Progressive Loading is a term used in rehabilitation to describe methods of safely and systematically applying load to injured or repaired soft tissues.
After an injury or a surgical repair to soft tissue (muscle, ligament, fascia or tendon) your body will lay down new collagen fibers to repair the damaged area. This new collagen is very disorganized and has low tensile strength and is, therefore, very susceptible to re-injury. If you apply too much load too soon after injury you risk tearing this newly formed collagen tissue and this can set your recovery back. This is not only frustrating but it can lead to poor final outcomes as well.
The new collagen can be slowly transformed into a stronger type of collagen that has well organized fiber bundles that are able to withstand the forces needed for you to return to your activities and sport. To transform and strengthen the new collagen we need to apply just enough force to cause micro-tearing and micro-stressing of the fibers. This micro-tearing will lead to a “healing response” or a strengthening adaptive response that is proportional to the stresses being applied. If you go beyond micro-tearing, you can have pain that lasts several days and you risk causing a bigger inflammatory response. Lots of inflammation usually means stopping activity and waiting several days before applying any new stress. This can be a vicious and frustrating cycle.
The difficulty with progressive loading lies in not crossing the micro-tearing/micro-stressing line too often or by too wide a margin. You will certainly cross the line a few times, and that is fine and maybe even desirable now and then. You’ll get into trouble if you cause macro-tearing too many sessions in a row or without adequate rest days to allow the inflammation to die back down.
For example; If you are training at slightly too high of an intensity every other day, the tissues are not only being pushed too far but also too often. This is not enough time to recover and allow adaptive strengthening of the collagen fibers. After a week or two of this you will cross the line into a larger tear and a larger inflammatory response, and you’ll start having pain that can last for a week or more.
I usually recommend a cycle of activity that incorporates 3 days in a row of rest every week for early recovery plans and 2 days of rest in a row for later in the recovery process.
Pain that starts 1-8 hours after a training/sport session is inflammatory. That is ok, and probably good, as long as the pain is mild (1-3 on a 0-10 pain scale) and so long as the pain is back to a baseline or a very low level after 8-16 hours. If pain lasts more than 24 hours, you have probably pushed too hard. If pain is more than a 5, you have probably pushed too hard. That’s fine but you’ll need to decrease the intensity of the next few sessions and you’ll have to add in 1-3 extra rest days before your next session. This is important. You’ll get in trouble and stall the whole process if you push too hard too many sessions in a row.
Pain is a necessary and desired part of the plan. BUT the pain must be on the milder side and shouldn't last very long.
If you have zero pain, then you probably aren’t challenging the tissues enough. If you have higher levels of pain that lasts for several days, then you are pushing too hard, and you will eventually have to stop and start over.
Additionally; If you take NSAID’s prior to training, you may have less pain, but you will be much more susceptible to crossing the line from micro-tearing to macro-tearing. NSAID’s can help control early inflammation, but this isn’t necessarily helpful for the long term health of the tissues and can even disrupt normal healing mechanisms. I usually only recommend an NSAID if pain is affecting sleep or work or daily activities and even then, only for only a day or two at a time.
Here are some basic tips to help you find the right balance of stress, rest, and load.
Make sure you can reproduce each exercise with the same weight or intensity as prior sessions.
Keep track of reps, sets, rest times etc... for each activity.
Don't add too many exercises at any one time.
Don't change intensity levels too quickly or make large jumps in resistance. 10-15% per week if things are going smoothly.
Add more rest if you're getting sore or aren't progressing.
Add aerobic activities and stretching activities to your recovery routine to promote overall health.
Stop smoking.
Eat well.
It can be difficult to design your own Progressive Loading Program. Get professional help you are having trouble finding the right balance!
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