The Return to Run Process in ACL Rehab
By Dan Rothenberg – Sports Chiropractor at Scope Sports Injury Clinic, Ipswich
Returning to running after an ACL injury isn’t about pushing through pain or rushing the process—it’s about earning the right to run again through smart, structured rehab. As a Sports Chiropractor who works closely with athletes of all levels across Ipswich, I’ve seen how critical this phase is—not just physically, but mentally too.
Whether you're a weekend warrior or playing competitively, your ACL rehab journey must include clear testing, progressive loading, and movement retraining to make sure your knee is ready—not just to jog, but to accelerate, decelerate, change direction, and eventually play sport at full pace.
✅ Return to Run Testing Standards
Before we greenlight an athlete to start running, they need to meet strength and control benchmarks. These ensure the knee has regained enough function to safely absorb and produce force.
Here are three of the key markers we use:
Single Leg Sit to Stand: 85%+ Limb Symmetry Index (LSI) compared to the uninjured leg. This gives us insight into quadriceps strength and fatigue resistance.
Single Leg Hop: 15+ repetitions with solid control and landing mechanics. This tests plyometric control and confidence.
Single Leg Glute Bridge: 15+ repetitions with proper form. This reflects posterior chain strength—critical for hip and knee stability during gait.
These aren’t just random numbers—they're functional indicators that your body can handle the demands of running.
🏃♂️ Gradual Progression: The Return to Run
Pathway
Once those baselines are hit, we start the structured return to run process. Here’s what it looks like:
Straight-Line Jogging: Soft surface. Controlled pace. Minimal impact forces. We're watching for any signs of swelling, limping, or apprehension.
Interval Running: Introduce slow-to-moderate intervals to rebuild cardiovascular endurance and test repeat loading.
Acceleration/Deceleration: This is where most ACLs are tested in real sport. We train braking control and force production.
Change of Direction (COD): Agility drills, cutting mechanics, and proprioceptive work to prepare for sport-specific movements.
Sport-Specific Integration: This stage is tailored. For some it’s ball drills, for others it’s jumping and reactive drills. The key is recreating the chaos of sport in a controlled rehab setting.
Athlete Story: Soccer Player, 29yo, Female
Mia came to us post-ACL reconstruction, eager to get back to her midfield position. She was determined—but her early testing showed quad weakness and hesitancy on landing.
We spent 10 weeks rebuilding single leg strength and balance. Once she hit her hop and sit-to-stand benchmarks, we layered in tempo runs, then agility ladders and lateral deceleration drills.
By week 24, she was back to modified team drills. Her confidence skyrocketed when she could pivot and tackle without hesitation.
Athlete Story: James – Recreational Basketballer, 32yo
James injured his ACL in a social game. His goal wasn’t elite sport—it was weekend games with mates and pain-free exercise.
He hit his strength targets around week 18 and began short jog-walk intervals on grass. His biggest challenge was learning to trust his knee again during sudden stops.
We used deceleration drills, reactive footwork, and open-court sprints to re-train that skill. He’s now back playing full court—stronger, smarter, and more mobile than before.
🧠 Final Thoughts
The return to run isn’t a timeline—it’s a process. At our Ipswich clinic, we make sure every athlete earns the right to run again by meeting objective criteria, regaining strength and control, and rebuilding confidence.
If you're working through your own ACL rehab and want to make sure your return to running is safe and sustainable, reach out. Whether you’re a soccer player, basketballer, or weekend runner—your journey matters.
Let’s get you Back 2 Your Best.
Looking for expert ACL rehab in Ipswich?
We help athletes rebuild stronger, move better, and return with confidence.
📞 check out our ACL Rehab Program HERE
