Paper title: Patellofemoral joint loading during the forward and backward lunge Publication: Physical Therapy in Sport. Jan 2021; Vol. 47, Pages 178-184 https://doi.org/10.1016/j.ptsp.2020.12.001 Publication date: Jan 2021 INTRODUCTION Patellofemoral pain syndrome (PFPS) is one of the most common causes of knee pain in young athletes. It usually presents as anterior and retro-patellar knee pain made... MORE
Taking the next step: progressing training loads
The perfect training load to elicit a desired functional adaptation is the elusive goal of every training session for every clinician and athlete. Doing so ensures that training is efficient and purposeful. However, there’s little guidance for measuring training loads in healthy athletes, much less those in rehab. Recently, Tim Gabbett, the father of training load theory, and others put forth an editorial of thoughts to consider when progressing training loads.
Thanks to Gabbett’s hallmark work on the acute:chronic load ratio, physios understand the need to progress loads in a way that doesn’t exceed the tissue’s capacity to tolerate the load. This editorial highlights the difference between sport-specific capacity and local tissue capacity. The sport-specific capacity is how well an athlete’s body responds to the training loads encountered in practice and competition. On the other hand, local tissue capacity is a specific structure’s tolerance to loads over time.
Coaches and trainers plan protocols based on an athlete’s sport-specific capacity. Injuries occur when this level of training loads a specific structure beyond its tolerance. The sports scientists put forth that dedicating some training time to local tissue capacity may decrease injury risk. This approach would be particularly relevant in an athlete with a previous injury since tissues are more prone to repeated damage once injured. It would also enable trainers to target common sport-specific injuries. For instance, tennis players suffer frequently strain their elbow tendons. Their training program should include exercises that improve their swing and serve and strengthen the arm muscles that bear the strenuous load of the sport.
Injured tissues have a lower load capacity due to pain, swelling, tissue damage, and fear avoidance. The researchers point out that load capacity also decreases in other areas of the body that weren’t injured because the athlete isn’t engaged with the same overall training load during recovery. Therefore, while local load tolerance decreases, so does sport-specific capacity.
The goal of rehabilitation is to progressively load the injured part enough to stimulate healing and regeneration while not stunting progress. Traditionally, clinicians use pain as an indicator of tissue tolerance. But, pain isn’t a reliable indicator of tissue status. Measures of the rate of perceived exertion (RPE) are also subjective and reflect internal load factors as well as the response to the external load(2). While there’s not a quantifiable way to measure tissue load capacity yet, the researchers share three main takeaways on the subject:
- Patient-reported feedback and measures of external load are the best way to gauge load tolerance. Use a measure of RPE and an observational rating of the effort required to move the training load to monitor how well the athlete is handling an increase in loading.
- Don’t forget about local tissue loading in healthy athletes. Ensure that their training program attends to previously or frequently injured muscles to keep them strong – especially when the sports-specific training may not address them.
- Rehabilitation efforts often stop once local tissue capacity returns. However, ignoring sports-specific capacity training during rehabilitation may set the athlete up for decreased performance at best and reinjury at worst. The authors highlight the need for a bridge of sport-specific training between rehabilitation and return to sport. Because the medical system usually funds rehabilitation, there may be limited resources for clinicians and specialists to oversee this phase of return-to-sports training before return to play. Collaboration between clinicians, coaches, and trainers ensures the best outcomes for athletes.
- Br J Sports Med. 2021;0:1-2. doi:10.1136/bjsports-2020-103769
- IDEA Fitness J. 8 Sept 20; https://www.ideafit.com/personal-training/help-clients-return-to-training-safely-smartly/