Understanding irritability and optimal loading
Irritability: the degree which symptoms increase and subsequently decrease with an aggravating movement/posture and is time-related. If symptoms cease immediately, then the symptom is deemed non-irritable.
When considering a patients irritability, ask;
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What activities or positions aggravate the symptoms?
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How long does it take while completing that activity or position before symptoms start?
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If the activity is stopped or the position is changed, will the symptoms continue to progress?
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How long do symptoms last before returning to baseline after the activity or posture?
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What can be done to reduce symptoms?
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Optimal loading:
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Aims to provide guidance for exercise prescription to ensure under-loading or over-loading of tissues is minimised during rehabilitation.
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It is concerned with the progressive manipulation of dosing including magnitude, variation and direction of load that is applied to a tissue that maximises its physiological adaptations, while maintaining high quality movement (Glasgow, Phillips, & Bleakley, 2015). It is dependent on tissue type, presenting complaint and the adaptation required for performance.
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Providing variations in magnitude, direction and rate of loading may prevent repetitive overload and modifications of direction of load, including compressive, tensile and torsional, allowing tissues to resist a range of loading types.
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Figure 1. (Brody, 2012)
What does this mean clinically?
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Specific patient education is required to ensure that the knowledge to adapt exercises depending on loads throughout each day is given.
For example, if there are days that patients are more/under active, educate them on ways to progress/regress exercises to achieve optimal loading between sessions.
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Clinicians should be cautious to progressively increasing stress to create change while respecting the patient’s requirements to perform ADLs and work-related activities (Brody, 2012).
For example, a patient with a high level of irritability & a physical occupation may have a smaller ‘window’ of optimal load where a patient a low irritability will have a larger ‘window’ of optimal load (Fig. 1).