Managing Injuries – A Case of Load vs Capacity

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As physiotherapists, when patients come to us with an injury, we will ask to determine what went wrong, and how clients can avoid history from repeating itself. Overall, most injuries involve an uncomplicated equation of load vs. capacity.

Every individual’s body tissue has its own level of capacity. When a high load is applied to these tissues, the capacity of the body tissues is being exceeded, leading to a higher risk of injury. This is why we see a great influx of patients after a HBF or another fun run. These patients usually have just completed a marathon with little training!

In order to avoid this, the body’s tissues need to be given time to adapt – by applying a graded load over a larger period of time. A graded load, will result in more resilient tendons, better bone density and improved muscle strength and endurance. If you apply a load too quickly, the tissues aren’t able to adapt, and therefore this can result in tissue injury/damage and therefore, a decrease in tissue capacity.

This may sound simple until other factors are taken into consideration; like stress, sleeping patterns, illness, nutrition and many other factors. These factors affect one’s tissues ability to adapt to a workout. Our response to exercise is further influenced by our beliefs, adaptations and past experiences (e.g. past injury).

Many people believe that their pain is due to biomechanical issues (e.g. posture), anatomy, footwear or desk ergonomics. Many people are told that their pain is because they have a ‘disc out of place’ or a ‘short leg’. These factors can play a very small role in injury and pain. What’s most important is that the body is given time to adapt. Do not be over analytical about pain, but rather look back on when your pain first began. Was there a period of over or under activity?

Always note that, if you’re sedentary, your body is going to react by decreasing its tissue capacity. Many people who have chronic lower back pain, choose to rest in order to ‘protect’ their back. However, this in turn reduces the capacity of the surrounding tissue further. If you take a graded approach to exercise, this is a much better outcome for injury.

Here are some tips on how to do this:

  1. Gradual change in training load: there are many factors to consider; Frequency, duration, intensity and time are all ways you can up your training load. Most people use a 10% rule, which suggests you increase either of these factors by 10%. However, this depends heavily on what you’re already doing or what you’re not doing. Introducing something new needs to be done carefully. This even includes a new pair of shoes. Always remember, adaptation takes time.
  2. Go by feel: Don’t stick to a certain level of exercise. For example, if you’re starting a new running program that requires you to run 2km, if you feel that you’re struggling with a grumble at around 1.5km – DON’T push it. That’s your tissue’s capacity. Then, you can stick to that load for now, and increase it next week to help your tissues adapt. Keep in mind – just because you don’t have less pain, doesn’t mean you’re not improving. Just because you don’t feel stronger doing an exercise, doesn’t mean you’re not improving. While these are good signs of progress, it takes TIME for strength and pain improvements to surface. Don’t become demoralised by your exercise therapy.
  3. Mix things up! Doing the same frequency, intensity (pace), duration and type of exercise day in day out, can lead to overload of certain tissues. This is why it’s always good to have a mixture of exercise to assist in loading different tissues throughout the body.
  4. REST: When beginning a new exercise program in particular, a rest day is essential. Many keen exercisers nursing an injury tend to forget having a rest day in between sessions. Listen to your body and don’t run through pain. That is when tissue capacity is overloaded.Always think about the risk vs. the benefit of pushing through a niggly run.
  5. Strength & conditioning is just as important as cardiovascular activity. Often, some people either love the gym and hate cardio, or vice versa! However, a little work on strength, balance and endurance goes a long way – research suggests this leads to a reduction in injury risk.
  6. Stay hydrated and well fueled.
  7. Sleep: Sleep plays a vital role in good health and well-being throughout your life.
  8. Plan your training: create a diary to monitor your progress and all improvements. Use the plan as a guide – you can still be flexible!

Whilst load vs. capacity may sound simple, it is not as easy to implement. Sometimes, when starting a new exercise regime or nursing an injury, we need advice from a physiotherapist that is based on sound knowledge and education. If this is you, book in with one of our physiotherapists today!

Blog written by: Dayna Fimmano, Physiotherapist @ComoPhysio

 

References:

https://thesports.physio/2017/03/14/pump-up-the-volume/

https://www.running-physio.com/trainerror/

Load Vs Capacity https://vimeo.com/339686848

https://blogs.bmj.com/bjsm/2019/06/19/load-vs-capacity-the-good-and-the-debatable/

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