Running after ACL reconstruction

If you work in a sports medicine environment like I do, then chances are you are getting quite a bit of ACL reconstructions this time of year.  With ski season in full swing, unfortunately, many end up with ACL tears.  However, a good majority of these patients are recreational skiers that like to dabble in many other sports.  

I recently had a few patients who asked about return to running following this surgery.  This is always a time when I like to educate the patients on what I want to see from them to get them back to running.  By establishing some criteria early on, it allows the patient to get in the mind-frame of what they need to accomplish as well as setting some goals.  However, there are many different opinions to what should be established for return to running post ACL.  

From my perspective, besides time frame and MD clearance, I like to see a few biomechanical considerations.  For example, I like to have a patient single leg squat a minimum of 10-15x under control with good form.  What do I consider good form? Well, I often use the single leg stepdown criteria that has been established in some of the literature.  Another thing I will look at is core stability.  Specifically, I typically like to use a front plank with reciprocal arm drivers.  The idea being that this test will look at rotational control when a patient is mimicking the arm swing during running.  Again, a general time frame I use is at least one minute.  Lastly, I like the reverse lunge for looking at great toe extension and hip extension.  

Remember that running is a full body exercise and it requires lots of moving parts.  While the above is not completely comprehensive, it gives a good starting point to look at with running.  Lastly, if you like this article, check out the post I made for New Grad Physical Therapy on some of the above criteria and more with pictures.  Or check out our Insider Access page where I go into very detailed return to sport criteria and exercises for multiple different sports and movements, such as return to lateral agility.  

- Dr. Brian Schwabe, PT, DPT, SCS, COMT, CSCS 

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