Stress loading refers to a specific scrubbing and carrying exercise; which was intended to improve the treatment of patients with reflex sympathetic dystrophy. The program is adapted from H. Kirk Watson and Lois Carlson: Treatment of reflex sympathetic dystrophy of the hands with dynamic stress loading patterns J Hand Surg 1987;12A:779-785. This system can be included in the treatment of any patient with complex mechanical hands whose condition is clearly more painful and swollen than the postoperative or trauma patient.
Stress Loading consists of two principles: scrubbing and carrying. Stress induction program provides vigorous movement of the affected joint and is worn for at least 3-5 consecutive minutes three or more times per day. Although stress load may initially increase pain or swelling after several days symptoms will begin to decrease. Use of the affected side in daily activities throughout rehabilitation is encouraged to prevent muscle guarding and disuse atrophy.
Complex Regional Pain Syndrome
Due to abnormal pain the patient experiences unbearable pain and therefore the painful part is not used and/or if it affects the whole body there is inactivity of the suffering person and therefore non-use occurs. To prevent that and regain normal range of motion and flexibility this technique is developed and developed according to stages of relief.
Application   
Scrubbing – Consists of moving the affected part backwards/backwards while carrying weight through the mouth. The patient cleans a hard surface so that the bristles of the brush are in constant contact with the surface while applying constant brush pressure. The amount of the weight transferred through the affected segment and the duration of the activity gradually increase. The patient is washed in quadrupeds to engage the upper back and is accompanied by elevated sitting or standing positions for the lower extremities. If upper extremity involvement the patient holds a massage brush with the affected hand. When it comes down to involvement, a long Velcro® strap can help secure the brush to the bottom of the sore foot.
Modifications can be made to increase performance or compliance. For example upper extremity scrubbing can be done standing at a table or counter. People with limited finger extensions may benefit from using a hand brush. Performance can be measured reliably with the Dystrophile®. It’s a a device designed to facilitate regular weight bearing and compliance during washing by activating the light when the patient reaches a predetermined load.
*Dystrophile® is ideal for the treatment of reflex sympathetic dystrophy/complex regional pain syndrome. To start exercising, press the Dystrophile® handle while swiping the device in any direction. Feedback lights and a timer activate when preset resistance and duration levels are reached. strength Up to 12 lbs. (5.4 kg). The timer records in hundredths of minutes as long as the preset load level is maintained. Includes instruction program guide progress record sheet and one 9-volt battery. Special plastic-coated Dystrophile@ Pad used as a surface for sliding dystrophic bacteria@ equipment.
Carrying or Loading – This is the second component in the pressure loading protocol. The affected side holds small objects, gradually turning into a handbag, and the weight is getting heavier and heavier. Carrying should be done throughout the day when the patient is standing or standing walk. The lower body can be loaded in a number of ways. Walking is an important weight-bearing technique if care is taken to ensure that weight is carried through the affected leg during gait, especially when assistive devices are used.
Weight bearing can be increased with verbal/physical cues or by having the patient carry a weight or bag on the affected side. It can also be done by engaging the patient in activities that promote weight shift and balance (i.e. throwing a ball) or placing During the static standing task, the unaffected foot was placed on a small footstool.
H. Kirk Watson and Lois Carlson: Treatment of hand reflex sympathetic dystrophy using active pressure loading procedures J Hand Surg 1987;12A:779
- Phillips ME. OT treatment for complex regional pain syndrome. OT Practt August 20, 2001.
- Carlson LK, Watson HK. Treatment of reflex sympathetic dystrophy using the stress-loading program. J Hand Ther 1988; 1: 149-54
- Watson HK, Carlson L. Treatment of reflex sympathetic dystrophy of the hand with an active “stress loading” program. J Hand Surg 1987; 12A (5): 779-85
- How to Treat Complex Regional Pain Syndrome : Scrubbing Exercises for Complex Regional Pain Syndrome Available from: https://www.youtube.com/watch?v=bNGoTTuzMRE