- Dr. Barry Triestman D.C.
How to decrease injury risk and increase performance! AKA Load Management
Why is load and load management so important? Knowing how much load or work we can do enables us to reduce injuries and increase performance and well being. So what really is load? It is the amount of work that we do in a day or in a specific time period. We can calculate that by multiplying the weight lifted by repetitions. If we could keep it simple let's use 2 examples. You do a squat with 10 pound dumbbells in each hand and you do it 15 times. So it would be your weight 180 lbs plus 20 lbs for the 2 dumbbells 20 lbs times 15 repetitions equals 3000 lbs and that would be your load. You could also walk with a fitbit and know how many steps you took in a day, let's say that was 10000 steps, that would be your load.
So how do we use the load information/data to prevent injury. We need to find the sweet spot. No too much or to little. We do that by charting our workload everyday and when we have a months worth of workload, we have the chronic workload. Chronic workload is the technical term, I like average. If we use the fit-bit example and we did the same amount everyday for a month, that would be 30 x 10000, which would be 300000. That would be our monthly workload and then we would want to average it for the day(10000) and week (70000) . So now that I have the average workload we look at the next week. That is our acute workload. We want to keep our acute workload to less then a 15% increase over chronic workload. If we go over this number that research has told us injury risk goes up significantly. So if we use the fitbit as an example again. We would not want our daily average to go over 11500 (10000+ (10000 x.15) = 11500) and our weekly average to go over 80,500 (70000+ (70000 x .15) = 80500).
Some people are more fragile and we need to be sensitive to this by maybe only increasing by 10%. The very young and very old and those that have been sedentary for a stretch. That could be due to an injury or lifestyle. On the other hand there are those that are more robust and they can stand a bigger increase in load and this could be due to genetics or long term intelligent training.
We can fine tune this by how we are feeling. Rate how you are feeling on scale of 0-10. If you wake up and feel like you could chew nails and spit them out that is a 10. You could probably increase the workload. If you wake up and feel like you have been hit by a ton bricks that is a 1 you need to decrease your load. We instinctively do these things but by quantifying them we will get better results. If we are trying to train a bit harder then feeling a 3-4 would tell you have hit your goal. If you are trying to recover and rebuild, we want you to feel like a 8--10.
When it comes to training loads we do want vary them intelligently. By having high load interspersed with low load we enhance performance and reduce injury.
If load is to little we degenerate. We lose muscle mass, bone density, skill, energy levels and neural drive. We get old to fast. If the workload changes rapidly that is the weekend warrior.
f we look at professional sports teams, a professional athlete like Lebron James or
Mikaela Shiffrin they have more resources to track the workload, recovery processes, and how you feel. They will have a coach, manager, chef, nutritionist, exercise physiologist, strength coach, personal trainer, physiologist, psychologist, doctor, massage therapist, physical therapist, acupuncturist, personal assistant, etc. Adding resources intelligently enables them and to step it up to the next level if we want to. The professional athlete can dedicate a lot of time to themselves, most of us can add a bits and scraps of time and energy to ourselves due to our life responsibilities, if we are highly focused.
Focus and motivation levels are the thing that separates the best from the rest of us. They have been highly focused for decades. I struggle with trying to motivate my patients to do the things that they need to do to get focused. I know that when I have a patient who comes in, I tell them to do an exercise like a box jump, they interrupt me and say how many, how often, how high, how intensely, that there success/healing is eminent. While if someone lets me explain everything and says OK. We are in for more of a battle.
So, what things can we use to judge our loads. The simplest thing to do is track the time and rate perceived exertion (RPE) of our workload. To accurately judge the intensity we use the RPE scale and then multiply it by time. Like 5 for exertion x 60 minutes = 300 units and track it just like the steps with the fit-bit. Using this approach which has been researched and judged accurate when compared to the very technical highly resource driven techniques used by the professionals.
Here is the scale
0 – Nothing at all
1 – Just noticeable
2 – Light
3 – Moderate
4 – Somewhat heavy
5 – Heavy
6 – Very heavy
7 – Very, very heavy
8 – Very, very hard
9 – I am gonna puke
10 – I am going to die
There are wearable devices like the Atlas Multi Trainer that can track the exact amount of workload in speed, velocity, quantity, weights lifted, type of lift or movement watts and connect to every machine, barbell, dumbbell and device in a facility. It will then download it to your team so they can adjust your workload. They would also incorporate some performance measures like the 40 yard dash, jump height and force plate dynamics. This technology is on its way to us just not yet. So tracking can be very precise. You also need to have a person to figure out how to utilize that data and not just collect data for data's sake. The website sportably.com has some great tools to help us judge training load and recovery right now .
One of the tools on there website and that has been researched extensively is Rest-Q sport. This is a questionnaire used by professionals and we can use it too. It helps us quantify many aspects of our lives that enable us to improve our lives which improves our health and performance. It also emphasizes that everything we do is interconnected. It will enable us to fine tune our lives.
The rest-q sport is broken down into 3 categories general stress, recovery and sport specific. The general stress subscales assess subjective strain, including: general stress, emotional stress, social stress, conflicts/pressure, fatigue, lack of energy, and physical complaints. Recovery subscales include: success, social recovery, physical recovery, general well-being, and sleep quality. Sport-specific subscales include stress (fitness/injury, burnout/emotional exhaustion, and disturbed breaks) and recovery activities (fitness/being in shape, burnout/personal accomplishment, self-regulation and self-efficacy)
The other side of the workload management is recovery. Since our bodies heal and rebuild themselves given the correct environment. We also can affect workload by focusing on recovery. The human body is not a car. We do not replace a part at a specific mileage. When we get to 1 million hip revolutions it is not time for a hip replacement. The amount of recovery and good stuff we do for bodies lets us repair and regenerate.
So what can we do? Rest, break up our work outs, mini breaks are great and underrated/utilized, cross train, take time off, work on sleep, hydrate well, eat healthy nutrient dense foods, smile, laugh, play, get hugs, give hugs, massage, chiropractic, etc, etc. One of the things that is important that often missed is that if we move well that helps us heal. If we move poorly we get injured. Moving poorly increases the load without increasing the positive effects of load. So how do do you know if you move well? Ask at least one if not 2 of these professionals . We might call them a coach, trainer, sport specific instructor, pilates instructor, yoga instructor that is trained in the Functional Movement Screen (F.M.S.) or health care professional, that is trained in the Selective Functional Movement Assessment (S.F.M.A.). If you have an injury and there are not many of us who have not and you have not had your movement analyzed you probably move poorly.
We all live in places where we have people that are successful. Generally if we can learn from them we can gain their success. So look at what you love to do? See how they load and recover. For me it is skiing, mountain biking and healing people. I love to eat and cook too but not sure if it is applicable. If I look at the skiers that have skied until they were really old. What did they do? They skied a lot, yeah. They managed load. They did it it there own way. They skied with people that were better then them for 2 days which increased there load. And then with people they were better then, which decreased the load. They usually loved those people which made it kind of like getting hugs. They ate well on the mountain by caring healthy snacks and hydrated with a hydration bottle. They did some cross training by going to the gym and walking the dog. They all laughed often and deeply. One who still skied into his 80’s drank 2 fingers of whiskey every night. Some did yoga, stretched and hot tubed.
So start managing your load and recovery well and get great.
This was originally done as presentation for The Squaw Valley Ski Patrol
Audio and slides together Load Management and Injury Prevention.
Slides for above presentation in google slides