ACL Checklist for a Safe Return to Running

Injuring your ACL can be a devastating and frustrating moment in time. Whether you recover non-surgically or follow through with a surgical reconstruction, there is a general consensus of at least 9 months of rehabilitation prior to returning to sport.

You can expect the first few weeks after the injury or surgery to move along quite slowly, but before you know it, you’ll feel like you can take on more load again. One very common question we get asked is “when can I run again?”

The Short Answer: There is no one clear-cut answer.

Even though the ACL is one of the main stabilisers of the knee joint, there are other important structures that we need to consider. Depending on your mechanism and severity of injury, damage to other structures such as the meniscus, ligaments or cartilage may add on time to your recovery.

The Long Answer: Returning to running after an ACL injury or surgery shouldn’t be based on time alone, rather, it needs to be driven by evidence-based criteria for a safe return.

Don’t get me wrong, time is an important factor in healing and allowing the knee joint to settle. At a cellular level, ACL graft healing is significant in the first 12 weeks post-surgery (this is also the time when it is at it’s most vulnerable).

See our ACL Early Phase Rehab Goals.

Another consideration is bony bruising and healing of drilled bone tunnels (as part of the reconstruction) also occurs over the first 8-12 weeks. Any excessive loading during this period may cause more delay and impair healing. It’s important to continue with a graded loaded strengthening program leading up to reaching your running milestone.

ACL Checklist Before Returning to Running

Waiting at least 12 weeks post-surgery or injury is a non-negotiable!

We also look out for the following:

• Minimal to no swelling in the knee joint

• Full knee extension (straightening)

• Quadriceps and hamstring strength should be at 70% compared with the uninjured side

• Your mental readiness and confidence to return to higher loading activities

There are numerous knee tests out there, but we have gathered all the up-to-date evidence to show you the 6 most important functional tests to pass for a safe return to running. See our video:

• Single leg sit-to-stand from a standard chair – 10 quality repetitions

• Single leg squat from a small step – 5 quality repetitions

• Single leg hamstring chair bridge – 20 repetitions

• Single leg calf raise – 20 repetitions

• Single leg balance 30 seconds

• Side plank hold 30 seconds

Meeting the above requirements gives you the best chance to return to running safely and to facilitate a smooth recovery after ACL injury. If you are unsure of how to progress and need further clarification, our physiotherapists are highly experienced in managing ACL and knee injuries to give you confidence in your recovery.

Are you stuck with your ACL recovery and not living in Perth, Australia? Don’t worry, we can still help with an online consultation via our Telehealth service. Rob O’Mahony and Alina Tran are very experienced in ACL management including second opinions. Click the button below.

References:

Hughes, M. (2018, July 25). Return to Running Following ACL Reconstruction [Video]. YouTube. https://www.youtube.com/watch?v=MnBVw3in8B4

Kyritsis, P., Bahr, R., Landreau, P., Miladi, R., & Witvrouw, E. (2016). Likelihood of ACL Graft rupture: Not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. British Journal of Sports Medicine, 50(15)

Randall Cooper and Mick Hughes (2020). Melbourne ACL Rehabilitation Guide 2.0 [PDF]