Running after an ACL Reconstruction is a major milestone in the physical therapy and the strength and conditioning worlds.  It is a point in the athlete’s rehab that they have worked hard for. They are not completely 100% ready to return to sport, but it is a great feeling from a strength and conditioning coach and physical therapist’s view point as well as the athlete for when they can start running again.

In Part I, I went into detail about the different tests that I would administer to an athlete when they are approaching that point in their rehab to start running.  Part I can be found HERE .

In Part II, I want to touch on some of the important, but less commonly discussed areas that also need to be addressed when someone is considering to run after an ACL Reconstruction.

Swelling

First and foremost, when someone is about the start running, I don’t want them to have any swelling.  If something is swollen, the entire knee or part of it, starting to introduce an activity like running is most likely only going to intensify that swelling.

Swelling is a very blanket term and can be due to a multitude of reasons ranging from program design to structural changes in the knee to limited ROM to being immediately postop, etc.

If someone is swollen before they start running, I’d like to see that resolve prior to starting a return to running program.

Full Range of Motion/Mobility

Another important area that needs to be addressed prior to running is full range of motion/mobility.  I like to see the athlete be able to have full knee extension, more like hyperextension.

and full flexion when lying on their back as well as when they are on their stomach.

Lying on their stomach takes into account quadriceps mobility and does the athlete have sufficient quadriceps and patellar mobility.  If they cannot achieve full knee flexion in prone, typically the quadriceps is a limiting factor, but extra-articular tightness around the knee itself can occasionally contribute to this.

I place an emphasis on having full knee flexion in prone because if the athlete can’t achieve full knee flexion due to limited mobility in the quadriceps, etc., then when they start running, their body is going to delegate that stress to the knee or somewhere due to them compensating vs throughout the entire body.

I also like to see full hip extension as well as ankle dorsiflexion to be able to handle the demands of running.

To check for full hip extension, I like to use the Thomas Test.

Thomas Test

Key Points:

-Thigh parallel to the table

-Knee relaxed and flexes to 90 degrees.

-Thigh in line with the hip; not flaring out to the side.

Knee to Wall Test

Key Points:

-Foot 4 inches away from wall.

-Foot straight ahead, no flaring out.

-Keep heel flat on the ground.

Introduction to Plyos/Controlled Landings

One area that isn’t usually discussed prior to running are plyometrics and/or controlled landings.  Over the years, plyometrics have been used after running, but after doing more extensive research and education, basically running is many little single leg hops one after another for a period of time.

Running may not be as intensive as a high-level plyometric program, but more or less, it does have a plyometric component to it.

I’ve started having my athletes have some exposure to an introduction to plyometrics and controlled landings prior to running so that they and their knee and body are accustomed to producing force as well as absorbing force.

Some drills that I like to incorporate into an ACL rehab are:

Drop Squat Variations

Line Hop Variations

The drills mentioned above are great options to incorporate so an athlete can become accustomed to the loading associated with running.

When considering returning to running after an ACL reconstruction, make sure to check out Part I and also make sure there is no swelling, full range of motion/mobility, and the athlete has been doing some form of low level plyometrics.