What’s in your cup? The Load-Capacity Framework in Rehab

The load-capacity framework can also guide our treatment plan and what we work on in our rehab. As a reminder, injuries occur when a load on your body exceeds your body’s capacity to handle it. That leaves us with two main ways to help someone- decrease the load or increase their capacity.

A great analogy for this comes from Greg Lehman when he asks, “what’s in your cup?” Imagine yourself as a cup filled with water. The water represents all the loads you face — not just physical activity, but also work stress, family demands, past injuries, and changes in training or routine. Your cup represents your current capacity to handle these loads. Things like anxiety, lack of sleep, prior beliefs about injury, or self-confidence can all change your cup’s size. Sometimes factors, such as your health status, can both add water and limit your cup’s size.

In rehab, our goal is to either limit the water or build a bigger cup. Limiting water could include adjusting your training program (like decreasing running volume or intensity), managing stress, or changing certain habits. Building a bigger cup might involve strengthening tissues, improving nutrition and hydration, or addressing fears about a specific movement.

Ideally, we can do both at the same time — reduce water and expand the cup. But sometimes we can only tackle one at a time. And sometimes, we can’t change either — reducing work stress might not be realistic, for example. That’s okay. The cup analogy is a way to acknowledge the factors influencing how we feel, and to understand that they’re always changing. Some days it’s like water slowly dripping into a pint glass. Other days, it’s like the Torc Waterfall into a shot glass, and it’s overwhelming.

Recognizing this helps you make informed decisions in training and rehab. A small change — decreasing intensity, taking an extra rest day, or adding one isolation exercise to the painful area — can be enough to manage the load or grow your capacity.

Rehab can be simple but also complex. The simple part is knowing to reduce load temporarily and increase capacity. The complex part is figuring out how, because everyone is different. That complexity might feel intimidating, but it also gives us freedom to find what works best for you.

Reference: Lehman, G. Do our patients need fixing? Or do they need a bigger cup? Online source, 02/05/2018.