Periodization in Anterior Cruciate Ligament Rehabilitation: New Framework Versus Old Model? A Clinical Commentary

The physiological and psychological changes after anterior cruciate ligament reconstruction (ACLR) do not always allow a return to sport in the best condition and at the same level as before. Moreover, the number of significant re-injuries, especially in young athletes should be considered and physical therapists must develop rehabilitation strategies and increasingly specific and ecological test batteries to optimize safe return to play. The return to sport and return to play of athletes after ACLR must progress through the recovery of strength, neuromotor control, and include cardiovascular training while considering different psychological aspects. Because motor control seems to be the key to a safe return to sport, it should be associated with the progressive development of strength, and cognitive abilities should also be considered throughout rehabilitation. Periodization, the planned manipulation of training variables (load, sets, and repetitions) to maximize training adaptations while minimizing fatigue and injury, is relevant to the optimization of muscle strengthening, athletic qualities, and neurocognitive qualities of athletes during rehabilitation after ACLR. Periodized programming utilizes the principle of overload, whereby the neuromuscular system is required to adapt to unaccustomed loads. While progressive loading is a well-established and widely used concept for strengthening, the variance of volume and intensity makes periodization effective for improving athletic skills and attributes, such as muscular strength, endurance, and power, when compared with non-periodized training. The purpose of this clinical commentary is to broadly apply concepts of periodization to rehabilitation after ACLR.