Why Your Training Program Won’t Work Without Sleep, Nutrition, and Recovery

Why Your Training Program Won’t Work Without Sleep, Nutrition, and Recovery

Written by Evelyn Calado, MKin, CSCS, RKin

One of the hardest things for coaches to accept is this:

You can write the most detailed, individualized, evidence-informed training program possible, and it still may not work if the big rocks are not in place.

I’ve seen this over and over again throughout my coaching career.

The athlete is committed.
They show up consistently.
They follow the sets, reps, tempos, and rest periods.
They train hard.
They genuinely want results.

But outside the gym?

They’re sleeping five hours a night.
Their stress is through the roof.
They barely drink water.
Their nutrition is inconsistent.
They rely on caffeine to survive the day and supplements to try to “fix” the problem.

At some point, the body stops being able to recover.

And recovery is where adaptation actually happens.

You Don’t Get Better During Training

Training is the stimulus.

Recovery is where the body adapts.

That means if you’re constantly exhausted, under-fueled, dehydrated, stressed, or running on poor sleep, your body has a much harder time repairing tissue, building muscle, improving conditioning, regulating hormones, and recovering from the demands of training.

This is one of the reasons why two people can follow the exact same program and get completely different results.

The program matters.

But the foundation matters more.

This is also why progress in strength, muscle growth, and conditioning often takes longer than people expect. Adaptation requires recovery capacity. How Long Does It Take to See Results from Training

Sleep Is One of the Biggest Performance Enhancers We Have

This is probably the most common issue I see.

People want better energy, better recovery, improved body composition, more muscle mass, lower pain levels, and better athletic performance, but they’re sleeping poorly every single night.

If you constantly wake up throughout the night, struggle with insomnia, or spend most of your day exhausted, your recovery capacity drops significantly.

Sleep impacts:

• Recovery from training

• Muscle repair and growth

• Hormonal regulation

• Mood and mental health

• Pain sensitivity

• Cognitive function

• Energy levels

• Immune function

You cannot out-train chronic poor sleep.

And no supplement stack is going to replace it.

Recovery Is More Than Just Taking a Rest Day

A lot of people think recovery simply means taking a day off from training.

But recovery is much bigger than that.

Recovery includes:

• Sleep quality

• Nutrition

• Hydration

• Stress management

• Recovery between training sessions

• Nervous system regulation

• Overall lifestyle habits

You cannot continuously add more stress to the system without giving the body the resources it needs to recover and adapt.

Sometimes the issue is not the program itself.

Sometimes the body simply has no remaining capacity to tolerate additional stress.

Stress Is Still Stress

This is another major piece people underestimate.

Your body does not separate “life stress” from “training stress.”

Heavy training is a stressor.
Long work hours are a stressor.
Financial pressure is a stressor.
Relationship issues are a stressor.
Anxiety is a stressor.

It all contributes to your total stress load.

One book I often recommend is the Why Zebras Don't Get Ulcers by Robert Sapolsky, which discusses how humans often stay stuck in a chronic fight-or-flight state.

A lot of people are constantly “on.”

Their nervous system never really gets a chance to downshift.

Then they wonder why they feel exhausted, inflamed, sore, unmotivated, or unable to recover.

Nutrition Is Not Optional

You cannot build a high-performing body without giving it the raw materials it needs.

Protein matters.
Micronutrients matter.
Overall calorie intake matters.
Hydration matters.

If most of your diet consists of highly processed foods, takeout, chips, candy, and energy drinks, your recovery, energy levels, body composition, and performance are going to suffer.

That does not mean you need to eat “perfectly.”

But your body still needs adequate nutrients and amino acids to:

• Build and maintain muscle

• Recover from training

• Support connective tissue health

• Improve body composition

• Regulate energy levels

• Support overall health and longevity

Supplements can support a good foundation.

They cannot replace one.

Creatine is great.
Protein powder can be helpful.
Certain supplements absolutely have value.

But supplements cannot compensate for chronic sleep deprivation, poor nutrition, dehydration, and unmanaged stress.

If you want a deeper breakdown on the supplements that actually matter most for recovery and performance, check out The Only Two Supplements Most Athletes Actually Need.

Hydration Is More Important Than People Think

This is another one that gets overlooked constantly.

The number of people I meet who drink one or two glasses of water per day is honestly surprising.

Many people function almost entirely on coffee and caffeine.

Hydration impacts:

• Performance

• Recovery

• Energy

• Cognition

• Joint comfort

• Muscle function

• Cardiovascular function

Even mild dehydration can negatively affect how you feel and perform.

Coaches Cannot Do The Work For You

As coaches, we can guide you.
We can educate you.
We can build individualized programs.
We can adjust your training loads.
We can help create structure and accountability.

But we cannot sleep for you.
We cannot manage your stress for you.
We cannot hydrate for you.
We cannot make your nutritional choices for you.

If we see you twice per week in person, that’s two hours out of a 168-hour week.

The other 166 hours matter.

A lot.

This is one of the reasons why our initial assessment process focuses on more than just exercises and sets and reps. Understanding lifestyle, recovery, stress, injury history, and daily habits matters when building an individualized plan. What Actually Happens During an Initial Assessment?

The Big Rocks Come First

People often search for advanced solutions before they’ve mastered the fundamentals.

They want the perfect program.
The perfect supplement stack.
The perfect recovery gadget.
The perfect optimization strategy.

