'The right advice': a qualitative study examining enablers and barriers to recreational running and beliefs about knee health following knee surgery.

Objectives: To examine the experiences, knowledge and beliefs of recreational runners with a history of knee surgery regarding (i) enablers and barriers to running participation, (ii) the association of running and knee joint health, and (iii) perceived benefits and motivations for running.

Methods: 17 runners (≥3 times/week, ≥10 km/week) with a history of knee surgery (7±7 years post-surgery, 9 women, age 36±8 years) participated in one-on-one semi-structured interviews. Interviews were recorded, transcribed verbatim and analysed using reflexive thematic analysis. Trustworthiness was built by following established qualitative research guidelines and by participant validation of findings in the final analysis stages.

Results: We identified 9 themes (5 subthemes) for aim (i); 3 themes (10 subthemes) for aim (ii); and 2 themes (4 subthemes) for aim (iii). Positive health professional support including education, exercise rehabilitation and a tailored return-to-run plan enabled participants to return to running following surgery. Effective load management either independently or with coach assistance, and consistent strength training were considered key to maintaining participation. Barriers to running following surgery included unhelpful health professional encounters, persistent knee symptoms and muscle weakness, new running-related injuries, anxiety and fear about reinjury, and difficulty finding time. Participants had varying beliefs about running and knee joint health, although most believed that running benefited long-term knee health. Improved mental health and social connection were the most common motivators to run.

Conclusion: Our qualitative findings may inform strategies to support adults to commence, or return to, and maintain running participation following knee surgery.