Why do we get hurt in the first place? Understanding Load vs. Capacity

Understanding the essential balance between your body’s capacity and the load you apply to your body is the secret to injury prevention, and is the most useful tool in healing your body after an injury. Listen to this brief conversation between Drs. Ellora and Kevin Maggs as they share some details about capacity and load and how they use this concept with their clients every day. 

Check out this video for more information about Load vs. Capacity and how you can help optimize your health by using these principles in your own life.

To learn more, you can reach us through our website peakperformancecare.com or by calling 209-532-1288.

Transcript

INTRO: Welcome to the "Simple Solutions for Health" podcast. We're glad you're here. This show is dedicated to helping you live your healthy, active lifestyle with more confidence, more knowledge, and more optimism. We bring you stories of what's working now for our clients as well as new concepts and evolving knowledge in the field of healthcare. We are here to empower you to get the most out of life every day with tools you already have. Now, here are your hosts, Drs. Ellora and Kevin Maggs.

Ellora: Welcome to the "Simple Solutions for Health" podcast. My name is Ellora Maggs and I'm here with Kevin Maggs. And we thought a good topic for this first podcast would be to share with you a philosophy that we implement in the clinic often. And as the title describes for this podcast, simple solutions are often best. That's something we stick to with a lot of the work that we do with our clients. And so this podcast is all about capacity versus load or capacity and load, and the relationship between those two variables. And we feel that this really simple understanding of capacity and load is a good way to understand how we get hurt in the first place, in addition to helping you understand how we're gonna help your body recover from an injury, you know, if you do get injured.

So, with the many podcasts that are coming on this show, I'm sure this concept of capacity and load is gonna come up several times, whether it be through, you know, clients that we interview or research papers that we highlight and showcase or techniques or whatever that we're finding are useful for our clients. This concept of capacity and load is something that both Kevin and I talk about in the clinic every day and so we just thought we'd, you know, dive into that first and foremost and just make sure everybody understands what we're talking about when we say capacity and load.

Kevin: Yeah. This idea of capacity and load is seemingly a very simple concept. If we just use an example of, let's say, a tree, you know, there's a certain capacity that the tree has. And if, let's say, there's too much snow that falls on a branch, sometimes the load that is imparted by the snow is gonna be exceeding the capacity and the branch will break, or in other cases maybe the wind blows too strong and the tree, you know, breaks in the wind, those are examples of load. And then on the other side is the capacity, right, if the tree is very old or if the tree is diseased, then that lowers the capacity of the tree, and so it can take less load. And so it's a simple idea in terms of pain and injury where the body is going to adapt to the load that we place on it as long as the application of the load doesn't exceed the capacity of the body to adapt to it.

So, we all know, you know, if you go to the gym and you work out, there's a response to the load, your body adapts to that by getting stronger in the muscles. And we know that to prevent osteoporosis, you wanna do weight-bearing exercises because the bones will gradually adapt to the load that you're placing on it with the weight-bearing exercises. We're all told to prevent cognitive decline, you wanna put a load into the brain by doing crossword puzzles and Sudoku and things like that. If you live in a bubble for two years, your immune system is going to adapt to that by getting weaker. So, you're gonna be pretty sick when you come out of the bubble and get exposed to viruses.

So, it's basically about adaptation. And what we find is that's a much simpler way to think about injuries rather than a much more complex way, which is very much invalidated in the research, this complex way of like, oh, you have scoliosis, oh, you have a leg length discrepancy, you have flat feet, you have a postural thing where your shoulder is a little higher or you move wrong, we see that all the time, and it doesn't help people because there's very little that we can do about those things, but the reality is the research shows that all those things exist in uninjured people, and so it's just a simple way of looking at it that you can have all those things, and if you apply a load in a gradual way that allows the body to adapt to that load, then you're gonna be fine.

Ellora: So, in a perfect world, how capacity and load fits into your life is thinking of it this way. So, just like Kevin said at the beginning, if you go to the gym, the whole point of going to the gym and doing it regularly and consistently is to try to build up the capacity of the tissue. Oftentimes we're thinking about our muscles, right? You're lifting some weights to try to increase the strength of the muscles and maybe increase the size of the muscles. So, the way that works is if you continue to increase the load on the muscle, then the capacity gradually goes up alongside. And as long as you do it gradually, then there's no mismatch and you stay within your capacity.

Kevin: So, because the body is so good at adapting, you know, there is a negative side of this too. If people are injured and they rest for an extended period of time, that means they're lowering the load a lot. And since the body's great at adapting, that means the capacity is going to go down. And over and over again, we see the research saying once you're injured, if you start loading a tendon early, if you start loading a muscle early, you're gonna have a better outcome. If you have surgery and you stay immobilized for an extended period of time, you're gonna have a worse outcome. If somebody tells you, you know, you have a weak back or, you know, you've had a disc injury in the past, so you should, you know, avoid horseback riding or, you know, whatever, then if you avoid keeping active and you lower the load, then the body's going to adapt. The capacity is going to reduce. So, as you take that approach, now you're more likely to suffer an injury because the result of the whole thing is that you have less capacity.

Ellora: So, you know, he brought up a couple of things like scoliosis and leg length discrepancies, and flat feet. I'm sure there's a lot of people listening to this that maybe that's you, maybe you have scoliosis, maybe you have flat feet, and perhaps over the years you've been told by a healthcare practitioner that that might be the reason for your pain. And so what Kevin kind of alluded to there is the last two decades of, you know, research, medical research on this has really clarified any question we might have had about that. And so, you know, for example, with scoliosis and low back pain, the amount of low back pain in a cohort of people whether it's, you know, scoliosis versus non-scoliosis is virtually the same. So, if you have scoliosis, you're no more likely to have low back pain than if you don't have scoliosis.

