Should I rest it or work it, you ask? Ah, the age-old question. And one that nearly every client asks on their first visit. And probably the most challenging one for me to answer directly! One thing is for certain- the extremes of each of these are rarely the right answer. Complete rest can not only be subpar, but can be harmful as it tends to stagnate the healing process. We need some kind of movement to help with blood flow to the injured area and flushing in with the “good” and out with the “bad.” That being said, if we overwork and try to force more movement or load than appropriate we can also risk prolonging the healing process or reinjuring the area. So, how do we know how much to rest or how much to work? The details will be individualized to you and your injury, but I will try to use the healing timeline to provide some insight on general rules of thumb:
- Inflammation (Phase 1)
During the initial phase of an injury, the area is inflamed- maybe red, hot and swollen…or maybe you don’t have a visual sign, but you know it feels raw and angry. This phase typically lasts 72 hours. Although this inflamed state is painful, it is a necessary one for healing as it starts the cascade of the rest of the process. In this phase, I would recommend:
-
Move the injured area through a pain-free range OR a range that does not increase existing pain levels. For example, if you are at a resting pain level of 2/10, if you can move in certain directions and not increase that number during or after the movement then we can be pretty sure you are not causing more harm.
-
Move the joints above and below the injured area- for example, if you have a knee injury, keep your ankle and your hip moving. If you have a low back injury, roll those shoulders and squeeze those glutes. Do as much as you can with these surrounding areas to help prevent secondary issues, as well as to help some blood flow to the painful area itself.
-
If truly visibly red, hot and swollen, consider ice, compression and elevation in the first 48 hours. Good old RICE without the R (so I guess that makes it ICE? 😊). But just know we NEED the movement along with this old school approach. This can’t be our only solution.
- Repair (Phase 2)
During the repair phase after an injury, your body will be laying down the scaffolding to heal the injured area. I like to think of this as patchwork, where collagen and scar is formed to bridge the gap between injured tissues. This phase can last from a few days to several weeks, depending on the severity of the injury. In this phase I would recommend:
-
Begin to regain range of motion of the injured area.
-
Begin slowly and gradually loading the involved area with controlled movement and exercises. This is the phase where it might be beneficial for a physical therapist or skilled trainer to help find your appropriate challenge point. The key is to find a load that begins to strengthen the area without reproducing your pain. Pain is different from muscle work, soreness or fatigue…but sometimes it is a fine line and you may have to trial and error a little bit to find the right dosage.
-
Strengthen the surrounding muscle groups- keep working above and below the injured area!
-
In life, continue to avoid movements that acutely increase your pain. Yes, it’s that simple- avoid what hurts. This is the phase where you might be tempted to check these motions to see “if it it’s still there.” We’re all guilty of it. In our anxiousness to feel better we keep doing the thing, thinking “how about now? Now? Maybe now?” Hoping the pain will be gone. Instead, try devoting your time toward more productive strategies!
- Remodeling (Phase 3)
During the remodeling phase, the body takes all of that random scaffolding from the repairing phase and begins to reorganize it in the way your body knows it needs it. Your body’s movement helps to re-teach the tissue what it needs. Appropriate and progressive lengthening and strengthening of the muscle help it relearn its role in given activities and restore normal tissue function and mobility. This phase can last from several weeks to months.
-
Continue progressive, gradual loading of the injured area- this may result in some discomfort in this phase which is normal and necessary. Our job is to figure out exactly how much and what kind is appropriate- for example, sharp 6/10 pain is very different than a diffuse 3/10 fatiguing discomfort. Exercise is like medication- everyone is different and we need to figure out the right dosage.
-
Make sure to focus on movements specific to your needs. If that means picking up your child who is 47 lb then we better be working toward lifting that amount safely. If that means being able to sit for 4 hours for work travel on a plane, then we can train endurance and postural stabilizing muscles. If that means playing pick-up basketball then we better be adding jumping movements into your program.
-
Try not to increase intensity, duration or frequency of work at the same time. Pick one variable and progress it when ready…then work on the next challenge. Otherwise, you may not know what is helping or hurting.
-
Remember that progress is rarely linear. You will have set backs or flare ups, and we need to respect those. You can respect those moments when they happen, and then move forward when your body allows.
-
Remember the nervous system is being remodeled, too. We have to help decrease the threat to the nervous system in the healing process- it has been in protective mode around the injury for a while now. This is why picking the right dosage is so important- overload and we send the nervous system into overdrive again as it senses threat to the system. Under-load the tissue and we never get the nervous system used to what it will need to do in life.
If you’re having trouble healing an injury on your own, Click here to set up a 30-minute complimentary assessment.
