Progressive Overload During Injury Rehab

Nikki Donovan

What is Progressive Overload?

·       Gradual increase in stress placed on the body in the context of fitness training and physical rehabilitation

·       The body will adapt to the demands placed on it, being able to handle an increased load by becoming faster, more efficient, stronger etc.

·       Conversely, if we do not place this stress on the body, it will become complacent, causing a training ‘plateau’, meaning that our fitness level will be maintained but there will be noincrease in strength, power, speed or endurance

·       It is widely used as a principle in strength and conditioning, but can sometimes be overlooked in injury rehabilitation

·      However, we believe it is a crucial aspect of injury rehab in order to increase performance and reach your goals.


Progressive Overload and Rehab

·       Our jobs as therapists is to help patients increase their function, which means we must cause some amount of stress through our rehabilitation methods

·       Performance is a relative term – different goals for an inactive 75 year old patient and a 20 year old international rugby player

·       However, principles of progressive overload are the same, they may even have very similar exercises at the start of their rehab programmes (though as time goes on, the exercises for both patients will differ quite significantly)

·       Its important to remember that it is relative stress that causes physiological adaptation and performance gains

·       So both patients need to be exposed to similar relative stress, it is just how these stresses look that varies

·      This tends to be where the industry can fall short, as obviously the athlete’s level of stress would need to be much higher in order to result in physiological adaptation.


So what if an exercise is…

Too easy?

·       If an exercise is no longer physically challenging, its time to progress

·       Ensure progression is gradual and consistent (the progression should make sense!)

·       Ensure correct technique and form in new progression

·       Don’t be afraid to regress or change the progression

·      Advance in small increments.


Too hard?

·       If you cant maintain proper form, if the exercise is causing pain, or if you just cant feel the exercise working, the progression is probably a little too intense

·       Maintaining form is very important, while we are using progressive overloading to get the best rehab results, we don’t want to cause different injuries with poor form and inappropriate progression choices

·       Remember that pain is an important indicator, it can interfere with your ability to perform an exercise effectively and may even delay progress

·      That being said, a little pain and discomfort is to be expected at some stages of rehab, work on the 4/10 rule – if an exercise is less painful than 4/10 then continue, if its above a four or it worsens as the reps/sets go on, stop and regress the exercise.


Ways of Progressively Overloading

·       Increase range of motion(same load for increased distance)

·       Same load and volume with better form, more control and less effort

·       Same load for more reps(volume)

·       Heavier loads (intensity of load)

·       Same load and volume with less rest time between sets (density)

·       Increased speed and acceleration (intensity of effort)

·       Same work in less amount of time, or more work in same amount of time (density)

·       More sets with the same load and reps (volume)

·       Same load and volume more often (frequency)

·       Same load and volume extending sets past technical failure e.g. forced reps, negative, drop sets, static holds, pauses, partial reps (intensity of effort)

·       Adding a dynamic component to the movement

·      Combining the movement with another exercise


Golden Rules For Optimal Loading

·       Increase training stimulus without exceeding your bodies capability to recover

·       Increase one thing at a time

·       Increase volume before intensity (volume = sets and reps, intensity = resistance/weight)

·       Progressive overload must only be performed with exercises you can do with perfect technical form

·       Progressive overload methodology is different for beginners than advanced athletes

·       Never prioritise loading over proper form, pain levels or post-op protocols.



How To Monitor Load?

·      It is important to know when to proceed with gradual stress and when to take a step back. There are multiple indicators of excess or less load

·      Increased swelling of the training muscles indicates inflammation-overload - ideally swelling should not increase between days, if it increases after training it should decrease by the evening, if it is still swollen by the next morning then training load should be decreased

·      Pain: VAS 0-10, rate the score to a specific movement or exercise - any change in score the day after training >1 that does not reduce by the evening may indicate overload 

·      Stiffness: especially in the morning, is a good mark of inflammation – for example, are certain movements difficult or impossible in the morning? If so, these muscles may be slightly overworked.




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