Hello and in this article what we're going to be talking about is the importance of returning to running as a key milestone in the ACL rehab process.

So to begin with what I'm going to look at is some key criteria that you need to hit if you're trying to return to running after ACL surgery, what some of the goals are and how to get to create a kind of clear progression plan to get you to that point.

So the importance of doing rehab properly can't really be understated. And there are a couple of key things here. The first is not just simply using time as a marker for return to running such as at 12 weeks, start running.

Because it might be that you individually don't have full capacity yet in the muscle groups associated with running like the calf, hamstring, glutes, that type of thing.

Or it could just be simply that you're not physically ready or mentally ready for that return to running just yet.

We don't want to rush the process. We want to make sure we're using clear criteria so that you know exactly when you're ready based on objective numbers, not just purely on a time-based criteria essentially.

So, the main goals of this article are going to be to give you a summary around the importance of proper rehab.

Progression plan, some of the key techniques you need to incorporate into return to running and how you can essentially monitor progress across this time frame.

Now, typically in a return to running phase from post-surgery to running, looking at anywhere between sort of 12 to 16 weeks usually in a return to run phase, but it's important that you have alongside that criteria and targets to hit so you've got clear milestones along the journey.

So, a couple of key ones to try and target here. First is strength, maximal strength, because if you're you don't have the lower body strength to cope with the demands on the body from running, then you're not going to necessarily be prepared for the loads associated with it.

In running at high speeds, you can hit sometimes 3, 4, 5 times the body weight of force through your body and in top speed sprinting.

Some of the forces in the soleus hit sometimes 7 plus times body weight. So it's a lot of load through your lower body.

Therefore, if you're not strong enough, you simply are not ready to return to running just yet. Another key consideration there is making sure the type of running you're doing is not going back to trying to do high speeds, but obviously just building in lower intensity work in a linear fashion, then faster speeds, linear, then low speed, multidirectional and then high speed, multidirectional and finally sports specific return to play phase, which comes much later.

So making sure you've got a clear progression plan for how you're going to do that is also really key. Now you've got to make sure you're doing this whole rehab process properly, so ensuring that you're rebuilding strength, stability and confidence in the knee and making sure that you're also checking
in with your coach, with your physio, with your surgeon, just to make sure that everything you're doing is appropriate for the stage of the rehab that you're at.

In terms of progression plan, it's important you've got key criteria to hit. Now some of these will include calf capacity, hamstring capacity, glute capacity, single leg proprioception and balance.

Single leg strength scores, and then also technique in walking and basic running techniques as well. Because that's another key thing which we'll sort of touch on in just a second.

So what's important is you start with walking and lower intensity impact activities early on so that you're preparing the tissue.

Choose for higher intensity running later and gradually introducing running intervals with short duration initially at slow speed and then gradually building the duration of the work that you're working towards.

So it's usually better to start with low intensity, short duration activities. It could just be a 30 second low speed jog initially in a linear fashion and then you're going to begin to increase that speed across time in a logical sequence.

So you're going from walking, linear, to jogging, linear, low speed, short duration. To a short duration at a slightly higher speed and then you're going to increase the duration and so on.

So you're having a really gradual progression in that linear running, not just going from 0 to 100. It's also important to listen to your body though and if you, for example, are experiencing some pain or you are not quite ready for that return to running and you're getting increased swelling or perhaps
you're getting some signs that your body's just not quite ready, ease back and just be more conservative with that rehab process.

In terms of technique, it's important that you also addressing the running techniques associated with the task as well. It's all well and good starting to run, but are you, are you actually walking effectively to begin with?

Are you able to hit some important positions associated with running before you then go into some higher speed work? So, for example, good postures, are you able to hit good postures and running in just a basic walking pattern?

So, can you do like a walking A-march and hit those key running shapes with good postures and good hip control without a loss of power?
posture or control? Is your stride length and foot strike appropriate? So, are you making sure that you're able to run in a in an effective way without risking further injury?

And just ensuring that you're hitting really good biomechanical positions. In will ensure that your injury risk goes down because what you don't want to do is begin to ramp up the volume of work you're doing and you're running and risk further injury if the technique underlying all of this isn't
very effective.

