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. 2019 Feb;14(1):159–172.

Table 1.

A schematic layout of an example periodized resistance training approach for the athlete after anterior cruciate ligament reconstruction. The program involves one pre-operative and five post-operative stages aligned with the functional recovery status of the athlete after surgery. The particular goal, strategy and approach are outlined discussing the factor relevant within the text. The program is a typical approach (and allocated time) to a professional athlete, who was able to return to team training at six months after reconstructive surgery. Time lines are dependent upon the injury (e.g., concomitant injury, such as cartilage, medial collateral ligament), and individual healing and progression time lines. Criteria and not time should be used to transition between stages.

Stage Weeks Goal Strategy Knee extension exercises Supplementary modalities (injured)
0 6 weeks pre-op to surgery

  • - Optimally prepare for surgery

  • - Resistance training to restore muscle mass and strength to within 90% of contralateral limb

  • - POLICE

  • - Resistance training (isolated, OKC, CKC, functional) depending upon post-injury status, low intensity (plus BFRT), moderate intensity (isolated and functional plus electrical stimulation) to high load training

  • - OKC – Knee extension

  • - CKC – Leg press

  • - Functional- squat & deadlift and derivatives, BL and UL

  • - Plyometrics (when good function)

  • - Electrical stimulation

  • - BFRT during isolated strength tasks with optimal supervision
1 0-4

  • - Recover from surgery

  • - Resolve pain, swelling, AMI

  • - Prevent atrophy and strength deficits of injured limb

  • - Preserve function of uninjured limb

  • - Injury treatment

  • - POLICE

  • - High load, low volume resistance training of uninjured limb

  • - Low load isometrics with electrical stimulation for injured limb

  • - Injured limb– Isometric isolated only plus electrical stimulation

  • - Un-injured limb – same exercise, maximal intensity

  • - Electrical stimulation

  • - ICE

  • - TENS

  • - Massage

  • - Cross-education
2 5-8

  • - Muscle endurance (and hypertrophy)

  • - Low to moderate load isolated resistance training with additional modalities to support muscle endurance and strength recovery, 12-20 RM

  • - Low load knee control (ensure optimal patellar tracking and VMO recruitment)

  • - OKC and CKC

  • - High load low volume RT for un-injured leg

  • - Electrical stimulation,

  • - Cross-education

  • - Optimal preparation to reduce AMI – cryotherapy, massage, stretching, pre-activation, TENS

  • - Non-load bearing lumbopelvic exercises to re-activate local core stability system
3 9-12

  • - Muscle hypertrophy and knee extensor strength recovery to within 20% of contralateral limb

  • - Moderate to high volume of low and moderate intensity RT (6-10 sets of 8-12 RM) across at least 2 exercises (OCK and CKC)

  • - Low load (plus BFRT) and moderate load RT). Example, 3 sets of knee extensions and 6 sets leg press with either BFRT or electrical stimulation

  • - Electrical stimulation

  • - BFRT

  • - Cross-education

  • - Weight-bearing and non weight-bearing lumbo-pelvic control and strengthening exercises
4 13-18

  • - Maximise muscle strength to within 10% of ‘trained’ contralateral limb

  • - Develop CKC maximal strength (iso, ecc, con)

  • - Develop functional strength

  • - Develop landing / deceleration control

  • - Moderate to heavy load isolated RT (OKC and CKC, 5-10 RM) of moderate volume

  • - Functional RT (6-12 RM)

  • - Motor pattern training

  • - Bilateral landing drills/ running initiation

  • - Squat and derivatives

  • - Deadlift and derivatives

  • - UL and BL

  • - Isolated – Knee extension, leg press

  • - On-field running and deceleration drills

  • - Optimal preparation (warm up, massage, stretching, pre-activation)

  • - Optimal technique in functional exercises

  • - Biofeedback in movement training

  • - Core stability training
5 19-24+

  • - Restore/ develop explosive neuromuscular performance

  • - High intensity, low volume neuromuscular conditioning

  • - Heavy load functional RT (3-8RM)

  • - Power training

  • - Agility exercises on-field

  • - Functional RT

  • - Plyometrics

  • - Ballistics

  • - Olympic lifts

  • - OFR

  • - Optimal warm up and training prescription

AMI = arthrogenic muscle inhibition; CKC = closed kinetic chain; OKC = open kinetic chain; iso = isometric; ecc = eccentric; con = concentric; BFRT = blood flow restriction training; POLICE = protection, optimal loading, ice, compression and elevation; RM = repetition maximum; BL = bilateral; UL = unilateral; OFR = on-field rehabilitation; TENS = transcutaneous electrical stimulation