Meanwhile:

• They sleep poorly

• They are chronically stressed

• They barely eat protein

• They drink almost no water

• They recover inconsistently

The basics are not boring.

The basics are foundational.

And honestly, these “big rocks” are not just important for performance or body composition goals. They are fundamental for living a healthier, more energetic, and more resilient life.

That’s one of the reasons why strength training and recovery habits become increasingly important as we age. Strength Training for Longevity: Staying Active, Capable and Competitive as You Age

Training matters.
Strength matters.
Conditioning matters.

But none of it works as well if the foundation underneath it is unstable.

Get the big rocks in place first.

Everything else works better after that.

At Avos Strength, we focus on individualized coaching that takes into account your training history, recovery capacity, lifestyle, stress levels, and long-term goals. Training is important, but sustainable progress comes from addressing the full picture.

If you’re looking for guidance with strength training, recovery, performance, or long-term health, you can learn more about our coaching and assessment services here.

Frozen Shoulder: Unravelling the Complexities and Providing Clarity

Written by Michael Crawley, BSc, BPT, CSCS

Nearly 100 years ago, Earnest Codman coined the term “frozen shoulder” and highlighted three clinical issues (Salamh et al. 2025):

• Difficult to define

• Difficult to treat

• Difficult pathology to explain to patients

Those three points still hold true today.

Multiple structures and pathological findings have been implicated in the development of frozen shoulder. This includes the accumulation of immune system mediators, thickening of ligaments, and altered collagen translation (Pandey and Madi 2021). Clinically, this presents as a shoulder with reduced range of motion in both active and passive flexion, abduction, and external rotation (as seen in the image below).

Figure 1: Reduced Shoulder range of motion (ROM) with frozen shoulder

The Real Impact of Frozen Shoulder

A scoping review examining how people experience and live with frozen shoulder demonstrates how debilitating and impactful the condition can be. King and Hebron (2023) identified five major themes:

1. “Dropping me to my knees, due to the pain”

2. Struggle for normality

3. Emotional change for self

4. Challenges through the healthcare journey

5. Coping & adapting

This highlights that frozen shoulder is not just a physical limitation. It can significantly alter how someone functions and experiences their daily life.

Unfortunately, frozen shoulder demonstrates a bias towards a particular demographic. Females in the 40–60 age category take the brunt of diagnoses. To rub salt in the wounds, females are more likely to experience a more prolonged and symptomatic course compared to male counterparts.

Types of Frozen Shoulder

Frozen shoulder can be broadly classified into two categories (Pandey and Madi 2021):

Primary:
A stiff shoulder developing with no known cause. However, there are commonly linked conditions, most notably diabetes mellitus and thyroid dysfunction. The incidence of frozen shoulder can reach as high as 30% in individuals with diabetes.

Secondary:
A stiff shoulder with an underlying cause such as direct trauma (e.g. a fall), infection, or inflammatory conditions.

The Three Stages of Frozen Shoulder

Frozen shoulder follows a series of stages, delineated by changing symptoms (Date and Rahman 2020). While approximate timelines are often attached, there is significant variability, and for some individuals, full resolution may not occur within 3–5 years.

Freezing Stage (Stage 1: 2–6 months)

• Predominantly characterised by moderate to severe pain and partial restriction of ROM

• Early stages may present with pain and only terminal loss of ROM

This stage can be confused with rotator cuff tendinopathy. However, ROM does not progressively worsen in tendinopathy, whereas it continues to worsen with each follow-up in frozen shoulder.

Frozen Stage (Stage 2: 4–12 months)

• Characterised by both pain and stiffness in varying proportions

• Early phase tends to be more pain-dominant

• Later phase becomes more stiffness-dominant

Thawing Stage (Stage 3: 6–26 months)

• Characterised by minimal pain

• Gradual resolution of stiffness

• Progressive return of movement

Pathologically, this reflects a gradual reduction in inflammation and restoration of movement.

Treatment and Management Across the Stages

What actually works, and when it matters

The research on the effectiveness of treatments for frozen shoulder remains conflicting. However, a conservative approach is typically recommended as the starting point (Date and Rahman 2020).

Common interventions include:

• Analgesics

• Physiotherapy

• Intra-articular injections

• Suprascapular nerve block

Early Stage: Movement Within Tolerance

In the early stage of frozen shoulder, gentle stretching and mobility exercises within a pain-free range are advised (Date and Rahman 2020).

Creativity can play a key role here, as Louis Gifford, the brilliant pain specialist, stresses. In his book Aches and Pains, he explains how adjusting body position can influence the amount of pain-free range available to a limb.

The videos below demonstrates this concept. The key idea is simple:

• The arm can move relative to the body

• Or the arm can stay fixed while the body moves around it

Shoulder Range of Motion Wall Drills:
https://youtu.be/9_GwO7r24hM

Passive and active-assisted exercises can also be incorporated. These reduce the working stress on affected structures, allowing the humerus to move through range without generating or exacerbating pain.

Active Assisted and Passive Shoulder:
https://youtu.be/072jZDVW-ac

As Pain Settles: Introducing Strength

As pain begins to reduce and become more manageable, strengthening exercises can be introduced.

Here, the principle that “the dose and position make the poison” becomes particularly relevant.

Using isometrics in varying positions and directions allows for global loading through the shoulder while staying within tolerable limits.

Entry Level Isometric:
https://youtu.be/mDzgyyKlzZo

Later Stages: What Are Mobilisations Actually Doing?

