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Why-do-we-get-injured | Blog | Physio.co.uk | Leading physiotherapy provider in Liverpool and Manchester.

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This is a question we often hear from our patients, especially those that cannot pinpoint a particular reason or event that may have caused the onset of their pain.  It can be a source of frustration and can feel pretty unfair at times!

There are a vast number factors which contribute to injury or pain, but with this blog I’m going to look at what I (and many others in the industry) feel is often the main culprit  . . . . . Load.  Or put another way, the stresses or forces we subject our body to.

‘Too much, or too little?’

Now, how much we load the tissues of our body (bone, muscle, tendon, ligaments, fascia, cartilage etc.) has always been a popular subject up for debate and we have all heard varying advice.  Examples include: “don’t run too often as you will damage your knees”, “don’t slouch in your chair it will give you back pain”, “the more you exercise the more benefits you will get”, “no pain no gain” or “use it or lose it”.  But how much of this is true? Some of that advice in surely contradictory? Can we really do too much or too little? . . . . Well, perhaps unsurprisingly, the answer lies somewhere in between.

‘Optimal load’

Subjecting our body to load or forces on a daily basis is extremely important if we want to reduce the risk of pain or injury.  But the answer lies in the type and amount of load.  In order to help prevent injury we need to consider what we refer to as ‘optimal load’.  This can be thought of as the most appropriate level of load/stress that can be placed on a tissue to promote a positive response, achieve training/performance goals and not cause injury.  This ‘optimal level’ will vary from one individual to another and would take into account factors such as: current fitness levels, mobility, movement patterns/motor control, body weight, strength and endurance to name just a few.  For example, the optimal load through the calf and Achilles tendon for an untrained person beginning a running programme would be much lower than that of a trained marathon runner.

The concept of optimal load would therefore suggest that there is the possibility to ‘overload’ or ‘underload’ a tissue of the body, which may have a detrimental effect and this is the important part.


Let’s start with underload.  We would be forgiven for thinking that if we are not subjecting the tissues of our body to any excess or abnormal load then harm is not likely to occur.  But in reality, ‘underloading’ a part of the body can be just as detrimental as overloading it.  Our body needs to be subjected to forces which stress the tissues in order to adapt, compensate and resist similar forces in the future.  If they do not get this stimulation, then tissues can lose their force resistive properties and their structural integrity can reduce.  The old ‘use it or lose it’ as mentioned earlier comes to mind.  If we take bone as another example, ‘Wolff’s Law’ states that bone remodels itself in response to the forces that it is subjected to.  Therefore, if a bone is stressed (e.g. through exercise) it will become stronger in response.  If it is not stressed, bone growth will lessen and weakening can occur.  Another example is with our tendons (e.g. the Achilles tendon).  Tendons thrive on optimal load, for them underload is a big problem.  Their main job is to transfer forces created by the muscles (as they contact) to the bones and generate movement at a joint.  They also play a big role in storing energy during ‘bouncing movements’ (plyometrics) and act like elastic bands to help you generate more force. When underloaded and not sufficiently stimulated, a tendon’s ability to resist these tensile forces can reduce and therefore lead to injury.


The problem of underload often becomes evident when an individual suddenly increases their physical activity or exercise levels.  This could be a change in job role, an increase in exercise such as starting a ‘couch to 5k’ programme or even just a sudden, more demanding movement such as lifting something heavy.  Placing a sudden increase in load on the tissues after prolonged underload will mean that they are no longer able to sufficiently resist those forces and tissue damage/injury can occur.  In a nutshell, this is where underload becomes overload.  Doing too much, too fast.

So how else can overload occur? Let’s go back to our example of a marathon runner.  If the runner did not train to a sufficient level prior to the event, then the risk of injury during the event may be greater.  This is because they may not have progressively encourage sufficient adaptations to occur at, let’s say, the Achilles tendon.  Then, when they run the marathon, they are asking the tendon to cope with stresses it is not used to and injury can occur.

‘What can you do and how can we help?’

This brings us back to optimal loading.  When starting out on a new exercise journey, it is important to respect the time it takes for our tissues to recover and adapt.  If you are new to an activity or planning to significantly increase your training intensity or frequency, then you need to be aware of load management.  Optimal loading can be a tricky business and it isn’t easy to get right.  You need to do enough to prevent underload but not too much or you may cause overload!  My simple tips for those who are starting a new exercise regime would be:

  1.  Start gradually and increase your training in small increments (let your body guide you).
  2.  Allow 36 hours’ rest before repeating the same activity where possible.
  3.  If you really must train within this time frame, perform a varied activity or exercise (e.g. Cycle instead of running)
  4.  If you are experiencing pain in an area the evening or morning after exercise, you may have done too much.

Physiotherapists are experts in progressive load and tissue management.  If you feel that you are suffering from a load related injury, then we can help.  Commonly, we would provide guidance on achieving optimal load, increasing muscular strength and control, improving balance, improving flexibility/mobility and biomechanical assessment.  Addressing these issues will keep you training at an optimal level.

If you require assistance with managing your training loads, preventing injuries or help to recover from an existing issue then please contact us on 0330 088 7800 to book an appointment with one of our physiotherapists.