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Load, Load, Load.. Blah, Blah, Blah!

2 Mar 2015
Paul Visentini
I have enjoyed the recent papers and the more recent twitter-fest discussing load management. A great conversation for sports injury managers and practitioners to be having. Do we need to prove that it works? Can we prove that it works? For me the answers are no, and no.

The best practitioners have one thing in common – they are experts in clinical reasoning – the ability to analyse and problem solve.  Clinical reasoning is immeasurable, like the art in our science, or the science in our art. Load management is similar – there are so many factors and variables that it would be impossible to isolate, and control for, in any type of meaningful research. With so many variables, taking a single aspect of load management or a collection as per many scoring systems, may ignore another more important component.

Perhaps the only way to research load management would be the pragmatic intervention, of the expert vs novice practitioners managing randomised groups….who has the better outcomes?  The hypothesised results wouldn’t change the world of injury management.

So many components to consider: volume, frequency, intensity, type of activity, periodization in/out of season, pre-season training volume and quality, type of force, direction of local loading ( ie tendon compression vs tensile), stress, sleep, fatigue, diet, abdominal adiposity, hormones, systemic disease, local and global forces and mechanics, the cellular response, the local tissue response, the response of a joint or an entire closed kinetic chain, fear, catastrophizing, motivation and other psychosocial components, central sensitisation, peripheral sensitisation, genetic differences……

Think about the many things that may potentially effect the function of the cell and related tissue – this is what the expert practitioner does. 

Perhaps we ought to conceive that load management is not an intervention like the use of blood products to enhance tissue change.  Load management can be viewed as the product of an analytical process within the clinical reasoning framework.  Load management includes mechanotherapy, pain management, education, strength, activation, mobilising, fitness training, relative resting, and nearly any other intervention utilised by injury managers.

Whilst difficulty in researching shouldn’t preclude us from the attempt, perhaps we are best served educating our practitioners in load management, in all its complexity. We should encourage engagement in publications from Cook and Purdam (BJSM 2014; 48: 506-509), and from Glasgow et al (BJSM 2015;49:278-279), and others, as well as in the tweets and editorials. 

We should all be MASTERS of LOAD, and in doing so, help patients to master their injuries.

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