Loads and the body
The previous blog was on monitoring of training loads amongst professional sports people. In a clinical setting, we tend to see more of the amateur sportspersons as well as both active and less active people. Training loads are relevant to the individual for example an external load such as cutting the hedge is the same for two people but if one is sedentary and the other is an active gardener then the internal load (physiological and perceptual response) is significantly different for each. The cutting of the hedge may also be a problem for an active person who although generally fit may never work at shoulder height and experience this type of tissue load.
Amateur sportspersons and active individuals will not have the care of a multidisciplinary team unlike a professional and have the added complications of managing their activities with their working lives without the help of a multidisciplinary team.
A common patient history is that they have sustained an injury, they have a period of recovery and on returning to their given sport or activity they re-injure. When analysing the patient history in more detail patterns often emerge with a period of intense training relative to the previous week or over the last month. They then have a period of rest without any activity and try to return to previous levels with a result in a re-injury. Often it isn’t necessarily that the return is too quick it is more about how that tissue has been re-loaded to adapt to the forces being put through it. The problem can be that the patient can enter an injury-return-injury cycle and this can occur several times before they seek advice. Training load history as well as other contributory factors need to be assessed for an appropriate rehabilitation programme
Sit or stand?
Other less sport orientated examples of changes in tissue loads are when patients work patterns or jobs alter such as going from a predominantly sitting one to a standing. In this instance problems may occur as all of a sudden daily tissue loads on the musculoskeletal have changed and the soft tissues such as muscles, ligaments, tendons as well as the bones, joints and sensory and motor areas of the brain haven’t had appropriate time to adapt. Interestingly some patients can adapt and accommodate to big tissue changes.
Is gardening a problem?
Another example is when a patient has had a whole weekend of gardening and cutting the hedges. They develop aches and pains as they have undertaken the equivalent of a two-day gym session. They may also have undertaken activities that they wouldn’t normally do, particularly above head activities that commonly patients do less of, unless you are a climber or racket sports person. This example is like an athlete having a spike in weekly training and subsequently sustains an injury as the soft tissues haven’t had time to adapt.
Ultimately we strongly recommend patient’s to be active but the starting of a new activity, progressing and improvement of a given sport as well as a return from an injury need consideration when thinking about tissue loading in order for these to adapt and improve.