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Too much rest may not be good.
Too much rest may not be good.

Don’t just rest after an injury

If you rest for a long while and don't 'load' the injured area, it's likely to do more harm than good

How often have you been told by doctors after having injured your back, knee, ankle, elbow or shoulder to stop doing the physical activity or sports that you love most, like morning walks, runs, squash, tennis, golf, swimming? Many doctors suggest that if a patient were to carry on with these activities, their condition would worsen. In doing so, I believe that doctors take the laziest way out and do a disservice to their patients because there isn’t enough scientific evidence to support this approach.

For a very long time in medicine, the bulk of the PRICE (protection, rest, ice, compression and elevation) regime has been recommended as self-help for people with muscular or soft tissue (muscular, tendon, ligament) injury. Protection was added later on, and this approach is not limited to sports injuries, but extends to any musculoskeletal ache or pain. The one thing that has been shown to be effective is the analgesic effect of applying ice. Protection and rest also make sense immediately after having sustained the injury, the catch being that it should only be allowed for a short time.

But if you rest for a long while and do not load the injured area following an injury, it is likely to do more harm than good. In fact, it can cause adverse changes to tissue structure and shape. We need to gradually, far earlier than thought, start using the body part while doing regular chores and specific exercises for the injured part to restore the strength of collagenous tissues.

It was a 2009 paper in the British Journal of Sports Medicine—Mechanotherapy: How Physical Therapists’ Prescription of Exercise Promotes Tissue Repair by Prof. Karim Khan, centre for hip health and mobility, department of family practice, and School of Kinesiology, The University of British Columbia, Canada—that reminded us about the science behind loading the injured part for optimum recovery. Prof. Khan says “movement" stimulates tissue to repair. “Rest" turns the cell machinery off. Appropriate loading—exercise, like a motor being switched on within the cell—tells the cell to respond and repair. We had discussed this in greater detail in a previous column (How much rest is too much?).

To understand the concept better, say you have lower back pain, it’s important that you stay mobile rather than be completely immobilized. If it’s too painful to move, you can start activating the core muscles by doing bracing and deep-breathing exercises. Gentle, slow backward and forward movement (flexion and extension) of the back, contrary to popular belief and advice, is not going to make the condition worse. Walking is a great exercise to gradually start loading the back.

C.M. Bleakley recommended in an editorial of the March 2012 edition of the British Journal of Sports Medicine that one should get “rest" with “optimal loading", i.e. a balanced and incremental rehabilitation programme where early activity encourages early recovery. Since every injury is different, and so is the response, a clinical decision needs to be made based on the need. He coined a new acronym, POLICE (protection, optimal loading, ice compression and elevation).

The biggest problem is to know what is “optimal". For that it is best to gradually work on it. The patient or sufferer needs to be more in control. They know their body best. Of course, they need to load and push it, but pain is going to be the indicator as to how much is safe. As soon as pain appears, it needs to be remembered, it is only a messenger reminding us to slow down. The injury hasn’t got any worse.

So, the next time, God forbid, if you or your loved one get hurt, you should not blindly stick to the bed or the couch and hope that your body will recover on its own. Demand a more proactive treatment plan than is currently offered. Ask your doctors and therapists why they aren’t getting you moving sooner. If they can’t give a convincing answer, you know you need to look for someone else who knows better.

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. He is also associate editor, British Journal of Sports Medicine.

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