Can You Run With A Torn ACL? | Advice From A Sports Physiotherapist

The anterior cruciate ligament (ACL) often gets injured in running or contact sports. (1) So, it’s natural for active people with this injury to ask “can you run with a torn ACL?”

Well, yes and no. The first factor to look at is the severity of your injury. Generally speaking, you can run with mild sprains. Any worse than that and you shouldn’t.

Honestly, this will be better answered by your physical therapist since he/she knows the specifics of your injury.

I’ll talk about the factors that tell you when you can and can’t run with a torn ACL. Here’s a summary of the topics you’ll find here:

• 3 scenarios where it may be okay to run with an ACL tear
• 3 scenarios where you shouldn’t run with an ACL injury
• When isn’t ACL surgery necessary?
• Who can benefit from ACL reconstruction?

Tap on the bullets above to jump to their sections.

You can run with a torn ACL if…

1) The tear is mild

There are 3 types of knee sprains – mild, moderate, and severe.

In mild ACL tears, the ligament overstretched but didn’t tear. This means it’s still capable of keeping your knee somewhat stable.

So, yes – you may have enough knee stability to run.

But, it may be best to do so while wearing additional support, particularly during the first 3-4 weeks after your ACL injury. (2)

During that time, you’ll likely have some pain, swelling, and compromised knee stability. These factors can cause further injury if you’re not careful.

But, you can reduce this risk by wearing a knee brace.

Knee supports protect your ligaments during the healing process. They also help you manage knee joint swelling and can enhance your recovery.

Just make sure you choose the right knee brace for your needs. Also, make sure that your physio thinks it’s safe for you to run.

These could help:

• The best knee braces for healing ACL tears
• The best knee supports for running

2) Your physical therapist considers it’s safe

If your ligament has healed enough or your muscles are strong enough to support your knee joint, your physical therapist may suggest running or playing sports again. She/he will likely give you some guidelines to follow, though, including:

• Home treatments to reduce pain and swelling.
• Wearing a knee sleeve or a hinged brace before, after, or while doing physical activities.
• A warm-up and/or cool-down routine.

Follow the recommendations from your physio to return to running as safely as possible.

Related: Is it okay to walk on a sprained knee?

3) It’s part of your rehabilitation program

If you’re an athlete, your physio will prescribe running at some point. It’s key to manage your expectations, though.

The average time it takes to start running again after ACL reconstruction is around 8-16 weeks post-surgery. (3)

Also, you should meet some physical requirements first.

Meeting them will reduce your risk of re-injury. Common criteria for return to running include (3):

• Having 95-100% of your knee range of motion back.
• Full knee extension.
• Little to no pain.
• No swelling.
• A normal gait pattern.
• The difference in strength between the injured and healthy side should not be more than 20%.

Don’t run with an ACL injury if…

1) The injury is fresh

During the first few days after injury, your joint may be swollen and painful. These are signs that healing is taking place.

But, this also means your knee is at a greater risk of getting other injuries. This is true even in mild tears.

So, running during this time can worsen your ACL tear.

The risk is even higher if you do it without the extra support of a brace.

If this resonates with you, please have a little patience and respect the healing process. This will help guarantee a safe return to sports.

2) The tear is moderate or severe

Moderate sprains refer to a partial tear of one or more of the major ligaments in the knee. A severe sprain means there’s a complete tear.

These types of sprains often involve more than one structure. Like a meniscus, the knee cartilage, the posterior cruciate ligament, and others.

Now, although pain and swelling vary from person to person, there will always be some level of knee instability.

So, it’s not wise to continue playing if you have a moderate or severe sprain.

The pain and swelling may stop you from doing much physical activity either way.

Some of these tears may also need surgical treatment while others do well with conservative measures (more on this below).

But, regardless of the treatment, you’ll need at least a few months of physical therapy before safely being able to run again.

3) Your physical therapist doesn’t think it’s safe

I’ve had so many patients recovering from an ACL tear say: “I’m feeling great! Why can’t I start running?”

The answer boils down to progressive overload – one of the main principles we use as physical therapists.

This means gradually loading the injured tissue so it adapts and gets stronger. Next time, we load it some more. Then, rinse and repeat until the ligament returns to pre-injury levels.

But, this process inevitably takes time.

Even if you’re doing everything to heal your sprain as fast as possible, there’s no way to rush this.

That’s why your physio will give you some strengthening exercises to master before running. This makes sure you have enough muscle strength to handle the load. Thus, reducing your risk of re-injuring yourself.

So, if your physio suggests waiting before running again, trust them.

When ACL surgery may NOT be necessary?

Non-surgical treatment is what we call “conservative treatment”. In ACL injuries, this often includes (2):

• Some period of immobilization or knee bracing.
• A thorough physical therapy program.
• Home care strategies.
• Medication if necessary.
• Follow-up evaluations.

