The golden principle of rehab and strength

Rehab can often times leave patients with even more questions than they arrived with. This dysfunction, that rotation, this fascia, that tightness, on and on. Although the intent is often to explain the detail of what the practitioner perceives. At the same time many of these details can often be irrelevant in the big picture. Some of the minute details may play a role but a much smaller one than people may believe. Hopefully after reading the article you will have a better understanding of a major rehab principle that may help you with your own aches and pains.

Progressive loading is one of my favorite concepts and approaches as it has so many application in most rehab situations as well as in strength and conditioning, power-lifting, etc. The principle applies in any situation where you are looking to get a positive adaptation such as increased strength, endurance, power, etc.First some terms to get to know. Loading simply put refers to applying a load or stress to a particular muscle, system, tissue, joint, etc. This can be single session or cumulative, such 2as a 10km run, or 50km total in a week. The running is the variable load or stress, the amount will determine what the consequent result is.

Let’s first look at what this concept means. First off every tissue, movement, etc has a certain load tolerance or capacity. If that capacity is exceeded there may be adverse reactions/overload as well as increased potential for injury. If the relative upper limits of the tissue is challenged but not exceeded this is where progress happens. If the load is far lower than the upper limits or tolerance then no adaptation happens and possible regression occurs. Let’s take an example to make more sense of this. You go to the gym and you lately have been squatting 200lbs for 3 sets of 10. At this point you continue to progress over time so this is currently a load that will cause a positive adaptation of increased strength and soon you will be doing 205lbs for 3x10. One day you go light and just lift 50lbs for 3x10, chances are you wont get much benefit from this, if you continued to do this you will start to lose strength. On the other hand if you decide to try to go for 250lbs instead of you usual 200lbs you likely won’t be able to complete 3x10 for this as well as increasing the chance you get a strain or some other adverse acute affect from going beyond your current capacity as well as feeling really sore the next few days. It doesn’t have to be more load either, the same occurs if you typically did 200lb squats twice a week but then decide to do 190lbs 7 times in a week. Even though the individual session load is less, the cumulative load over time is much more.

This concept very much applies to working out especially with heavy loads such as power-lifting. Often times you will hear power-lifters working in “blocks”, these are phases of their training. For example a lifter will push themselves and continue to increase the load for 6 weeks, cumulatively they may begin to reach the upper load tolerance by week 6. This is where they take a “de-load” week which means they still lift but at relatively less load and intensity. This decreases the challenge or loads on the tissues and can be considered active recovery in a sense. After this sub threshold week they being another 6 week block. Here they may start with a bit less load than they were doing at the end of the first block but will do more by the end of this block. Progressive loading for me is the golden principle of strength training of any sort.

In a rehab situation let’s take a look at two different examples. The first we will look at an office worker whose main activity is to run 2-3 times a week. They ended up deciding to do ramp up training for a last minute half marathon and after the race they are experiencing knee any time they run more than 5km, but they still try to go for their 8-10km per session. Some may look at their running pattern, their joint mobility, etc; all that is likely irrelevant in this case as there is a clear change in load. In this case assuming there’s no other underlying conditions it can be simply finding their initial tolerance which in this case seems to be around 5km. Of course there would likely be some strength work involved as well but to start I would recommend this person goes for 4km run 2-3 times in the first week. If there's not adverse reaction then subsequently they can add 1-2km per week until they get back up to their 8-10km pace. At this point it is up to the runner to decide if they will be racing again in the future. Clearly their tolerance to load was less than that which is required to do a half marathon, so it would be recommended to have some sessions that are more than their usual 10km in order to gradually increase their capacity to tolerate that race.

Another example is a basketball player who has begun to get pain in the front of their knee. This can often be attributed to overloading of the patellar tendon especially in a sport such as basketball that requires a lot of lower body explosiveness and thus loading of the quadriceps and patellar tendon. In this case it is evident that the cumulative load of the practices, games and training was started to go beyond the capacity of the athlete. In the middle of the season resting is not a very viable option. So if we can’t decrease the load, then we have to increase the capacity and tolerance to load of the tendon. In order to increase the tolerance to high velocity loading we can increase the athlete’s strength. In this case a focused loading program such as doing squats with a focus on loading the quads would commence. Doing this about 3 times a week over the next few weeks would increase his tolerance to loading and thus his capacity as studies have shown that in season loading can be very beneficial in cases like these.

So hopefully that made sense in how it can be applied in both a training and rehabilitative scenario. Progressive loading is a great and in a sense the only way to make progress in your fitness and training goals.

Thanks for reading, Vitas