Philosophy only matters if it translates into action. The Elevate Loading Ladder is the practical framework that allows us to apply progressive strength training throughout the rehab process.
It consists of five levels and two parallel threads, each addressing different but complementary aspects of initially developing stress capacity and latterly restoring and improving function.
The Two Threads of the Loading Ladder
1. Injury-Specific Isometrics – this thread addresses athlete’s software (neuromuscular system), specifically:
– Rate of force development
– Maximal force output
2. Dynamic Exercises – this thread addresses athlete’s hardware (muscle-tendon units), specifically:
– Maximal force output (primarily via increases in muscle fibre cross-sectional area)
– Enhanced tissue robustness (via improved MTU architecture)
Now let’s explore one example of how we can apply the loading ladder framework in the context of quadricep/knee-injury rehabilitation…
Level 1 – Acute Phase: “Stop the Drop”
Isometrics:
Single-leg swiss ball leg extension build (typically performed @ 4–6/10 RPE)
Compound & Isolation:
Single-leg BFR mini-band leg extension
This level coincides with the acute phase of rehab. Once we are comfortable that the athlete is ready to return loading, we introduce a mechanical stimulus that aims to promote more meaningful activation & recruitment, whilst continuing to respect tissue healing constraints.
BFR allows us to enhance the potency of low-load resistance training by increasing the metabolic stress and, in-turn, muscle activation, reducing the mechanical strain on injured tissue/joints while helping preserve muscle mass and neural drive i.e. “stopping the drop” (Hughes et al., 2017).
Level 2 – Early Phase: Building Capacity
Isometrics:
Single-leg leg extension hold (typically performed over 30-40s)
Compound & Isolation:
Single-leg leg extension
Our level 1 isotonics are initially prescribed with higher rep ranges (8-12 reps) at lower intensities (%1RM) before gradually shifting to more traditional “strength” ranges (5-6 reps) at higher intensities.
This stage prioritises building muscular endurance/work capacity and increasing force tolerance. The longer duration isometric holds improve sustained force output, while isotonic work builds strength through range.
Level 3 – Early Phase 1: Increasing Force & Intent
Isometrics:
Single-leg leg extension ramp (typically performed as a 3-5s build into a 3-5s push @ maximal intent)
Compound & Isolation:
Single-leg leg press
Initially, our top-set and back-off structures allow athletes to experience high mechanical tension through heavy loads during their top set(s) whilst also accumulating volume at reduced intensities in their back-offs. This ensures a blend of mechanical and metabolic stress to achieve high levels of recruitment within as many muscle fibres as possible.
We then look to progress further using cluster training. This is where short intra-set rest periods are introduced, which allows high force outputs to be maintained with reduced metabolic fatigue. This is particularly valuable in rehab, as it allows us to accumulate more reps at higher intensities as well as preserving intent and technical execution (Tufano et al., 2017).
Level 4 – Mid Phase 1: Overloading Strength through Range
Isometrics:
Single-leg leg extension push (typically performed as hard and as fast as possible over 3-6s)
Compound & Isolation:
2:1 AEL leg extension
At level 4 of the loading ladder we introduce accentuated eccentric loading. In order to do this, athletes are required to perform the concentric portion of their lift with both legs, before performing the eccentric portion with just one. This offers exposure to loads that exceed their single-leg concentric capacity to achieve “supramaximal” levels of mechanical tension, relative to what could be achieved with traditional isotonic lifting, and therefore enhanced adaptation (Douglas et al., 2017).
We combine this with pushing (or overcoming) isometrics with the aim of developing maximal force output and rate of force development. Typically we perform these through a variety of ranges, given the specificity of those adaptations to the joint angles in which the exercise is performed.
Level 5 – Mid Phase 2: Bullet-Proofing for Speed and Chaos
Isometrics:
Single-leg trap bar catch
Compound & Isolation:
Manual eccentric single-leg leg extension
We’ve now reached the summit of the loading ladder, which features some of the most potent training tools in our arsenal. Manual eccentric loading allows force to be graded precisely (matching the length–tension relationship of the target muscle) to achieve the highest possible force outputs across the full range of motion.
Reflexive eccentrics require high rates of force development and offer tissue-specific jerk, providing essential preparation for sprinting, cutting and reactive sporting actions.
Final Thoughts
The Loading Ladder ensures that every increase in stress is matched by a corresponding increase in capacity. By progressing force, speed and complexity in a structured way, we reduce re-injury risk and prepare athletes not just to return, but to thrive.
References
Douglas, J., Pearson, S., Ross, A., & McGuigan, M. (2017). Chronic adaptations to eccentric training: a systematic review. Sports Medicine, 47(5), 917-941.
Hughes, L., Paton, B., Rosenblatt, B., Gissane, C., & Patterson, S. D. (2017). Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. British Journal of Sports Medicine, 51(13), 1003-1011.
Tufano, J. J., Brown, L. E., & Haff, G. G. (2017). Theoretical and practical aspects of different cluster set structures: a systematic review. The Journal of Strength & Conditioning Research, 31(3), 848-867.
About The Author
Chris Bakker
Head of Performance Systems
Chris spent over a decade working in professional football and rugby, most recently playing a major role in Bath Rugby’s historic treble-winning season – their most successful in the professional era. With a deep background in performance science, systems design, and athlete support, Chris strives to ensure no stone is left unturned when it comes to returning athletes back to peak performance.
About Us
At Elevate: Speed & Rehab, we specialise in Performance Rehab for athletes dealing with ACL, hamstring, calf, ankle, hip & groin injuries; helping you reduce recovery time and get back performing at your best, and beyond. Whether you’re an athlete looking for expert sports rehabilitation, or a coach or physio wanting to develop your practice, we’ve got you covered. Find out more by clicking here