The catchphrase in physio and strength and conditioning at the moment is ‘optimal loading’. I can see you switching off already but hang with me a second as this could be the game changer for getting your injury better and preventing it from happening in the first place.
The British Journal of Sports Medicine defines Optimal Loading as ‘the load applied to structures that maximises physiological adaptation. Achieving optimal loading is challenging but should be driven by variables such as the tissue type, pathological presentation and the required tissue adaptation for eventual activity. Specific loading goals may include increased tensile strength, collagen reorganisation, increased muscle–tendon unit stiffness or neural reorganisation’. Translation: We actually need to load our bodies to get them to produce more tissue/ bone/ tendon/ muscle/ nerve.
Back in the old days we used to RICE every injury… Rest, Ice, Compress, Elevate. As research has continued and we have better ways of investigating what happens in our bodies, we now understand that rest is a bad thing. No more going to bed for six weeks when you hurt your back; the key is to get moving as quickly and efficiently as possible.
So how much load?
This is the million dollar question, load too much, too often and you are at risk of injury. Don’t load enough and the risk is the same!
Here are a couple of scenarios:
Dave has Achilles tendinopathy that he’s had for about five months and it’s grumbling on. He plays football once a week, but other than that he walks the dog twice a day (total 40 minutes) and is on his feet quite a bit at work. Dave is given heel drop exercises by his GP which he completes every day for a few days but then stops as it is painful and it isn’t really making any difference.
The reality is that the only heavy loading that Dave is doing on his Achilles is the football, and actually just being on your feet and doing a bit of walking is quite low grade loading. He needs to consistently load it with higher load and then give himself some rest in order to allow the tendon some time to make some new fibres. He needs to do his heel drop exercises with weight (either in a gym, or with a backpack full of bricks, or his eight year old piggy-backed… something like that!) a couple of days in a row and then have a day off, another couple of days in a row, day off. The 7-4-2 rule works quite well if you’re needing a blueprint (it’s not perfect but it’s a good start).
Some resilience in that tendon is needed to be built up, but unfortunately tendons take a long time to improve, so Dave is looking at 3 months of rehab before he starts to feel a bit better. Tough times.
Lucy decides that she fancies doing the London Marathon, and starts training on the 2nd January. She used to regularly run 10ks and half marathons before she had her two kids (6, 8), so she picks up her running pretty quickly. By the end of week three she is running 15 miles a week, by the end of week 6 she is running 45 miles a week, and by the end of week 8 she is running 60 miles a week, running every day apart from Monday as she is really enjoying it! Suddenly she develops foot pain on a run (she’s sprained the ankle on the same foot a few years before and has always felt that this foot is weaker). Physio doesn’t help at all to relieve her pain and she is sent to a sports physician for further assessment. Sadly she is found to have a stress fracture in her metatarsal and she is put in a moonboot for six weeks. The London Marathon dream is now on postponement.
What did she do wrong? She went from zero to hero in six weeks. Lucy obviously is a good runner with a natural endurance/ capacity for it as she has run a lot in the past. However taking time off from regular high impact loading of her bones (which running is) to have her kids means that her bones have become deconditioned to repetitive loading. They too need to build up slowly, and no matter how good she was feeling, she really should have built up her mileage slower, with more rest days, interspersing it with some good strength and conditioning.
Other things that you need to consider when building up to the capacity you want to achieve (eg running a marathon), is what variables you have to play with:
In my opinion the three main ones are:
Time doing the exercise
Distance covered/ volume. How much you do is important
Speed/ intensity (eg hills, effort etc).
Try not to change more than one variable at a time. For instance don’t decide after doing a 30 minute 5K run three times a week for three weeks, to suddenly doing 10K in 50 minutes, four times a week. I know that seems obvious, but sometimes when you are in it it’s difficult to see these things.
Plan your progressions carefully, changing one variable at a time and you are more likely to reach optimal loading in one piece. If you increase one variable it may even be an idea to back off slightly on one of the other variables… eg if you normally run 10K in an hour and want to run 12K, try run it at 7 minutes /km instead of 6 minutes/km and build back up to your 10K pace.
In short, try to look at the big picture, look at the types of exercise you are doing and make sure you are not doing loading exercises every day, but do make sure that you are doing some loading exercise. The key is load on/ load off… enough load to stimulate tissue growth, and enough rest to give it time to do the growing.
Good luck with your new life in balance :-)