Physio Blog
Neck

Neck pain causes: Do you know your load threshold?

Hi, I’m James, the CEO of Reach Physio. The Load Threshold Barometer has been one of the most useful tools to help me better understand the physical factors that cause neck pain; and how to manage, overcome and prevent it.

I especially want to share this simple and practical tool because it’s helping me change the way I understand my body and to keep as active as possible, even during times of injury or pain.

So I’ll introduce the Load Threshold Barometer through my own injury story and then I’ll hand over to Andreas, our Head Physio at Reach. Andreas will get into the medical side of how to use the barometer, and how it can help you to get a grip on what activities and exercises you can do and how much load you can place on your body at any given time, to speed up your recovery and to make sure you don't aggravate symptoms and experience setbacks.

Introducing the Load Threshold Barometer...through my own injury story

Your load threshold is defined as the amount of load you can tolerate on a certain body part or area, before the point of overuse is reached and before pain or other symptoms in that body part begin.  When we talk about load for this subject, we refer to overuse over a period of time, and not a sudden traumatic injury such as a break or ankle sprain.

Below is an illustration of my regular life and activities presented on the Load Threshold Barometer before I (stupidly, say many!) started training for an ultra running challenge.

Diagram of Load Threshold Barometer during normal activity

Over the years I had increased my load threshold above the regular weekly activities shown above, so every week I was doing upper and lower body strength training as well as running an occasional 5-8k run and this was causing no problems for my body.

The problem started when I decided to enter an ultra marathon (as so many poor decisions are made, it was over a cider or two with friends).

Being in my 20s and a little too confident, I said “I’ll run a half marathon (13 miles) and if I can do that pretty easily, then I’ll accept the race place”. That was my first step towards 6 months of pain. As you can see below, I was suddenly putting some parts of my body under a much higher level of load than they were used to, and way above my threshold and load tolerance.

Diagram of Load Threshold Barometer at the beginning of training

After a month of running 13 miles every weekend, the pain started in my achilles. After two months, I had to stop running and pull out of the race altogether. By exceeding my load threshold too far and too often, I injured myself and so, my threshold suddenly dropped - as can be seen in the illustration below. I went from being able to climb stairs, cycle to work, do exercises and more, to barely being able to walk without severe pain.

Diagram of Load Threshold Barometer after training above threshold for a period of time

I’ll now handover to Andreas, our Head Physio at Reach, to explain what happened and how to use the barometer to recovery from, manage and prevent neck pain.

How doing too much, too soon, can cause you a stiff and painful neck

Overuse injuries and pain, that stem from putting more load (stress) on your body tissues than they are used to, occur by:

  • Making a quick or sudden increase in load, for example, if you're doing upper body strength training and all of a sudden increase the load by too many kilos, while increasing the number of sets you do. Or,
  • Loading specific muscle tissue too often at, or just above their limit, without adequate time for your body to repair. For example, if you do CrossFit, Gymnastics or Yoga and you move from practicing handstands once a week to suddenly doing them every day.

With both examples you are increasing your risk of injury in the neck but also the shoulder.

I do want to note that increasing the load on your body tissues (muscles and joints), above what they are used to, is also the way you progress and get stronger. The key here is to do so slowly and  gradually and to leave enough rest time so they can adapt and strengthen.

Empower your active best with the Pain Threshold Barometer

Having the Barometer in mind and a good idea of where your load threshold currently is, will help you make decisions on a daily basis with regards to how far you can push your body, when both recovering and preventing injury.

Taking recovery first

If you currently have pain or injury, you need to work out where your threshold has dropped to. You can do this by visiting a good, recommended physio, using the Reach Physio App, or maybe you already have a good understanding of your body and can work it out yourself - either way there is often some trial and error involved in working out exactly where you are.

Once you have an idea of where your load threshold is, you should make sure that none of your daily activities are above that threshold and causing you more harm. For example, if you have neck pain and your regular cycle to and from work makes your pain worse, consider these changes:

  • first make small tweaks such as switching a race bike for a bike that lets you sit more upright and puts less strain on your neck
  • If it’s still aggravating your injury then try to find an alternative means of transportation for a period, while staying active and training around the pain to build up the tolerance in your neck

Now that your everyday life is not going to hold you back, it’s important to be doing specific exercises prescribed by a physio. These exercises should be just around your current load tolerance. Sometimes mild pain can be accepted, as long as it goes away quickly after finishing the session and as long as you can feel your body adapting to that activity over time, meaning that after a few sessions it doesn't hurt anymore and you feel that you’re able to withstand that specific load. From there, your physio can help you with progressing the exercises and your physical activities.

At Reach the main tool we use is a specific exercise plan personalised for your pain and we aim to find exercises that hit your current level and load tolerance and gradually progress on parameters such as exercise difficulty, frequency, intensity, volume, and speed, to help you become pain free, stronger and more resilient to load and stress. This is how we gradually get you back to everyday activities and/or sporting activities that were causing you pain in the beginning.

Injury Prevention

The Load Threshold Barometer can be utilised for injury prevention in the same way that it can be used for training or recovery. Firstly, work out where your current load threshold is, then set your goal level on the barometer. By planning a course to gradually increase your threshold from your current level up to your goal level, you should be able to reach your goal without getting injured along the way.

If we revisit James’s example of running an ultra marathon, he should have set a course for a half marathon first, then a marathon or two, then the ultra marathon. With each stage, James needed to progress gradually, over months and maybe even a year or so, with a mix of running (both speed and distance) and exercises to strengthen key muscle and joint areas to increase strength and load tolerance. It may look something like this:

Example diagram of what a good Load Threshold Barometer should look like

If you’re looking to maintain your level of activity then the barometer is also a great tool to have in mind. Here are two common scenarios where a little consideration towards your personal threshold barometer, could mean the difference between feeling your active best and waking up with long-term neck pain:

  1. Perhaps a busy period at work and two weeks holiday mean you stop running or going to the gym for over a month. When you start back up, be aware that your pain/load threshold will have reduced a bit, so you should start with slightly less activity than you did before and build back up over a few weeks.
  2. You have been training more than usual by doing an extra workout class or two a week. After a few weeks, you feel your body being more tired and sore than usual. This could be an indicator that you’ve progressed your activity too quickly, working over your threshold and not giving your body tissues time to recover and strengthen. So you haven’t been able to move your threshold up to handle the increased activity on a regular basis. If this is the cause then regress your activity a bit, perhaps doing a few recovery sessions with lower volume and/or implementing an extra day of recovery before the next session

Wrapping up

Hopefully, thanks to Andreas’ explanation, you now have a much better understanding of how the load you put on your body can be a factor in the cause of your neck pain, and pain in general - as it’s relevant to all body areas.

As I explained at the start, like me you can use the Load Threshold Barometer as a regular tool to assess where your current load threshold is and how you can regress and progress your activities to recover from, manage and prevent pain and injury.

If you’re suffering from pain and want help with getting your threshold back to where it was, or even higher, then check out our Reach Physio App.

Here’s to your active best!

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