Key point
Loading has three basic principles: specificity (you develop what needs to be developed), loading (to improve, you need to ask a little more of your body than usual – without loading, there is no improvement), and gradual progression (you increase the load gradually). These three principles form the framework for safe recovery.
The functional ladder – what builds on what?
Recovery does not happen randomly, but along a logical ladder. Each rung provides the foundation for the next – if you skip one, the next will be unstable. Click on the rungs:
First, you need to regain the ability of the joint to move through its natural range of motion. There is nothing to strengthen with a stiff, restricted joint. The aim here is gentle, repeated movement within the pain limit – often still with assistance or support.
After a long period of protecting the area, the nervous system needs to “find” the muscle again. Small, targeted, controlled contractions are the aim – the muscle must switch on and become controllable before it receives a real load.
Once the muscle switches on reliably, you can gradually rebuild strength: you load it with increasing resistance so that it can produce more and more force. This rung helps you stand up, climb stairs, lift and grip again.
Daily life is not about a single effort, but about repetition: walking around a shop or managing a walk. The aim here is for the muscle and circulation to tolerate the load over many repetitions – lower resistance, more repetitions, longer duration.
The final rung: combining the regained movement, strength and endurance into safe, automatic movement. This also includes balance and position sense (proprioception) – these make safe walking and a return to familiar activities possible.
Important: the rungs may overlap, and not everyone starts from the same point. Your physiotherapist assesses where you are and how quickly you can progress – but the logic of the ladder is similar for everyone.
How can you move up safely?
The key to improvement is progressive overload: you should always ask your body to do a little more than it is used to – but only a little more. The good news is that you can do this in several ways, not only by increasing the weight.
What does the research show?
The effectiveness of resistance training is based on three principles: specificity, overload and gradual progression – the scientific literature also highlights these principles in older adults living with muscle loss, typically using two sessions per week, 1–3 sets and around 6–12 repetitions. A randomised study found that loading can be increased by increasing the weight or the number of repetitions – both approaches produced similar muscle adaptations. In other words, if you are not yet ready to increase the weight, you can increase the repetitions first.
Practical progression
- Change only one thing at a time: either the resistance, the number of repetitions or the number of sets – not all of them at once.
- Small steps: with an elastic band, move up one resistance level; with weights, use the smallest available increase.
- Quality before quantity: move up only when the movement is clean and controlled.
- Give the tissue time: recovery is part of improvement – loading days and rest days work together.
Pain: how far can you go?
The “no pain at all” principle may be too strict, while “grit your teeth and carry on” can be dangerous. The reality lies between the two: in some conditions, moderate, well-tolerated discomfort during loading is not necessarily an obstacle.
What the studies show
In chronic musculoskeletal pain, a systematic review and meta-analysis found that programmes allowing moderate pain during loading showed a small but significant short-term benefit compared with exercises performed exclusively without pain; in the medium and long term, there was no clear difference between the two approaches. The conclusion is that moderate pain during therapeutic exercise is not necessarily an obstacle to a good outcome – but this is not encouragement to overload yourself. It is a decision that should be supervised by a professional and tailored to the individual.
A simple guide to pain
- Tolerable, dull tension during the exercise: generally acceptable – monitor how your body responds.
- Sharp, stabbing pain: stop; this is not the aim.
- Next-day response: if the pain returns to its starting level within 24 hours, the load was probably proportionate; if it continues to increase, reduce the load.
Always discuss the specific limits with your therapist – they depend on your condition.
Signs of overload – when should you step back?
Gradual progression works when you pay attention to the feedback. The following suggest that you asked too much or progressed too quickly – in this case, step back one rung and consult a professional:
- Pain continues to increase for hours or days after exercising and does not settle back down
- New swelling, warmth or increased heat develops around the joint
- Your range of motion decreases compared with before
- Sharp, stabbing or numbness-like symptoms occur during loading
Stepping back is not a failure – it is part of recovery. Dropping down one rung and rebuilding from there is always better than forcing it and losing weeks because of a reinjury. After recent surgery, with a fresh wound, fever or an unstable condition, you must always obtain medical approval before loading (see: rehabilitation – how to regain lost abilities).
Which device helps at which point on the ladder?
Home-use devices are useful because they allow you to practise every day at the level set by your therapist. Here are some typical pairings:
| Rung | Aim | Typical device |
|---|---|---|
| Range of motion | Regaining joint range of motion | Ergometer (active/passive) |
| Muscle activation → Strength | Activating the muscle, rebuilding strength | Elastic band, ankle and wrist weights, hand exerciser |
| Endurance | Tolerating the load over many repetitions | Ergometer, elastic band |
| Coordination, balance | Safe walking, proprioception | Balance training devices |
| Recovery (throughout) | Muscle relaxation, recovery | Massage devices |
Choose a device suited to your rung
You can find a home-use device for every rung, from range of motion to balance – choose it together with your therapist.
Frequently asked questions
When you can complete the current level with clean, controlled movement and without an excessive next-day reaction. This often means taking a small step every 1–2 weeks, but it depends greatly on your condition – your therapist sets the pace.
Research suggests that both approaches work. At the beginning of rehabilitation, it is generally safer to increase the number of repetitions first while keeping the resistance unchanged, and only then move to a higher load.
In some conditions, moderate, well-tolerated discomfort may be acceptable and is not necessarily an obstacle to a good outcome. Sharp, stabbing or steadily increasing pain, however, means you should stop. Always agree the limit with your therapist.
Yes, increasing the load too quickly can set back your recovery. This is why it is worth watching for signs of overload and stepping back one rung if necessary – this is a normal part of the process.
Summary
Scientific sources
The biomedical references are sourced from the PubMed database.
- Hurst C, et al. Resistance exercise as a treatment for sarcopenia: prescription and delivery. Age Ageing. 2022;51(2):afac003. PubMed: 35150587 · DOI
- Plotkin D, et al. Progressive overload without progressing load? The effects of load or repetition progression on muscular adaptations. PeerJ. 2022;10:e14142. PubMed: 36199287 · DOI
- Smith BE, et al. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Br J Sports Med. 2017;51(23):1679-1687. PubMed: 28596288 · DOI
