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Manual therapy vs loading-based physio treatment: Fast track your recovery

Updated: Dec 15, 2020


The human biological system is a complex powerhouse.


Depending on what part of the body you are dealing with, whether it is muscle, bone, nerve, ligament or tendon, this dictates treatment. Further complicating the matter, the brain often likes to get involved and trick us too! So with this combination of factors, it can leave fitness and sports enthusiasts scratching their heads for answers when it comes to the best injury treatment or prevention.

Therefore, this means, there’s no one-size-fits-all approach. And thankfully, the modern physiotherapy profession has evolved and progressed to treat complex conditions with more than just a poke in the back, foam rollers and heat packs.


There are two predominant approaches to physiotherapy; loading-based and manual therapy.

Manual therapy uses external force with techniques such as massage, foam rolling, trigger point balls and stretching to reduce pain in the acute phase. It has a long history within the profession and has shown to help manage pain and reduce soft tissue swelling.

On the other hand, a loading-based approach uses internal forces to shape tissues and build work or tolerance capacity. Its rationale is founded in the knowledge that our body and tissues need to be conditioned to perform the tasks we want them to do.


Often, the two approaches go hand in hand. But at the Move Clinic, we are big believers in using a load-based approach to facilitate biological adaptations, restore normal function, improve capacity and prevent re-injury.


The long term treatment goal is about building enough strength in the body, to withstand the demands of life and its adventures.


Manual therapy can facilitate early gains in freedom of movement and pain relief, but it has no ability to load tissues in the same way that strengthening exercises does. Meaning it doesn’t necessarily improve long term structural changes for injury prevention and pain relief is often superficial and short lived.


So what’s the best approach to treat and prevent injury?


It really starts with an accurate diagnosis and thorough understanding of how the injury occurred so we can ascertain the exact piece of anatomy or structure that is complaining. You’re in safe hands at the Move Clinic and we have extensive experience and protocols in place to reliably and accurately diagnose injuries.

The next step is to try and understand what’s causing the issue. This looks like a biomechanical analysis encompassing technical form, lifestyle habits and determining areas of weakness.


Finally, treatment planning needs to executed appropriately. The treatment has to strongly reflect the principles that underpin the root cause with a progressive approach, that is specific to the tissue type. You confused yet?


Let’s take a common climbing shoulder injury for example – rotator cuff tendinopathy.


Context- there was no traumatic injury. Just a bit of an “ouch” each time you reach overhead that came on after trying a crux gaston move too many times one weekend.

Tendons have a habit of becoming painful while not necessarily being structurally “damaged”. So the key here is not to rest, but continue to maintain a sustainable level of loading. This is because tendon tissues don’t like complete rest.


The important part of managing this injury is to find the sweet spot between sustainable load and rest and overload. Striking the balance is a challenge, but understanding baseline tolerance is the objective.


Climbing frequency and intensity can play a large role here, and these differ between the acute and late stages of recovery. For example, it’s often more beneficial to climb moderately and more frequently in the early stages of injury as opposed to climbing two hard days and resting five.

One of the most overlooked factors in injury management is that every treatment plan has a lifecycle with distinct phases. Returning to our rotator cuff injury as an example, the injury may run its course over 12 weeks – but what’s best for the injury varies greatly within that timeframe.

How we manage an injury in the acute stage is very different to the final stage of building strength greater than pre-injury levels.


The distinct phases of injury treatment include:

· Recovery to minimise further damage;

· Reduce the impairment with strengthening work;

· Correct or eliminate the injury risk with progressive treatment;

· Pain free, where the shoulder is stronger than its previous state.


Getting a shoulder to a point where it is pain free is only half the work; the other half is addressing why it happened in the first place, which involves strengthening work and joint position modifications to positively impact someone’s performance.


Having injuries is a rite of passage as an experienced athlete or climber. The difference between being smart and managing them well, and managing them poorly is how severely they impact your performance and for how long.


Hot tip – see a physio early in the injury lifecycle to get on top of pain and back in the game, stronger than before.


Lee Cossey is a qualified physiotherapist and has been one of the best climbers in the country for the last 20 years. He has extensive clinical experience working with patients across a diverse health spectrum having a strong passion for analytical thinking and providing practical and compassionate solutions.

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