After a musculoskeletal injury the immediate reaction is to immobilize and rest. Most people have likely heard of the acronym RICE or RICER meaning - rest, ice, compress, elevate, and refer to a medical professional.
In regards to the first 'R,' here are some important considerations to keep in mind:
Rest is not meant to be absolute, only relative. Meaning a certain low-level intensity of movement should begin as soon as possible. This is why rest is sometimes replaced in the acronym with an 'M' for movement.
The extent of the damage, resulting impairments, as well as the individual's response to movement will dictate the initial intensity. It can neither be too much (delay healing) nor too little (add no benefit).
Movement can and should begin even in the inflammatory stage of healing after an injury, as long as it doesn't cause further aggravation which will delay healing. This is why that second 'R' is important.
In acute injury management, a healthcare provider will perform an examination to formulate a plan of care based on the findings. The particular movement prescription needs to also reconcile identified impairments with the patient's concerns about how the injury will impact their daily, occupational, or recreational life.
The purpose of this early movement is to mitigate any further loss in function. Let's use an inversion ankle sprain as an example. As the figure below demonstrates, post-injury tissue tolerance is significantly lower than prior to the injury. Anything inside the circle is within loading tolerance. Anything outside, runs the risk of causing tissue injury. This means that post ankle sprain, even seemingly innocuous daily activities like mowing the lawn or using the stairs can be strenuous or symptom provoking:
Our bodies are constantly adapting to environmental stresses, and the resulting loading tolerance after an injury will not return to pre-injury levels on its own without purposeful intervention. Tissue doesn't have a memory. It only responds and adapts to imposed stresses. Realize this means the tolerance can go in the opposite direction as well. Prolonged movement avoidance reduces loading capacity and has the potential to further sensitize tissues to trigger alarm signals (which can result in pain) with harmless stimuli. Resting for too long after an injury is maladaptive for this reason. The only way to improve the loading tolerance of newly deposited tissue is through graded exposure with movement and exercise. This is essentially the role of injury rehabilitation:
Once rehabilitation is complete, further training can be of great benefit depending on the goals of the patient. In general, I personally will always make at a minimum a recommendation for further training, if not outline the plan for the patient myself. To me it doesn't make much sense to only return a patient to the point where they got injured, and expect a different outcome once they return to their target activity.
Stronger tissues have more capacity. And higher capacity translates to an ability to handle larger forces prior to tissue injury, or at least minimizing the amount of damage done.
I encourage anyone that has failed to get better with solely resting, after an injury, to seek guidance from a rehabilitation professional. They can help facilitate your return to doing the activities you love!
Thanks for reading,
Dr. Piotr