How to Apply Load Management for Injury Recovery Like a PT

Around here, we talk a lot about the Alleviate Method - the at-home application of the gold standard of physical therapy. With three pillars of treatment (load management, soft tissue mobilization, and progressive strengthening), the Alleviate Method is designed to give everyone the tools and methodology to recover from repetitive stress injuries at home.

The three pillars work together to reduce pain quickly and make the relief stick for the long run. Today, let's do a deep-dive into one of the three pillars: load management.

In professional sports, coaches and trainers monitor and control how much force, or load, goes through an athlete’s body over a period of time, like a season, to prevent injuries and maximize performance.

Too little training is obviously not ideal, but neither is too much training (i.e., too much load placed on an athlete’s body): it’s inefficient, unsustainable, risky, and even harmful. Load management is a way to train just the right amount to maximize performance over time, with periods of unloading and recovery built into the cycle.

Even if you don’t use the exact term, this concept has been widely embraced in recreational sports as well - most of us use rest and recovery intentionally to get better at activities and sustain our physical and mental ability to enjoy them. 

The fundamental concept of load management is the same in physical therapy: it’s about giving your body just the right amount of load to maintain or increase your capacity without aggravating your existing injury. It's not the same as simple load reduction (a.k.a., "just take a break"). More on that in a bit!

Unloading the tissue at the beginning of your healing process protects the injured tissue from further aggravation. At this stage, load management focuses on reducing or modifying the load on the sensitive tissue to give it time and space to start healing.

Immediate pain relief comes with load reduction. Usually, the pain won’t go away entirely with just load management, and you’ll need other treatments to make the relief stick.

However, for most people with a repetitive stress injury, load management provides enough pain relief to go about your day without wincing, and stay active so that you can maintain your overall fitness while you heal.

Load management isn’t called load reduction for a reason: as the tissue heals, you gradually increase the load in a controlled manner, so that the injured tissue gets stronger. More resilient tissue will be able to withstand more load without pain or damage.

Typically, progressive strengthening is done through physical therapy exercises that target the injured tissue, as well as all the muscles, tendons, and ligaments that work with it. You can think of a stronger, more stable kinetic chain as a protection for the now-healed tissue.

This is why good physical therapy isn’t just for pain relief now - it builds your defenses against flare-ups and recurrences.

“Take a break for a bit and see if it improves” is an all-too-common doctor’s recommendation for repetitive stress injuries. While this advice can be good if your symptoms are minor and acute (i.e., just started in the last week or so), it's certainly not a cure-all. Load management is a much more effective way to treat chronic pain conditions.

The key differences are:

• Taking a break means a simple reduction in load. While you’ll get welcome pain relief temporarily, pain will return as soon as you return to the triggering activities.

• A long break will reduce your capacity over time, making you more susceptible to flare-ups, even from less load than your original trigger.

• Load management reduces load first. Like a break, it gives the injured tissue time to heal - but it doesn’t stop there. A good physical therapist will give the tissue just the right amount of challenge as it heals, so that it maintains and eventually increases capacity.

In physical therapy, the primary tool for load management is taping. Let’s look at two examples: Plantar Fasciitis and Tennis Elbow.

Load management is one of the three pillars of effective physical therapy treatment for repetitive stress injuries. We know it works well, especially when you pair it with progressive strengthening and soft tissue mobilization (massage). Taping for load management is effective, but it also has major drawbacks:

• Taping loses efficacy quickly. Especially when you’re engaged in intense activities, it only lasts for 30 minutes to an hour. You’d have to get it re-applied for continued support.

• PT visits are time-consuming. It’s logistically and economically unrealistic to go to a physical therapist every day to get taped.

• There’s a learning curve. You can learn to tape yourself, but to give yourself an effective tape job, it’ll take some learning and practice. Depending on which body part you’re taping, it can be quite tricky!

This is why we developed our foot brace and elbow brace that replicate physical therapy tape jobs, so that everyone has the tools to treat chronic, repetitive stress injuries at home.

To get the same benefits of load management without daily visits to your PT’s office, wear a brace during any activities that cause you pain.

As mentioned earlier, load management is one of the three pillars of repetitive stress injury treatment. It might be tempting to stop at pain relief from taping or a brace, but that’s partly why injuries like Plantar Fasciitis, Runner’s Knee, and Tennis Elbow have high recurrence rates. To make your pain relief stick, make sure to incorporate the other two components of the gold standard of physical therapy:

• Soft tissue mobilization. Working directly on the injured tissue to break up scar tissue, reduce adhesions and tension, and promote the growth of healthier, stronger tissue. This is the technical term for the healing massage physical therapists use to treat injuries.

• Progressive strengthening: Gradually increasing the load on the injured tissue, as well as the rest of the kinetic chain, to build strength and stability that defend against flare-ups.

Alleviate was founded by a patient-clinician duo to bring the effective chronic pain treatment from physical therapy offices to everyone's home. With our all-in-one Systems for Plantar Fasciitis, PTTD, and Tennis Elbow, you can use the Alleviate Method to treat your pain, without the hassle of traditional physical therapy.

All of our Systems include a brace for load management, a massager for soft-tissue mobilization, and a Guided Recovery Program for PT guidance and progressive strengthening.