up to par before we start running on it. Researchers note, “normal or optimal gait biomechanics cannot occur without normal or optimal joint motion [knee flexion and extension] and so the restoration of joint range of motion is essential to target the restoration of optimal gait” (Buckthorpe et al. 2020).
More simply stated, to run (or even walk) normally, your joints HAVE to be able to move through adequate ranges of motion (knee flexion and extension in this scenario). If mobility is lacking in the knee, and you try to rush back to running, then joints up or down the chain will begin to compensate, leading to abnormal mechanics, which athletes have to unlearn throughout the rehab process. Being patient in waiting to return to running is tough, but unlearning movement patterns is even tougher.
4. Walking normally
A thorough gait analysis by a PT to assess your walking is a MUST before initiating running in your ACL rehab. If you aren’t walking normally, you can guarantee you won’t be running normally.
Walking may be challenging as the quads learn how to dial back up their activation after surgery in order to fully extend and bear weight through the knee below. If you are still walking abnormally, it means something in that leg isn’t fully doing its job and your Made 2 Move PT can work with you to figure out what it is that just “isn’t quite right,” and causing your walking to be off.
So what does this mean for me?
ACL reconstruction is more than just the operation your surgeon did at your knee. There is a neurophysiological (how your brain is communicating with your knee and the messages your knee sends back to your brain) component as well. One way to address this neurophysioloical aspect of ACL surgery is by attacking rehab with a developmental and step by step approach. Humans learn to flex/extend their knee before they learn to walk and before they learn to run, and this should be how your ACL rehab is structured as well.
It’s time to ditch the time based approach to ACL rehab and focus more on a function based approach. Every ACL rehab is going to be varied and must be individualized based off the athlete’s FUNCTION and quality of movement rather than TIME and quantity of days it has been since their surgery.
Sometimes we have to do the not so glamorous work- gaining full ROM, getting swelling down, and walking normally, before we get back to more sport-specific tasks. But we promise, it will be worth it. The “not so glamorous” will increase your preparedness and decrease your retear rate when it comes time to get back on the field or court.
✅ICYMI: Instagram post for Returning to Run after ACL Tear: Part 1
✅ Stay tuned for parts 2 and 3 of this series!