Mobilisations performed by a physiotherapist in the later stages have shown some utility. However, the mechanism behind their effectiveness is contested.

For many years, the prevailing thought was that inferior mobilisation directly impacted the shoulder joint capsule. However, Jeremy Lewis, a well-known Australian shoulder specialist, has pointed out that a physiotherapist would need to generate approximately 600kg of force to meaningfully affect the capsule.

I am not aware of many Canadians with a 600kg deadlift.

The best approach at this stage would be to continue to progress strength training through pain free range.

Injections and Medical Management: Timing Is Key

Outside of physiotherapy, injections and pharmacological treatments are often used.

Nonsteroidal anti-inflammatories have shown little impact in the case of frozen shoulder. Intra-articular steroid injections, however, have demonstrated positive effects, particularly when used at the right time.

Again, Jeremy Lewis stresses that these injections must be used in the early stages, when pain is highest. This reinforces the importance of early and accurate diagnosis.

A similar pattern is seen with suprascapular nerve blocks, which can also have a positive effect on pain relief when applied early (Date and Rahman 2020).

Surgical Options: Often Less Helpful Than Expected

Surgical options are available, but often yield little additional benefit.

Beard et al. (2018) found no clinically significant benefit of shoulder arthroscopy compared to sham surgery. This was further supported by the large UK FROST trial (Corbacho et al. 2021), which reported that early physiotherapy was more cost-effective and accessible compared to invasive and costly surgical approaches.

Interestingly, manipulation under anaesthetic, which previously had negative connotations, has shown some efficacy. This likely relates to the reduction of muscle guarding and tension that can develop with frozen shoulder. When under anaesthetic, this guarding effect is temporarily removed.

Looking Beyond the Shoulder

An important point that is often not expressed or evaluated in the research is that frozen shoulder may be a sign of broader health issues, stemming from multiple systems in the body.

In many cases, it can act as a wake-up call to incorporate strength and conditioning into your lifestyle and address other health metrics.

You may not be able to train the affected side in the same way, but there are still many full-body exercises that can be performed without exacerbating the shoulder:

• Towing a sled

• Belt squat

• Walking lunges

• Step-ups

Why This Matters

There are three key reasons why this approach is important:

1. Approximately 1 in 5 people go on to develop similar symptoms in the opposite shoulder (Pandey and Madi 2021)

2. Sedentary individuals are more likely to receive a frozen shoulder diagnosis

3. Well-designed strength and conditioning programs can positively influence the systems linked to frozen shoulder development, including endocrine, immune, and cardiovascular systems

Deeper Dive into Causation and Management

Recent research has continued to highlight the multi-faceted nature of frozen shoulder and the challenges associated with its management (Navarro-Ledesma 2025a).

This is not a condition driven by a single structure or isolated tissue. Instead, it reflects the interaction of multiple systems within the body.

The diagram below highlights this well. Rather than being caused by one specific issue, frozen shoulder appears to sit at the intersection of several physiological systems, all of which can influence one another.

Estrogen and Menopause

One of the more consistent patterns seen in the research is the increased prevalence of frozen shoulder in peri-menopausal women. This has led to estrogen being identified as a key player in its development (Wend et al. 2012).

As shown in figure below, estrogen has effects that extend well beyond the reproductive system. Its influence spans multiple systems that are directly relevant to frozen shoulder.

Neuroendocrine System

Declining estrogen levels can influence the nervous system through several mechanisms, impacting pain thresholds, resilience to stress, and central sensitisation.

A useful way to think about this is the “fire alarm” analogy.

You leave the bacon on the grill too long and the fire alarm goes off because of the smoke. There is no fire, but the system reacts as if there is.

With reduced estrogen levels, the threshold for triggering that “alarm” can become lower. The result is an amplified pain experience, even when the underlying tissue irritation may not fully justify it.

Metabolic System

Estrogen also plays a key role in fat metabolism, glucose regulation, and resistance to oxidative stress.

When these systems are disrupted, it can create an internal environment where tissue repair is compromised. This contributes to fibrosis, which is a hallmark of frozen shoulder.

Immune System

The same pattern continues within the immune system.

Declining estrogen levels tend to promote a more pro-inflammatory state. Immune system mediators accumulate within the tissues involved in frozen shoulder, and when combined with metabolic dysfunction, this can further drive the condition.

Targeting the System, Not Just the Shoulder

The research highlights how frozen shoulder is influenced by multiple systems, not just the shoulder itself. As a result, management is not limited to physiotherapy or surgical intervention alone.

There are a number of factors that could be explored here, but for the purpose of this piece, three of the more relevant and actionable areas will be discussed below.

Strength and Conditioning

Well-designed and properly implemented strength and conditioning programs have demonstrated positive impacts on estrogen levels, muscle mass, and fat mass in menopausal women (Razzak et al. 2019).

As mentioned previously, even with an impacted and painful shoulder, this does not mean avoiding training altogether or waiting for full resolution before doing anything.

The whole-body and multi-system benefits of strength training can influence long-term outcomes indirectly. While the shoulder itself may be limited, the broader physiological adaptations still matter.

Nutrition

Diet quality also plays a meaningful role.

A nutritional approach centred around higher-quality, minimally processed foods has been shown to impact symptom severity in individuals with frozen shoulder (Hamed-Hamed et al. 2026).

In practice, the decision to implement a structured strength training program often leads to improvements in other lifestyle behaviours, including dietary choices.

