If you’re a runner, you’ve likely lived firsthand the unique bond that comes with running as a sport — there’s that unparalleled appreciation for hitting the road, finding your stride, and finding escape through running.
But to have that world suddenly interrupted by injury is shocking, to say the least.
To make matters even more difficult, if you’ve specifically endured a meniscus injury or surgery, you’ve likely been told to stop running altogether.
Not only has the initial injury sidelined you from training, but you’re also directly discouraged from running again by medical professionals. And as you probably know, being told that you can’t and shouldn’t run again is equivalent to asking you to give up your passion and source of stress relief.
However, we’re here to tell you: unless there are concrete facts to justify why you may have to put an end to that running career, it’s entirely possible to ensure a safe return to running.
Our team is determined to help runners rehabilitate and get back to doing what they love — the right way.
Is It Safe to Run After Meniscus Surgery?
Short answer: yes!
Long answer: yes… but with a few caveats.
One of the most common issues for runners post-meniscectomy is progressing through rehab far too quickly in order to get back to running as soon as possible. Unfortunately, returning to running sooner doesn’t mean that rehab went better, nor does it guarantee the best possible outcome.
Reintroducing running after knee surgery is an extensive process that requires time and diligence — and that means taking into account all aspects of your rehabilitation journey, from the cause of the initial injury to gait deviations and weakness after surgery.
But, we’re here to walk you through the details — what changes occur, and how they affect your running in the bigger, biomechanical picture. For the purposes of this blog, we’ll be focusing specifically on meniscectomies (which remove a portion of the meniscus), rather than a meniscus repair (which fixes the tear using sutures; typically only performed in younger populations).
Free Guide to Help Your Journey Back to Running Strong
If you are looking for more information on how to “safely: return to running after meniscus surgery, then check out this FREE special report.
- Top strategies in building a running program after surgery
- Functional strategies to “test” your knee before running
- How to progress miles and speed post-op
- The importance of adding strength training to your program
Changes After Meniscus Surgery
Right after undergoing your procedure, you’ll likely experience localized swelling around the patella and lower quadriceps anywhere from 1 to 9 weeks post-op. This swelling is another major factor to address for your rehabilitation plan, as it can otherwise impede proper training for your quadriceps muscles.
Multiple studies have concluded that people recovering from meniscus surgery typically present some degree of altered or deficient gait mechanics while walking (let alone with running) on the operated leg. More often than not, these deficiencies cause improper shock control, often as a result of decreased flexion or improper alignment at the hip and knee.
With a meniscectomy, people will experience some degree of the following physiological and anatomical changes:
- Decreased shock attenuation
- Decreased knee stability
- Decreased joint protection
And as with most biomechanical deficiencies, the issues travel well beyond the shock absorption — this lack of joint flexion in the lower extremity leads to compensations elsewhere, including the pelvis, trunk, and opposing leg.
(If you know anyone else who’s gone through a meniscectomy, you may have heard them complain about low back pain or pain in their non-surgical knees about 2-3 months after their procedure. This is one of the most common indicators that they shortened their rehabilitation timeline and therefore weren’t able to achieve peak condition before running again.)
Biomechanical Expectations during Rehabilitation
In order to avoid the pitfall of returning to running too soon, it’s imperative to establish checkpoints in the rehabilitation process to ensure forward progression and keep you on the right path.
A solid rehab protocol will address the issues listed above (swelling, range of motion, and knee stability), but should also address changes in gait and loss of strength.
Some of your primary benchmarks for a safe, post-op gait include the following abilities:
- Fully straightening out the surgical leg
- Squeezing your thigh muscle (allowing the knee cap to glide upwards)
- Performing 10 straight-leg raises while lying down (keeping the leg locked straight)
Each of these foundational skill sets will help you achieve full functionality in the quadriceps muscles, which is imperative for recovery. Your quads are directly connected to the knee via the quadriceps tendon, and any deficiencies or compensations with the muscle can cause increased pressure and forces at the joint. So, it’s essential to develop sufficient muscle strength and full contraction before you begin a walking program (making it doubly important for a running program).
As you progress through quadriceps reactivation and move into walking (and eventually running), it’s important to address the how in addition to the what — and this is where biomechanics come in.
The patterns you teach your body during rehab will have a bearing on whether or not you can return to pain-free running. If the motions you train aren’t biomechanically sound, you open yourself up to future re-injury or pain with running.
After all, something caused your meniscus injury in the first place. If you return to squatting, jumping, and running without addressing the form errors or inefficiencies that put you at risk in the first place, you’re putting your newly-repaired knee back in the same situation.
