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Stress Loading Patient Handout

Stress loading is use of active traction and compression exercises to produce stress in the extremity with minimal motion of the painful joints. Stress loading follows the basics of exercise physiology: Your body adapts in response to demands placed on it. Your response to pain has been changed, so now any stimulus is interpreted as a painful stimulus. Stressful exercise is needed to override what has become "abnormally normal" for that area. An overload is required to achieve a training effect and to break the pain cycle that you and your body are experiencing. This means you need to do something to overload your neural, vascular, sensorimotor, and musculoskeletal systems to break the existing pain patterns your body is feeling.

basically, no pain no gain

Stress loading consists of two simple exercises:

  • Scrubbing is using a scrub brush with the affected extremity to apply as much pressure as possible using a back-and-forth motion. Ideally, you apply weight through the affected limb for maximum pressure and contraction of all your muscle groups. The clinician may make modifications to ensure that you are able to perform the scrubbing.
  • Carrying involves lifting and transporting a weighted backpack, suitcase, or purse in the hand on the affected side. You'll carry the weight throughout the day while you stand or walk. Your arm should hang down, so it swings normally as you walk. The weight of the bag should be at maximum tolerance; most people start with 1 to 5 pounds and add weight as their tolerance increases. Sometimes the handle can be built up, so the weight is comfortable in the hand.


You must take an active role in this treatment to achieve good results. Stress loading won't work if you don't load the extremity to produce the stress. You need to do the scrubbing and carrying exercises consistently, both in the clinic and at home. Your therapist may give you a log sheet to record your scrubbing and carrying to help you perform these exercises regularly.


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