The Problem With Physical Therapy

Traditional physical therapy has a problem when it comes to getting people stronger. Most providers, especially during ACL rehabilitation do not use adequate resistance or stress to make the body more durable. This is a problem because tissue adaptation occurs when you progressively load tissue to see a change. For our specific clientele, depending on where you are in the ACL rehabilitation timeline, strengthening the quads and hamstrings are key. This could set someone behind in rehabilitation and not give them the confidence when attempting higher level activity. In this article we’re going to discuss some strategies to consider when attempting to get stronger during the recovery process.    

What is Strength

Strength is the ability to produce force. There are different ways to express strength and it can be produced at different velocities. The biggest factor behind strength is understanding the intent behind strength. If you are looking to get faster you can move moderate loads at a faster speed. If the intent is to improve the amount of force produced then you need to move progressively heavier loads with adequate rest time in between sets.

Strength and ACL Rehabilitation 

In the mid-to-late stages of ACL rehabilitation the goal is to produce more force. Therefore, 4-5 sets of 8-12 repetitions with progressively heavier load is ideal. We utilize the concept of repetitions-in-reserve to determine if a client is adequately challenged. This means after a set of squats for example, if a client states they could perform 8 more repetitions, the load is not enough. We typically utilize 2-3 repetitions-in-reserve. 

Why This Matters

Being underloaded during physical therapy will not create tissue adaptation. The soreness and fatigue you feel after a good workout is a form of tissue adaptation. This means muscles are rebuilding to become stronger. This is a key aspect of a successful outcome during ACL rehabilitation. It takes weeks to months in order to see consistent strength gains and adaptation. If you are consistently performing the same exercises with the same weights, at the same speed, you will not get stronger. 

The MANA Difference

We have the time and expertise to utilize the concept of repetitions-in-reserve to determine whether or not we are adequately loading our clients. At MANA Performance Therapy we will objectively test strength either using a 3 repetition maximum test or inline dynamometry when it is appropriate. Progressive overload is needed to see adaptation and allows our clients to reach their goals.


Underloading is a problem in the PT community. Far too often athletes are being chronically underloaded. To truly strain tissue you need to be working at 4-5 sets with 8-12 repetitions. Utilizing repetition-in-reserve can be a helpful way to gauge whether or not you need to increase weight. Tissue adaptation happens when you have a plan and properly load. This will lead to a successful outcome for ACL rehabilitation. Let us know if you have questions on how to integrate these strategies into your rehabilitation!