In the same way that hormonal, metabolic, and immune factors can drive the development of frozen shoulder, lifestyle decisions can push back against these drivers. This not only has the potential to improve current symptoms, but also to reduce the likelihood of future development.

Sleep and Circadian Rhythm

Circadian rhythm and sleep regulate inflammatory processes, hormonal release, and tissue repair (Navarro-Ledesma 2025a).

These are central to both general health and the development and recovery of frozen shoulder, as well as adaptation to strength training and exercise.

This is where the entanglement of systems becomes more apparent.

Bringing It Together

Sleep, exercise, and nutrition can be thought of as a three-legged stool. Each supports the others, and removing one weakens the entire system.

Addressing these factors will not provide an immediate solution to frozen shoulder. However, they can set the conditions for recovery and reduce the likelihood of recurrence, particularly when considering that approximately 20% of individuals will experience similar symptoms in the opposite shoulder.

Summary and Takeaways

Frozen shoulder is a systems issue, not just a joint problem

Frozen shoulder is not a local condition. It can have significant and long-term effects on both physical and psychological well-being.

In some cases, it can be so debilitating that it alters how an individual functions day to day. That may sound hyperbolic, but when revisiting the five themes outlined earlier, alongside the number of systems involved, it becomes more understandable.

Approaching treatment with a reductionist lens, relying solely on an injection or a home exercise program, is akin to using a hammer where a scalpel is required. This sentiment is supported in a recent review by Brindisino et al. (2026).

Effective management requires a more nuanced and personalised approach that considers the multiple drivers involved:

• Hormonal (endocrine)

• Immune system (autoimmune / inflammatory)

• Strength, mobility, and capacity

• Cardiovascular health

• Pain psychology (sensitisation and emotional drivers)

• Structural factors

• Circadian rhythm and sleep

Key Takeaways

• General strength training can still be completed and is beneficial with a frozen shoulder diagnosis

• Surgical interventions are often unwarranted and do not demonstrate superior outcomes

• Frozen shoulder is multi-factorial, and lifestyle factors such as exercise, nutrition, and sleep play a critical role in both management and risk reduction

References

Beard, D. J. et al. 2018. Arthroscopic subacromial decompression for subacromial shoulder pain (CSAW): a multicentre, pragmatic, parallel group, placebo-controlled, three-group, randomised surgical trial. The Lancet 391(10118), pp. 329-338. doi: 10.1016/S0140-6736(17)32457-1

Brindisino, F. et al. 2026. Beyond the capsule: an integrated perspective on the wide world of frozen shoulder. A collaborative viewpoint. Pain Management, pp. 1-20. doi: 10.1080/17581869.2026.2636725

Corbacho, B. et al. 2021. Cost-effectiveness of surgical treatments compared with early structured physiotherapy in secondary care for adults with primary frozen shoulder : an economic evaluation of the UK FROST trial. Bone Jt Open 2(8), pp. 685-695. doi: 10.1302/2633-1462.28.Bjo-2021-0075.R1

Date, A. and Rahman, L. 2020. Frozen shoulder: overview of clinical presentation and review of the current evidence base for management strategies. Future Sci OA 6(10), p. Fso647. doi: 10.2144/fsoa-2020-0145

Hamed-Hamed, D. et al. 2026. Impact of nutritional profile on pain and functionality in patients with frozen shoulder: a cross-sectional observational study. Frontiers in Medicine Volume 13 - 2026,  doi: 10.3389/fmed.2026.1785577

King, W. V. and Hebron, C. 2023. Frozen shoulder: living with uncertainty and being in “no-man’s land”. Physiotherapy Theory and Practice 39(5), pp. 979-993. doi: 10.1080/09593985.2022.2032512

Navarro-Ledesma, S. 2025a. Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications. J Clin Med 14(20),  doi: 10.3390/jcm14207315

Navarro-Ledesma, S. 2025b. Frozen Shoulder as a Systemic Immunometabolic Disorder: The Roles of Estrogen, Thyroid Dysfunction, Endothelial Health, Lifestyle, and Clinical Implications. Journal of Clinical Medicine 14(20), p. 7315. 

Pandey, V. and Madi, S. 2021. Clinical Guidelines in the Management of Frozen Shoulder: An Update! Indian J Orthop 55(2), pp. 299-309. doi: 10.1007/s43465-021-00351-3

Razzak, Z. A. et al. 2019. Effect of aerobic and anaerobic exercise on estrogen level, fat mass, and muscle mass among postmenopausal osteoporotic females. Int J Health Sci (Qassim) 13(4), pp. 10-16. 

Salamh, P. et al. 2025. An international consensus on the etiology, risk factors, diagnosis and Management for individuals with Frozen Shoulder: a Delphi study. J Man Manip Ther 33(4), pp. 309-320. doi: 10.1080/10669817.2025.2470461

Wend, K. et al. 2012. Tissue-Specific Effects of Loss of Estrogen during Menopause and Aging. Frontiers in Endocrinology Volume 3 - 2012,  doi: 10.3389/fendo.2012.00019

ACL Injuries: How They Occur, Who Is at Risk, and Why Training Quality Matters (Part 1)

Written by Michael Crawley, BSc, BPT, CSCS

BACKGROUND

Anterior cruciate ligament injuries (ACLI) are often viewed as sudden, unavoidable events that are “fixed” through surgery. In reality, both injury risk and long-term outcomes are strongly influenced by training quality, rehabilitation approach, and the decisions made before and after injury.

