The emphasis is always on keeping active and avoiding complete rest even in times of chronic pain or injury. Retrospectively, I now realise that that is not enough for you to make sense of what to do.

We’ll look at load management today to give you an idea of how keeping active in spite of injury may look. In doing so, I hope you can find actionable strategies to get moving starting today.

Most of the content shared here is inspired by acclaimed podiatrist Michael Nitschke‘s work on sustainable running. He is a certified sports podiatrist and middle to long distance running coach based in Adelaide, Australia.

p.s. there will be tons of references back to sports science and sports medicine because that is where most of the research on loading in the context of injury prevention is being developed. 

What is load management?

pain management, singapore pain clinic, exercise pain
Screenshot of a slide from a presentation on running gait by chiropractor Luke Nelson. He is the president of Sports Chiro Australia and a committee member with Sports Medicine Australia.

At its essence, load management is about balancing the stressors that you put into your body vs. the capacity of your body to tolerate them.

The first thing you should pay attention to is that load is not always mechanical (movement, exercise). Your daily mood, mental health, and sleep quality all has a part to play. Load management is a holistic view into what you should or should not do.

As you can imagine, it is a complex process because we do not know how all of these variables interact with each other and their independent/singular effect on a particular health outcome.

How does training load management in running look like?

running singapore, training intensity, sports injury
I like how Michael illustrated training characteristics/total training stress in a mixer format. If you were to change only one of the variables (i.e. other conditions remain constant), the output will change. Similarly, we can manipulate a few of them at the same time to balance a runner’s training so the overall training stress remains constant.

To get started, we’ll use running injury as an example.

Most runners with injuries understand that they may have to run less so their bodies can recover. However, many injured runners fail to execute an adequate load management strategy.

While they may decide to train less (i.e. reduced mileage), most unknowingly end up running faster. When that happens, the increase in intensity may overwrite the deloading effects of reduced mileage. If that is the case, the overall training stress increases.

This means more load!

When looking at managing the overall effects of a physical activity, we have to at least consider frequency, volume (distance), duration, and intensity.

Looking at running mileage, running pace, or max heart rate in isolation gives us an incomplete picture at best.

Likewise, when changing physical activity levels in chronic pain management, we can look at these factors as well.

  • How often are you looking to exercise?
  • How much exercise are you looking to do? In distance or quantity (sets, repetitions)
  • How long do you plan to spend performing the exercises?
  • How intense will you be executing the exercises?

New isn’t always better

Having that said, you don’t have to introduce new exercises into your daily life to increase activity.

You can pick any activity that you are already performing in your daily life and modifying it according to the four factors mentioned earlier.

Let’s say I work in an office and I have chronic back pain. I know that increasing my physical activity levels would benefit me.

However, I intensely dislike the idea of exercising. The last time I signed up for a gym membership, I cancelled it within a month.

I know exercise is important. What can I do?

To start, it’s always good to begin with what you are already doing.

Research tells us that sustainable changes, however small, triumphs the effects of unsustainable grand gestures. So, let’s start with what is already in your daily routine and find small modification that we can gradually implement.

Here are some small modification ideas for your consideration:

  • Taking the stairs instead of the escalator or elevator
  • Walking instead of taking the feeder bus service
  • Do calf raises while brushing your teeth instead of standing still
  • Opt to stand instead of sitting on public transport

Don’t forget about yourself!

Now that we have discussed how to evaluate physical activity loading, we have to consider your tissue capacity.

How much can you reasonably do without causing more injury to yourself?

If you are doing this by yourself, I highly recommend that you take a more conservative approach. It’s better to err on the side of caution than to worsen your current injury.

Keyword: injury.

It’s important to note that when it comes to capacity, we are looking at how much your tissues can take before failure or injury. It’s not about how much it takes before it starts to hurt.

Take for example, stepping on a tiny lego brick. The sole of your foot would robust enough to withstand the stress from standing on a lego piece. However, it does hurt. It probably will be very painful.

Back to my earlier example, it’s reasonable to expect my back to be more sore if I started using the stairs instead of the elevator. Given that climbing stairs is a fairly low intensity activity and that I have no other health issues, it’s reasonable to expect that I would not injure myself more taking the stairs.

That doesn’t mean climbing stairs wouldn’t aggravate my symptoms.

It’s important for chronic pain patients to be able to make this distinction.

Research shows that people living with chronic pain who are unable to understand pain doesn’t mean injury tend to be at higher risk of fear-avoidance behaviour. Following which, they have more unpleasant pain experiences and poorer recovery outcomes.

p.s. please do not excessively trigger a pain response as you increase your physical activity. Generally, we consider pain intensity of 4-5/10 and below to be acceptable. Your pain should also subside within the hour or at latest by the next morning. If you find that your pain level is the same or worse the next morning, you may want to consider reducing the overall load.

p.p.s. complete rest is not advisable for majority of the cases.

p.p.ps. if unsure, seek help from an evidence-based professional. I cannot emphasise this enough. A chiropractor, physiotherapist, or even medical doctor who isn’t up to date with the latest research is more likely to provide less effective, or even detrimental, advice. In doing so, they delay your recovery.

Always be mindful of the non-physical factors

I have focused largely on the physical considerations when introducing additional physical activity. However, as mentioned in the beginning, non-physical factors have an influence on you as well.

The amount of sleep you may have will determine your energy levels and motivation to exercise more. Exercising while fatigue and distracted may also increase your risk of injury.

Your state-of-mind and self-efficacy levels will have an effect on how meaningful your exercises will be and how much you can gain out of doing them.

Remember, it’s a balancing act. The more good stuff you can put together for yourself, the better position you will be in for your own recovery.


If you are ready to take action today, I highly recommend that you book in with me to let me guide you through this recovery process.

Remember, my life and business mission is to make myself redundant to you. There is nothing more that I’d like than empowering you find your own freedom from pain.

Book in with me today to discover the difference the right care can make.

Your Recovery Journey Begins Now

Frustrated by the lack of quality pain management and ethical business practices in Singapore, chiropractor Jesse Cai founded Square One to deliver recovery goals in just 4 to 7 visits. Not getting results from your chiropractor, TCM doctor or physiotherapist? Book an appointment and find out how we can take your recovery to the next level.

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