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- When To Run?
Being able to run again is a huge milestone after ACL reconstruction surgery and one many athletes eagerly look forward to. It is the first step for them to really start to feel like an athlete again.
In my opinion however, based on the athletes I have worked with, I think many athletes get pushed into running before they are ready. Many ACL protocols rely on a purely time-based criteria that calls for reintroduction of running as early as 12-weeks post surgery (1). Of those that do also use objective criteria for return to running getting the involved leg to within 70% of the non-involved leg in terms of strength and hop tests is seen as satisfactory to begin running (1).
This early in the process however, we are not going to get a lot of out of observing their gait pattern in my opinion. With that big of a deficit in strength we typically see significant alterations in gait mechanics as that leg is simply not strong enough to support the body's full weight in a plyometric fashion. As a result what you often see is a much shorter ground contact on the injured leg and much longer on the non-injured leg as the body looks like it is 'in a hurry' to get off that side and won't spend as much time or put as much weight into that leg.
This was particularly true for an athlete like Caleb who, at 12-weeks post ACL & Meniscus surgery (having a meniscus repair also slows things down in the early stages but doesn't effect total length of recovery) couldn't get past 90-degrees of knee flexion. Obviously he was in no state to run at this point and even when we started working together at 4 months he still was greatly struggling with range of motion.
Even at month 6 when we had him jogging he didn't look awesome, not super smooth or comfortable, but by continuing to prioritize strength in key movements like the step up he was able to win a state championship at the end of month 8.
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I highlight this case to show that it's ok to wait longer to introduce running and other plyometrics and that by prioritizing qualities like strength, range of motion, and structural balance running and movement quality will improve as a byproduct.
Now it's unlikely that if your PT has you running this early you're going to get injured, but it's probably not going to feel great and you're just not going to get that much out of it. You only have a limited amount of time in each session and I want to maximize every minute of that with something that is going to get you better.
What I have seen in my experience is that getting stronger improves running but running does not improve necessarily improve strength.
Therefore, especially in these early stages, let's work towards getting as strong as possible, reducing that strength deficit as quickly as possible, and your running will get significantly better as a result.
The various step up exercises we use are one of the key indicators for me and my athletes of their readiness to introduce running. Due to the similar joint angles we see in the step up exercise and jogging and running we see a very good correlation to increase in strength in the step up exercise and comfort and symmetry when running.
25 reps of a Poliquin Step Up (where the heel is elevated) on a 4 - 6" box with perfect form and control is a great metric to indicate an athletes readiness for running.
Progressing to Petersen Step ups (with a floating heel) is a great progression to then incorporate the foot and ankle and is one of the best indicators of how smooth an athlete will look when running.
The other unique thing we will do to enhance an athlete's running ability when coming back from an ACL or other serious knee injury is incorporate backwards jogging and sprinting as well.
Backwards running, compared to forwards running, has lower ground reaction forces but greater 'isokinetic muscular torque production' and, researchers have concluded that: "Backwards running may be clinically useful for reducing stress to injured joints and for increasing knee extensor strength" (2).
Basically it's less impact on the knee and better at building strength in the muscle.
I use a lot of backwards running with my athletes (and at a higher volume) to provide both a training stimulus and gauge how much we want to push intensity with our jogging and sprinting based on how comfortable they feel going backwards.
A daily backwards walk (outside, barefoot, in the grass) is a simple prescription I recommend everyone I work with add into their daily routine because of how simple and effective it can be at improving strength, function, and just subjective well-being of the knee. It's easy to skip over because of how basic it seems, but done consistently it can really be a great addition to your recovery.
These are all ways we are able to get our athletes running faster with more confidence and power: by not forcing it before they are ready. By building a base of strength in key muscle groups we are able to improve their confidence and mechanics when we do start to introduce more dynamic movements.
If you have more questions about this process feel free to reach out on Instagram @ZakWoodwardATP
If you are looking for guidance with your own recovery following and ACL or other serious knee injury check out my training application:
That's all for this week! See you in next week's article, bye! ✌🏼 .
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