At The Injury Clinic Physiotherapy, our Geelong physiotherapists regularly see clients before and after undergoing a variety of different knee surgeries. We find a common theme between all different kinds of knee surgeries and the rehab involved is the importance of returning back to running in a safe and effective manner. Doing so allows the client’s knee to gradually return to a high impact activity that is an essential aspect of most sports and exercise types, as well as giving them their first real step to feeling back to normal and back to what they enjoy doing. This month’s blog will focus on when we typically are able to return to running after a knee operation, what are the steps we need to tick off before we begin, and what’s the best way to structure a return to running plan.
In this blog, we will be focusing on the recovery from three separate knee surgeries: ACL (anterior cruciate ligament) reconstruction, meniscus repair or a menisectomy.
ACL reconstruction:
An ACL reconstruction may be performed after someone has suffered a ruptured ACL, and uses a graft (typically from the patient’s hamstring or quad tendons) to reconstruct the ACL. The typical recovery time back to sport for this kind of surgery is 12 months or more, and requires diligent rehabilitation to improve the knee’s stability and strength post surgery.
Meniscus Repair:
A meniscus repair is a surgery to stitch back together a tear in the meniscus, which are two pieces of thick cartilage in the knee joint that helps with shock absorption. This surgery requires at least a 6 month recovery time, due to needing sufficient time for the meniscus to heal post surgery.
Meniscectomy:
In contrast, a meniscectomy is a surgery where a part of the meniscus is cut out of the knee joint rather than repaired, after it has been torn away from the rest of the healthy meniscus. This surgery is a much quicker recovery but can lead to poor joint health in the long term.
Return to Run Guidelines:
After any knee surgery, there are some general guidelines we need to follow before the patient is able to return back to running. All of the guidelines below are just based on returning to light walk:runs, and are not the basis for returning to someone’s full running load or back to their sport. The general guidelines for returning to running are:
- Pain free walking and activities of daily living ie. getting up from a chair, bending down
- Able to walk for 30 minutes without an exacerbation of pain
- Can complete 10 x single leg hops and squats without pain
- Full knee range of motion
- 70% lower body strength of surgical side compared to non-affected leg
- All contributing factors assessed by a physiotherapist i.e. biomechanics, nutrition, footwear and psychological readiness
There are also surgery specific guidelines for returning to running. These are important to be aware of as the rehabilitation for each surgery will be approached differently, and they will include running at different timeframes. The surgery specific guidelines for return to running are:
ACL Reconstruction:
- Timeframe: 12-16 weeks
- Clearance from surgeon required
- Functional and clinical stability
Meniscus Repair:
- Timeframe: 12-16 weeks
- Clearance from surgeon required
Meniscectomy:
- Timeframe: 4-8 weeks
- No clearance from surgeon required
How to Start?
Once a patient has passed all of the guidelines required to be cleared to return to running, it can be difficult to know where to start. How we begin a return to running program is best done guided by a physiotherapist, and must be based on the individual themselves: on their previous running history, their own specific injury history and surgery, how their rehab is progressing and their future goals.
For all patients post knee surgery, we recommend beginning with a walk:run program, where each session is broken up into periods of running at low intensity and periods of walking. This allows the body to gradually be exposed to and adapt back to running without causing overload to the tissues that may still be healing and also other possibly deconditioned areas.
An example session of a walk:run program may look like:
- 5 minute walk warm up
- 4 sets of 3 min jog (RPE 3), 2 min walk
- 5 minute walk cool down
A walk:run program should be progressed through over a minimum of 3-4 weeks, with at least 1 rest day in between runs and all runs being down at a low intensity. We may expect some soreness during and after these runs, but the time spent running should not be progressed until the session is pain free. After progressing from 1 min run efforts to 6 min run efforts over the 3-4 weeks, the next progression will be to a continuous 20min run. After this, the patient can begin progressing slowly back to their regular run volume.
Running Considerations
Once through a walk:run program, the next steps will be defined on how the patient is managing their new run volume and their goals going forward. Below are the factors that need to be considered when progressing running loads after knee surgery:
- Intensity
- All runs initially should be completed at an “easy pace”. This should refer to a rate of perceived exertion (RPE) of 3, or an intensity at which you can maintain a conversation.
- Runs at a higher intensity, interval sessions or other types of quicker running should not be added until the patient is back to 50-60% of their regular running volume and managing this well. After this, their overall volume should stay stagnant while they progressively increase their intensity minutes per week.
- Running surface
- All runs should be completed on a flat surface initially, and any incline/ decline should be added as its own variable down the line while all other variables (volume, intensity etc.) stay stable.
- Keep terrain consistent initially whether this is road, grass, concrete or track. No sand running should be done during the rehab stages.
- Strength considerations
- As part of the rehab program, running specific strength exercises should be added at least 4-6 weeks prior to the beginning of a running program. Plyometrics and running drills should be added at a similar time.
- Use running drills as part of a warm up prior to a run
In Summary:
- Returning to running after an ACL reconstruction, meniscus repair or meniscectomy, requires: strength at a minimum of 70% of the non-surgical knee, full range of motion with no pain with walking or other daily activities, as well as other specific prerequisites for each surgery.
- All running programs should begin as a walk:run program, which can be progressed through over 3-4 weeks, with all other factors in a running program addressed.
- Intensity and/ or hill running should not be added to a return to run program until they have progressed back to at least 50-60% of their pre-surgery run volume.
- Returning to running after a knee surgery may feel daunting or even risky, but when completed in a structured and evidence-based process guided by a physiotherapist, it can be a successful and exciting aspect of rehab.
If you’ve had knee surgery and are interested in returning to running, physiotherapists at The Injury Clinic Physiotherapy in Geelong are able to help!
