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While rest does help inflammation go down after injury, too much rest can actually slow down or inhibit the healing process. Ashley Heller, PT explains how resting after an injury is not the solution to healing.

BY ASHLEY, MPT, RAUSCH PHYSICAL THERAPY

Patients will often come in for physical therapy only after resting their injury for weeks; these are the same people who then ask me, “Why am I still injured and in pain? I took a whole month off!” It’s a common belief that staying off of and resting an injury will help it heal back to normal. In reality, when you rest an injury for a month, all you accomplish is four weeks of weakening the surrounding muscles.

While it does play an important role, rest is typically not the full solution for an injury.

What about R.I.C.E?

Rest does allow for inflammation to go down. In fact, R.I.C.E (rest, ice, compression and elevation) is key during the acute inflammation phase (first 24 to 48 hours after injury.) However, as the complete inflammatory process begins to calm down (between two to three weeks after initial injury) it’s important to return to modified activity to avoid tissue irritation and to prevent chronic swelling.

So yes, rest is good, but like most things in life, too much of a good thing can be bad! With rest comes de-conditioned muscles, which can then potentially lead to muscle imbalances or muscle atrophy. Returning to previous activities with these types of strength deficits after a month of rest can result in rapid re-injury and chronic pain. Remember, Resting → De-conditioning → Atrophy → Muscle imbalances → Increased risk of re-injury.

As illustrated in the following infographic, the person who begins to stretch and strengthen after the acute inflammation ends is able to make a quick, full recovery, while the person who instead chooses to rest their injury for a month as his rehab method has only put himself at risk for re-injury when attempting to return to normal activity.

Use it or Lose it

During the muscle strengthening process, strength gains made in the first two weeks can be attributed to “neuromuscular strengthening,” which refers to muscle memory and the brain’s ability to “turn on” a muscle. After those first couple weeks, true muscle strength gains begin to occur between four and six weeks.

In comparison, muscle atrophy happens much quicker than muscle strengthening. The early stages of muscle atrophy can occur as soon as one to two weeks. The extent of muscle atrophy directly relates to the injury severity and amount of time immobilized, meaning the longer you don’t “use it” the more you “lose it” and the longer it will take you to regain full, true strength back.

When to Start Stretching and Strengthening

Think of scar tissue like a scab that lays down in a randomized fashion over the injured tissue during the healing process. Although trying to stretch the scar tissue too soon will damage the adhesions that are trying to form, stretching scar tissue at the appropriate* time will allow the tissue to lay down in a more organized fashion and promote flexibility. Likewise, soft-tissue work during this time is essential to promote better flexibility.

*The appropriate time to start stretching scar tissue is when it can be done without localized pain at the site of the injury (this can vary from patient to patient and the severity of the injury.

Forget ‘No Pain, No Gain’

Just remember, there is a significant difference between “good” pain and “bad” pain. You should leave PT feeling less restricted and able to move more freely; subsequently that newfound mobility or strength may be accompanied by treatment or exercise soreness, which I refer to as “good pain.” Good pain is that feeling after a good deep-tissue massage, muscle soreness from a great workout, or a specific stretch that is making change. “Bad pain” refers to pain as a likely result of treatment or exercise that is too long, too hard, or too intense, which can cause tissue irritation and pain. Finding just the right amount of exercise and activity is crucial to finding balance between recovery and progression rather than taking steps back.

Conclusion

Ultimately, your physical therapist is there to help guide your recovery during the healing process. PTs are your best resource for advising you what you should be doing and what you should be avoiding at your current stage during the recovery process. People re-injure themselves when they do too much too soon after an injury. This can happen when the weakened tissue is put under too much stress too soon. PTs are experts when it comes to progressing you to the right exercises at the right time, with the right amount of intensity or resistance. Although physical therapy cannot necessarily “speed up” the body’s inflammatory response and healing process, it can enhance tissue recovery, joint restrictions, muscle function, and address potential movement pattern dysfunctions that could lead to the initial injury. Your PT can help advise you of the appropriate amount of activity during the recovery process so you can get back to doing what you love quickly, healthier and stronger than before.

Ashley Heller, MPT is a licensed physical therapist at Rausch Physical Therapy & Sports Performance. She received her Masters of Physical Therapy degree at California State University, Long Beach and is passionate about working with patients with shoulder, knee and ankle injuries. With background in orthopedic-related injuries and post-operative rehabilitation, Ashley believes that the combination of manual therapy and personalized therapeutic exercise program is vital to recovery. Known as the Water Sports PT, Ashley says her goal is to help her patients better understand their injuries and the plan for their road to recovery.

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