Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines

Resistance training is critical for strength development and physical recovery after anterior cruciate ligament reconstruction (ACLR). Traditional percentage-based training (PBT) methods, which often focus on maximal strength and training to failure, are not able to objectify rapid force development...

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Main Authors: Nicky van Melick, Mario Bizzini, Alexandre Rambaud, Florian Forelli, Patrice Marine, Ayrton Moiroux-Sahraoui, Jean Mazeas, Mathias Thoelen, Bram Swinnen
Format: Article
Language:English
Published: BMJ Publishing Group 2025-04-01
Series:BMJ Open Sport & Exercise Medicine
Online Access:https://bmjopensem.bmj.com/content/11/2/e002503.full
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author Nicky van Melick
Mario Bizzini
Alexandre Rambaud
Florian Forelli
Patrice Marine
Ayrton Moiroux-Sahraoui
Jean Mazeas
Mathias Thoelen
Bram Swinnen
author_facet Nicky van Melick
Mario Bizzini
Alexandre Rambaud
Florian Forelli
Patrice Marine
Ayrton Moiroux-Sahraoui
Jean Mazeas
Mathias Thoelen
Bram Swinnen
author_sort Nicky van Melick
collection DOAJ
description Resistance training is critical for strength development and physical recovery after anterior cruciate ligament reconstruction (ACLR). Traditional percentage-based training (PBT) methods, which often focus on maximal strength and training to failure, are not able to objectify rapid force development. Velocity-based training (VBT), using movement velocity as a metric for training intensity, offers a promising alternative. This article promotes the use of VBT in ACLR rehabilitation, emphasising its potential to enhance neuromuscular recovery and return-to-sport outcomes. A narrative review of current literature focuses on mid- and late-stage rehabilitation to examine how VBT can address PBT limitations and improve functional recovery and sports performance. VBT provides several advantages, including real-time feedback, individualised load adjustments and better alignment with daily physiological variations. It facilitates the accurate training load prescriptions, enhances motivation and reduces unnecessary fatigue. Monitoring load–velocity profiles and velocity-loss thresholds enables more effective strength and hypertrophy adaptations without reaching muscular failure. In midstage rehabilitation, VBT not only helps to restore muscle strength and hypertrophy using submaximal loads and individualised velocity profiles but also addresses unwanted neuroplasticity following ACLR by providing augmented feedback and facilitating an external focus. In late-stage rehabilitation, VBT focuses on improving explosive strength and power, crucial for sports performance. Despite its benefits, VBT application in rehabilitation is limited by a lack of data on injured populations and specific exercises, such as open-chain single-joint movements. Integrating VBT allows practitioners to enhance traditional rehabilitation protocols, potentially leading to better clinical outcomes and providing a more personalised rehabilitation process.
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spelling doaj-art-ee1c2ca827b84528a90f3c89dee819a32025-08-20T03:52:29ZengBMJ Publishing GroupBMJ Open Sport & Exercise Medicine2055-76472025-04-0111210.1136/bmjsem-2025-002503Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelinesNicky van Melick0Mario Bizzini1Alexandre Rambaud2Florian Forelli3Patrice Marine4Ayrton Moiroux-Sahraoui5Jean Mazeas6Mathias Thoelen7Bram Swinnen8Sports and Orthopedics Research Center, Anna Hospital, Geldrop, The Netherlands1 Research, Schulthess Clinic Human Performance Lab, Zürich, Switzerland2Société Française des Masseur-Kinésithérapeutes du Sport, La Talaudière, FranceOrthopedic Surgery, Ramsay General Health Group, Domont, FranceOrthosport Rehab Center, Domont, FranceOrthopedic Surgery, Ramsay General Health Group, Domont, FranceOrthopedic Surgery, Ramsay General Health Group, Domont, FrancePhysical Therapy, Anna TopSupport, Eindhoven, The NetherlandsIntegrated Performance Training, Hasselt, BelgiumResistance training is critical for strength development and physical recovery after anterior cruciate ligament reconstruction (ACLR). Traditional percentage-based training (PBT) methods, which often focus on maximal strength and training to failure, are not able to objectify rapid force development. Velocity-based training (VBT), using movement velocity as a metric for training intensity, offers a promising alternative. This article promotes the use of VBT in ACLR rehabilitation, emphasising its potential to enhance neuromuscular recovery and return-to-sport outcomes. A narrative review of current literature focuses on mid- and late-stage rehabilitation to examine how VBT can address PBT limitations and improve functional recovery and sports performance. VBT provides several advantages, including real-time feedback, individualised load adjustments and better alignment with daily physiological variations. It facilitates the accurate training load prescriptions, enhances motivation and reduces unnecessary fatigue. Monitoring load–velocity profiles and velocity-loss thresholds enables more effective strength and hypertrophy adaptations without reaching muscular failure. In midstage rehabilitation, VBT not only helps to restore muscle strength and hypertrophy using submaximal loads and individualised velocity profiles but also addresses unwanted neuroplasticity following ACLR by providing augmented feedback and facilitating an external focus. In late-stage rehabilitation, VBT focuses on improving explosive strength and power, crucial for sports performance. Despite its benefits, VBT application in rehabilitation is limited by a lack of data on injured populations and specific exercises, such as open-chain single-joint movements. Integrating VBT allows practitioners to enhance traditional rehabilitation protocols, potentially leading to better clinical outcomes and providing a more personalised rehabilitation process.https://bmjopensem.bmj.com/content/11/2/e002503.full
spellingShingle Nicky van Melick
Mario Bizzini
Alexandre Rambaud
Florian Forelli
Patrice Marine
Ayrton Moiroux-Sahraoui
Jean Mazeas
Mathias Thoelen
Bram Swinnen
Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines
BMJ Open Sport & Exercise Medicine
title Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines
title_full Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines
title_fullStr Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines
title_full_unstemmed Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines
title_short Velocity-based training in mid- and late-stage rehabilitation after anterior cruciate ligament reconstruction: a narrative review and practical guidelines
title_sort velocity based training in mid and late stage rehabilitation after anterior cruciate ligament reconstruction a narrative review and practical guidelines
url https://bmjopensem.bmj.com/content/11/2/e002503.full
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