Running After Post-Op ACL - The Calf

I do a ton of consults.  All of our instructors do.  And part of doing consults is seeing trends and recognizing these more quickly to allow a rapid resolution.  I'd like to talk through a recent consult with some easy to take away points to help our ACL Reconstruction patients return to running.  

This consult was with a recreational runner who was just shy of 4 months post-op ACL Reconstruction.  She had been progressing well with no joint effusion and only minor deficits remaining.  Suddenly, she began to experience posterior knee pain when running and generally was just getting increasingly sore.  The treating therapist had to shut down the runner for a couple of weeks and then in conjunction with the surgeon decided to do a consult and get a second set of eyes. 

There are a ton of issues that can create the problem described here and fortunately, most of those looked good on her.  We found one glaring issue.  Her calf!  She struggled substantially to perform a unilateral calf raise.  41% of the power during the running gait cycle comes from the calf and having someone run that still likely doesn't have a perfectly functioning knee as well as a poorly functioning calf takes away just about all the margin for error!

The goal after the consult was for the therapist to come away with 3 main points:

1.  Never feel bad asking for a second set of eyes.  The best of us do it quite frequently.  It's a badge of honor to fully understand that 2 brains are better than 1.

2.  In the case of this runner, let her restart her running progression, but progress more slowly and continue a run/walk interval longer than you may normally because her calf is going to fatigue rapidly, which may lead to greater knee issues.  At the same time, make sure she is performing some other type of cardio, such as the elliptical, swimming, etc.

3.  Once any ACL reconstruction patient is safe in single leg stance, start doing calf raises on 1 leg.  This is typically very early on in the rehab process and saves a lot of frustration later.  Many patients who struggle with this will find compensations and you need to cue these to not occur.  

Blog Post Written by: Ari Kaplan, PT, DPT, SCS, CSCS, COMT, Cert MDT

LinkedIn: Ari Kaplan

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