Are you loading your patients and clients enough?

Was reading an article recently by Dr. Scott Dye titled “The Pathophysiology of Patellofemoral Pain: A Tissue Homeostasis Perspective.” In this article Dr. Dye goes on to describe what he terms the “Envelope Of Function” or “the capacity of the knee in a live person (or could be applied to almost any joint) to safely accept and transfer a range of loads” without the development of tissue injury or pathology.

A diagram from this article can be seen below.

envelope of function

So what does this mean?

This description and graphical representation got me thinking about load and the way we use it as one of the 10 key variables in training and rehabilitation that we teach as part of the Functional Movement Groups Functional Treatment + Training course. Could it be the most important variable of all?

From a conditioning training stand point we know that optimal loading causes positive adaptation to the tissues. Muscles undergo hypertrophy, connective tissue strengthens and bone density can increase. We also know that if we push too far in the loading of healthy tissue, whether this be suddenly or repetitively over time that this can lead overloading beyond the point of tolerance or total tissue failure (ouch!). Therefore in a conditioning realm it is important to understand where the “goldilocks” zone is for load of any movement to cause positive change and avoid negative consequences.

The exact same principles apply for using the load variables in the rehabilitation space, only often the playing field is more complicated. Rehabilitation patients are often de-conditioned, coming back from adequate healing times, have irritable tissues, have alterations in the way in which they move and their pain experience can often be influenced and or heightened by their own perceptions and beliefs. This leads to a difficult environment for creating an optimal loading environment to evoke positive change!


To make matters even harder many patients that we see are suffering as a result of activities of daily living that are delivering to0 great a frequency of load that cannot be handled by the tissues (think tendinopathy and other repetitive stress conditions). This then also leaves the practitioner in a complicated position on how to monitor and manage load variables with the patients that they deal with.

The Rehabilitation Process: All About Tolerance

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We see it everyday in the clinical setting but coming up with effective management plans for the injured patient, especially those with repetitive stress type injuries (eg plantar fasciitis in an older patient who does a lot of standing, or a patellar tendinitis in a runner training for an event) can be difficult.

The cause of the pain and pathology is usually a fairly simple one in these patients, for whatever reason we have had excessive load on the tissues that has pushed past the envelope of function. The rehabilitation process must then focus on gaining more control of this process by:

Reducing the load that has caused or is maintaining the problem: This could be making adjustments to the work place, changing ergonomics, adjusting training plan intensity or duration etc.

Increasing tissue tolerance: Often this is about utilising strength and conditioning or rehabilitative principles. Developing greater strength and capacity for handling loads has been shown to be an effective strategy while eccentric and isometric loading protocols for tendon pathology has also showed some promise.

The hard parts here are in the implementation. Reducing the load can be difficult because it is often things that the patient has to or loves to do that is the problem. Increasing tissue tolerance can also be difficult because too great an exposure pushes into the supraphysiological loading zone leading to re-aggravation and flare up.

At the Functional Movement Group our Functional Treatment + Training course is designed to come up with principles and strategies for using load and 9 other movement variables to find the ideal “goldilocks” zone for an individual’s training based on their needs, wants and goals. Utilising these 10 movement variables we can then develop an individuals Movement Capacity, Movement Competency, Movement Variability and their Movement Confidence. These strategies create robust individuals, capable of achieving their movement goals and minimising their risk of injury.

If you would like to learn more about the Functional Movement Groups Functional Treatment + Training course click here to find out when we are next in your home town!