When is it safe to return to running after knee surgery?

Most of our clients are itching to get back to running after their knee surgery, such as ACL reconstruction and meniscectomies. Who can blame them, runners want to run! However, athletes need to be cautious about returning to running too soon as there is a risk of re-injury. So, when is it safe to return to running after knee surgery? Our return to sport expert, Helen Cortes, PTA, is here to tell ya! Keep reading!

The 6 Return to Running Tests

Many factors play into our decision to clear a client to return to running after knee surgery (including time, type of surgery, objective data on the range, swelling, and tissue integrity at the knee).

In addition, there are 6 tests our clients have to pass to start a Return-to-Running program(*): 

  1. Quads Limb Symmetry Index (LSI) > 70%. 
    • LSI = [quad strength of the operated leg/quad strength of the non-operated leg]*100
    • At Runners’ Edge we use a device called a dynamometer to measure the peak force generated by the muscle group being tested (quads, hamstrings, etc.).
  2. Single Leg Squat > 15 reps
  3. Single Leg Bridges (with foot on elevated surface) > 20 reps
  4. Single Leg Heel Raise > 20 reps 
  5. Vertical Hops > 15reps 
  6. Forward Hops > 15 reps 

(*)These tests must be performed with proper form and without signs of fatigue.

Click the gallery below to see how these tests are performed! 

Regaining Quad Strength

Regaining full quad strength is key to safely returning athletes to running and sports after knee surgery. 

  • Research shows that for every 1% difference in LSI (relative quad strength) the risk of re-injury when returning to sport increases by 3% (when the LSI is < 90%).
  • So, for example, if an athlete returns to sport when the operated quads are only 80% as strong as the non operated quads, they are 30% more likely to re-injure their knee over the next 2 years.

After extensive surgery, money spent, and time taken off from running and sports, this is not a risk we are willing to take! 

How can we speed up the healing and strength building process?

One way to accelerate muscle strength gains and LSI scores is by using Blood Flow Restriction Training (BFR). 

BFR training can help a client make greater strength gains while lifting lighter loads, which is perfect for those who have restrictions as far as how much stress a limb can undergo following knee surgery. 

Read more about BFR HERE

Our ability to use BFR during the PT sessions helps clients maximize strength gains so they are ready and SAFE to return to sports quicker.


Returning safely to running is a progression

Once a client is cleared, it doesn’t mean they should jump right back into a full running training plan. Our PTs are running specialists and will help progress you safely back to your running goals. 

Once cleared to return to running after knee surgery, be sure to read our FREE Return to Running E-book

Return to Running Ebook Cover

Are you recovering from, or preparing for knee surgery?

Our therapists are experts at getting runners back to running after surgery! 

Give us a call or schedule a FREE discovery session today to learn how PT can help you get back to what you love… Running! 

Written by: 
Helen Cortes, PTA
ACL & Return to Sport Specialist 

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Runners' Edge Alaska

"We Empower Active Alaskans Of All Ages To Return To The Activities They Love Safely And Efficiently…For Life"
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