This article highlights the complexity of ACL injuries, explains how and why they occur, and outlines key training and rehabilitation considerations that influence risk and return to sport outcomes. While ACL injuries are often discussed in isolation, they are rarely simple knee injuries, and successful outcomes require a broader, long-term view.

The information presented is intended to provide practical, actionable insight for a range of athletes and stakeholders, including:

• Youth multi-sport athletes and their parents

• High-level collegiate and professional athletes

• Competitive recreational athletes of all ages

ACLI have increasingly been described as an epidemic across both amateur and professional sport. Several studies report that ACL injuries account for approximately 50 percent of knee injuries. Over the past 10 to 20 years, female and youth athletes have experienced the largest increase in incidence. Childers et al. (2025) identified female adolescent athletes as the highest-risk group, with a 1.5-fold increased risk compared to their male counterparts.

Importantly, ACL injuries often occur alongside meniscal and cartilage damage. These associated injuries substantially increase the risk of long-term joint degeneration, including osteoarthritis and the need for total knee replacement (Petushek et al. 2019). This added complexity also plays a significant role in surgical decision-making and long-term outcomes.

HOW DOES THIS HAPPEN

ACL injuries generally fall into two categories:

1. Contact injuries

2. Non-contact injuries, which account for nearly 80 percent of all ACL ruptures (Beaulieu et al. 2023)

Most non-contact injuries occur during high-speed or high-load movements such as single-leg landings, rapid deceleration, or sharp changes of direction. These movement patterns are common across many sports and can occur both during high-intensity competition and through repeated lower-intensity exposures over time.

Sports such as basketball, soccer, netball, and rugby place consistent demands on these movement patterns, emphasizing the importance of preparing athletes not only for isolated high-risk moments, but also for cumulative loading over a season.

RISK FACTORS AND TRAINING IMPLICATIONS

ACL injury risk is influenced by a combination of anatomical, biomechanical, and training-related factors. While some risk factors cannot be changed, many can be meaningfully influenced through education and training.

Female Athlete Considerations

In female athletes, structural features of the tibia, such as posterior tibial slope, along with hormonal influences on ligament laxity, contribute to an increased risk of ACL injury (Kikuchi et al. 2022; Beaulieu et al. 2023).

While these factors cannot be modified, they highlight the importance of early education for young female athletes and their coaches. Building awareness around neuromuscular control, strength development, and movement quality is a critical component of risk reduction.

Playing Surface

Research examining the influence of playing surface has produced mixed findings. However, some studies report higher ACL injury rates in NFL athletes competing on artificial surfaces compared to natural grass (Hershman et al. 2012).

Although athletes cannot always control the surface they compete on, training exposure can be diversified. Incorporating training on a variety of surfaces may help improve adaptability and tolerance to different loading conditions prior to competition.

Fatigue and Repetitive Loading

Emerging evidence suggests that ACL rupture does not always result from a single traumatic event. Fatigue and repetitive sub-maximal loading may contribute to progressive ligament failure over time (Wojtys et al. 2016).

From a training perspective, building tissue capacity in key muscle groups such as the hamstrings, quadriceps, calves, and adductors may increase tolerance to repeated stress and reduce injury risk.

Whole-Body Strength and Neuromuscular Control

Although ACL injuries occur at the knee, load can be transmitted from both the top down and bottom up through the kinetic chain. Poor three-dimensional strength across the trunk, hip, knee, and ankle can increase stress on different portions of the ACL (Beaulieu et al. 2023).

Training that develops strength in multiple planes of motion, both in isolated exercises and integrated movement patterns, helps improve robustness and neuromuscular control.

For example, multi-directional jumping exercises can target trunk, hip, knee, and ankle coordination simultaneously:

• Jumping exercise example: https://youtu.be/foi2J2Tpks8

WHAT IS CONSIDERED SUCCESSFUL ACL REHABILITATION AND HOW IS IT ACHIEVED

Over the past decade, the definition of successful return to sport (RTS) following ACL injury has evolved. A well-regarded Canadian kinesiologist, Carmen Bott, emphasizes that simply returning to sport is not the same as returning successfully.

Long-term data highlight the difficulty of maintaining sport participation following ACL injury. Pinheiro et al. (2022) reported that among elite athletes followed over five years, participation at the same competitive level declined from 75 percent in year one to just 20 percent by year five.

Outcomes are even less favorable in competitive amateur athletes. Approximately 65 percent return to pre-injury level, with overall return to competitive sport roughly 10 percent lower (Nwachukwu et al. 2019).

Following a well-structured, progressively loaded strength and conditioning program can enhance both physical capacity and confidence during rehabilitation. A simplified progression may include:

• Heel slide + straight leg raise (early post-surgery): https://youtube.com/shorts/MyEWyGisbug

• Wall squat (introducing controlled strength): https://youtube.com/shorts/M2ZhZGdo11Q

• Drop squats (early preparation for landing mechanics): https://youtube.com/shorts/MW-KZrf18RU

• Nordic hamstring exercise (high-level strength development): https://youtube.com/shorts/4YNp9C0PQ_4

• Full-range jumping progressions: https://youtube.com/shorts/lDO7zvvshUo

This progression represents only a snapshot of a rehabilitation process that commonly spans 9 to 12 months. Progression should be goal-oriented rather than time-driven, with athletes meeting clearly defined prerequisites before advancing.