And that leads us to one, huge consideration in training your knee for running…
The Importance of Double- and Single-Leg Drills
Typically, post-operative rehab programs focus heavily on rebuilding strength and muscle activation in the surgical leg. Goals are set around achieving a certain percentage of pre-operative strength and creating symmetry side to side, and while that’s certainly important, it’s not the whole picture.
One of the most important facets of return-to-running training is ensuring that both sides are on an equal playing field when it comes to muscle activation and strength, as well as control, alignment, and shock absorption.
When we look at running biomechanics, the motions are actually quite akin to single-leg bounds performed over and over (and over). Although running requires both legs, at no point in your gait will both feet be in contact with the ground at the same time — so, by biomechanical nature, it’s actually deemed a single-leg sport.
This makes drills like single-leg squats and step-down tests incredibly important; they best emulate the muscle activation and joint movements found in running, and they help assess whether or not your surgical leg is prepared for bearing the load of your standard bodyweight.
Once your body has mastered the biomechanics of double-leg squatting, you’ll move into single-leg squats, step downs, and “mini hops” to ensure sufficient shock absorption. Practicing jump mechanics is necessary in order to prepare that articular knee cartilage for increased impact forces.
If it’s available to you, it’s best to transition to jump drills using a force plate to assess your loading rates through your training. This will help you determine if you’re actively absorbing shock through the muscles, or if your body is still relying on passive shock absorption on the bones, joints, and ligaments. (Though the latter isn’t ideal, it’s common in the rehabilitation process! It takes time and lots of repetition for your body to learn the necessary motor control for active shock absorption.)
When Can I Run Again?
Alright, let’s address the elephant in the room: when can you actually get back to running?
The answer is… it depends.
We know, we know; that isn’t the answer you came looking for. But there’s a whole lot of context that goes into answering that question.
For a general timeframe, many runners can begin a (safe) return to running program around 8-12 weeks post-op. This timeline provides enough time to significantly reduce swelling, improve strength at the hip and quadriceps muscles, and implement a gradual progression/training plan to resume proper walking mechanics.
But of course, time since surgery isn’t the only determining factor to keep in mind.
Clinical Requirements for Returning to Running
To be truly certain that it’s time to begin running again, you’ll have to undergo a thorough biomechanical evaluation. (Surprise, surprise!)
While it may seem tedious at first, you’ll soon see that biomechanical assessment is the only way to ensure that your body is capable of handling the rigors of running again, and that underlying form errors or injury risks are minimized.
Thankfully, there’s a set list of prerequisites that can gauge how ready you are:
- Full, pain-free range of motion in your surgical knee
- Excellent quadriceps strength (equivalent to the non-surgical leg)
- Sufficient hip strength (equivalent to the non-surgical leg)
- No pain with walking, climbing stairs, or squatting
- Ability to demonstrate proper knee and hip control with double- and single-leg squats
- Ability to perform 10 single-leg step-downs from an 8-inch box (with proper alignment)
- Ability to perform 25 single-leg calf-raises (with proper alignment)
- Ability to perform 50 double- and single-leg “mini hops” in place and while moving forward/backward (without pain and with sufficient control)
If you’re thinking that’s a lot of criteria to meet, you’d be right! Running generates forces approximately 2-3 times your usual body weight with every step, so it’s imperative that your body has sound biomechanics to properly tolerate that much load.
Given the depth of criteria necessary for a safe return to running, most athletes will have varying timelines for how well their body recuperates and responds to the progressive training of rehab. The 8-12 week mark is a general guideline, but starting later than that is not unusual!
Starting a Return-to-Run Progression
Once you’ve mastered the necessary drills and assessments, you’re ready to officially begin your return to running progression! It’s been a lot of hard work and patience to get to this point, and it’s quite an exciting milestone to hit.
Just remember: the key to a successful return-to-running program is progression.
Similar to how you shouldn’t take on too much, too soon when increasing your (non-injured) running mileage, you also shouldn’t push yourself too hard as you start to hit the road again. This becomes especially imperative after knee surgeries, as your joint is much more susceptible to reinjury if subjected to increased impact forces too suddenly.
Most studies will suggest starting with a run-walk program to ensure that you’re very gradually introducing your knee joint to increased loading in the tissue. Plus, with a set measure for your running and pacing, your body will get to relearn these loading patterns in a predictable, progressive manner.
It’s important to continue integrating targeted training to match your progression, as well. Remember: running is a skill that requires deliberate practice, so your supplementary training has to suit your needs as you advance. In particular, be sure to hone in on those single-leg, plyometric activities involving hip and knee flexion. Practicing these biomechanics are key for controlling loading rates and ground reaction forces, thus protecting your knee in the long-term.
Managing Your Expectations
And finally — and this might be the hardest part of rehab — there’s a mental factor to fully and safely returning to running.
