Boom and bust are terms we are used to hearing in relation to the business world. In this regard, boom is rapid expansion potentially overstretching the business without having the infrastructure in place to cope. Bust comes when either the bottom falls out of the market or the business can’t meet the demands being placed upon it.
This isn’t something we’re accustomed to thinking about with our physical health or our experiences of pain. With regard to physical health, boom and bust can reflect people who go through fads of exercise going from 0-60 miles per hour, no exercise and then go straight into 5km runs or into the gym to lift weight 3 times a week. The tissue is loaded in a way that causes micro-trauma. If appropriate rest and recovery are allowed then the body can deal with this and often adaptation takes place strengthening the muscles and bones physically and the psychological boost of achieving a goal. However, if the load is is more than our body can cope with and our recovery isn’t enough, we can have a painful event, going from boom to bust. This has been heavily investigated in elite sport leading to the development of the Acute: Chronic Workload theory. Essentially stating that gradual build-up in workload incrementally without really-hard workload days (spikes of load) reduces the likelihood of injury (Gabbett, 2016) and is often applied pre-season or for players returning from injury. Research into whether this theory applies to industrial athletes is currently being conducted.
Those who have persistent pain levels that linger on past natural healing timeframes often describe this boom and bust cycle:
These changes can overload take load beyond our capacity, resulting in a bust, a few weeks into new work, or a small event like bending forward that was the straw that broke the camel’s back as it were, leading to the onset of pain. Research has ably demonstrated that often these events represent sensitisation of the structures and not always damage (MCraken et al 2007). In some cases, persistent pain leads to fear avoidance of movements, deconditioning lower tolerance and the cycle of boom and bust. This has only been amplified by the pandemic where we see people unable to engage in their habitual physical exercise routines due to pool, gym and organised team sports being stopped to prevent the spread of the virus. As a nation, with some notable exceptions, our overall physical and mental health is not in as good a state as it was in March.
So now that we understand the boom and bust cycle and how it can relate to physical health and persistent pain, how can we minimise the risk of this happening I hear you say? Well, essentially it’s “pacing” and graded exposure. This is often seen in those with diagnosed arthritis or rheumatological conditions where tolerance to exercise is reduced and if exceeded causes pain, asking the individual to break up the bouts of load into manageable chunks instead of gardening for 4 hours straight, do 30 minutes (keep the load within your tolerance) have a rest for 20-30 mins and then go again. Over time the idea is to build up the tolerance of the joint to load by gradually progressing the amount of load in small increments exposing the muscles, tendons, ligaments, and joints to incremental load so they adapt increasing the bodies confidence in the structures to cope with load and symptoms start to reduce. In the example given, that might be progressing up to being able to do an hour of load by weekly adding 5 minutes extra activity to bouts weekly so that over a 6 week period you can then do 1 hour of activity at a time.
In another example, a manual worker has been signed off for 3 months after knee surgery. If they went straight back to their previous job with no gradual increase in load to allow the tissue to adapt, the chance of experiencing boom and bust is increased. For that reason, they often complete a phased return to work starting at 25% or 50% of their normal hours and building up to 100% over a fixed time period dependent on the severity of the injury and level of prior de-conditioning. So graded exposure in these ways increases the system’s tolerance to load and allows us to get back to our prior levels of fitness.
It’s important to understand that these are not always linear processes and there can be days of discomfort and bumps in the road where we have increased pain, the important thing to understand is this doesn’t mean you have done damage just that you have overloaded the tissues, let it settle and go again with smaller increments. Sometimes this may need to be guided by a therapist, other times the person may be able to slowly progress or regress their programme with appropriate guidelines. Such as you can progress if you feel the exercise isn’t stressing you at all and you aren’t getting any muscle ache the day after activity or regress if after the exercise bout you have soreness that lingers more than 48 hours, this is one example but your therapist may give you different parameters for progression or regression everyone is individual and should be treated as so.
Over time, this cycle can increase our tolerance allowing us to be more active within the limitations of our condition or complete recovery and return to pre-injury levels of activity, building our physical capacity for load but also building our mental resilience by helping achieve manageable goals but also understanding pain better.
Ultimately boom and bust for physical health doesn’t have to happen, sometimes smaller increments in load guided by a professional either in person or remotely can give individuals the tools they need to exercise, assess response and progress increasing capacity. If you are in a situation where you think this applies to you and you need some help, why not speak to one of our NHS FCPs or occupational health experts to help get you back to work and the activities you love.