TO CUT OR NOT (NOT MEDICAL ADVICE)

When an athlete is diagnosed with an ACL injury, the immediate assumption is often that surgery is required. Indeed, 98 percent of orthopaedic surgeons recommend ACL reconstruction for athletes aiming to return to sports involving running, cutting, and jumping (Weiler et al. 2015).

However, surgery is not always the appropriate choice. Non-operative management may be suitable depending on several factors (Komnos et al. 2024), including:

• Individual expectations and current sport level

• Presence of concomitant injuries such as meniscal or cartilage damage

• Degree of knee laxity and perceived instability

Fitzgerald et al. (2000) classified individuals into three groups:

1. Copers: return to pre-injury level of sport

2. Adapters: return to a reduced level to avoid instability

3. Non-copers: unable to return due to persistent instability

A notable example is a Premier League footballer who returned to play eight weeks after a complete ACL rupture without surgery (Weiler et al. 2015). While this represents a single case, it highlights the importance of individualized decision-making.

What Does This Mean for Non-Professional Athletes?

Athletes outside professional systems should:

• Ask detailed questions about the structures involved in their injury (ACL only vs associated damage)

• Communicate subjective symptoms such as instability, confidence, or locking

• Clarify long-term goals, whether returning to competition or maintaining an active lifestyle

• Consider an initial period of structured rehabilitation before committing to surgery, particularly when instability is not present

In the Premier League case study, the athlete consulted three surgeons, two of whom recommended surgery, while one supported a conservative rehabilitation-first approach. This underscores the value of informed discussion and shared decision-making.

SUMMARY AND KEY TAKEAWAYS

• ACL injuries are complex and influenced by multiple interacting factors including age, sex, sport demands, training exposure, and movement quality.

  • Educating female athletes about menstrual cycle considerations and ligament laxity may be beneficial.

  • Monitoring training load during high knee-stress activities is important.

  • Developing tissue capacity through comprehensive strength training can enhance tolerance to stress.

• Returning to previous levels of sport remains challenging, particularly for non-professional athletes.

  • Rehabilitation should be thorough and guided by experienced practitioners.

  • Successful return to play depends on strength, neuromuscular control, and power that match sport-specific demands.

• Surgery is not the only option.

  • Decisions should be made collaboratively between the athlete, physiotherapist, and surgeon.

  • Clear communication around injury extent and long-term goals leads to better outcomes.

Looking for Individualized Support?

If you’re currently dealing with an ACL injury, returning from surgery, or unsure how to safely progress your training, working with an experienced coach can make a meaningful difference.

Michael works closely with athletes across all levels and has extensive experience supporting ACL rehabilitation and return-to-sport training in collaboration with physiotherapists and medical professionals.

If you’d like to explore whether coaching support is right for you, you can book an initial assessment here.

PART 2: WHAT TO EXPECT

The next article will focus specifically on female and youth athletes and will explore:

• Graft selection considerations when surgery is required

• The role of prehabilitation in improving long-term outcomes

References

Beaulieu, M. L., Lamontagne, M., Xu, L., & Li, G. (2023). Loading mechanisms of the anterior cruciate ligament. Sports Biomechanics, 22(1), 1–29. https://doi.org/10.1080/14763141.2021.1916578

Childers, J. D., Weiss, L. J., Pennington, Z. T., Nwachukwu, B. U., & Allen, A. A. (2025). Reported anterior cruciate ligament injury incidence in adolescent athletes is greatest in female soccer players and athletes participating in club sports: A systematic review and meta-analysis. Arthroscopy, 41(3), 774–784.e772. https://doi.org/10.1016/j.arthro.2024.03.050

Fitzgerald, G. K., Axe, M. J., & Snyder-Mackler, L. (2000). A decision-making scheme for returning patients to high-level activity with nonoperative treatment after anterior cruciate ligament rupture. Knee Surgery, Sports Traumatology, Arthroscopy, 8(2), 76–82. https://doi.org/10.1007/s001670050190

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Kikuchi, N., Hara, R., Hiranuma, K., Nakazawa, R., & Fukubayashi, T. (2022). Relationship between posterior tibial slope and lower extremity biomechanics during a single-leg drop landing combined with a cognitive task in athletes after ACL reconstruction. Orthopaedic Journal of Sports Medicine, 10(7), 23259671221107931. https://doi.org/10.1177/23259671221107931

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Why Women Should Think Twice About Cold Plunges

Written by Evelyn Calado, MKin, CSCS, RKin

Cold plunges are everywhere right now. Scroll through social media, walk into any boutique gym, or listen to the latest biohacking podcast, and you're bound to hear someone praising the "recovery magic" of ice baths. But there's a problem: this recovery trend is not built for female physiology. And no one seems to be talking about it.

As a woman, especially one training hard and aiming to get stronger, faster, or more resilient, you need to know this: cold plunges can actually hinder your progress.

The Hype vs. The Science

The fitness industry often pushes one-size-fits-all solutions that are, in reality, designed around male physiology. Cold water immersion is no exception. The main argument for it is that it reduces inflammation and muscle soreness. But what’s rarely discussed is that blunting inflammation also blunts adaptation—the very thing you're working hard for in your training.

A key study published in The Journal of Physiology (2015) found that post-exercise cold water immersion significantly reduced long-term gains in muscle mass and strength by suppressing key anabolic signaling pathways. In simpler terms, jumping into a cold plunge after lifting can shut down the processes your body needs to get stronger.

