Nearly every injury will respond well when you learn to load it well. This is the reason load management is so crucial in rehabilitation!
Yet so often we will neglect this most important element of treatment.
If we all learnt to apply this principle of load management to our injuries, we would be living in far less pain. Some injuries may still need further input – but managing your load is an excellent place to start.
You may already be asking the following:
What is load management?
Load management is referring to the concept of seeing how much an injured area is under load throughout the day – and adjusting this load as necessary.
Every injury begins because the structures’ ability to tolerate load was less than the load applied to that structure.
Let’s take the simple example of an ankle sprain.
When you rolled over onto the ankle, the force from your body was too much for the tendons around the ankle to bear. This results in some or all of the fibres snapping.
The way to rehabilitate this ankle sprain (short of surgery) is to slowly expose it to more load, as scar tissue forms. This helps the scar tissue align nicely and encourages more growth of fibres because of the load it needs to withstand.
Why is load management important?
Many patients will be compliant with exercises given by a physiotherapist, but not understand that they are loading their injury far too much in their everyday life.
There is always an optimal load for your injury at any given time. If you place too much load through the injured tissue, there’s a chance that pain will increase. If you don’t load enough, then the tissue may not heal adequately.
The picture below also describes that after injury, a tissues tolerance to load is reduced – meaning it will respond with less load than normal tissue.
(https://www.clickphysiotherapy.com.au/wp-content/uploads/2019/04/load-tolerance-with-load-1.png)
I have expertise in Achilles’ injuries and often find that even if patients do well with exercise – their job requires them to navigate uneven ground and climb ladders. In this scenario we can’t expect the tendon to heal without first a change to the walking and climbing of ladders.
How do I know what activities are loading my injury?
Every injury is unique, and it is hard to exactly define what activities may be causing too much load in your scenario. My advice would be to talk with a physiotherapist. They can advise on what activities would be increasing your load.
Another piece of advice is to think about what aggravates your symptoms. These activities are probably the culprits for loading the affected area. Be careful with this as sometimes your pain may only be evident a couple of hours after you performed the activity. You may need to think back about what could have aggravated your pain.
Lastly, create a pain diary. Document through the day the times when your pain increases. This could help you to identify certain activities that may have aggravated your symptoms. It could even be posture that will load certain structures in the back/neck or hips/shoulders.
How do I apply the principle of load management?
Identifying what causes your symptoms is only half of the puzzle. The real art, where physiotherapy shines, is helping your slowly load that injury back to health.
It is easy to stop the things that are aggravating your symptoms, and that may be needed. But for many people they need to get back to work, or doing the other things they love.
The idea behind load management is to slowly expose your body to more and more load over time. This is where exercises can really help – as it is easy to monitor how many you do, and progress these one step at a time.
Ask your physiotherapist how to self-progress some of your exercises to get quicker results.
Think of exercises like taking a pain-killer. You would never eat 10 panadol at once, because this wouldn’t be good for your body. You can also overdo exercise, and this will have bad results for your injury. The dosage of exercises is just as important as the dosage of pain-killers or other medical drugs.
Remember pain is really your guide to how much load your injury can tolerate. If you start exercises and this flares up your pain, there is a good chance you simply applied too much load to the injury. Instead of giving up altogether, try halving the number of repetitions and see how your injury responds.
In Summary
Load management in crucial to your recovery and if you understand this principle, you can help to speed up the recovery by not doing activities that aggravate your symptoms. You can also take ownership of your exercises, making sure you do them regularly and as prescribed. This will help your injury to respond much quicker than just relying only on passive help.
This was written by Caleb Gray, Founder of Click Physiotherapy (www.clickphysiotherapy.com.au)