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The negative effects of rest for injury management

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Initial response to injury

It seems to be a fairly generic and universal response to most niggles, pains and injuries. You pause your running/gym/field training and have some time off to let things settle. But what’s often forgotten is the significant negative effects of rest for injury.

While the occasional rest has its place in injury management, it’s one of my biggest frustrations as a physio – hearing the magic phrase “I had a month off but it’s no better”.

To understand why resting can be so counterproductive, we need to go through the effects of rest. We’ll go through the changes that occur over the course of the month. The timeframes discussed may be slightly different depending on your age and training history.

No one is immune to the effects of deconditioning!

Effect of resting for two days

After two days off:

  • Muscles have a chance to recover and regain their full capacity
  • Tendons and other connective tissue maintain their bounce and are still ready to run
  • Acute inflammatory response, the body’s initial response to structural injury such as a ligament tear, is just winding down. (A typical inflammatory response lasting two to three days after injury)
  • Bone irritation, such as from stress fractures and impact injuries, is pretty much unchanged after only two days. The soreness it generates will ease slightly due to a lack of ongoing loading.

So overall your body’s had a good rest. Most adverse symptoms are beginning to ease and you’re feeling better overall.

Effect of resting for one week

After 7 days off:

  • Your strength is beginning to decline
  • Movement patterns (including running technique) start to get a little rusty and inefficient
  • Your connective tissue begins to lose some of its bounce, so you feel a little bit less spring in your step
  • Acute inflammatory response has finished days ago and soreness from ligament and muscle tears has reduced
  • Bony soreness has usually eased a fair amount by this stage but the underlying bone reaction is virtually unchanged.

Overall, your symptoms have reduced. But so has your capacity and tolerance to loading. It’s the start of the negative effects of rest for injury. And that’s not a good thing when you’re already carrying an injury…

Effect of resting for 1 month

One month after resting from training:

  • Strength and fitness have significantly declined. After four weeks, you’ve lost around 8-12 weeks of training gains and you’re still declining
  • Your movement patterns have lost their efficiency so tasks require more effort for less output
  • Your connective tissue has lost even more spring and elasticity, making movement feel flat and heavy
  • The combination of less strength, less bounce and more effort required to move all compound the issue and make it much harder to complete any activity.
  • Symptom-generating inflammation has eased off, although typically not fully resolved. But it no longer causes soreness at low loads
  • Bone reactions have begun to settle, reducing in severity and soreness.

So the good news is that your soreness has eased and you feel better. But, and it’s a big “BUT”, you’re less capable of generating and tolerating loads due to loss of strength, bounce and efficiency. So your risk of overload is huge and the return to sporting activity is prone to re-aggravation.

You’ve achieved a month of symptom reduction, which feels better. But you’re now more prone to injuries and reinjury due to a lack of load tolerance.

There’s around three months of training required to catch up but you’ve got to take it slower due to your injury risk. So three months of training will probably take 4-6 months to achieve. That’s assuming you don’t have any setbacks with symptom aggravation.

Suddenly the month off seems like a very short sighted “solution”, right?