So, that's a very important part of this as well. Some of the key things we can look to do here are basic running technique drills early on.

That's really underlined by walking drills. So, making sure you've got key kind of tasks you're doing early on with learning how to walk effectively, learning how to hit those running shapes at low speed, running technique drills, and then you can gradually increase the speed at which you're doing the
running drills later. So, things like A marches, A skips, postural holds, things like that are going to be really key just to make sure hitting those key shapes.

And that comes down to good mobility, comes down to good neuromuscular control. comes down to good postural control, and making sure you've got that in place before starting to ramp up that intensity or volume.

Now, it's also important that you're looking at, as you're increasing the volume, the way in which you're running isn't breaking down.
starting to increase the speed, your technique's not starting to break down because of that increased demand on the body. Now, if that is happening, it's probably a sign, again, you just need to slightly ease back, focus on the control, and then start to rebuild again.

So, for example, if your postural control starts to break down as the duration of the training increases, again, it's probably just a sign that your body just isn't quite ready for that increased volume just yet.

So, you can just ease back, focus on the key things that underpin that, such as proprioceptive control and postural control, and then start to increase again.

In terms of monitoring progress, the most important thing here is making sure that if you're risking re-injury by doing things that you're not quite ready for, that you're listening to your body and you're recognising signs that could lead to further injury down the line.

So, things like pain, swelling, maybe some instability. Those are all signs that your body's not quite ready for what it is you're asking it to do.

So, you can possibly just be a little bit more conservative and then begin to build up again. Again, if any of those things happen, just make sure you are seeking out medical advice, speaking to your physio, speaking to your surgeon.

If you are experiencing pain, experiencing things like that in the early stages. Some of the common signs of over-exertion, again it could be pain, it could be pain in the knee itself, there might be some increased swelling if you're asking the body to do something it's not quite ready for and a little
bit of pain, a little bit of swelling at times.

It is unfortunately a natural process in an ACL rehab but it's just making sure that it's managed effectively and you're not kind of doing things too soon.

Lastly then it's the mental preparation component of this and ensuring that you're psychologically ready for a return to ACL rehab.

Return to running post ACL surgery and some of the key things here is about managing the anxiety that might come with returning to running and rehab and really just giving you that support around how you can do this in a safe and effective way.

Sometimes there's a missing piece really of the might be physically ready for these things but are we mentally ready to go back into the kind of speeds and the shapes and the positions that we're being asked to do uhm on the pitch that actually caused the injury in the first place.

So just making sure we're also mentally ready. And then by doing that what we allow our body to do is to be prepared for the demands on the body.

We're also preparing our mind for you know some of those check those key challenges and making sure we're really just in a very good position for a effective return to sport.

So in summary those points. So the first is making sure that you're doing things properly, you've got a proper rehab plan, you've got a clear progression plan in place, you've got good technique underlying what you're doing, you're monitoring your progress and the potential warning signs that come with
an increase in load and volume and you're also addressing that mental component, so you've got the psychological readiness to return to the activities that possibly caused the injury in the first place if it was a pivoting running based injury which can be quite common in ACL.

Finally then just in terms of what you would be looking to do before running. I've mentioned some of them already but you probably want to make sure you've got a single leg strength marker such as like a single leg press, single leg knee extension um as a key strength marker really on.

You want to make sure that you've got some kind of capacity markers in place so things like Come. of capacity single leg um squat under body weight load, single leg bridges, side plank uhh duration tests and then also some balance and proprioception scores too so things like a star excursion test, things
like hot based movements, things like um single leg balance. And also things like perturbation based balance movements as well as things like having to turn your head side to side up and down whilst maintaining good control in the lower limb.

All of those things are going to give you good exposure to the more basic and rudimentary elements that make up effective ACL rehab before returning to running as well.

And then finally just on the walking front making sure that you're walking effectively so you're not limping for example so you might have you know good capacity scores but if you're walking is still affected that's probably a sign you're not ready to ink.

The intensity and start running just yet making sure that your technique in the running is really good so you're working through good running base rehab exercises as well and then finally when you are ready to return making sure that's done in a logical sequence you're not doing too much.

So I hope that's been useful just to give you a quick overview of some of the key considerations for return to running and some of those key markers you might be looking for before going back.

Next Steps:

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