Why I (Almost) Never Prescribe Rest as a Treatment Strategy for Pain & Injuries

We have a problem in the physical medicine world. And that problem is the over-utilization of outdated methods of training, recovery, and injury rehab/prevention. Too often, we rely on old information and methods to inform our practices when the evidence has clearly progressed. One of the most prevalent of these outdated methods is the instruction of athletes and individuals to refrain from their sport/activity when injured and to just rest. While in some instances this is sound advice, more times than not, total rest is not what injuries need in order to heal.

DISCLAIMER: Please note that, for the purposes of this blog, when I talk about pain and injuries, I’m referring only to the things that fall under my scope of practice as a chiropractor. These include things like sprains/strains, overuse injuries, general aches and pains. This does NOT include broken bones, dislocations, complete tendon ruptures, or other emergent injuries or surgical cases. This is my little corner of the pain world, which largely involves non-traumatic muscle, nerve, and joint related pain and injuries. We’ll call this mechanical pain. (Please also note that pain is a very complex and multidimensional experience that is unique to each person and involves a variety of factors, and this blog is not meant to over-simply pain but rather to dissect a small sliver of the pie.)

Ok, let’s talk about some things that can cause mechanical pain. My brain likes to group things into categories to better conceptualize complex topics, so I’ve divided some heavy-hitting mechanical pain drivers into two main categories: biomechanical issues and loading issues.

1. Biomechanical issue

Definition: Biomechanics basically refers to the way your body moves. It’s your motor patterns—the sequences in which you activate or move certain body parts when accomplishing a certain task. And if you have incorrect or suboptimal biomechanics, range of motion deficits, etc., it can eventually manifest as pain.

Example: I’ll give you a super common example. Let’s take running. An optimal running pattern involves proper activation and control of the hips to not only propel the body forward, but also to stabilize the knee. If we don’t have this good activation at the hips, we often see the knee “crashing” in toward midline during the stance phase (the part where the foot is touching the ground) as a result. This repetitive collapse of the knee can cause unnecessary stress on the knee joint and often results in knee pain.

Why rest doesn’t work: To treat something like this, we’d typically spend a lot of time focusing on the hips and working on building that mind/muscle connection to achieve better activation and thus to prevent the knee from crashing in. When the knee is better positioned over the foot during the stance phase, the stress is absorbed/distributed more optimally, usually leading to a resolution of the knee pain (hooray!).

So back to the whole “resting” thing. Say we told our runner with knee pain to just take a few weeks off of running to let his knee heal. And say he does that. Then, after his period of rest, he returns to running, utilizing the exact same faulty motor patterns as before and still letting his knee cave. How do you think his knee is going to feel after a few runs? The issue here is that we haven’t corrected the problem. And sadly, his knee pain will likely return. Many of you have probably experienced the frustration of an old pain/injury returning after a long period of rest. If so, it’s likely because resting has not resolved the root issue driving your pain, especially if it’s a biomechanical issue.

2. Loading issue

Definition: Simply put, load is the amount of force or stress you’re putting onto any particular muscle, joint, tendon, or ligament. Load is our friend! It’s absolutely essential. But it can be tricky, because improper loading strategies—too much load or too little—isn’t good and can manifest as pain. Think of Goldilocks and the three bears—we don’t want that porridge too hot or too cold, but juuuuust right.

Too MUCH load:

• This happens when you do too much too fast, no matter how perfect your form is. A really amazing thing about the tissues of the human body is that they adapt and change in response to the stress placed on them (fun fact: this is why resistance training is recommended to help prevent osteoporosis—because you can literally increase your bone density by putting this stress on them), but they need time and progressive overload to do this. Too much too fast, and the tissues simply don’t have enough time to adapt and cannot tolerate the load. This usually results in pain.

• Example: I’m going to use another running example (sorry, runners). But let’s say you just spent the last 10 months during quarantine doing nothing but sitting on your couch. (Hey, I get it). But then the weather finally starts to warm up and you decide you want to train for a half marathon, so you start running 5 miles a day. Woah. After 10 months of putting little-to-no stress on your muscles and joints, suddenly running 5 miles a day is going to really rock their world. They haven’t had time to adapt to this kind of stress, and they’ll probably let you know by getting real inflamed and painful.

• Why rest doesn’t work: Even in an instance of too much load, rest still isn’t the best strategy! And that’s because it’s, yet again, not solving the root issue. We need to strengthen those tissues to prepare them for the kind of training you’ll be doing, and that sure doesn’t happen with rest. A better strategy would be starting small and slowly building toward that higher mileage, as well as incorporating cross-training. This is why those “couch to 5k” programs exist and are so effective, because even though it may feel silly running for only a few minutes at a time and walking a lot in between, that is how we progressively load and adapt your muscles and joints to eventually be able to run many miles consecutively without injuring yourself.

Too LITTLE load:

• Our bodies were made to MOVE, people. I know I talk about this a lot, so I don’t need to beat a dead horse here, but our bodies simply were not made to be in repetitive, prolonged postures day in and day out. Our ancestors spent their days hunting, gathering and lifting heavy sh*t, not sitting at a desk for 8+ hours. Every tissue in our bodies thrives off of movement—it helps lubricate our joints, bring blood flow to our brains, strengthen our muscles, regulate hormone levels, and many, many other benefits. For this reason, without enough movement, we can experience pain!

• Example: Let’s say you have a desk job, as many people do. Day in and day out, you sit in the same posture at the same place doing the same things. Maybe in the morning you feel fine, but toward mid-afternoon you’re really starting to feel tension in your shoulders or neck. Maybe your low back is aching, or maybe a headache has set in. That’s because those structures are literally screaming at you to move. They weren’t meant to be in those prolonged postures—they want blood flow and a positional change to keep them nice and happy and balanced.

• Why rest doesn’t work: In this instance, I would hope it’s pretty obvious why rest isn’t a good option. In order to treat this kind of pain or discomfort, we want the exact opposite. We want movement. Taking a break from your desk to walk a couple laps around the office or do some stretching, go to a yoga class, ride your bike are all great ways to counter this type of pain/discomfort.

In conclusion, keep movin’, my friends. If you’re battling an injury and have tried unsuccessfully to heal it through ice and rest, please know a better solution exists for you. Know there are professionals out there to guide you through the healing process and provide you with strategies to work through your pain in a way that will give you lasting relief and help you return to the activities you love. If this sounds like you or if you have any questions, don’t hesitate to reach out via the contact tab. I’m only an email or phone call away!