How Long Should You Stop Your Favourite Activities After an Injury?

From a slight tingle in your shoulder blade to a dull throb under your kneecap, chances are, you’ve become familiar with the first signs of an injury. And whether you’re an avid athlete or simply prefer an active lifestyle, you figure that an injury can only mean one thing: time away from your favourite activities… or does it? Is rest truly the only cure for muscle and joint injuries?

The verdict is in, and as it turns out, time off after an injury does not always work. In fact, sometimes a period of inactivity can not only exacerbate the injury itself but also prolong the uncomfortable inflammation that accompanies muscle and joint damage. If you’re concerned how a recent injury might take you away from your favourite activities, this is what you should know.

‘Relative Rest’ Versus Inactivity After an Injury

After an injury, it’s common for a doctor to advise you to stop doing whichever activity got you into trouble in the first place. So, if you were a soccer player who suffered a knee injury while playing soccer, it’s almost guaranteed you will be told to discontinue playing soccer for a certain amount of time while your body is given a chance to heal. In naturopathic medicine, we call this ‘relative rest.’

So, what is relative rest, anyway? (Spoiler alert: It doesn’t mean you lay in bed and do nothing all day.) Relative rest involves completing certain types of exercises and physiotherapy movements while still giving your body time to heal. It’s not so restrictive that recovery is slowed or compromised, but it will involve avoiding activities that aggravate the injured area to the point of impaired healing.

Now, this does not mean that you will need to avoid your favourite activities forever — it’s almost always just for a short period of time we refer to as the inflammatory response to an injury, when white blood cells invade the area to help your immune system heal the underlying damage. Sports injuries produce an inflammatory response to help your body regenerate and repair itself.

New evidence has shown muscle cells release positive regulators to speed up the inflammatory process. In particular, muscle-derived nitric oxide (NO) has been found to inhibit inflammation and protect healthy muscle. Fortunately, certain types of exercises advised in relative rest can ramp up NO production to limit inflammation, aid in muscle regeneration, and enhance healing.

Realizing When Rest Doesn’t Help Healing

The timeline for relative rest varies depending on the severity of the injury and several secondary factors like age and concurrent health conditions. Sometimes, however, the advice to take time away from your favourite activities while the body heals itself does not work. At Neurvana Naturopathic Medicine, I see patients who tried that approach, but their supposedly short-term pain now lingers.

In some cases, this is because muscle-derived proteins called cytokines signal for a continuation of the inflammatory process, which can limit the repair of damaged structures and trigger muscle atrophy (the thinning of muscle mass). Likewise, being that the inflammatory response to muscle damage is not uniform for all patients, older individuals and those with chronic inflammatory conditions may still struggle to heal from a sports injury, even with doctor-advised relative rest.

When limiting activities no longer contributes to healing, the conversation will shift away from relative rest and more toward active recovery. We’ll begin to discuss how much exercise you need to be doing and what types of therapeutic activities you should be completing — along with when resuming your favourite activities can be possible and how to ease back in with confidence.

Relearning Physical Boundaries After an Injury

After the inflammatory response from a sports injury, there is a very good chance you will experience some pain or discomfort when you first get back into the activity you love. While this is a normal part of the healing process, it’s still essential to relearn (or reset) physical boundaries after an injury. One of my favorite ways to do this is through what I call the ‘four out of ten’ rule.

In this rule, zero represents no pain whatsoever and ten represents the most pain you’ve ever been through in your entire life. Four out of ten is when general discomfort turns to pain. At level four, you might be thinking, “I feel it, I know that it’s still there, but I can do my favourite activity as normal. I don’t have to change my gait and I’m not changing my rhythm to avoid the sensation.”

A shift happens when you reach level five. Here, discomfort becomes pain. You might notice a limp, struggle to support your body weight, or have to grip the rail when going downstairs at level five and beyond. I advise my patients to use the ‘four out of ten rule’ as a personal compass to guide whether you’re doing too much too soon, being sure to stop activity when discomfort turns to pain.

Reclaim Your Favourite Activities (Sooner Rather than Later)

Rest is a really necessary piece of the medical pie, but it’s certainly not the whole thing. During relative rest, a naturopathic doctor like myself will advise you to complete a variety of therapeutic exercises ranging from balance and strength training to aerobic conditioning. We can also develop a personalized treatment plan to begin to treat any underlying damage at the source. 

Strategies we may incorporate to help reclaim your favourite activities post-injury include: 

• Prolotherapy
• Laser therapy 
• Manual muscle therapy
• Physical manipulation (adjustments)
• Trigger point injection
• Acupuncture