Returning to running after an ACL tear is not an easy task. The ACL, or anterior cruciate ligament, is one of the primary stabilizers of the knee and prevents your lower leg from shifting forward while you run or cut. When the ligament is torn, knee instability results and activities like jogging or playing sports become much more challenging. Utilize the steps below to help you return to running after this type of injury, however it's important to understand the risk factors that this entails.
Early Rest and Range of Motion
Early on after an ACL tear, abstain from running in order to allow your knee time to recover. Typically knees are very swollen after a tear, so icing and elevation are important.
For the first 1 to 2 weeks, apply ice for 10 to 15 minutes out of each hour you're awake. In addition, regain the range of motion in your knee so you can eventually return to a normal gait pattern while running by doing heel slides.
How To: Sit on a bed with your knees straight and a towel wrapped around the ankle of your injured leg. Slowly slide your heel towards you as you gently pull on the towel. When you feel a gentle stretch, hold this position for 5 to 10 seconds. Then, slowly extend the knee until another stretch is felt. Maintain this position for another 5 to 10 seconds before resting. Repeat the exercise 10 times and complete it twice daily. Be sure not to force the knee into pain. The stretches should be mild to moderate in intensity.
Once your swelling has subsided and you're able to walk without limping, begin to strengthen the muscles of the leg. Muscles like the quadriceps and the hamstrings provide stability to the knee and help to prevent the painful shifting that can occur after tearing your ACL.
In particular, the hamstrings, a group of three muscles in the back of the thigh, play an influential role. These muscles mimic the action of the ACL by preventing the lower leg from translating forwards.
Strengthening these muscles can help to minimize feelings of instability in the leg when making athletic movements like jumping or running. Bridges are an effective way to target the hamstrings.
How To: Lie on your back with your feet on the ground and your knees bent at a 90-degree angle. Squeeze your abdominals and lift your buttocks off the ground. Hold it here for 10 seconds before lowering back down again. If this is too easy, progress the exercise by keeping your unaffected leg straight and lifting with just the injured side. Do three sets of 10 repetitions of the exercise each day.
In addition to strengthening, individuals looking to run after an ACL tear should consider a functional knee brace. These braces are designed to block the forward shifting or translation of the lower leg from occurring while you exercise. In addition, wearing a brace while you run may actually improve knee stability by changing your running mechanics.
A brace tends to give you greater hamstring activation when your foot strikes the ground. Because these muscles help limit excessive shifting in the lower leg, fewer painful translations may occur in the knee joint . Each of these benefits makes wearing a brace worthwhile when attempting to run.
Return to Running
Once your pain levels are minimal and you have recovered to your pre-injury range of motion and strength, you may be ready to attempt to run again. Do so cautiously.
Begin by jogging at a slow pace for 1 to 2 minutes before walking for the same amount of time. If you're able to do this without increased symptoms, repeat this same interval two to three more times that day. Go out a maximum of three times per week to allow your knee time to recover. Each week, slowly progress the running time by another minute or two as symptoms allow.
Even if you're able to return to running, it's not without risks. Because the ACL is one of the primary stabilizers in the knee, performing athletic movements subjects an injured knee to small amounts of shifting with each stride you take. Continuing to run after this type of tear puts you at a greater risk of developing osteoarthritis later on in life. In addition, because the knee is more unstable than before, structures like the meniscus are more prone to damage or tearing.
Warnings and Precautions
Following an ACL tear, it is a good idea to weigh the pros and cons of returning to running. Alternative versions of cardiovascular exercise, such as swimming, biking or using an elliptical may be preferable options. If you do attempt to run and pain or instability persist, it is best to speak to your doctor about whether formal therapy or surgical correction of the tear are necessary. Continuing to run through pain may lengthen your recovery timeline and is not recommended.