Perhaps the best way to introduce this topic would be to pose the following questions..
Why do some runners demonstrate a poor style with limbs thrown all over the place with no obvious control yet they can continue uninjured?
So how are these lucky individuals able to continue to exercise pain free while many people with better style and form continually run into strings of injuries?
It seems clear therefore that injury does not solely relate to style, biomechanics or perfect alignment.
Each of us has a certain amount of capacity in our tissues to tolerate stresses and loads. Some may have a huge amount of leeway (the sloppy runner who is injury free) and others very little (the perfect runner who is always injured). Some people may be able to suddenly and drastically increase their training loads without injury, while others only have to make the most minimal of changes and they run into trouble. As a general rule of thumb however large changes in activity does seem to be a precursor to injury. The concept of tissue regulation and capabilities of tissues to tolerate load is not something new, in fact it was first described by Scott Dye an American knee surgeon in 2005 (Source).
The model that Scott puts forward should have huge influence in the way we treat patients today. We feel this is a very important concept for the majority of our patients to understand and we have tried to explain it in its most simple terms.
OPTIMAL LOADING - sensible appropriate loads at the right intensity, speed and position with the correct amount of recovery will in time improve the capability of that tissue to tolerate load. No different from training for a marathon, take it too quick and you run the risk of injury, take it too slow and you waste time. It is a balancing act.
UNDERLOADING/SUBOPTIMAL - e.g complete rest! This will create the reverse effect and decrease the tissues capability to deal with load, as it would when you take time out injured. This can result in malnourishment, pain and pathology. The same principle applies with overloading. This is why we will try to avoid at all costs and will very rarely prevent you from having to stop participating in your activity.
How do you know if your exercises are pitched into the right zone for you?
If you can tolerate your current exercises/training load or activity in a pain free manner, with no flare up of pain on the second day after exercise then you are likely to be working within a capable zone for that tissue. Be careful though as it is common for tissues to flare up 24 hours later. This can often be due to a latent production of an inflammatory chemical called cytokines.
No pain, no gain in the majority of cases is therefore not applicable what so ever!
What is the ideal?
Theoretically it is best to remain working at the upper limit of your optimal zone. Loading OPTIMALLY and allowing correct progression and recovery time will increase the capability of that tissue to deal with a task in a healthy manner.
What to do if I'm injured?
You will need to work in a lesser zone and then slowly build back up again. Even injured joints can function very well with certain activities. Examples of this can be using swimming and cycling where there is less direct impact yet you can still maintain strength and movement without continuing to overload and worsen your injury.
In summary, your tissues don't take well to sudden changes. Changes such as increases in training need careful grading. Think of your tissues like employees, if you drastically change someone's job role overnight without prior warning, you will have outrage and backlash on your hands. If you make small changes and are appropriately prepared it will make for a smoother transition. This is an especially important principle when dealing with patients chronic pain, they may well need to take much smaller steps and take them over a much longer period of time.
Exercise prescription is therefore something that should be taken extremely seriously. It is not just a case of picking exercises, giving them a go and quickly abandoning them if they don't give you the results you want. Exercises and training regimes must consist of OPTIMAL loads and need to be sensibly and accurately applied. The volume and intensity of your exercises needs to be monitored in order to be able to progress and regress them appropriately. The principles we have discussed here about regulating tissues must be applied in order to ensure successful recovery.
Thanks for reading