Some groups may heal their injured ACL with these strategies alone. Those include (2):

Children and teenagers

If the growth plates haven’t closed yet, the ACL tear will likely heal on its own. (2)

Mild or moderate tears

If the ACL doesn’t have a complete tear, it may heal spontaneously if you (2):

• Don’t have a previous medical condition.
• Live a healthy lifestyle (i.e. eat nutritious foods, don’t smoke, sleep +7 hours each night, etc.)
• Follow your rehab program properly.

This doesn’t mean complete tears can’t heal without surgery, though. But, it’s less likely to happen. (2)

Non-competitive athletes

If you’re not a competitive athlete and your tear is mild or moderate, you probably won’t need surgery. (2)

The simple fact is that non-competitive athletes don’t put the same demands on their knees as athletes who play their sports for a living.

But, not every elite-level athlete with an ACL tear will need surgery. Some can heal with conservative treatment if they follow a good rehab program. (4)

People that don’t want surgery

Surgery is a personal choice.

Your doctor, physical therapist, and other healthcare professionals should discuss the pros and cons of conservative and surgical treatments with you. That way, you can make an informed decision.

Here are some things to consider before undergoing surgery:

• Surgery can slightly increase your risk of knee osteoarthritis compared to non-conservative treatment. (6)
• ACL reconstruction may not be functionally superior to conservative management in the long term. (5, 6)

When ACL surgery may be necessary?

If conservative treatment wasn’t enough

Truth be told, you may still have persistent knee instability after months of physical therapy. In this case, a surgical repair of your ACL may help.

Now, the type of surgery will depend on the specifics of your injury. But, most of the time the choice is arthroscopic surgery.

This is a minimally invasive procedure that repairs the torn ligament. Some people can walk shortly after surgery. You will still have to undergo physical therapy afterward to recover from the surgery.

If you want to go back to elite-level sports

Elite athletes rarely have time to wait and see if the ligament heals on its own. So, they may choose to undergo surgery to speed up the process.

If the sprain is severe, the athlete may need an ACL reconstruction surgery.

ACL reconstruction is a more complex procedure than arthroscopy.

Here, the surgeon takes a little piece of one of the hamstring tendons to “build” a new ACL. Another option is taking a healthy ligament from an organ donor.

Then, the doctor replaces the torn ACL with the new one. And the results are promising – 65% of the athletes that undergo this procedure may return to pre-injury levels. (1)

But to get there, rehabilitation must be followed to the dot.

If you want to get surgery

As mentioned above, surgery is a personal decision. If the pros outweigh the cons, by all means, go through surgery.

If it’s right for you, it will improve your quality of life and you’ll be able to return to your physical activities.

Just make sure to ask your surgeon about the details of your surgery. Talk about the possible outcomes and risks with your doctor.

And please, don’t be afraid to ask. Part of our jobs as healthcare professionals is answering any questions you may have. We want you to feel as confident and at ease as possible.

FAQs:

Conclusion: When to run with an anterior cruciate ligament injury

Now you know when you may run with a torn ACL, and when it’s best to rest. Yet, please remember that the healthcare professionals treating you will give you better advice than this article.

Follow their recommendations and be patient. You’ll heal in no time!

Resources:

1. Evans J, Nielson Jl. Anterior Cruciate Ligament Knee Injuries. [Updated 2021 Feb 19]. Statpearls. Retrieved on November 2021 from: https://www.ncbi.nlm.nih.gov/books/NBK499848/
2. Park, Yong-Geun, et al. “Is it worth to perform initial non-operative treatment for patients with acute ACL injury?: a prospective cohort prognostic study.” Knee surgery & related research vol. 33,1 11. 6 Apr. 2021, DOI: 10.1186/s43019-021-00094-3
3. Rambaud, Alexandre JM et al. “Criteria for return to running after anterior cruciate ligament reconstruction: a scoping review.” British journal of sports medicine vol. 52,22 (2018): 1437-1444. DOI: 10.1136/bjsports-2017-098602
4. Paterno, Mark. “Non-operative Care of the Patient with an ACL-Deficient Knee.” Current reviews in musculoskeletal medicine vol. 10,3 (2017): 322-327. DOI: 10.1007/s12178-017-9431-6
5. van Yperen, Daan T et al. “Twenty-Year Follow-up Study Comparing Operative Versus Nonoperative Treatment of Anterior Cruciate Ligament Ruptures in High-Level Athletes.” The American journal of sports medicine vol. 46,5 (2018): 1129-1136. DOI: 10.1177/0363546517751683
6. Smith, TO et al. “Is reconstruction the best management strategy for anterior cruciate ligament rupture? A systematic review and meta-analysis comparing anterior cruciate ligament reconstruction versus non-operative treatment.” The Knee vol. 21,2 (2014): 462-70. DOI: 10.1016/j.knee.2013.10.009