ACL Recovery Timeline: When Can I Run Again?

Getting injured is any athlete’s nightmare, especially when an injury can end your season. One of these season-ending injuries that are all too common is a torn ACL. You probably know a football or basketball player who had surgery to repair that ligament - it may even be you. 

While the injury can seem debilitating, there is hope for a full recovery with proper rehabilitation and strengthening. Physical therapy can be an excellent treatment option whether you have surgery or not - at EW Motion Therapy, we help many clients with ACL tears return to their sports and stay injury-free for years. Even if you decide our services do not fit your needs, we hope you’ll read on for our discussion of why ACL injuries are so common, what recovery can look like based on the severity of the injury, and how physical therapy can help. We will also discuss the all-important question of when you can run again. 

Why are ACL injuries so common in sports? 

ACL injuries are common in sports due to the demands placed on the knee during athletic activities. The anterior cruciate ligament (ACL) is one of the major ligaments in the knee, responsible for stabilizing the knee joint and preventing excessive movement. The ACL is particularly vulnerable to injury during sudden stops and changes in direction, as well as jumping and landing.

During these activities, the knee is exposed to significant forces that can place stress on the ACL, such as the twisting or pivoting motions that occur during basketball or soccer. Additionally, athletes who participate in sports that require them to decelerate quickly and change direction, such as football or tennis, are at an increased risk of ACL injury.

Other factors that can increase the risk of ACL injury include:

• Poor conditioning or training techniques

• Improper footwear or equipment

• Muscular imbalances or weakness

• Previous knee injuries or surgeries

It's important to note that ACL injuries can occur in non-athletic activities as well, such as slips and falls or car accidents.

While ACL injuries can be a significant setback for athletes, with proper treatment and rehabilitation, most people can recover and return to their previous activity level. Preventative measures, such as adequate conditioning, training techniques, and protective equipment, can also help reduce the risk of ACL injury.

What does recovery look like? 

The recovery timeline for ACL repair depends on the severity of the injury and the sport or activity to which you want to return. For a grade 1 injury, where the ligament has become stretched out, you can usually return to sport in 4-6 weeks with the proper rest. You will likely do a lot of quad strengthening as the ligament heals to help support your knee joint. For a partial tear (grade 2), you may need surgery depending on your age, activity level, and the sport(s) you play. Total rehab and return to sport can take 9-12 months along with quad strengthening. A grade 3 complete tear always requires surgical intervention, as they have to replace the torn ligament with a new one. This procedure typically uses a graft from the patient’s tissue or a donor. After surgery, patients need to rest and immobilize the knee before starting physical therapy. With that in mind, full recovery and return to sport can last for over a year.

How can physical therapy help ACL recovery? 

Physical therapy is essential to ACL tear recovery, whether or not surgery is performed. Physical therapists can design a customized rehabilitation program that includes exercises to help restore range of motion, strength, and balance in the knee. These exercises may consist of:

• Range of motion exercises: These exercises help the knee move freely and smoothly. Examples include heel slides, which involve sliding the heel along a flat surface while bending and straightening the knee, and wall slides, which involve leaning against a wall and sliding the foot up and down.

• Strengthening exercises: These exercises help rebuild the muscles around the knee. Examples include leg presses, squats, and step-ups.

• Balance exercises: These exercises help improve stability and prevent re-injury. Examples include single-leg stance, in which the patient stands on one leg and tries to maintain balance, and wobble board exercises, in which the patient stands on a board that wobbles and tries to maintain balance.

Physical therapy is typically started a few weeks after surgery, or as soon as possible for non-surgical treatment. The duration of therapy varies depending on the patient’s progress and goals but may last several months. It is best to visit a physical therapist for your rehab instead of trying to figure it out on your own - they can ensure you do the right things at the right time in the healing process to promote healing and reduce swelling.

In addition to physical therapy, patients may also benefit from other treatments such as pain management, ice and heat therapy, and massage. They should also avoid activities that may put excessive stress on the knee, such as high-impact sports or activities that involve sudden stops or changes in direction.

When can I run again? 

Now you know more about ACL rehab and the treatment timeline for each type of injury. To be able to run on your ACL again, the typical protocol is 12 weeks of rest and physical therapy, but this is a rough estimate based on an average timeline. You need to have good quad control and range of motion in your knee joint, and you need to be able to put the correct amount of load on that ligament, which can only happen with a slow progression over time. Ultimately, your physical therapist should decide when you can run again. They hopefully know how to work with ACLs and can return you to sport safely and efficiently. 

A torn ACL can be a debilitating setback for any athlete, but recovery is possible with the proper treatment and rehabilitation. Physical therapy is a critical component of ACL tear recovery, whether or not surgery is performed. With the guidance of a physical therapist and a commitment to the rehabilitation program, most patients can expect to return to their pre-injury activity level in due time. We provide the best care possible for our injured athletes at EW Motion Therapy by creating individualized treatment plans with sport-specific exercises and progressions. If you are curious about what else physical therapy can do for you, click the button below to download our answers to 20 frequently-asked physical therapy questions.