We know with pretty good certainty now that, you know, if you have flat feet, you're no more likely to have foot problems or knee problems than somebody who doesn't have flat feet. So, we take this as really good news. And so in our world, it's always about empowerment and reminding you of what your body is capable of doing because, in general, the body can heal itself. So, with things...the literatures kind of continue to come out in support of this idea that it's not really moving wrong or being built wrong that is a predicator for injury. It's usually an imbalance in the capacity and the load and in our world of orthopedics and sports medicine, this is often training errors, right? So, you do too much too fast, right? So, if you're a runner and you're training for a marathon, you just start running too many miles too quickly and you don't give your body time to adapt. But it can be, even if you're not feeling like an athlete and you're not doing a sport per se, it could just be, you know, you start doing more chores around the house that you hadn't been doing and your shoulders don't have the time to adapt to that, it's an easy way to get hurt. So, we take this as all good news that it doesn't matter what structural, you know, abnormalities you may have that, in general, the body will adapt to the load that you place on it so long as the load is not greater than your original capacity. And a lot of what we do in the clinic is to help you increase your capacity for the long haul so that you are less likely to overload in the future.

Kevin: Yep. And part of the whole premise of these simple solutions, if you read the title of our podcast and description, it's about having a more optimistic approach to things. And I see it all the time with runners who come in and they're injured, and they're told that they run wrong, or they have flat feet, or they have a leg length discrepancy or, you know, you're too old. I hear that all the time from patients where other healthcare providers have told them that, but none of those things really have any merit when it comes to predicting who's going to have a running injury or not. If you look at people running, it's pretty obvious that running style is wildly variable amongst runners, and that doesn't mean that you're more likely to get injured.

And, obviously, just, if you look at the person sitting next to you or across the room for you, you can see anatomy is wildly variable too. And, you know, if somebody tells you, "Oh, you have a leg length discrepancy," well, now you're gonna be stuck with this lift in your shoe for the rest of your life if that was really the problem. But, you know, when you're 40 years old and you're told you have a leg length discrepancy and that's why all of a sudden you have knee pain, well, you've had that leg length discrepancy your whole life, so, why all of a sudden is it a problem? And the answer is just because, you know, you overdid it. And I think it's very defeating for a lot of people when they hear, you know, that they run wrong and now running becomes a really cognitive thing because they're really conscious about it or they have to be, you know, wearing this, you know, shoe lift or something like that.

And it's the same across the board. I mean, golfers, you look at golfers, like, pro golfers, they don't all swing the same. There's highly variable methods that they swing. As you look at baseball, there's pitchers who have wildly different pitching techniques. And it doesn't mean that one of them is gonna get more injured than the other. It's just a matter of, you know, keeping track of the pitch count, making sure that you don't overdo it on a day-to-day basis. But the load capacity thing, you know, it sounds really simplistic, but if you think about it on the load side, we're talking about things like compression and shear and torque, and that can come in the form of exercise, it can come in the form of...like, in exercise, you can even break it down further, it's the duration of what you're doing in the exercise. It's the intensity. It's the frequency.

If you suddenly change those and you jack up the load more than the capacity, then you're gonna have a problem. But if you increase the load slowly, then the body is going to have time to adapt to it and the capacity is gonna increase. And that's the same with posture, it's the same with footwear, it's the same with lifting form or running form. If you change your running form all of a sudden, you're gonna be applying load to tissues that aren't used to it and you might get more injured. It gets even more in-depth, and this is the job of the healthcare provider as far as I'm concerned, it gets more in-depth when you look at the capacity side because the capacity of everybody's tissue, like what we talked about with the tree, it's maybe old or maybe it has a disease process in it, but when it comes to humans, when it comes to capacity, we're talking about the tissue integrity. And the tissue integrity is dependent on things like sleep and stress and diet and age, previous injury, and your training experience. Right?

We have lots of evidence that shows that if you run more miles in a week, you're less likely to get injured because your tissues have adapted to it compared to people who run less miles, or other health conditions, like you could have diabetes or something else that, you know, lowers the tissue capacity. So, it's up to the healthcare provider to find out how much load should be exposed to this person and what rate should we expose them to this load so that they can adapt properly, which is so much easier than saying, you know, you're built wrong or you move wrong.

Ellora: So, in a nutshell, we hope this makes a little bit of sense. So, in the future podcasts, we have some really great things lined up. So, we've got several clients that have done amazing things and we've kind of interviewed them to just hear their story and hear their journey about how they've, you know, managed this capacity and load to be able to achieve what they're after. And we have...well, you know, we've got a podcast on arthritis, we've got several things coming down the pike. And we just wanted everybody to understand this concept of capacity and load so that as we talk about things in the future, you understand the lens through which we're seeing the body. So, hopefully, this makes sense. Kevin actually made a fantastic video about this capacity and load with some good graphics and visuals. So, we'll have a link to that in the show notes. And, you know, you know how to reach us. If you have any questions, our email is info@peakperformancecare.com. And hopefully, this sheds some light on maybe how you get hurt and how we get out of injuries if you do get hurt. And we'll look forward to seeing you soon.

Kevin: So, keep active and keep it simple.

Conclusion: Thanks for listening. We hope you found this talk interesting and entertaining. If you've got a suggestion for a podcast topic, please email us at info@peakperformancecare.com. Until next time. 

This podcast is for general information purposes only. It does not constitute the practice of medicine, nursing, or other healthcare services, including the giving of medical advice. Additionally, no doctor-patient relationship is formed. The use of this information and the materials linked to the podcast is at the user's own risk. The content of the podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not delay or disregard obtaining medical advice for any medical conditions they may have and should seek the assistance of a medical professional for such medical conditions.