Why LOAD is Important During Rehab

Hi, everyone, it’s Erienne from Peak Endurance physical therapy in Madison. I’m here to talk to you guys about why your rehab or your physical therapy journey needs to involve load. Specifically progressive overloading. And if it does not include load, it is a disservice to you and your physical therapy journey.

So when we first come to physical therapy, especially if we are in active pain or we are moderate or high irritability, manual techniques are very important in order to be able to tolerate more movements, more load, and all that. It helps decrease our pain. It helps put the fire out. That’s what first brings us in. This is a very important stage of physical therapy, and I don’t want to underplay that by any means.

But even though these passive, manual therapy techniques will help you to feel better, sometimes even pain free, that does not mean the issue is solved. And I want to explain why.

So most of the people who come through our doors are encountering what we call an overuse injury. Basically, the demand of the activity they’re doing, whether it is the volume or the intensity, is higher than the capacity of their tissues. I made this graph here to explain.

So on the X axis we have the capacity of our body, and then the demand on the Y axis. If you are doing an activity where your capacity is higher than the demand of the activity, you’re going to be fine. You’re not going to have any pain. You’ll be able to continue doing that activity for as long as you like. However, if you are doing an activity where the demand is higher than your capacity, that’s when we start to have breakdown and dysfunction and eventually pain. That is where overuse injury lies.

So in order to not be up in this pain/dysfunction category while still doing the activity with the same amount of demand, we have to increase our capacity. We need to get to a point where our capacity is higher than the demand of that activity.

And how we increase capacity of tissue is simple. We have to overload it. We have to build a stronger muscle and have to have a more tensile-y strong tendon. And that’s what takes time. That’s where this progressive overloading process comes into play.

So again, yes, passive manual therapy techniques are very important. Especially to help decrease pain in the beginning of the rehab process. But if we do not increase the overall capacity of that tissue, the next time we go out and require that same demand, we’re still going to have pain because we haven’t increased our capacity at all.