Most people think about pain as something that just happens to them.

The back goes out lifting a laundry hamper. The knee swells up after a long hike. The shoulder starts aching during a workout that seemed routine. The event gets the blame. “I threw my back out taking laundry upstairs.” “I hurt my knee hiking last weekend.” “Something happened during my workout.”

The event is almost never the real cause.

What the event did was cross a threshold. It was the straw that broke a particular camel’s back, but the camel was already loaded. Understanding why that threshold existed, and how to raise it, is the single most useful framework I can give a patient for thinking about their pain, their recovery, and how to prevent the next episode.

The framework is load versus capacity.

 

What Load and Capacity Mean

Load is the total demand placed on a tissue over time. It includes mechanical load (the forces going through a structure), repetitive load (how often those forces are applied), and cumulative load (the accumulation of stress over days, weeks, and months without adequate recovery). Load is not just exercise. It is your job, your commute, your sleep position, the hours you spend at a desk, the weekend you spent doing yardwork after a week of sitting.

Capacity is the tissue’s ability to handle load. It is the sum of a structure’s strength, endurance, coordination, and recovery. Capacity is built through appropriate progressive loading and adequate recovery. It is eroded by underuse, deconditioning, and overuse without recovery.

Pain occurs when load exceeds capacity. The injury is the symptom of that imbalance. The laundry hamper was the load that pushed an already-strained low back past its threshold. The real question is why the capacity was low enough for a laundry hamper to do it.

 

Why This Changes Everything

Once you understand load versus capacity, several things that seemed random start making sense.

Why some people can do the same activity as others and get hurt. Same load, different capacity. Two people can do the same workout. One gets hurt. The one who got hurt had lower tissue capacity for that specific demand, not because they are weaker in some global sense, but because their capacity in that specific tissue at that specific time was insufficient.

Why pain flares seem to come out of nowhere. They usually do not. They come after a period of cumulative loading that has been eroding capacity without enough recovery. The “random” flare is actually the result of a slow burn that reached a visible tipping point.

Why doing less does not fix the underlying problem. Reducing load below the symptom threshold makes the pain go away. But it does not build capacity. The threshold stays where it was, or moves lower. When life demands return (the physical job, the workout, the long weekend) the same imbalance is still there.

Why building capacity is the treatment, not just rest. The goal of a good rehab plan is not to return you to the state you were in before the injury. That state was already insufficient. The goal is to build capacity above the demands of your actual life, so that your daily load stays well below your threshold.

 

The Arborist’s Pattern

A tree climber I treated had managed chronic low back pain for over a decade. Every flare, he rested. When the flare resolved, he went back to the physical demands of tree climbing and waited. “I constantly fear doing something that will cause it to flare up.”

That fear was justified. His capacity had never been developed above his occupational load. He was working at or near his threshold every day. Any accumulation (a harder week, a poor sleep stretch, an unusually demanding job) tipped him over.

What he was doing (managing around flares) is the most common pattern I see in patients with recurring pain. It is not failure. It is a rational response to an incomplete picture. When the only tool you have been given is rest, rest is what you use.

The load versus capacity framework gives you a different tool. Instead of managing around the threshold, you raise it.

 

How We Build Capacity at COSJ

The COSJ framework (Repair, Retrain, Reinforce) is a direct application of the load versus capacity model.

Repair

Repair is the phase of reducing the acute load on a tissue and allowing the immediate irritation to resolve. Joint manipulation, dry needling, and directional preference work reduce the compressive and irritative inputs that have pushed the tissue past its threshold. This is the phase that gets you out of pain.

Retrain

Retrain is the phase of rebuilding the movement patterns and coordination that govern how load is distributed. If the hip extensors are not contributing to a deadlift, the lumbar spine absorbs the compensatory load. If the deep cervical flexors are not coordinating with the upper traps, the suboccipital muscles handle too much. Retrain identifies where the load is going and redirects it.

Reinforce

Reinforce is the phase of building genuine capacity above the demands of the patient’s life. This is where progressive resistance training becomes the primary tool. Tonal-based loading allows us to build the posterior chain, lumbar extensors, and hip stabilizers with precision, tracking progression, ensuring appropriate adaptation, and bridging the gap between clinical exercise and independent training.

The goal of Reinforce is a body that has a reserve. Not just enough capacity to handle daily life, but enough that daily life occupies only a fraction of what it can handle.

 

What This Means for You Practically

If you have recurring pain, ask these questions:

What is the demand that crosses my threshold? Is it a specific movement, a sustained position, a volume of activity? Identifying the load that produces symptoms tells you what capacity needs to be built.

What is keeping my capacity low? Deconditioning, poor sleep, inadequate recovery, long-standing movement compensations, and past injuries that were never fully rehabilitated are the most common answers.

Am I treating the injury or building capacity? Taking ibuprofen, icing, and resting treats the injury. Progressive loading builds capacity. Both may be needed, but only one produces the lasting change.

 

FAQ

What is the difference between load management and avoiding activity?

Load management is adjusting the type, volume, and intensity of activity to stay within the current capacity while building toward a higher threshold. Avoidance removes the load entirely. Avoidance prevents flares temporarily but also prevents capacity development. Load management lets you continue moving while the capacity grows.

Can capacity be rebuilt after a significant injury?

In the vast majority of cases, yes. The body is adaptive. Tissues respond to the demands placed on them. The relevant question is whether the loading is appropriate for the current state of the tissue and whether it is progressive enough to drive adaptation.

How long does it take to meaningfully raise tissue capacity?

Research on tendon and muscle adaptation suggests meaningful structural changes occur within six to twelve weeks of consistent, progressive loading. Full capacity development to the level required for demanding physical work typically takes three to six months. There are no shortcuts, the adaptation takes time.

Can I do this on my own or do I need a provider?

Some patients, particularly those with clear movement patterns and a straightforward presentation, can make significant progress with a well-designed self-directed program. For patients with complex presentations, significant deconditioning, or a history of recurring injury, professional guidance (particularly in the Retrain phase) produces better outcomes and faster progress.

 

A Different Way of Thinking About Your Pain

The laundry hamper did not hurt your back. The threshold did.

Understanding where your threshold is and what it will take to raise it is the most useful piece of information you can have about your pain. If you want to understand that picture for your specific situation, come in. We will do a thorough assessment, identify the load and capacity balance, and build a plan that actually addresses the pattern.

Schedule at cospineandjoint.com/schedule-appointment

Committed to your strength,
Dr. Blake Richard, DC
Central Ohio Spine and Joint | Westerville, OH
cospineandjoint.com/schedule-appointment