Many clinicians face questions about managing fatigue and optimizing recovery during long-term rehab, especially after ACL injuries. One common question I field from student PTs during their clinical internships is whether “deload” weeks or days should be incorporated into a patient’s plan of care (POC). Here are my thoughts and considerations on this subject.
Should Deload Weeks Be Part of a Long- Term Rehab like ACL Rehab?
In short, the answer is yes—deload weeks can play a role in long-term rehabilitation. However, the extent to which they are implemented should be based on a variety of factors (intensity of training, frequency, volume, and density are all considerations). Let’s break down the key considerations.
Setting and Consistency in Care
Where you treat your athlete may impact how intentional you can be with deloading.
School or Professional Sports Settings: In these environments, athletes are surrounded by a well-structured support team, making it easier to implement a consistent POC. Deload weeks can be strategically placed because of the predictability and consistency in the athlete’s schedule. These athletes consistently train at higher intensities, volumes, and densities that may necessitate intentional deload periods.
Outpatient Setting: Here, you’re likely dealing with less control over the athlete’s schedule and visit consistency. Communication between you, the athlete, and any other healthcare/fitness professionals and coaches is crucial. While deloading is still valuable, it may be harder to plan without that consistency. You also have to consider whether you are truly achieving a high enough exercise prescription that necessitates intentional deload periods. Not all clinics are set up to achieve this level of workload. However, if the athlete is being co-managed by a strength and conditioning professional that you have a good relationship with it is a good idea to structure deloads.
When to Introduce Deload Weeks in the Context of ACL Rehab
I don’t feel that deload weeks are necessary until after the initial 12 weeks of rehab.
First 6-12 Weeks: Once initial symptom acuity is managed, we can begin preparing for impact and training to manage the forces associated with running. Intensity and training volume starts fairly low and builds during this phase. However, it is likely not high enough for any significant amount of time to necessitate a deload week.
Post 12-Week Phase: Once the athlete is running and handling more intense workloads, deload weeks become more beneficial. When introducing novel stimuli, a deload week can help the athlete adapt without risking overtraining or setbacks. If you plan to implement deload weeks or sessions a frequency of about every six weeks is probably adequate. These six week mesocycles allow enough time for adaptations to occur and intensity/volume to build to necessitate a deload week. This will provide structure to your plan, and will make you intentional with what adaptations you are aiming to gain. (max strength, power, elasticity, conditioning stimuli, etc.)
Type of Periodization in Rehab
The type of periodization that you use can also influence when and how and when you implement a deload week.
Linear is appropriate for the vast majority of individuals, especially those that have lower training age or are just looking for more general physical preparation. However, you can’t do linear increases in load for forever without taking some time to deload an individual.
Undulating periodization has natural deloading built into programming as the intensity and/or volume will, as the name suggests, undulate during microcycles. As your athlete achieves higher workloads they may benefit from this. For example, an athlete is coming in 2x/week.
If they are a high output athlete, they may benefit from a “high day” and “low day” structure. On high days, push the bill a bit more. On low days, slightly pull back the loading. This allows time for recovery between the highest output days and enough time for proper adaptations to occur. This will naturally protect against developing subsequent issues and “under recovery injuries” (overuse injuries).
Either way you will have to consciously implement deload periods when you have higher consistency and intensity in a plan of care over longer stretches.
Natural Breaks in Training
With long-term rehabs, it’s important to be flexible. Athletes will have natural breaks in their training, whether it’s due to holidays, vacations, or unforeseen circumstances. These can serve as organic deload weeks. Instead of rigidly sticking to a plan, consider adjusting your rehab to incorporate these breaks naturally.
Conclusion
Deloading in ACL and long-term rehab can be a highly effective when implemented at the right time and setting. For school or pro-level athletes with consistent care and higher stimulus training, deloads can be integrated more systematically. In outpatient care, structured deload weeks may not be as necessary because you have less control over the consistency of the POC. Regardless, the more consistent the plan of care at higher intensities for longer stretches of time, the more deliberate you will have to be with the implementation of deload sessions/weeks.
Remember, flexibility is key in long-term recovery. Natural breaks in the athlete’s schedule can be just as valuable as planned deload weeks.
Interested in learning ways track workload in a program? Check out this blog post “Acute to Chronic Workload: A Demonstration”
