Unfortunately, sometimes we come face to face with patients who have a rather long road ahead of them when it comes to returning to their pre-injury status. An ACL or Achilles reconstruction for example. This means a longer period for them to be vigilant, compliant and motivated with their session attendance, exercise and management techniques in and away from face-to-face sessions. I for one know that if I was placed in this scenario, I would find it tough to keep the same level of determination to adhere to my programme from beginning to end. So, can we use a little something to aid this lengthy process for our patients which will not negatively impact their progress? In my opinion, yes. Deloading.
Bell et. al (2023) (1) define ‘Deloading’ as a period of reduced training stress designed to mitigate physiological and psychological fatigue, promote recovery, and enhance preparedness for subsequent training.
In the realm of sports rehabilitation, the concept of deload periods has gained significant traction as an approach to managing and enhancing recovery from injuries. Deload periods, often implemented within a structured rehabilitation program, involve a planned reduction in exercise intensity and or volume. This technique is particularly beneficial in long-term recovery processes, offering numerous physiological and psychological benefits that can expedite healing and improve overall outcomes
The primary physiological benefit of deload periods is the mitigation of overtraining and excessive fatigue (Rogerson et.al 2024) (5). During a prolonged rehabilitation process, continuous high-intensity training can lead to increased stress on the injured tissues, potentially exacerbating the injury or slowing down the healing process. By incorporating deload periods, the body is afforded the necessary time to recover and adapt to the rehabilitation exercises without being overwhelmed by continuous strain.
Deload periods can also play a crucial role in preventing the risk of re-injury. As targeted structures are gradually strengthened during rehabilitation, they require adequate rest to fully recover and adapt to the increased loads. Without sufficient recovery, these structures remain vulnerable to further damage. As per Mosewich, Kent and Kowalski (2013) (4) deloading helps ensure that the healing tissues are not subjected to undue stress, thus reducing the likelihood of setbacks.
Additionally, deload periods facilitate metabolic recovery. Intense exercise sessions can deplete glycogen stores, disrupt hormonal balances, and lead to an accumulation of metabolic byproducts. A period of reduced training intensity allows for the replenishment of glycogen stores, normalization of hormone levels, and clearance of metabolic waste, thereby optimizing the body’s readiness for subsequent training phases (Ivy 2004) (3).
Beyond the physiological advantages, deload periods offer substantial psychological benefits that are vital for a successful rehabilitation journey. Long-term injury recovery can be mentally taxing, often leading to feelings of frustration, anxiety, or even burnout. Scheduled deload periods provide individuals with a break, helping to alleviate mental fatigue and maintain motivation throughout the rehabilitation process. It is a well-known fact that within elite sport it is common for a player to be advised to go away to somewhere warm to put their feet up for 7-10 days at a certain stage of their recovery. This gets the player away from the current rehabilitation setting, enabling them to switch off mentally and relax.
The psychological relief afforded by deload periods also promotes adherence to the rehabilitation program (Bell et. al 2022) (2). Consistently high levels of training intensity can lead to a sense of dread or reluctance towards rehabilitation sessions. By incorporating periodic reductions in training demands, individuals are more likely to remain engaged and committed to their recovery plan, ultimately leading to better long-term outcomes
The implementation of deload periods within a rehabilitation program should be tailored to the individual’s specific injury, recovery progress, and overall training load. Generally, deload periods are scheduled every 6-8 weeks, but this can vary based on the intensity and frequency of the rehabilitation exercises. Monitoring the patient’s feedback, progress, and any signs of overtraining or fatigue can help in deciding the optimum time for this process also. During a deload week, exercise intensity and volume are typically reduced by 50-70%, allowing the body ample time to recover without completely halting progress.
So, I think based on the above, it is safe to say that as therapists we should very much consider the implementation of the deload principle into the rehabilitation plans of those patients who have a longer and slightly more mentally and physically testing battle ahead. It is a big part of our role to support our patient’s and to keep them on the right track. Sometimes that may mean periodically seeing them and doing less to achieve more down the line.
Reference List
- Bell, L., Ben William Strafford, Coleman, M., Patroklos Androulakis-Korakakis and Nolan, D. (2023). Integrating Deloading into Strength and Physique Sports Training Programmes: An International Delphi Consensus Approach. Sports Medicine – Open, 9(1). doi:https://doi.org/10.1186/s40798-023-00633-0.
- Bell, L., Nolan, D., Immonen, V., Helms, E., Dallamore, J., Wolf, M. and Androulakis Korakakis, P. (2022). ‘You can’t shoot another bullet until you’ve reloaded the gun’: Coaches’ perceptions, practices and experiences of deloading in strength and physique sports. Frontiers in Sports and Active Living, [online] 4. doi:https://doi.org/10.3389/fspor.2022.1073223.
- Ivy JL. Regulation of muscle glycogen repletion, muscle protein synthesis and repair following exercise. J Sports Sci Med. 2004 Sep 1;3(3):131-8. PMID: 24482590; PMCID: PMC3905295.
- Amber D. Mosewich , Peter R.E. Crocker & Kent C. Kowalski (2013): Managinginjury and other setbacks in sport: experiences of (and resources for) high-performance women athletes, Qualitative Research in Sport, Exercise and Health, DOI:10.1080/2159676X.2013.766810
- Rogerson, D., Nolan, D., Korakakis, P.A. et al. Deloading Practices in Strength and Physique Sports: A Cross-sectional Survey. Sports Med – Open 10, 26 (2024). https://doi.org/10.1186/s40798-024-00691-y
