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Move on: Injury should not be an excuse for long-term inactivity.

Move on: Injury should not be an excuse for long-term inactivity.

How much rest is too much?

How much rest is too much?

From the time we are born, we have to work against gravity, starting from learning to sit up, crawl and then eventually, one fine day, walk as well. It is our ability to gradually adapt to the environment we are in that keeps making us stronger. This prepares us better to handle the physical challenges we have to face in the future.

Move on: Injury should not be an excuse for long-term inactivity.

Instead of using this beautiful gift of adaptation as our platform, however, almost all of us take a very conservative approach when there is an injury to our muscles, ligaments, bones and joints. Based on either “expert" advice or our own logical thinking, we stop moving completely. Rest seems the obvious thing to do. The logic is to “unload" the affected joint or body part for a particular period. It’s a good approach for a small time period. However, if the period or duration of inactivity is too long, it is not good for the body. If rested, in effect unloaded, for too long, this duration has a counterproductive effect. Recent medical research backs up this statement.

Prolonged rest produces adverse changes to tissue biomechanics and morphology, which weaken them to a point where they are not capable of supporting the body even for regular life chores.

In a paper, Mechanotherapy: How Physical Therapists’ Prescription of Exercise Promotes Tissue Repair, in the 2009 edition of British Journal of Sports Medicine, Prof. Karim Khan, centre for hip health and mobility and department of family practice, University of British Columbia, Canada, confirms that “mechanotransduction" is an ongoing physiological process in the human body, just like respiration and circulation, where cells sense and respond to mechanical loads. In the absence of activity (load), the mechanotransduction signal is weak, so connective tissue is lost (eg, osteoporosis) or muscle mass is lost.

Not surprisingly, Prof. Khan found that mechano- transduction is not being taught as an important biological principle in physiotherapy or medical programmes. Progressive mechanical loading, or gradually increasing the workload on a healing muscle or bone, is the ideal approach to injury rehabilitation, as suggested by C. M. Bleakley, research associate, Health and Rehabilitation Sciences Research Institute, University of Ulster, UK, in a September editorial in the British Journal of Sports Medicine. The trick is finding “optimal loading", the correct balance between loading and unloading (rest), to aid in the quick healing of tissues.

As Bleakley suggests in the editorial, optimal loading means replacing rest with a balanced and incremental rehabilitation programme where early activity encourages early recovery. Injuries vary, so there is no single one-size-fits-all strategy or dosage for this. Only a qualified doctor or physiotherapist can tailor the rehabilitation exercise programme.

So if you are 30 years old and suffering from lower back pain, just rest is not enough. Once the pain starts abating, an exercise-programme to strengthen the lower back is a must—else the lower back will heal, but will be weaker than before, and susceptible to more frequent injuries that might become lifetime companions.

Rajat Chauhan is an ultra marathon runner and a doctor specializing in sports and exercise medicine and musculoskeletal medicine, and founder of Back 2 Fitness.

Write to Rajat at treadmill@livemint.com

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