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Return to Running after ACLR: Expectations vs. Reality

acl atlanta brookhaven decatur dr. mike physical therapy recovery running surgery Mar 07, 2024

POV: you’re several months out of surgery, passed all of your performance tests and you’re now cleared to start running! One can imagine the excitement and maybe fear that may accompany this milestone. At this point, there has likely been a 4-6 month gap in time since you last ran. If you have been there, you know the feeling. Then reality hits and you may think “This doesn't feel quite the same as it did before.” 


Well, you certainly aren’t alone. Look at this as level 1 of the new phase of rehab. Let’s consider the good and less good aspects of level 1. 


Good: Your leg has gotten A LOT stronger since surgery, functional mechanics have improved tremendously, plyometric exercises aren’t causing issues, and the most important thing is that you are taking a huge step in the direction of your former athletic self. 


Less Good: Although your strength has improved significantly, your brain has likely forgotten how to use the strength the way that it used to. Again, at this time strength is good but could be better. Because of this, you will likely feel like you aren’t able to produce and absorb loads as well with the ACL leg, which can lead to the feeling of altered running mechanics - maybe this leg feels heavier than the other. Overall muscular capacity is at a deficit and your muscles have less endurance, limiting how much load or what type of loading they can handle right now. 

Great - now what? 


All of these feelings are normal, but most importantly, to continue improving on these things you must progress your overall workload with the proper dosage. Just like any aspect of fitness, strength/power/endurance/stability gains come about with consistent work. You will realize the fruits of your efforts and patience. A lot of times when working with ACL athletes during their rehab I hear things like, “I’m just so out of shape”, “I’m so slow, I never used to be slow”, or “I just feel off, it’s like I’m favoring my other leg.” These statements hold merit - but it’s expected. There are a myriad of secondary factors that play a role in these sensations after reconstructive surgery. 


I think this is a good place to discuss ACL graft healing. The reconstructed graft is at its strongest just after surgery and over the next couple of months, graft strength decreases due to the process of ligamentization. Around months 3-6 post-op, the graft is at its weakest and then will undergo a maturation process that continues for 1-2 years. While this may sound a bit scary, it’s a completely normal part of healing and it’s safe to run during this time. I would like to point out that the return to running process shouldn’t be rushed, no matter how eager you are to see what you can do. Remember that time is your best friend! Remain patient, celebrate every small victory, and take on each day with a 1% better mindset. Your comeback story is being written. 


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