How Can We Monitor Load in Rehabilitation?

Q: How Can We Monitor Load in Rehabilitation?

A: Internally & externally.

Let's discuss...

When it comes to 'dosing' our exercises in both a rehabilitation and performance setting, there are various ways in which we can monitor the client's response to our dose.

In rehabilitation settings we find is that there is often a hyper-focus on monitoring external loads, whilst neglecting to monitor internal loads. This can lead to situations where we may 'overdose' or 'underdose' a load intervention.

So, how can we better understand load monitoring to correctly 'dose' our rehabilitation?

Being aware of internal loads and ensuring that both you and your clients are monitoring these, will give you both the upper-hand when it comes to navigating the unpredictable journey that is physical rehabilitation.

There are considerable bodies of literature relating to internal load monitoring in physical performance and training settings. Not to mention relatively recent publications identifying the links between training loads and injury.

When it comes to the development of musculoskeletal injuries it simply boils down to the load - capacity equation. When an applied load exceeds the body's capacity to tolerate said loads, injuries develop.

So whilst the equation in itself is simple, the application of it to an individual is often not.

We have internal loads & external loads/stressors interacting with our body's physical & emotional capacity at any given time.

There may be periods in which our capacity is high, so our ability to tolerate applied loads is high.

Think of those days where you're running at a cracking pace but it feels surprisingly easy, or a time where you're juggling a tonne of things at once and you're feeling on top of your A-game and kicking goals left, right & center.

Then there will be periods in which our capacity is low, so our ability to tolerate applied loads is diminished.

Think of those days where you're running and it feels like a 9/10 effort but you're running at a sloth pace, or those days where spilling your coffee is literally the thing that will tip you over the edge.

Firstly, what are Internal and External Loads?

In a rehabilitation setting think of the external loads as the activities our client undertakes on any given day, in addition to our prescribed movements and their associated 'dosage'. This dosage incorporates volume, intensity and density of load.

In relation to internal loads, there are a number individual characteristics that will influence how our body responds to external loads. For example; sleep, nutrition, stress and a range of other factors... The interaction of external loads with us and our individual characteristics at any give time, will give us our internal load.

In a rehabilitation setting, there are a number of ways in which we can monitor internal loads that will greatly assist us (and our client) navigate the daily ups-and-downs of their rehabilitation journey.

External Load Measures

Our 'dosage'

Exercise / Movement Selection

Sets / Reps / Rest

Resistance / Tempo / Pace

Frequency

All of these will influence the amount of internal forces generated and applied to the body, to trigger the desired adaptations to meet our therapeutic goals.

Internal Load Measures

In physical performance two of the most common ways in which we can monitor internal loads are RPE (Rated Perceived Exertion) and HR (Heart Rate).

In rehabilitation I add VAS-P (Visual Analog Scale of Pain) to the equation, via the traffic light system.

There are a number of benefits for health professionals utilising internal load measures.

1. Improve a client's body awareness & understanding.
2. Reduce the likelihood of injury flares.
3. Improve a client's self-efficacy & self-management skills.

In the cases of plantar heel pain and lower limb tendinopathy, it is expected that a client will have days in which the pain flares and is less tolerant to load. Other days the pain will be significantly less and their tolerance is higher.

I will the VAS-P & RPE as an education tool and find it really helps clients understand their body and pathology better, which is a key factor for successful treatment outcomes.

In the cases of plantar heel pain and tendinopathy in regards to the VAS-P & their exercise dosage, I will typically advise the following:

0-3 good to go.

4-6 caution warranted.

7-10 ease up.

Now the education and specific instructions I will attach to these numbers varies from person to person and I do explore this is a number of other lectures, resources and presentations.

The take home message from this, is that I feel the more we are able to integrate strength & conditioning principles in to rehabilitation practices, the better our rehabilitation outcomes will be.

If you'd like to watch the video version of this week's blog click HERE

To download my FREE resource, The Movement Prescription Blueprint click HERE

The MPB will help guide you through 3 KEY elements of exercise prescription, to help set you (and your clients) up for treatment success!