Why Rest is Not Always Best

In the past the advice that was usually given after sustaining an injury was to rest your injured body part and ‘put your feet up’ for a few days to help manage your pain. That advice is now outdated and often not always the key to the best recovery. Extended periods of rest can be detrimental to your recovery as it can result in joint stiffness, muscle degeneration or muscle loss, scar tissue formation and perhaps most frustratingly, prolong your recovery time

There are some cases such has bone fractures and post-surgery where an acute period of rest is recommended to aid recovery, however research has shown that even in some of those cases, getting moving earlier is beneficial to tissue healing. Most people will know the acronym RICE: Rest, Ice, Compression, Elevation for acute injury management. However more recently, this has been replaced by a POLICE: Protection, Optimal Loading, Ice, Compression, Elevation.  Let’s break these down and explain each element further:

Protection: This is a short period of immobilisation to prevent unnecessary excessive tissue damage and minimise scar tissue formation. This can be in the form of casting, braces, or crutches, and for most injuries, a few days is sufficient before the tissues can withstand gentle stressors.

Optimal Loading: Optimal loading replaces rest from the old acronym and can harness the benefits of early tissue loading through movement and exercise. Early loading has been shown to reduce swelling, improve strength, speed up return to work and/or sport time, and increase overall patient satisfaction. The key thing to note is that the loading needs to be ‘optimal’ – too much can cause further tissue damage, however too little and you will not receive the benefits that it can provide.

Ice: Ice is best used for the first 48-72 hours of an injury, applied for 20 minutes every 2 hours. Ice has been shown to have some benefit in the reduction of swelling but it is mainly applied to help manage your pain.

Compression: Compression is applied following a soft tissue injury (such as sprains and strains) to increase pressure to the injured area which assists with the drainage of fluid to help reduce swelling. There are a number of ways to achieve compression – a simple compression bandage is a cheap and effective solution.

Elevation: This once again assists with drainage by getting the injured limb above or close to the level of the heart. This can be achieved though a sling or brace for the upper limb or resting the legs on a chair.

Optimal Loading – How much is too much?

When it comes to early loading there is no magic answer as every individual is different, and every injury is different. It would not make sense to give one patient who ruptured their ACL the same advice as one who pulled a calf muscle. How much load you apply is best discussed with your physiotherapist as they have specialist knowledge and experience to take into account a patient’s tissue damage, injury location and medical history.  The loading during the rehabilitation of an injury should progress frequently as the patient goes through each phase of healing. Loading does not always mean lifting heavy weights or running either – in the early rehabilitation phase it can be some simple isometric exercises or taking the injured joint though range of motion exercises to gently increase the stress on the injured area.

Come and see our expert team at our Auckland physio clinic today to help structure a plan for your rehabilitation and to allow you the best chance at optimal recovery.