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Practice Policy Update regarding COVID-19

Published on: 29-Jun-2020

Restarting sport and fitness activity with too much intensity and too much training load is s setup for an overuse injury;

Lessen your chances for an injury by starting back into activity about 50% of your pre-isolation load and increase by 10% to 20% per week if you’re feeling good.

I’ve been writing about trying to keep up with some amount of exercise during our stay-at-home limitations. While many of you have found ways to maintain- and even improve- your fitness levels, the reality for many folks is that there was simply no way to keep up with fitness levels during our recent restrictions.

So now as we start gradually easing restrictions on outdoor sports and fitness you’ve got an opportunity to get some of your lost fitness back. But a few words of caution are in order here: getting back too fast, with too much load, and too soon is a recipe for an injury.

A sensible approach calls for a restart at about half intensity from your previous level, and then ramping up each week. In professional sports the phrase used for this type of limited activity is “load management”. It works for all of us.

What Happens To Your Body During Extended Time Off

Every part of your body is helped by regular exercise and unfortunately that also means that every part of your body is negatively affected by a lack of exercise. If you’ve previously been healthy and fit but have now spent the last 3 months sitting at your desk on Zoom calls, well, there have been a lot of things happening in your body from all that inactivity and most of them haven’t been good.

Adult athletes, especially older adults, will become deconditioned fairly quickly. Noticeable differences happen from 2 weeks off from exercise. Young people have more reserve capacity and either won’t feel as much deconditioning or it will take a longer time off to feel the effects. Even fit young athletes will feel the effects by 4 weeks off.

Among the systems related to your fitness, your heart and lungs will lose some of their efficiency with time off. Muscles will become weaker and tendons will generally become stiffer. The issue with the muscles and tendons is most relevant to athletes returning to sport after a long layoff, and those issues make you more susceptible to injury on your return.

Strategies To Ramp Back To Sports

Do you remember the day when there was spring training for MLB and off season training for the NFL?  Well, those were times when even elite professionals are susceptible to overuse injury coming back from off season rest, and athletic trainers carefully monitor the players’ return to activity. Using sophisticated data, the trainers start “load management” protocols to safely get players back to fitness.

For the rest of us, the basic principles of load management still apply, and should help to reduce the risk of muscle strains and tendon injuries in all age groups, and growth plate issues in kids.

For adults and kids a reasonable way to start is at about 50% of your old training volume and intensity. You’d then closely monitor how you feel. Some soreness is to be expected when starting up, but if you feel especially bad then take a couple days off. If you’re feeling good then increase activity by 10% to 20% the following week. I’d recommend over-50 adults ramp up at the lower range, closer to 10% per week.

Let’s say you are a young athlete who used to practice and play your sport around 10 hours per week pre-virus. When you start back you’d target about 5 hours per week the first week, and if feeling good you’d increase that to about 6 hours per week the second week.

Stay safe, and embrace the challenge.


By Dev K. Mishra, M.D., President, Sideline Sports Doc, Medical Director, Apeiron Life, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

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The post Why “Load Management” Matters. Ramping Back To Sports After Covid-19 Layoff appeared first on Sports Medicine Weekly.