What’s heavy work and why does your therapist keep recommending it?

By Christine Hemelians, MSOT. OTR/L

Heavy work is a commonly recommended sensory activity that occupational therapists oftentimes suggest to the families that they work with. Occupational therapists use heavy work activities for children that struggle with sensory processing issues. Heavy work refers to any activity that activates our proprioceptors. So what does this mean? Proprioceptors are embedded within our joints and muscles that receive feedback each time we move; they provide us with information about our body’s position in space and where each body part is, as well as what it’s doing. They also give us information regarding how much or how little force we are exerting. Children with sensory processing issues may have difficulty with their proprioceptive system working effectively and efficiently. This system controls balance, movement, and body awareness. Some examples include writing too lightly with a pencil, having difficulty stacking Legos on top of each other, slamming the car door really hard, or stomping feet while walking. Someone who has difficulty processing proprioceptive input might think that they’re pushing down hard enough while writing with their pencil, using less force when shutting the car door, or they might think they’re walking and not realize that they’re stomping their feet. When children have difficulty with processing proprioceptive input, heavy work can help them know where their body is in space, and what it should be doing. 

Proprioceptive input can improve focus and help calm and regulate the child’s body. Heavy work activities, as a therapy tool, allow children that are struggling with sensory processing issues to “jump-start” their systems. Those who seek proprioceptive input may seek input by crashing into things or jumping off things or engage physically in other unsafe ways. Heavy work is any activity that pushes or pulls against the body, essentially creating resistance. For example, when you push a shopping cart, you create resistance, if you carry a backpack, there’s resistance, or when pulling something, like opening a door, you create resistance. When you’re participating in these activities, you’re activating your proprioceptors. The goal is to provide activities that activate as many muscles and joints as possible at the same time, and for a short period of time; these types of activities are the most effective heavy work activities. Heavy work activities, that calm children and assist with self-regulation, can be embedded throughout the day in play and in everyday chores. OT’s can work with children to come up with a sensory diet (list of activities tailored to the child’s specific sensory needs) to incorporate heavy work activities throughout the day to provide the input that they’re seeking. Now keep in mind that some children might require more activities to improve sensory regulation, or they might need to do them for a longer period of time. Below are some examples that heavy work can be incorporated throughout the day. 

Household chores: 

  • Carrying grocery bags into the house 
  • Digging in the garden 
  • Pushing a wheelbarrow during outdoor chores like gardening 
  • Cooking/ baking: have the child help stir thick batter, knead and roll pizza dough, use rolling pin, peel fruits 
  • Taking out the trash
  • Mopping or sweeping 
  • Raking leaves/ mowing the lawn
  • Carrying or pushing a full laundry basket
  • Vacuuming 

Outdoor play/ Park:

  • Riding a tricycle/ bicycle/ scooter
  • Playing catch/ ball toss (preferably using a weighted ball)
  • Swinging on monkey bars
  • Jumping rope
  • Jumping on a trampoline 
  • Swimming 
  • Climbing on playground structures 
  • Wheelbarrow walks (walking on hands while a partner holds feet up)
  • Rock climbing 
  • Tug-of-war
  • Animal walks (bear walks, crab walks, snake crawls, frog jumps)
  • Digging in a sandbox
  • Kid’s Yoga 


  • Squishing play-dough/ putty/ kinetic sand
  • Blowing bubbles/ harmonica/ whistle/ pinwheel
  • Playing twister
  • Marching/ running in place
  • Wall push-ups 
  • Animal walks 
  • Wrestle/ rough house for fun 
  • Kid’s Yoga 
  • Building a fort (using large pillows, chairs, couch cushions, etc.)

Mealtime/ food options: 

  • Provide chewy or crunchy food at snack or mealtime (i.e. celery, carrot sticks, apples, fruit leather, jerky, pita chips, uncooked pasta, licorice, etc.)
  • Drink thick liquids through a straw (i.e. smoothie, shake yogurt, applesauce)
  • Drink liquids from a suction water bottle (try the CamelBak eddy water bottle)
  • Chew gum 

Here is an instance in which this was incorporated during occupational therapy interventions. A therapist created a list of activities and strategies to provide proprioceptive input to a child that demonstrated difficulty with regulation. The parent reported concerns regarding emotional regulation. The child would get easily frustrated and slam their fists against doors, walls, or bookcases. Additionally, during treatment sessions, the child appeared to be clumsy and would trip and fall easily while running indoors or outdoors. They also demonstrated sensory seeking behaviors such as pushing a garbage can back and forth, as well as pushing their hands against the wall, dumping stuffed animals into a basket, then dumping stuffed animals over them. The occupational therapist created a tailored list of activities, personalized specifically for the client, to provide the input that they were seeking. These activities were also recommended to be provided throughout the day, in order to improve transitions, improve regulation, and improve their body awareness.


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