03 Apr Important Clinical Questions In Relation To Gradual Loading and Return To Play

1. Have the tissues that are hurting you been injured as some point? They often have not. Is this pain useful, useless, reflective of healing, pointless or maladaptive?

2. How long has it been since the injury or onset of symptoms? This will educate us on tissue strength from the general stage of healing an injury of this type would be. An example would be a pulled hamstring tendon where the focus has been resting, ‘care’ and ‘minding’ and it is into month four you are well into remodeling and it is ready for loading even if not at the stage a regularly loaded 4-month injury.

3. Have you been using the tendon normally or resting and protecting it? If you haven’t been using it sufficiently then it simply hasn’t had anything like the forces required to stimulate adequate remodeling let alone return it to the require strength.

4. Have you been loading it minimally or a lot? It is often not enough.

5. Is it time to start loading it? The key question here is have you considered the natural history and healing time frame. If the answer is yes, your sole focus should be adequate loading alongside sufficiently regular assessments of place on return to goal protocols.

6. Every musculoskeletal tissue has that is put to work has the capacity to adapt and increase its capacity. Graded loading should start early and rest should be no more than a few days. Tissues are almost always strong enough for some form of loading and get back to normal function.

7. Take into consideration the fitness of the person. The starting point and rate of progress may be directly related to this. Physical stress is essential. Finding a way to load the tissue is essential. The body will adapt.