So, you’ve recently suffered an ACL tear and have undergone ACL surgery, and are wondering when you can start running again so you can eventually get back to the things you love, whether that’s running for fun or competitively, or playing and competing in a particular sport.
This is one of the most common questions that we hear from our patients who work with us after ACL surgery, along with “when can I start practicing and playing my sport again?”
Unfortunately, the answer probably isn’t as straightforward and easy as you were hoping for.
Recovery after an ACL tear and ACL surgery is an incredibly multi-faceted process, that takes MANY things into account, such as:
- Time since the surgery
- Strength of the ACL graft and donor site (depending upon the type of ACL repair)
- Flexibility of the hip, knee, and ankle
- Strength of the hip, knee, and ankle musculature
- Ability to produce and control force at high speeds
- Ability to control the leg in different planes of motion
- And many other factors
While many medical and rehab professionals would be quick to say that you can return to running at the 12 week/3 month mark, it’s not as simple as that.
In order to return to running after an ACL surgery in a safe and effective manner, you need to hit certain benchmarks. These benchmarks are a mix of time-based and performance-based benchmarks, and JUST relying on time as your guide to start running again may set you up for a longer recovery, worse outcomes, or a possible second ACL tear.
With that being said, below is a list of benchmarks that you need to be able to hit before you try to start running after your ACL surgery!
1. 12 Weeks Post-Op
The amount of time that has passed since your actual ACL surgery will definitely play a role in your ability to return to different activities. Like any other tissue, when you have a surgery and place an ACL graft, that graft has to mature and increase its strength and ability to withstand different types of forces, and this takes time. Most research shows that at the 12 week mark the ACL graft is healed well enough to withstand the forces of running, so this is usually a good time to being the return to running process. However, it’s important to note that this time-based benchmark is only one of several important benchmarks to hit before trying to run again.
2. Range of Motion
Range of motion, or the flexibility of the knee joint, is the first performance-based benchmark we look to hit with our clients before beginning to run again. Ensuring that you have full knee flexion (bending) and extension (straightening) range of motion prior to running will allow you to run with proper mechanics, which will help the ACL graft better tolerate the forces of running.
Strength measurements are one of the most important benchmarks to hit after ACL surgery, as the force that your muscles can both tolerate and produce will play a huge role in running mechanics, ability to jump, decelerate, and change direction, and lifting mechanics. When trying to return to running, you want to have at least 70% of the quadriceps and hamstrings strength on the surgical-side as compared to the non-surgical side.
The issue is that in most sports physical therapy clinics, the physical therapists are “measuring” strength by having their patients kick and pull into their hands. This is an incredibly inaccurate way to measure strength, and can place patients at risk of returning to higher level activity when they’re not ready for it, and suffering a second injury as a result.
At our sports physical therapy clinic, we want to take all of the guesswork out of the equation, and use tools called hand-held dynamometers and isometric dynamometers to very accurately measure quadriceps and hamstrings strength. This allows us to know exactly how strong our patients’ legs are, which lets us make much better return-to-running and return-to-sport decisions.
4. Single Leg Squat Test
The single leg squat text is the next performance-based benchmark that we aim to hit before having patients return to running after ACL surgery, and is a test of both single leg strength and stability. The goal is to be able to perform 10 reps of a single leg squat to approximately 90 degrees of knee flexion without any significant side-to-side movement of the knee.
5. Y Balance Test
The Y balance test is a test of multi-directional single limb stability in which you stand in one spot and push a marker as far as you can in three different directions. You then add up the total distance that the marker is pushed in the different directions, and compare it to the non-surgical side. Before returning to running, you want to see the surgical limb be able to achieve 90% of the total distance of the non-surgical limb.
6. Hop Testing
Hop testing is a category of tests that most commonly has three single tests within it. These tests are the single hop test, the triple hop test, and the crossover triple hop test.
In the single hop test, you simply stand on one leg and jump forward as far as possible, landing on the same leg. In the triple hop test, you perform three forwards jumps as far as you can, all on the same leg. In the crossover triple hop test, you perform the same actions as the triple hop test, but you cross a line from side-to-side with each hop.
When performing these tests, you want the surgical limb to hop at least 90% as far as the non-surgical limb.
The tricky part with these tests is that people can have SIGNIFICANT limitations in quad strength, and still be able to hop well, so it’s so important to directly test quad strength, as mentioned before.
If you meet all of these benchmarks, then it is most likely safe to being running again!
If you want to take the guesswork out of your ACL rehab and ensure that you get back to the highest level of performance and function possible, click the button below to talk to one of our expert staff members to see if we can help you!