Traditionally, our immediate response to a musculoskeletal injury is to rest and let the body heal itself, after all everyone who has done basic first aid knows that the R in R.I.C.E. is rest!
However, the importance on rest has been greatly overemphasised in the past and this thinking has perpetuated to this day, even though we have more and more evidence telling us that this may not be the best thing to do, and may even cause harm.
The reason behind the old way of thinking is that, because there was not nearly enough scientific evidence to lead practitioners one way or another, medical doctors and other practitioners would fall back on the Hippocratic saying ‘first of all do no harm’ and instead of suggesting any interventions they would simply advise bed rest for many musculoskeletal injuries. To be fair, rest by itself may reduce the initial symptoms but it has now been established that it can lead to long-term adverse effects.
In cases of some acute injuries (e.g. broken arm, muscle tear, ankle fracture) rest still is the best management in the initial stage. However, for other acute injuries such as (not exhaustive) a muscle corky, ankle sprain, a tendinopathy flare-up, etc. rest will not lead to better outcomes and may prolong recovery times.
The reason for this is that these types of injuries cause a decrease in our body’s function (our body’s ability to move and perform activity) therefore to recover from these injuries we must focus on improving our body’s function, rather than not moving and waiting for the injury to resolve. If we simply rest after an injury, the acute symptoms and pain may resolve but when attempting to return to our regular lifestyle activities we will find that our ability to carry out our daily functions are impaired, which can lead to a long-term decrease in ability.
Some adverse effects to rest include:
- Reduction in muscle strength (muscle atrophy)
- Improper scar tissue formation
- Reduced blood flow to the affected area
Instead of completely resting after an injury, your osteopath may give you modified exercises that mimic your chosen activity (e.g. walking instead of running). This strategy is known as relative rest, where we decrease the workload on the body but don’t completely remove the workload – known as absolute rest.
A well-researched example of this is in the case of acute ankle sprains. The old method was to rest and immobilise, however the most current evidence has found that the best way to speed up recovery and improve long-term outcomes is to immediately start mobilising the joint. This mobilisation increases the blood flow to the area, reduces excess swelling, and prevents any muscle atrophy that may occur. Immobilisation is strongly discouraged and starting a walking program as soon as pain permits is also now recommended. This is a great example of how relative rest can be much more effective than absolute rest, and also a great example of how the evidence has shifted towards this train of thought. (Vuurberg et al., 2018).
For any chronic injuries, such as chronic low back pain, or an osteoarthritic knee, rest is strongly discouraged. This is for all the reasons listed above plus the fact that improper healing may have occurred and interventions such as exercise therapy will be required.
To sum up, the old method of simply resting when injured is outdated. The evidence is clear that for most injuries we need to be doing some sort of functional rehabilitation and modification of physical activity loads in order to optimise our recovery. For the small number of injuries that do require absolute rest, the timeframes are short and a quick return to movement is almost always necessary.