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. 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.