Goldilocks Principle of Rehab
Let’s start with a fairytale…
Goldilock and the 3 bears:
Once upon a time, there was a little girl named Goldilocks. She went for a walk in the forest. Pretty soon, she came upon a house. She knocked and, when no one answered, she walked right in.
At the table in the kitchen, there were three bowls of porridge. Goldilocks was hungry. She tasted the porridge from the first bowl.
"This porridge is too hot!" she exclaimed.
So, she tasted the porridge from the second bowl.
"This porridge is too cold," she said.
So, she tasted the last bowl of porridge.
"Ahhh, this porridge is just right," she said happily and she ate it all up.
WELL.
You may be wondering how this all relates to rehab?!
The short explanation goes as follows, when training during rehab:
Too little: ie. sitting in bed, doing nothing all day -> strength deficits
Too much: ie. maxing out constantly -> most likely to develop a muscle injury eg "a strain"
Just right: ie. able to do the perfect amount of intensity and volume, day after day, week after week -> build muscle
NOW, the long part for those who are interested.
Firstly, We need to understand:
"Just right" isn’t a fixed point. It exists on a spectrum that differs from person to person and can fluctuate over time.
Depending on your training history, your "just right" volume might be different from someone else, and will continue to change as you continue to train, or as you take a break from training.
Consider the Goldilocks story: The 3rd porridge was "just right". For you maybe if the porridge was 1 degree warmer or colder, it would’ve still been just right. For someone else maybe the porridge needed and extra 5 degrees hotter or colder to be just right.
BUT,
How about the other factors that make the porridge "just right"? Ie. the flavor and texture? Serving size? Toppings or ingredients mixed in?
In terms of building muscle, how’s your "diet, sleep & stress"? And are you considering the variables that help create and environment that makes muscle building "just right"?
Goldilocks principle to injuries.
Many injuries occur from doing too much too soon.
This is one of those things that everyone kinda intuitively knows and understands, but then completely ignores in practice.
Consider these 2 examples:
Someone doing an AMRAP (as many reps as possible) bench press challenge, experience elbow pain, and blame their injury on a lack of stretching.
Someone that started couch to marathon, develop knee pain and blame the pain on running shoes.
In either case, it would be easier for these people to accept that they probably just did a little too much, too soon.
What is an injury?
An Injury occurs when:
load (volume, intensity, frequency) exceeds current capacity (ability to handle and adapt to various stressors on a day to day, week to week basis.)
After an injury:
capacity is lowered (as your ability to deal with stressors is lowered)
Therefore the goal is to increase your capacity where it's greater or equal to the stressors that you're exposed to on a regular basis.
The challenge is:
You don’t want to do too much, where your constantly exacerbating symptoms and limiting progress. And you don’t want to do too little where youre deconditioning and not working towards your goal.
Instead you wanna find the just right level of activity that compliments your goals, while minimising flare ups.
Mistake 1: the do "too little" individuals.
Chronically do too little, because they’re fearful of what their symptoms are and what their symptoms might mean. Without a structured plan, and as a way of avoiding pain, they do less and less over time to a point that their capacity becomes diminished.
Mistake 2: people that persist and push through pain, leading to an incapacitating flare up.
They do too much and require a time of rest, to allow for the spike in symptoms to subside. And, when they feel better, they try and repeat that same level of activity, but come to realise that the flare up happens to come up sooner. This cycle repeats until their capacity is also deminished.
Supercompensation is the adaptive response of our bodies to a training programme. In other words, by training hard and getting your work-to-recovery balance right, you will achieve better results. Each individual will have their own optimum level of exercise and recovery to increase their base fitness level over time.
Negative Adaptation in training is perceived as a gradual loss of sensitivity or weakening of response due to prolonged stimulation.
The art of rehab is about finding the fine line between doing too much and doing too little. You rarely need to completely rest and avoid all symptoms. But you also shouldn’t approach rehab with a no pain no gain mentality.
Load management: as mentioned above.
Activity modifications: identifying certain movements, positions that exacerbate symptoms, and determining if there are ways that you can modify them.
Graded loading: gradually reintroduce the loads so that you induce positive adaptations to drive your capacity higher. Simply put, you’re just trying to do a little more over time.
Graded loading is similar to hiking a mountain.
Many people assume that rehab is going to be a smooth and linear process. Sometimes it is, but often times its messy. If you wanna climb to the top of a steep mountain, you're not gonna get there by staying on flat ground, you're just circling the base of the mountain, you’re doing too little. Similarly, the best path is also not the steepest, you might end up in a dead end, or end up hurt, you’re doing too much. The best way to get to the top of mountain is to use the trail that gradually takes you higher in a reliable manner. Some parts of that pathway could be steeper, some could be flat, and some parts might even be downhill a bit. And most importantly, everyone is going to be climbing a different sized mountain.
4. Tracking progress:
How do you know if you’re moving in the right direction?
Well if your trying to gradually increase your capacity by exposing yourself to greater and greater loads. Its helpful to keep track of those loads.
Are you writing your running mileage? Weight lifted? Time spent walking? Are you also taking note of how you are responding to those activities? Its much easier to monitor progress if you have it written in a logbook or journal.
Remember, when you are dealing with an injury, you are generally starting at a new baseline. Wherever you are now is completely fine. Start there without comparing yourself to others or even where you used to be. You might want to strive and get back to where you used to be, but it might help if you accept your current situation, so you don’t end up doing too much too soon.
5. Pain monitoring:
a. 3-5/10 pain levels is okay to exercise with, anything more that that is too much and need to -> dial it back
b. Pain at night after exercise? Affecting sleep? If yes then too much load -> dial it back
c. Pain next day after working out? Affecting day to day activities? If yes then too much load -> dial it back
Becoming pain free:
Increasing capacity doesn’t always equal to decreased pain. Capacity could be represented by the ability to lift more weight as strength has improved, or ability to run more as conditioning has improved, but could also mean that your tolerance to handle load has improved. A 4/10 pain at 100kgs bench to 2/10 pain at 100kgs bench is a good indication of improvement. Although pain is the goal for many individuals, sometimes it isn’t something we can control or guarantee.
Other markers to look for:
Has your function improved?
If the severity or frequency of symptoms have decreased?
Are you able to do more of the things that you enjoy?
Do you have more control over the symptom?
Just like how Goldilocks had to trial hot and cold to find just right porridge, there will be times where you do too much or too little, and it’s completely okay. Its all part of the rehab process.
If you’ve read this far, I hope that this has helped. All in all, you don’t need to walk this road alone. During your rehab journey, our experienced physios will work closely with you to help you find the safest and most effective way back to your normal life.
Your friendly neighbourhood physio,
Tony
Resources:
The ‘Goldilocks Principle’: designing physical activity at work to be ‘just right’ for promoting health
THE GOLDILOCKS PRINCIPLE AND INJURY
Goldilocks Principle of Rehab (Everyone Should Know This)
Goldilocks Training: How to Maintain Momentum
