Eccentric cycling for ACL-R rehabilitation: A masterclass

Eccentric training is a well-established method for developing strength and its implementation has become increasingly common in anterior cruciate ligament reconstruction (ACL-R) rehabilitation. Although traditionally introduced in later stages of recovery, early progressive eccentric exercise has been investigated from approximately three weeks post-operation in selected patients, with evidence suggesting potential benefits for quadriceps atrophy and strength deficits. Beyond improving strength, eccentric training may also enhance performance in return-to-sport (RTS) assessments. However, its implementation should be gradual and individualized, with consideration of clinical status and loading tolerance, particularly during the early phases of rehabilitation. Eccentric recumbent cycling offers a practical solution, allowing clinicians to monitor power outputs and regulate intensity through rate of perceived exertion (RPE) scales. This article explores the benefits of integrating eccentric cycling into ACL-R rehabilitation and outlines an exemplar eccentric cycling program.