The full process of rehab, from surgery to running pain-free, is a long process that requires tenacity, patience, and determination. Without running to relieve stress and provide your exercise fix, the situation can feel overwhelming at times.
It’s important to remember that rehab is a process, and even though we talk about benchmarks and progressions, the process is anything but linear. Even when everything is going to plan, there will be days where things are more painful or exercises feel harder. This is completely normal (albeit frustrating!).
The same applies to starting to run again. Once you’re cleared to run, you’ve been cleared to start running, but you’ll still need to progress gradually. Chances are, if you’ve done your due diligence, your first few runs will feel great — and that’s where people get in trouble.
It’s easy (and so tempting!) to have a few good runs and be ready to crank up the intensity, only to find your knee swollen and painful after doing so. Following your walk-run protocol will keep you from pushing too far, too fast, and keep you on track even when you have hard days.
Just like rehab in a clinic setting, during your running progression, you’re going to have great days and not-so-great days. There will be times when your knee aches or hurts, and it can cause a lot of fear and anxiety about reinjury.
A cautious return to running requires self-control and faith in the process, and that’s where your physical therapist can help guide you, understand the difference between good and bad pain, and take care of any aches and concerns that come up along the way.
When the process feels frustrating and hopeless, remember that the path isn’t a straight line, and understanding the variable nature of rehab will keep your mental game strong throughout the process. With diligence, patience, and hard work, you’ll be back to pain-free, confident running again.
Will Running Increase Risk of Arthritis?
Though many people feel antsy to get back to running, it’s also natural to experience some degree of trepidation when it comes to potential reinjury or other problems. In particular, it’s common for runners to express concern for developing arthritis.
It’s a fair assumption — with all the pounding and increased forces at the knee joint, it makes logical sense that running would increase your likelihood for arthritis.
However, research often suggests otherwise.
Multiple studies have reported little to no significant correlation between running and knee osteoarthritis (OA). Both new and old research has concluded that the nature of running does not inherently contribute to the development of OA. In fact, some researchers even go so far as to say that running can actually decrease risk of pathology in the knee when executed correctly. (Even Runner’s World has published multiple articles debunking the myth.)
But then you may find yourself wondering: if that’s the case, then why do runners experience OA?
Risk Factors for Osteoarthritis After Meniscectomy
Runners who develop knee OA often experience it as a result of several risk factors, most of which aren’t exclusive to the scope of running. But, more often than not, OA is brought on by more uncontrollable factors, such as:
- Age over 40
- Female sex
- More than 1/3rd of the meniscus was removed
- Meniscus tear is in the outer side of the knee
- Meniscus tear is degenerative, rather than traumatic
As you can see, the likelihood of developing OA can be influenced by a wide range of factors, some of which are chalked up to ever-aging biology, and others that are dependent on the type of meniscus injury you sustained in the first place.
All relevant, but not specific to your running lifestyle.
Other Considerations for OA and Running
Granted, these uncontrollable factors aren’t the only culprits for OA.
There are a small handful of running errors that can potentially increase your risk of OA, like knee valgus or knee varum. If left unchecked, these kinds of errors can contribute to joint damage and symptoms of arthritis, but they typically won’t be the main cause for concern.
In fact, the most common cause for arthritis in running is a previous history of OA prior to your actual injury or surgery; if you were diagnosed with OA before surgery, you’ll still have it post-op. And unfortunately, running is likely to progress the issue regardless of how optimal your running form is.
If you present a majority of these unchangeable risk factors, you’ll likely be recommended to switch to a lower impact sport (especially in the case of a prior OA diagnosis). But, the good news is that it isn’t all black and white — depending on your circumstances, it may still be feasible to run without risking arthritis.
Certain aspects can be better accommodated with a proper gait assessment and sufficient biomechanical training. Working with a running specialist is the best way to ensure that you’re maintaining proper mechanics and decreasing your risk of arthritis throughout your training.
Returning to running after a meniscectomy is, for the most part, a feasible venture. The key is to focus on all your biomechanics: the muscles, the joints, the full-body movement. With an effective rehabilitation program, your body can recover and train at a steady progression, developing a solid foundation for your running form.
And while biomechanical soundness isn’t the only important facet of a return-to-run progression, it’s a vital component to understanding your recovery. Oftentimes, it’s what makes the difference between a runner having to sacrifice their favorite activity and a runner finding success with their running longevity.
The goal of this article was to provide some guidance as to what “having a meniscus surgery” can actually mean for runners. Dealing with meniscus surgery and its aftermath can feel overwhelming, and as with any daunting, big-impact changes, it’s important to ground yourself in information and set realistic expectations.
Best wishes to all runners recovering from meniscus surgery!
Originally published on 9-14-2015; updated on 10-20-2021.