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Today I am going to touch on a topic that I always speak to my clients about but really isn’t specific to my formal education in physiotherapy. I rather think of it as my common sense rule to rehabilitation and exercise. It’s my talk on Progressive Loading and Tissue Tolerance.

As an example, here are some typical conversations to illustrate how I want my clients to understand the principles of progressive loading and tissue tolerance.

Conversation with Client A:

Me: So are there any activities that aggravate your injury (whatever it may be)?

Client: Running, it messes up my injury all the time. I can’t run anymore.

Me: How far or how long of a run does it take to aggravate your symptoms?

Client: I try to run 30-45 min to get a good workout but I’m always in pain the next day.

Me: Well, how would a 15-20 min run feel?

Client: I don’t know. I don’t try to run less than 30-45 min.

Me: Next week, I want you to start with a 10 min warm up walk then run for 20 min and finish with a 10 min cool down for a total of 40 min. Then take note of how you feel the next day.

Conversation Client B:

Me: So you wrote down bench press as an aggravator for your shoulder

Client: Yes, every time I do a heavy chest workout my shoulder kills me.

Me: So how much weight are you typically bench pressing?

Client: 225 lbs on a heavy day depending on what other chest exercises I have done already.

Me: Well, how would 200 lbs feel on your shoulder?

Client: I don’t know, I always try to hit 225 lbs on a heavy chest day.

Me: Ok, next week I want you to only go up 200 lbs or take out 2 of the 5 chest exercises you normally do. Then take note how your shoulder feels.

So without even ‘treating’ these 2 individuals, I may have been able to change their pain relation to their specific activity. My goal at this point is to try and determine what is the body’s tolerance to their activity – ‘Tissue Tolerance’. Once we find an appropriate level of load then we can start increasing the load progressively towards their ultimate goal. So the next week my conversation might be as follows:

Me: So, how did the 10 min walk, 20 min run, 10 min walk feel?

Client: Fine, no pain

Me: Great, let’s try the same thing but increase the running to 25 min this week.

So, even though they had no pain with running the key is to slowly increase the load to see how the body reacts. A jump to running 45 min would have probably ended up in failure. What if the 20 min of running had caused pain? Then I would have dropped them down to 15 min of running the following week then slowly increased if successful.

Now of course we are most likely running through this scenario as we change your mechanical problems with manual therapy and exercises. But I can’t stress the importance of understanding the basic principle of ‘progressive loading’ and knowing the ‘tissue tolerance’. Even prescribed exercises is part of the ‘progressive loading’ protocol. If you don’t abide by these simple rules, your chance of success is greatly decreased. We as your physiotherapist or massage therapist are trying to work with your lifestyle and activity level, but we ask for a level of understanding and accountability to achieve your treatment goals.

If you are struggling with an injury or having difficulty achieving a specific goal, any of our registered physiotherapists or massage therapists at PhysioWorks would gladly assist you in your journey.

Rob Iwasaki, BScPT, BScKin, Clinical STOTT Pilates, CAFCI, IMS