For a long time, early loading after ACL reconstruction (ACLR) has been treated with caution — sometimes excessive caution. The fear of harming the graft, increasing pain, or provoking swelling often leads to overly conservative rehab in the early weeks.

But early loading, when done intentionally and strategically, is not reckless. It is one of the most powerful tools we have to restore movement confidence, muscle function, and long-term capacity.

If you want to learn more about this topic, you can watch Nicole Surdyka's lecture here:

Click here

Early loading is not about doing more
A common misconception is that early loading means pushing harder or progressing faster.
In reality, early loading is about:

• Respecting tissue healing timelines

• Understanding arthrogenic muscle inhibition (AMI)

• Managing pain and swelling

• Choosing the right type of load at the right time

Why early loading matters after ACLR

After surgery, poor quadriceps activation and limited ROM are rarely a problem of effort. They are largely driven by:
• Pain and joint effusion
• Neural inhibition
• Fear and loss of movement confidence

Avoiding load completely can actually prolong these issues.

Strategic early loading helps:
• Restore quad force production
• Reduce arthrogenic muscle inhibition 
•Improve ROM tolerance
• Prevent excessive deconditioning

3 Key Strategies for Early Loading After ACLR

1. AlterG: Manipulating Load Intelligently

When full bodyweight is not tolerated, tools like the AlterG :
• Reduce effective bodyweight
• Maintain movement quality
• Progress walking, jogging, or hopping earlier
This keeps movement patterns alive while respecting current capacity.

2. Blood Flow Restriction (BFR)

In the early stages post-ACLR, external load is often restricted.
BFR allows:
• Muscle hypertrophy and strength stimulus at low loads
• Reduced atrophy during protected phases
• Earlier engagement of the quadriceps

3. Isometrics

Isometric contractions are one of the most underappreciated early loading tools.
They allow:
• High muscle activation with minimal joint movement
• Safer force production when ROM is limited
• Reduced pain through neural mechanisms

Monitoring Response: 

Early loading only works when response is monitored.
Key markers to track:
• Pain during and after sessions
• Joint effusion
• ROM changes
• Quality of movement

If you want to learn more about this topic, you can watch Nicole Surdyka's lecture here:

Click here

Source:
From the lecture ‘Early Post-Op Rehab After ACL Reconstruction’