The Female Factor: Why It’s Worse for Women

Dr. Stacy T. Sims, PhD, exercise physiologist and author of ROAR, explains that women already have a more robust anti-inflammatory response, largely due to estrogen. This is great for recovery in general—but it also means that adding more inflammation-suppressing strategies (like cold plunges) can tip the balance too far.

Here’s what that means:

• Estrogen helps buffer inflammation, so you don’t need the added suppression from cold water.

• Cold plunges inhibit mTOR signaling, a critical pathway for muscle protein synthesis. Since women already face challenges building and maintaining lean muscle due to fluctuating hormone levels—particularly during the high-progesterone phase of the menstrual cycle—this further suppresses adaptation.

• Women have a shorter post-exercise anabolic window. That means the timing and environment for recovery matter more. Cold exposure immediately post-training can close this window prematurely.

Heat, Not Cold, Supports Female Recovery

Dr. Sims recommends heat-based recovery tools for women, such as sauna use or hot baths. Heat increases blood flow, supports mitochondrial adaptations, and promotes muscle repair without blunting the natural signals for strength and hypertrophy.

Where cold shuts down your body’s growth processes, heat helps amplify them—especially beneficial for women looking to increase muscle mass, endurance, and overall athletic performance.

Let’s Talk About the Real Issue

This isn’t just a science debate. It’s a visibility problem. Right now, women are being told to do what’s trending without being informed of how it might hurt them. The fitness industry is ignoring female physiology. And it’s not okay.

If you're a woman who trains, lifts, runs, or just wants to be strong and healthy, you deserve better than a one-size-fits-all recovery strategy. You deserve recovery tools that actually work with your body, not against it.

So the next time someone tells you to jump into a cold plunge for recovery, remember that your physiology is different. And according to Dr. Stacy Sims and peer-reviewed research, cold plunges may be doing more harm than good for women.

Let’s change the conversation.

The Only Two Supplements Most Athletes Actually Need

Written by Evelyn Calado, MKin, CSCS, RKin

Walk into any supplement store and it’s overwhelming. Rows of pre-workouts, amino acids, test boosters, fat burners, and other shiny tubs promising to change your game overnight. But the truth is, most of it is noise.

At Avos Strength, we keep it simple. If you’re training hard and want to support performance, recovery, and overall health, there are only two supplements that actually matter.

And they aren’t flashy.

1. Protein Powder: The Most Underrated Tool in the Game

You don’t need protein powder to build muscle, but it can make it a lot easier to get enough protein — especially if you're busy, training often, or just not eating enough.

Protein is the building block of muscle. Without it, recovery slows down and progress stalls.

The general recommendation for active individuals and athletes is 1.6 to 2.0 grams per kilogram of body weight per day. If you're trying to put on muscle or training at a high volume, aim for the higher end of that range.

This means a 70-kilogram athlete should be getting 112 to 140 grams of protein daily. That’s a lot of chicken breast and Greek yogurt — and that’s where a high-quality protein powder can help.

Look for a product that:

• Lists all essential amino acids (a complete protein)

• Contains at least 20 to 25 grams of protein per serving

• Comes from a reputable source like whey isolate, casein, or a solid plant-based blend with a full amino acid profile

If you are a competitive athlete, make sure your product is third-party tested and carries a Safe for Sport stamp such as NSF Certified for Sport or Informed Sport. This ensures there are no banned substances and that what's on the label is actually in the product.

Using protein powder post-training or to fill in gaps throughout the day is one of the easiest and most cost-effective ways to hit your daily targets.

2. Creatine: The Most Researched Supplement in the World

Creatine is a naturally occurring compound made from three amino acids: arginine, glycine, and methionine. It’s stored in your muscles and used to quickly regenerate ATP, the energy source your body relies on for short, powerful efforts like lifting, sprinting, and jumping.

If there’s one supplement that lives up to the hype, it’s creatine. It's been studied for over 30 years and is backed by more peer-reviewed research than any other supplement on the market.

Creatine helps you:

• Perform more reps at a given load

• Recover faster between explosive efforts

• Improve high-intensity performance over time

What’s even more exciting is the emerging research around brain health. Studies now suggest creatine may improve cognitive function, especially under sleep deprivation or mental fatigue, and may play a protective role in aging populations.

How to Take It

• For muscle saturation: Take 5 grams of creatine monohydrate per day. No need to load or cycle it.

• For brain health benefits: Newer research suggests 10 to 20 grams per day may be more effective, though higher doses should be discussed with a healthcare provider or sport nutritionist.

As with protein powder, if you're a competitive athlete, use a creatine product that is NSF Certified for Sport or Informed Sport. This ensures the supplement is free from banned substances and batch tested for safety.

Creatine is:

• Safe

• Inexpensive

• Naturally occurring (your body makes it, and you also get it from meat and fish)

• Non-hormonal

• Effective for both men and women

Just take it consistently. It doesn’t need to be timed perfectly with your workout, and you don’t need a fancy pre-workout mix to get the benefits.

Don’t Get Caught in the Supplement Hype

BCAAs, pre-workouts, collagen, fat burners — they all have their place in the marketing stream, but they are not essential.

If you’re on a budget or just want to stick with what works, protein and creatine will give you the most return on your investment. Everything else is secondary.

And most importantly, no supplement replaces hard training, smart programming, and real food.

