Classroom to Clinic: What New Grads Should Know About Load

By Dr. Michael Minenna D.C., B.Sc., SFMA, FMS

If you're finishing chiropractic, physiotherapy, or athletic therapy training, you've absorbed an enormous amount: anatomy, pathology, assessment, technique. What new graduates often tell us they feel least prepared for isn't any of that — it's the practical art of dosing. How much exercise? How fast to progress? When to push and when to hold? This is load management, and it's one of the most important skills you'll develop. Here's a head start.

Load is the lens, not just a topic

The single most useful reframe for a new clinician is to stop thinking of injuries as things that are simply "damaged" and start thinking in terms of capacity versus demand. Most non-traumatic musculoskeletal pain reflects a tissue being asked to do more than it was prepared for. Once you see problems this way, the treatment writes itself: reduce demand temporarily if you must, then systematically build capacity so the demand is no longer a problem.^1,2

This lens turns you from a technician applying treatments into a clinician solving a problem. It also keeps you honest, because it forces the question every plan should answer: what capacity are we building, and how will we know it's working?

The principle that anchors everything

If you remember one phrase, make it this: there are no bad exercises, only too much too soon.¹ New clinicians are often tempted to forbid movements or label tissues as fragile — it feels safe and authoritative. But fear-based, restrictive advice tends to produce passive, deconditioned patients. The evidence-based path is almost the opposite: keep people moving, load them appropriately, and progress gradually.³ Your job is rarely to take exercises away; it's to get the dose right.

What "managing load" looks like in practice

A few habits will carry you a long way. Establish a baseline — know where the tissue is starting so you can dose from reality rather than a textbook. Change one thing at a time when you progress, so you can tell what's helping and what's flaring. Use the patient's response over the following 24 hours as your guide: settling soreness is fine, escalating pain is feedback to dial back. And respect that connective tissue adapts more slowly than muscle and fitness — the eager patient who feels great often outruns their tendons.

Watch the spikes most of all. The research is consistent that rapid increases in load, more than high load itself, drive injury.^1,2 Whether you're rehabbing an injury or returning an athlete to sport, your value is often in slowing the ramp down to something the tissue can actually follow.

Don't forget the whole chain

Finally, resist the gravitational pull toward the painful spot. The source of a problem is frequently a link or two away from the symptom — regional interdependence is real and clinically useful.⁴ Building the habit of assessing how the whole body moves, not just where it hurts, will make your load-management plans land where they actually matter.

The clinic is where it clicks

None of this fully makes sense until you're doing it with real people, which is exactly why mentorship matters so much in those first years. At Boreal Spine & Sport, helping new clinicians turn classroom knowledge into confident, evidence-based practice is part of our mission — and load management is right at the centre of it. Get this skill solid early, and you'll be a better clinician for the length of your career.

References

1. Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? Br J Sports Med. 2016;50(5):273-280.
2. Soligard T, Schwellnus M, Alonso JM, et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med. 2016;50(17):1030-1041.
3. Lin I, Wiles L, Waller R, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2020;54(2):79-86.
4. Sueki DG, Cleland JA, Wainner RS. A regional interdependence model of musculoskeletal dysfunction: research, mechanisms, and clinical implications. J Man Manip Ther. 2013;21(2):90-102.