Don’t rest when you’re injured!
Why do you get injured? Why isn’t rest the best solution? How do you treat an injury? This is a long article, so we’ll start by summing up the most important key points:
- An injury often occurs because you exceeded the capacity for load in a muscle, tendon or bone. This risk is usually introduced if you increase exercise volume and intensity too quickly.
- If you take rest as your recovery strategy, it is likely that you will heal more slowly and less effectively. You will tend to lose muscle strength and endurance, which leaves you weaker (with lower capacity) when you return to sports or recreational exercise. That in turn leaves you exposed to relapse or new injury.
- After an injury, you should try to find the balance between avoiding load until the body has had a chance to repair the acute injury, but at the same time using and moving the body. Finding the optimum balance will stimulate healing and maintain as much muscle function as possible. A helpful guide to finding that balance is the «PEACE and LOVE» principle. You can read more about that and more about the specific treatment of specific injuries in our app. As pain allows, it is normally good to increase load gradually in a controlled manner; of course it is wise to consult a physiotherapist if you are unsure.
- Remember that when you return to sport, you need to aim to have become stronger then you were when the injury occurred , certainly if you want to return to the same level of exercise that resulted in the injury. This is because the overuse injury occurred as a consequence of insufficient strength to endure the exercise load you were attempting, so your muscles, tendons and bones will need a higher capacity for the higher intensity.
So, don’t rest?
Alright, you shouldn’t read that too literally. Of course you’re supposed to avoid loading a body part that has been injured. Protecting the injury from loads will allow the injury to heal. But there is a difference between ‘load’ and ‘movement’. And there is a huge difference between resting and rehabilitating. To understand this, you need to learn more about how injuries happen, what rest is good for, but why rest also increases your risk of injury.
Why do you get injured?
There are a number of ways an injury can occur. Some injuries are just accidents that could not be avoided: a twist, a collision impact or suchlike. Most injuries however occur due to an increase in exercise volume or intensity where the tissue (muscle, bone, tendon) haven’t had time to adapt to the total load.
For tissue to become stronger and withstand increasing loads, it needs time. A gradual increase of total load and sufficient rest between the workouts will stimulate the tissue to adapt and grow stronger. That way, you increase its capacity for load. This has to be managed gradually, step by step. If you progress too quickly, the tissue will not have time to adapt. If it is exposed to wear and tear during exercise that’s greater than its capacity, and can’t recover quickly enough before you subject it to more wear and tear. That’s when most injuries happen.
What happens when you rest?
Rest allows us to heal. Some days of rest after a workout will allow the body to repair the wear and tear from the workout. The muscles, tendons and bones adapt to the demands you subject them to by growing stronger. After one, two or three days, depending on the intensity of your workout, your body is ready to perform again. If you keep resting beyond the point where you’re completely recovered, your body will see that as a sign that bigger and stronger tissue isn’t needed. Bigger and stronger tissue requires energy to maintain. The body is a smart thing. Instead of spending energy on maintaining strength that isn’t necessary, it will get rid of what is doesn’t need. The longer you rest, the weaker you get.
Increased risk of injury
So, as you might have now understood, you need to balance rest and load to become stronger. Resting after an injury will allow the body time to repair the damage, and your symptoms will decrease. But the injury has left the tissue weakened. The damage might have been repaired but the tissue still isn’t as strong as it used to be, so it needs to be rehabilitated. Because the other muscles, tendons and bones aren’t stimulated and loaded when you rest for a prolonged period of time, the body as a whole begins to become weaker. As a consequence, the body as a whole will be capable of enduring less load than before the injury.
Most people do not consider this and they throw themselves back into exercise at the level they left off before they were injured, which is the same level that exceeded the capacity and caused the injury. If the body was not strong enough for that intensity before the injury, the chances are the capacity for load will be even lower afterwards.
You’ve probably seen where this is going, but we’ll spell it out: Resuming the same level of exercise volume and intensity as before will leave you at considerably increased risk for recurrence and for a new injury. Very many injuries occur after summer break or when returning after rehabilitation, due to returning to a higher level of activity then the body is ready for.
How are you supposed to treat an injury then?
If you’re not supposed to avoid loading your body when you’re injured, but you’re not supposed to rest it either, how are you supposed to treat it? There are 3 important steps you need to follow: Give the injury some PEACE and LOVE, make sure to startcarefully loading as soon as possible and make sure your return to sports is gradual. Let’s look further into the three:
PEACE and LOVE for acute injury management
Have you heard of the PEACE and LOVE principle? This is a useful acronym that serves as a reminder how to treat an acute injury to:
- Reduce the extent of damage
- Shorten recovery time needed
- Help stimulate optimal repair (for example by avoiding scar tissue to form in a way that will bother you later on)
- Avoid recurrence
You’ve probably heard of “Rice” or “Price” or “Police” as treatment principles for acute injuries. In 2019, PEACE and LOVE was proposed as a more accurate, evidence based new principle. “PEACE” is to be used to first 3-4 days. It instructs you in how to protect against further injury and how to stimulate the healing process in the body. The thing about “PEACE” that might surprise some is that A is for “Avoid ice and NSAIDs (antiinflammatory medication). Ice has been widely used as acute treatment to reduce sweeling and pain. Yet it has been showed to disturb the body own healing processes.
LOVE is for the sub acute phase, and following LOVE from day 4 and until you’re recovered will leave you with a better recovery outcome and help you prevent new injuries. It is well worth learning the PEACE and LOVE principle. You can read more about PEACE and LOVE here.
‘Optimal load’ is part of the PEACE and LOVE principle. The expression means that you should, as soon as the injury allows, start moving and loading, but with some restrictions. Never push through pain. All injuries will have different healing time, depending on degree of injury and type of injury. How long you need to avoid load and when your tissue will tolerate gradual exposure to load depends on the individual and the degree of injury. As soon as you can, you should start to do some light and easy non-loaded movements for the injured body par. Preferably within days. That will allow faster and stronger healing.
Try increasing range of movement day by day. Listen to your body and as soon as pain allows, you can start to load it carefully. For example, loading an injured foot could mean something simple like trying to stand with equal body weight on each foot. Increase load gradually day by day. You body will let you know if you’re doing to much. You should never ignore and push through pain, but there will be some light discomfort when you start loading. Talk to a physiotherapist who can guide you, or check out the Trigo app for advice on specific injuries.
You should also try to maintain fitness. Even when you are avoiding load on the injury, you will benefit from staying active with alternative exercise, if your injury allows it. Perhaps try doing some cardio on a stationary bike. Perhaps consider sports specific technique training that doesn’t affect your pain. Seek out strengthening exercises for other areas of the body. All of the above will help maintain fitness and promote a quicker, better recovery.
Gradual return after injury
As soon as your pain allows, you should start strengthening the injured tissue (muscles, bones, tendons). You might feel weak at first, so begin carefully and increase gradually. Injured tissue is at increased risk of recurrence when you return to sports or recreational exercise. That’s why you should aim to become as strong as possible before you resume your normal activity levels. Thinking you can return to a similar exercise level and intensity without being stronger than before isn’t a good idea. Remember, the injury occured because your tissue wasn’t strong enough to tolerate the load you exposed it to. You need more strength and a higher capacity to endure that level of exercise.
Finally, when resuming exercise or sports, remember that your whole body will be weaker than before because you haven’t been able to maintain the same level of fitness. Don’t jump right back in where you left off. Give yourself 3-4 weeks to gradually build up to the same intensity and same volume as before. That way, you reduce the likelihood of recurrence or new injury.