Rest Is Not Best! A different perspective on injury rehabilitation.

For anyone who has had the misfortune of suffering a muscle injury, whether it was a small strain in your calf muscle at the end of a long run or tearing your hamstring sprinting to keep the ball in play, you will probably have gone through a couple of weeks where you did no exercise at all. Let the injury rest, you’ll go back running when you feel good and ready. We now know that this rest period may actually be prolonging your recovery period, thus delaying your return to sport.

Many of you may have come across the PRICE guidelines when it comes to injury management. In other words, when you get injured you need to;

Protect the injury (stop the exercise that you’re doing at the time)

Rest (stop training for a week or two until it all feels better),

Ice (strap a pack of frozen peas to your leg)

Compress (tight bandage),

Elevate (put the feet up, put on Netflix)

Sounds good, right?

PRICE vs POLICE

As a profession, we have started to rethink this model of injury rehabilitation. What has been proposed, and which is also getting increasing support from research, is that rather than PRICE and injury, we should call the POLICE! The change here is that rather than using Rest as an immediate treatment, you should be Optimally Loading the injured area. This is not to suggest that you go back training straight away. Optimal Loading essentially means providing exercises that will target the injured area to decrease pain, regain full movement, and ultimately strengthen the muscle to a higher level than before the injury. After assessment of the injury, a rehabilitation plan should be developed between the patient and the physiotherapist. Depending on the severity of the injury, the rehabilitation should be as active a process as the patient can tolerate.

Start Early

A recent study compared the difference between starting rehab either 2 days or 9 days after the injury occurred. Both groups followed a progressive loading/strengthening protocol with the early group returning to their sport on average 3 weeks earlier than the later group.

When this study was published late last month, the physiotherapy profession got very excited, so much so that my twitter feed was overflowing with tweets and re-tweets about these results. From experience, we here at DSC would always be advocates of active rehab and early loading, so it was great to finally see some solid evidence that getting patients to start their rehabilitation early really works.

The early start is crucial if you want to optimise your rehabilitation but there are some other key points that you need to adhere to as well to successfully return to sport with a minimal chance of re-injury.

Return To Sport

Optimal Loading of a muscle injury as the patient is closing in on a return to sport means that you are progressively increasing the difficulty of the exercises to match and exceed the demands of their sport. Too often patients will go back training once they no longer feel pain in day-to-day life. However, the load demands of your sport are very different  to those in daily life. Approximately half of re-injuries occur within the first 25 days of an injury. This is because the injured muscle might not have fully healed yet, or that the underlying weakness that led to the injury has not been strengthened sufficiently yet.

So when your physiotherapist recommends that you might not be ready for a return to sport just yet, they are actually trying to prevent a further injury.

So if you get injured, be prepared to put in the hard work on your rehab if you want the best results and to prevent re-injury.

Blog by William Cuddihy MSc. MISCP, Chartered Physiotherapist at Dublin Sports Clinic.

If you are currently injured or experiencing pain and are looking for a suitable treatment plan, contact Dublin Sports Clinic on 01-5517343 or [email protected] to book a physiotherapy consultation.

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