Build your foundation first. Let supplements support that — not define it.

How to Train Like a Pro Without Overtraining: 3 Conditioning Mistakes Every Fighter Makes

Written by Evelyn Calado, MKin, CSCS, RKin

“You’re in shape… until you aren’t.”

Every boxer knows the feeling. You think you’re in shape, you’re sparring well, and then by Round 2 your legs feel like concrete. The problem isn’t effort. It’s the wrong kind of conditioning.

In combat sports, the difference between being fit and being fight ready is small but critical. Fighters often equate exhaustion with improvement. But fatigue is not the goal. The goal is to develop a system that lets you recover, repeat, and stay sharp under stress.

True conditioning teaches your body how to sustain power and recover faster between bursts. It builds the capacity to deliver the same output over and over without falling apart technically.

Mistake #1: Living in the “No-Adaptation Zone”

Most fighters train at one speed all the time. The intensity is too high to truly build aerobic qualities, yet not high enough to improve anaerobic power. This middle zone feels hard but does not create meaningful adaptation.

Training in this gray area leaves you constantly tired without improving the key factors that drive endurance. The aerobic system is the foundation for every other energy system. It is what allows you to recover between flurries, maintain composure, and control your pace.

When the bulk of training sits around 80 to 85 percent of maximum heart rate, the heart and muscles are working, but they are not being pushed to develop either side of the spectrum.

Fix:
Include one dedicated aerobic session each week. Keep the effort at a comfortable but steady pace where you can still breathe through your nose.

• 25 to 30 minutes at 65 to 75 percent of maximum heart rate, or RPE 4 to 5.

• Use light jogging, a spin bike, or shadowboxing flow work.

These lower-intensity sessions build the foundation that makes every other type of conditioning more effective later in camp.

Mistake #2: Mistaking Fatigue for Progress

If every session leaves you completely drained, you are not building capacity, you are burning it.

Fatigue by itself does not equal progress. When you constantly push to exhaustion, your coordination drops, timing slows, and recovery between rounds suffers.

Conditioning should improve the ability to produce high effort repeatedly, not the ability to survive pain. The aim is quality effort, not constant exhaustion.

Fighters often overload glycolytic, or medium-duration, efforts. They push too hard for too long and never develop the shorter, high-power system or the longer aerobic system that supports it. The result is a strong first thirty seconds and then a quick drop-off in speed and output.

Fix:
Introduce short, high-quality power intervals that target your explosive energy system.

• Perform 8 to 10 seconds of all-out work such as a bike sprint, heavy bag flurry, or sled push.

• Rest for 80 to 100 seconds at an easy pace before repeating.

• Complete 6 to 8 total efforts.

These efforts improve maximal power and nervous system efficiency while allowing full recovery between reps.

Mistake #3: Ignoring the Aerobic Engine

The aerobic system is what keeps fighters explosive through multiple rounds. It is also what allows the body to recover between rounds and between training sessions.

Aerobic training does not make a fighter slow. It develops the internal engine that supplies energy to every burst and every exchange. A well-developed aerobic system improves the ability to replenish ATP, clear hydrogen ions, and use lactate as a fuel source during sustained work.

The common idea that fatigue is caused by lactic acid buildup is outdated. Lactic acid does not actually accumulate in the muscles. Instead, it separates into lactate and hydrogen ions, and the resulting increase in acidity contributes to fatigue. Aerobic training improves the body’s ability to manage that acidity and maintain performance over time.

Fix:
Use structured aerobic capacity intervals once or twice a week.

• Work for 2 to 3 minutes at 80 to 90 percent of maximum heart rate or RPE 6 to 7.

• Recover actively for 2 to 3 minutes until your heart rate drops below 130 beats per minute.

• Repeat 4 to 6 rounds.

This type of interval work develops both delivery and utilization of oxygen, helping you stay relaxed and efficient even at higher outputs.

Why Smart Conditioning Wins Fights

The best-conditioned fighters are not always the ones who look the fittest in training. They are the ones who can stay calm, explosive, and efficient no matter how chaotic the fight becomes.

That calmness is a physiological skill. It comes from balancing the aerobic system that drives recovery, the anaerobic system that fuels sustained power, and the alactic system that supports short, explosive actions.

Smart conditioning develops all three systems in the right sequence and with the right intent. Build the base first, layer power on top, and taper the total load before competition.

Train Systems, Not Just Willpower

The difference between being in shape and being ready to fight is not about effort, it is about precision.

Conditioning should make you faster, more efficient, and more durable. It should leave you confident that your body can keep up with your skill. Hard work matters, but only when it builds something specific.

“Hard work is only as good as what it builds.”
— Joel Jamieson

Take the Guesswork Out of Your Conditioning

Knowing what to train is only half the battle. Knowing when and how to train each energy system is what separates a well-conditioned fighter from a tired one. A structured plan designed around your schedule, fight calendar, and current fitness level turns theory into progress.

If you’re serious about improving your fight conditioning, click here to explore our custom programs for fighters— designed to help you train smarter, recover faster, and perform your best when it matters most.

References

• Jamieson, J. (2009). Ultimate MMA Conditioning.

• Bott, C. (2023). Uncovering Limitations in Work Capacity.

• Robergs, R. et al. (2004). “Biochemistry of Exercise-Induced Metabolic Acidosis,” American Journal of Physiology.

• Brooks, G. et al. (2005). Exercise Physiology: Human Bioenergetics and Its Applications.