What does it mean?
Load management is a medical term that is often used by physiotherapists when talking about adjusting or modifying something that causes you discomfort. It is used most often when talking about tendon related discomfort
I’m still not sure what it means.
Often, when you have something that is uncomfortable such as a tendon complaint (but can include lots of other muscle and joint issues) there are things that you can still do comfortably but there are things that increase the discomfort or that you now find difficult. These can often be really simple things like getting dressed, lifting the kettle or going upstairs If you are able to think of these things as your body having to perform a job or move/use a ‘load’ it might start to make sense.
The best way to think about your complaint (elbow, knee or shoulder etc.) is that it has found itself with less ability to cope with the things (or cope with the ‘load’) that you used to do easily.
Ok, I’ve got it but what does it mean for my particular issue?
Most of the time, these problems are nothing to be concerned about (even the really painful ones), but can be very frustrating as the discomfort gets in the way of doing normal things.
Pleasingly, most problems can improve by themselves without physios or doctors but sometimes we have to do something different to help them settle down and recover.
Why have I got this problem?
That is often a very difficult question to answer and interestingly, it is likely that only you know. Problems can come about through various ways such as injuries, overuse or even underuse.
Interestingly, it is quite common for tendon related issues to come about because of doing more of something, doing something you’re not used to or more likely, not being able to cope with certain activities due to reduced fitness and strength.
Ok, but what does this mean for me?
We all have a wonderful body that for the most part, does everything we want and need it to do.
You can normally pick up cup without your arm aching, you can normally walk up a slope without your hip hurting and you can normally get dressed in the morning without your shoulder complaining. However, sometimes these things do become a problem and often the reason is that before the start of the issue you may have done something more, or different, or not been as fit as before and that has pushed your body’s ability to cope and it is now complaining about it.
Let us explain with pictures…
The bubble represents you body’s ability to cope with things.
Before the start of your problem, everything you wanted to do would fit inside the bubble and therefore you wouldn’t have any discomfort or problems.
If you find yourself doing more of something (like a heavy day in the garden), then occasionally you may find that you push your body’s ability to cope with things. Certain things then start to sit outside the bubble and you may find you get discomfort.
Or, if you have found yourself doing less over a period of time and maybe you are not as fit or strong as you might have been in the past, doing normal things even in the way you’ve always done them might push your body’s ability to cope. This is because your bubble (you body’s ability to cope with things) may have 'shrunk'.
What should I do?
Firstly, try not to worry. Discomfort can be really scary, especially when it is really sore or is getting in the way of things that you used to find easy. It is well known within the health professions that worrying about an issue can actually make it worse! (Mallows et al., 2018)
Secondly, in order to settle the issue, you need to consider looking at the things that your problem doesn’t like, in other words the things that make it sore, a try to make some adjustments. Try to think along the lines of ‘if it hurts to do it this way, how else could I do it?’. Below are some ideas that may help but do not feel that you need to limit your self to these.
Lying on the uncomfortable side
Lie on the other side or place a pillow under the uncomfortable side
Lifting the kettle
Use the other arm or fill the kettle only half full
Using the computer
Take more breaks or set a timer to change position regularly.
Try a different route or reduce the distance for a time
Why will doing things differently help?
The aim of the adjusting or modifying the thing that you find uncomfortable is to calm down the irritation (think of ‘shrinking it’) and allow the task/ activity to move back into the bubble (where your body can cope with things more easily).
Is this really that important?
In short, yes. With a lot of problems, this is one of the most important parts of your recovery. By making simple changes to the things that you find uncomfortable will allow your issue to calm down.
Is this all I have to do?
That would be nice wouldn’t it? Unfortunately, if we only made adjustment to those things that are sore, you may find that when you go back to doing them normally again things may become sore again.
Ok, what else should I do?
Get stronger. In order to recover from your issue and to reduce the likelihood of it coming back, you need to improve your body’s ability to cope with things and this generally means becoming stronger. Often, if you are more confident in your body and what it can do, you are stronger and fitter, you can actually increase your body’s ability to cope with things ('grow the bubble') allowing you do eventually do more.
How do I get stronger?
If you are working with one of our physiotherapists, they will advise on a program of exercises that would be right for you. If you are not working with a physiotherapist or want to explore some of the options for yourself, please explore our exercise libraries.
These can be found here ‘self help’
• Your body has an amazing ability to do what you want it to do normally without complaining.
• Sometimes if you do more of something, do something different or are not as fit and strong as you used to be, you can push the body’s ability to cope.
• Painful things often don’t mean that something is damaged and more likely to be simply irritated.
• By making some simple changes with the things that are sore (asking for help, using the other arm, taking more regular breaks) you can start to settle things down.
• Making changes/ adapting painful things are really important steps towards recovery.
• Just making changes to things that are uncomfortable will help but to really try and get better, you need to think about growing your body’s ability to cope with things and this means getting fitter and stronger.
- Mallows, A; Debenham, J; Walker, T; Littlewood, C. (2017). The association of psychological variables and outcome in tendinopathy: a systematic review. http://keele.ac.uk Accessed on: 03/08/2018.
- With acknowledgement of content from ‘The Shoulder Complex doesn’t have to be Complicated’ education course written by Adam Meakins. Attended 20th June 2019, University of Ipswich, Suffolk.