Returning to Running After an ACL Injury: What You Need to Know
- Nailsea Physio
- 4 days ago
- 3 min read
Returning to running after an ACL injury is a big milestone. It’s something many people with an ACL injury look forward to during their recovery, but it’s also a step that requires careful consideration. This article breaks down why running can be challenging after an ACL injury, how people are often cleared to start running, and what the latest research suggests for a safe return to running post-surgery.
Why Is Running Hard After ACL Injury?
When people with an ACL injury begin their recovery, they often get advice that they’ll be able to start running around 3-4 months post-surgery. Many trust that once this time comes, they’ll be ready to go, as their physiotherapist may not have clearly explained the specific criteria for safely returning to running. But unfortunately, research shows that simply waiting for a certain amount of time isn’t enough.
A major review of 201 studies found that only 1 in 5 rehabilitation programs used more than just time from surgery to assess whether someone was ready to run. In fact, a study on return-to-sport clearance showed that 42% of the time, the only factor considered was time, not whether the person was truly ready.
This is concerning because research also shows that nearly half of physical therapists don't measure key things like quadriceps (quad) strength at all. Of those who do, many use methods that aren’t very accurate.
What Does Research Say About the Best Way to Return to Running?
The key to a successful return to running after ACL surgery is quadriceps strength. A 2021 study found that a specific level of quad strength (1.45 Nm/kg of body weight) is an important predictor of success when starting a running program.
Another study discovered that when someone’s quad strength is less than 80% of the strength on their healthy side, the forces across the knee joint are much higher than normal. This can lead to pain, swelling, and long-term damage if not addressed. However, when strength is more balanced (80% or better), the knee forces are more similar to those of healthy individuals.
Additional Key Criteria for a Safe Return to Running
In addition to quad strength, other important factors to consider before starting a running program include:
Minimal or no swelling (effusion): Ideally, there should be only trace or no swelling in the knee.
Full range of motion: You should be able to fully straighten your knee (hyperextension) and match the mobility of your other leg.
A stable, “quiet” knee: This means the knee can handle your daily activities and exercises without pain or discomfort.
When Should You Start Running After ACL Surgery?
While many rehabilitation programs suggest starting running at 3-4 months after surgery, this should be considered the earliest possible time frame. Most people with ACL injuries need more time to reach the criteria listed above. Those who meet the necessary strength and mobility goals, particularly those who have had a hamstring graft or did prehab before surgery, may be able to return to running earlier. However, starting too soon can be risky and potentially delay recovery.
It's important to note that starting a running program before meeting these criteria doesn’t speed up recovery and can lead to setbacks, including long-term joint problems like osteoarthritis.
In Conclusion
A successful return to running after ACL surgery requires more than just waiting a set number of months. Strength, mobility, and knee stability all play a key role in ensuring that you can run safely without risking further injury. If you’re uncertain whether you’re ready to start running, it’s a good idea to discuss these criteria with your physiotherapist to make sure you’re on the right track
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