What is the anterior cruciate ligament (ACL)?
The anterior cruciate ligament is a structure in the knee whose main function is to provide stability, but it also provides information to the brain about where and in what position the knee is located.
The ACL can be injured directly, by a blow to the knee, or indirectly, due to sudden movements that generate excessive tension on the ligament and cause it to rupture.
Why is it not good to rely solely on time criteria when deciding to return to running after an ACL injury?
For a long time, the only criterion used to clear someone to run was three months post-surgery. Today, we know this is insufficient. Biological time is important (the new ligament needs to mature and the bone tissue needs to regenerate), but every body heals at a different rate.
Relying solely on the calendar can lead to starting to run with muscles and tissues that aren't yet ready. This can result in overuse injuries, tendinopathies, poor adaptation of the structures, or, in the worst-case scenario, an increased risk of re-injury. Biological timing is one factor to consider, but it should never be the only one.
What requirements must my knee meet before taking the first step in an ACL injury?
Although there is usually a minimum safety period of between 12 and 16 weeks (3-4 months), at Evolution Physiotherapy we assess whether you meet the following criteria:
- Full extension: Your knee should stretch exactly the same as your healthy leg.
- 95% of symmetry in bending: You need to be able to bend your knee almost completely.
- Zero pain and zero inflammation: The knee should not hurt during any activity nor remain swollen (joint effusion). Also, during plyometric training (jumping exercises) prior to running, we will monitor how the joint reacts to impacts.
- Symmetry of the 80% in strength: Objectively measured, your quadriceps, hamstrings, and glutes should all have at least 80% of the strength of the healthy leg. Remember: quadriceps strength is the factor most closely related to a safe return to running.
In our clinic we have dynamometry to perform accurate and objective measurements, and to be able to progress properly in the rehabilitation of an anterior cruciate ligament injury
- Pre-discharge tolerance: Being able to run in the water without any discomfort.
- Ability to jump and stop on one leg: At Evolution, we firmly believe that to run, and therefore jump, you must first know how to stop. Before taking your first running stride, you must have jumped in countless ways so that running then becomes second nature.
To verify all of this, we also carried out objective tests, the most commonly used being:
- Single leg squat: We evaluate how your hip, knee, and ankle behave when you squat on one leg.
- Depth Jump: We analyze your ability to brake with one leg.
- Unilateral jumps (vertical and lateral): We checked the power, responsiveness, and stability of the operated leg.
If you're interested in learning more about the criteria, feel free to look at the Aspetar guide.
What will my progress be like once I start running after my ACL injury? Can I run 5 km straight away?
Absolutely not. Continuous running creates repetitive stress that your knee must gradually learn to tolerate. Ideal progress follows these guidelines:
- Walking + Running (CA-CO Method): We will start by alternating minutes of walking with minutes of light jogging (for example: 1 minute of jogging for 2 minutes of walking).
- Logical progression: We will make very gradual increases as long as the knee responds well.
- The 24-hour test: The success of a running session is not only measured while you are running, but often you have to check if the knee swells or hurts in the following 24 hours.
Is it normal to feel discomfort when starting to run after an ACL injury? When should I worry?
Feeling some stiffness, tightness, or very mild discomfort at first is perfectly normal. Remember that your tissues are adapting to the repeated impact with the ground.
When should you worry? If the pain increases or persists for a long time, or even after a session the pain causes you to limp, you should stop and consult us so we can correct any minor deficiencies and adjust the workload.
What happens if I try to run too early in an ACL recovery?
The ACL graft goes through a biological process called ligamentization, In this process, the implanted tissue goes through a phase of weakness before becoming a strong ligament. If we introduce the repeated impact of running before the ligament is mature and without the necessary muscle strength to protect it, we risk:
- To stretch or give of the graftThis causes an increase in laxity in the knee and, therefore, a greater feeling of instability.
- Causing tendinopathies due to overuseThe impact will accumulate in tendons that are not yet ready. Furthermore, the area from which the graft is taken (patellar tendon, quadriceps tendon, semitendinosus tendon, etc.) plays a significant role, as that "donor" area will require more specific rehabilitation.
- Drastically increase the risk of another ACL ruptureA weak knee and an immature ligament create the ideal scenario for a relapse.
It's true that some patients might be ready to run a little before three months. However, in anterior cruciate ligament rehabilitation, going slower is usually synonymous with going safer.
Anterior Cruciate Ligament Rehabilitation in Alcalá de Henares.
Have you had anterior cruciate ligament surgery and don't know when or how to safely return to running? Evolution Physiotherapy, In Alcalá de Henares, we have a team specializing in ACL rehabilitation and readaptation to running.
Don't leave your return to sport to the whims of the calendar. We design individualized programs to get you back on the field safely. If you're ready to take the next step, don't hesitate to contact us. Book your appointment.
