This is the second topic I would like to discuss in a series of fortnightly blogs. See my previous article on the topic of the emotional impact of sports injuries.
REST? WHAT IS REST?
When I found out about my shoulder injury I was told that because of the damage already incurred I needed to rest and rehab it. For me, the idea of rest was the worst news I could receive and I was overwhelmed with frustration. I still had my club rugby season with Old Belvedere women to go back to play. The thought of missing out on really important AIL games was devastating and I felt I was letting my team down. However, other athletes respond differently and may be happy to respect the process and give their body the time it needs.
Is there such a thing as too much rest?
What if you get out of shape or lose muscle?
Is it necessary to rest completely, or is it adequate to rest only the injured part?
Is “taking it easy” enough, and for how long?
How do you know when to lay off and when to “use it or lose it”?
How can you rest anatomy that you need to use all day, every day?
The most common objection to resting: the fear of getting out of shape
Before we get rolling, I want to quickly shoot down the most common objection to the suggestion to rest thoroughly: the fear of “going to pot” or getting critically out of shape. This fear is often expressed by the most fit people, who are actually in the least danger. Worry about healing first, and then concern yourself with restoring any fitness you have lost. Why?
You certainly will "go to pot" if you never heal. Chronic pain is a much greater threat to your fitness than resting and nothing will keep an overuse injury going like more use!
Peak conditioning is vulnerable, but the bulk of your fitness is actually quite stable and hard to lose. No one goes completely to pot in three months (or even six). Even if you do get out shape, it’s really not that big a deal to get back into shape.
It’s also usually easy to rest/protect an injury while still maintaining some fitness by exercising in other ways (relative resting strategy).
In my own experience, I was advised to rest from rugby and alter my gym training. I got impatient and struggled to stay motivated with my rehab exercises; all I wanted to do was get back on the Rugby pitch. When I attempted to get back to playing too soon, I ended up flaring up the shoulder pain and going back to square one.
One step forward, two steps back.
It was my body telling me “I need more of a break than you’re giving me.” I finally faced the music and accepted that I will get back to playing rugby when my body says I can. You would expect that as a qualified Physiotherapist I should practice what I preach! Easier said than done. I know better than most that rest and recovery following an injury are a somewhat difficult pill to swallow, but it is an integral process to let the body do what it is best at – adapt and heal.
“Bed rest” is dead
Let’s get this out of the way early as well: bed rest (a.k.a. total rest) is pretty much dead as a concept in rehabilitation. These days, doctors won’t even cast a fracture if they can avoid it — fractures heal faster when they aren’t completely immobilised. Even a hip fracture doesn’t get you a get-out-of-exercise card any more. Replacing bed rest is the concept of “early mobilisation” or “active rehabilitation.” The idea is to get you moving as soon as possible — short of actually re-injuring you. A great deal of scientific evidence suggests that the stimulation of movement, especially in the early stages of healing, is a crucial part of recovery from injuries and surgeries. Acute low back pain has been shown to respond much better to normal activity than to bed rest. Achilles tendon ruptures have been shown to heal faster with early mobilisation after surgery. Whiplash victims recover much faster if they get moving right away after their accident, rather than wearing a collar.
This week I would like to take this opportunity to discuss the different forms of rest that we advise our patients and why.
DIFFERENT FORMS OF REST:
REST FROM TRAINING
If you have suffered an injury from training (eg. Rugby), this is a very specific sport with specific movements. An injury may need rest from these specific types of movements, but this does not need you just need to sit around at home. For example, I needed rest from Rugby training that involved excessive movements and weight through my shoulder for example heavy gym sessions, passing, tackling and getting up from the ground.
During these times, cross training is important. Often you can find an alternative activity which does not aggravate your injury. For example, given my shoulder injury- ski erg and rower were not appropriate for me to perform but stationary bike and running were suitable alternates so that I could maintain my aerobic fitness capacity.
REST FROM A CERTAIN MOVEMENT
Some of us will have pain aggravated by a certain movement, e.g my shoulder pain was aggravated by back squats. This is because during back squats the humeral head is translated upward in an abducted/externally rotated position. In other words, the extreme cocking position and back squat bar position readily provoke labral problems once they are in place. This does not mean that I couldn’t squat at all, it just meant that I did front squats instead. It means that we could benefit from avoiding the painful activity for a week or two, whilst we work on our rehab, and during this time continue with all exercises which are pain free. After a period of rest from the particular movement, you slowly start to reintroduce it, perhaps using a different technique.
Deloading refers to reducing load. Load can be in the form of weights, sets, reps, distance covered etc. Some clients find that they can run 5km, but as soon as they run 10km, they get a niggle or pain. This type of injury does not need rest – rest will only decondition you (decrease in muscle strength and cardiovascular fitness) and when you try and return to the activity, the niggle comes back. What this client needs to do is continue the distance they can which is pain free (in this example 5km), work on their specific exercises, and build up gradually over the following weeks from 5km to 7km to get to 10km pain free. Rehabilitation is rarely linear, so you might need to change your plan and increases in loading as time passes.
This is when you need to completely rest the injured area, for example with a broken ankle you may or may not be in a brace and use crutches. For a shoulder, elbow or wrist you may be in a sling and have to use your other arm for everything. This type of rest is usually used for broken bones that need to heal or when ligaments need to be in a position to allow for ideal healing. Stress reactions or stress fractures, (often a result of overtraining) sometimes need a period of non weight bearing to allow for adequate healing.
SOME KEY PRACTICAL TAKEAWAYS:
Seek advice and listen to health professionals when they talk about rest and recovery, they may know what they are talking about. And again, as long as you don’t rest for too long, then you are doing the best thing for your body.
Find Out More
If you need advice, a physiotherapy assessment or feel your team/business could learn more about workplace ergonomics, contact Kathryn at email@example.com or visit www.ffs.ie/physiotherapy.
About the Author
Kathryn Dane is a Chartered Physiotherapist working with FFS Physiotherapy, a practice based on Leeson St Lower. Chartered Physiotherapists have specialist knowledge in the field of work-related injury management.
She also plays for the Ulster Senior Women’s Rugby team and Irish Senior Women’s rugby team. If you need advice or a physiotherapy assessment, contact Kathryn at firstname.lastname@example.org or visit www.ffs.ie/physiotherapy.