Strength and power training in rehabilitation: underpinning principles and practical strategies to return athletes to high performance

Key points

1. 01Residual deficits in maximal strength, rate of force development (RFD), and reactive strength persist after common musculoskeletal injuries including ACLR, hamstring strain, Achilles tendinopathy, and patellofemoral pain.
2. 02Maximal strength training (80-100% 1RM, 1-6 reps, 3-5 sets, 3-5 min rest, 2-3 times per week) is the foundation; athletes who cannot back squat at least 1.6 times body mass benefit most from prioritising maximal strength before ballistic power training.
3. 03RFD deficits are clinically important because non-contact ACL tears occur in less than 50 ms, yet the quadriceps requires more than 300 ms to reach peak torque, highlighting the gap that standard rehabilitation does not address.
4. 04Reactive strength and stretch-shortening cycle (SSC) capacity should be progressively restored via plyometric training using a 4-phase model, with attainment of adequate maximal strength as a prerequisite.
5. 05Return-to-play criteria should assess maximal strength, RFD, reactive strength, and power across the full force-velocity curve in multiple planes, not time-based or single-velocity strength measures alone.

How it was conducted

Design

Narrative review article

Topic scope

Strength and power training principles for musculoskeletal injury rehabilitation in athletic populations

Injuries covered

ACLR, hamstring strain, Achilles tendinopathy, patellofemoral pain, groin pain, ankle sprain, meniscectomy

Key constructs

Maximal strength, rate of force development (RFD), reactive strength index (RSI), force-velocity curve, stretch-shortening cycle

Practical output

Staged exercise prescription tables for post-ACLR and Achilles tendinopathy rehabilitation over 12-16 weeks

What they found

• Athletes who back squat greater than 2 times body mass benefit more from ballistic power training, while those below 1.6 times body mass benefit more from maximal strength training (Cormie et al., cited).
• An individualised force-velocity profile training programme improved jumping performance by 12.0 +/- 5.6% (ES 1.26), 11.1 +/- 5.8% (ES 0.81), and 7.2 +/- 4.5% (ES 0.36) in velocity-deficit, force-deficit, and well-balanced groups respectively, compared to traditional training (Jimenez-Reyes et al., cited).
• Return to competitive sport after ACLR is achieved in only 44-55% of athletes despite an overall return-to-sport rate of 65-88% (Ardern et al., cited).
• 85% of ACLR studies used time-based measures as return-to-sport criteria; strength criteria were reported in 41% of studies and physical performance-based criteria in only 20% of studies.
• Strength training can reduce sports injuries by one third and overuse injuries by almost half (Lauersen et al., cited).
• Significant deficits in RFD were found at 6 months post-ACLR in professional soccer players who had achieved near-full recovery on IKDC, Tegner, KT-1000 and MVIC measures (Angelozzi et al., cited).
• Quadriceps RFD deficits were demonstrated at 6 months post-ACLR with patellar tendon autograft (Kline et al., cited).

Limitations

• The article is a narrative review and does not perform a systematic search or meta-analysis, so the evidence synthesis may be subject to selection bias.
• Much of the cited rehabilitation research uses lighter loads (often described as 80% 1RM but with high rep ranges such as 15 x 3) without clear load details, limiting direct prescription translation.
• The specific numerical benchmarks cited (e.g. 1.6 times body mass squat threshold) derive from studies in non-injured athlete populations and may not directly apply to rehabilitating patients.
• No formal assessment of the risk of bias of included studies is provided, and many cited findings come from small observational cohorts.

Why it matters

For patients

Athletes returning from injury need more than pain-free movement - targeted strength, explosive force, and reactive strength testing should confirm readiness before unrestricted sport return.

For clinicians

Rehabilitation programmes should progress through periodized maximal strength, RFD, and plyometric phases, using evidence-based load prescriptions rather than defaulting to low-load high-rep schemes.

For readers

This review provides a practical framework linking sports science physiology to clinical rehabilitation, useful for physiotherapists and strength and conditioning coaches working with athletic populations.