Recently I was at a training day considering sensory processing and autism. The presenter asked the audience, ‘Have you heard of heavy work?’ Of the 200 people sitting in the room, most of them put their hand up. The presenter continued and asked, ‘Does anyone know what heavy work is? Could you show me an example?’ After this question, not one hand went into the air. The room fell silent. The presenter began to answer his own question started to demonstrate some squashes and compressions. The audience was amazed. It was as if they had never seen heavy work in action before.
As an occupational therapist this surprised me. Whilst most of the attendees in the audience said they had heard of the term heavy work, many of them didn’t seem to know what it really was. The term ‘heavy work,’ is frequently mentioned in books and advice for children with sensory processing difficulties and/or autism. It is commonly recommended to help support their sensory issues. Yet, to those in the audience, what term actually meant seemed to be a mystery. In this post, I hope is to solve the mystery of heavy work.
Heavy work = Proprioception
When occupational therapists use the term heavy work they are usually referring to any activity that activates our proprioceptors. Our proprioceptors are parts of our joints and muscles that receive feedback when we move. They tell us the position our limbs are in. They let us know how much or how little force we are using. We discuss proprioception in much more depth in our post ‘What is Proprioception?’ If you haven’t read this post, or aren’t familiar with the term proprioception, we recommend you read it first before you continue.
Heavy work is a commonly recommended sensory activity. It includes any activity that provides resistance. When you push something, like a shopping trolley. you create resistance. When you pull something, like a door open, you create resistance. If you carry something, like a backpack, there is resistance. Moving your body in any way activates the proprioceptors. However, when therapists refer to heavy work they typically mean moving with or against resistance.
When should we use heavy work?
Sensory integration theory indicates that proprioceptive input helps to calm and organise the brain. This results in the input being suggested as a strategy to help children calm their bodies down. Heavy work can be a good sensory strategy for a child that experiences sensory overload, both before and after activity they find overloading. Therapists often recommend it for a child or adult who has sensory sensitivities, especially if this is with their touch sense. It is also a good sensory strategy for sensory seekers as it can also help them organise. Heavy work activities are also often recommended to help those with autism.
If you’re not familiar with the different sensory processing challenges children and adults may have you can learn more about them here.
What heavy work activities could we try?
Any activity that includes resistance, gives extra proprioceptive sensory input. This list gives some examples of day to day activities which include increased resistance.
Digging & pouring (e.g. with a sand pit or water tray)
Rolling and cutting out play dough
Resistance band exercises
Pushing a trolley, cart, wheelbarrow or box – encourage the child to be creative in the play space
Carrying a bag with some weight, this needs to be adapted for each child and we would recommend starting with no more than 5% of their body weight in a backpack, bag or container. Carrying their water bottle and snack might be just the right amount for a young child.
Tug of War
Cycling and scooters
Teenagers and adults may find weight training a good option. It is recommended professional advice is sought initially to ensure they are using these items safely and with correct technique
Rowing, including rowing machines
Hanging from a bar is also a great way to get intense proprioceptive feedback. This could be a ‘monkey bar’ in the playground, or an indoor our outdoor chin up bar. Many families find the gorilla gym a good option for inside.
What about squashing and brushing?
Squashing and brushing are often included under the heading heavy work. I think this is because occupational therapists often use these strategies to help children to calm down. They may use them in the same session and alongside heavy work. Technically speaking they are not the same as heavy work. This is because they target the touch sense not the proprioceptive sense. As the sensory input is to the skin, they trigger the skin’s touch pressure receptors, not the proprioceptors in the joints and muscles. Whilst they are helpful strategies to help to regulate some children with sensory sensitivity I think it is important to understand exactly which sense they target. This is because it helps to ensure the right strategy is being used correctly with the right child.
What about weighted products?
There are also numerous weighted products available, such as weighted blankets and vests. These by themselves are not heavy work. Like squashing they activate the touch sense, primarily deep touch pressure. However, when a child moves under or wears a weighted product, the weight provides additional resistance to their movement. This will active their proprioceptors and, if you remember back to the beginning of this post, we said heavy work = proprioception.
An occupational therapy assessment is the best way to find out which strategies are most appropriate for each child. You need to make sure the therapist you see has completed additional training in sensory integration or sensory processing. We also cover this information in more detail in our introductory course – Sensory Processing: What’s the Fuss.
- Ayres, A.J. (1972). Sensory Integration and Learning Disorders.
- Lane, S. (2002). Chapter 4 Sensory Modulation in Sensory Integration Theory and Practice 2nd Edition by Bundy, Murry & Lane.
- Miller, L.J. (2014) Sensational Kids Hope and Help for Children with SPD–Revised
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