by Dave Alfano, PT, DPT

Posted in Blog.

May 21st, 2019

How Long Should You Be Resting An Injury? | Part II

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This is a two-part series blog post addressing injury and the rest and return to exercise protocol. Part 1 can be found here and reviewed returning from Soft Tissue Injuries.

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PART II

You’ve had a nagging pain for the last few weeks and have decided rest is the best option. But will resting it for a longer period of time help it go away?

The answer is, not always.

 

In most circumstances immediately resting for a few days is a great idea to help calm down some of the inflammation and reduce pain, but what happens next?  How long am I supposed to take off? How come I’ve rested for weeks yet when I try to run the pain is still there or comes back? In this post, we will focus on soft tissue and bone injuries and how we can:

 

1. Maintain our fitness,
2. Help speed up recovery, and eventually
3. Return to running.

 

**It must be stressed that this blog serves as a general guideline for returning to running but it is most important first to find the cause and severity of the injury; was it simply overtraining, incorrect footwear/orthotics, a biomechanical issue, a mobility/strength issue, or a change of surface, intensity and/or volume? **

 

BONE STRESS INJURY

There is no doubt that an initial period of non-running or activity is essential in dealing with a stress reaction or stress fracture. However, it is important to maintain some level of conditioning and movement during recovery for the stimulation of soft tissue repair and the release of chemical growth factors to maintain, repair, and strengthen the soft tissue and increase blood flow to the injured area.

 

Stage 1: Conditioning

Conditioning activities should be introduced early, as endurance-trained athletes experience declines in cardiovascular performance in as little as 2 weeks following training cessation. This may take the form of cycling, swimming, deep-water running, and eventually anti-gravity treadmill activity. (Consult with your doctor or PT before starting)  

 

Stage 2: Pain Elimination and Controlled Movement

When beginning to start moving through the injured bone, ask yourself 2 questions:

1. Does it hurt if I move the area at all?
2. Does it hurt if I put weight on the area (either standing if it’s on your lower body or by pushing against the wall if its upper body) 

If any movement causes pain, then most likely you are not ready for Stage 2. If putting some weight through the involved area causes pain, then stick with easier movements while sitting or laying down.

For example, if you are dealing with a stress fracture in your shin and it hurts to walk, consider sitting while making different shapes with your ankles, performing repetitions of bending your knee or lifting your leg up and down while it’s straight. If standing does not cause pain, it may be appropriate to walk, march, or stretch. Any pain-free movement is better than no movement at all!

 

Stage 3: Strengthening and Loading

After the pain has subsided, in a very controlled manner and when appropriate, it is important to start the process of gently loading (bearing weight on the limb) as to prepare the bone, soft tissue, joints, and body for the demands of a return to run program. Appropriate loading can be defined as loading that does not provoke the bone injury either during or after completion of an activity. Once a runner is pain-free with walking, the process of reintroducing running-related loads can be started. 

 

Stage 4:  Return to Running

See the return to running protocol listed below where again, plyometric activities are introduced to simulate the impact of landing and pushing off during running.

 

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RETURN TO RUNNING PROTOCOL

When the time comes to start transitioning back to running, there are a few steps that must be taken. Many return to run programs exist, but ultimately it comes down to a few things:

 

• Step 1: Can you walk pain-free with a strong cadence for 25-30 minutes on a consistent basis?  If yes, advance to step 2.

 

• Step 2: Can you hop on 2 legs in place, forward/backward, and side to side for 30 seconds per time without pain?  If yes, can you do it with one leg? If yes, can you perform a single leg broad jump for 4 sets of 5? If yes, advance to step 3.

 

• Step 3: This is where our walk/jog progression takes place on level ground.  

 

1. 1. 1. Stage 1: Walk 5 mins, jog 1 min
      2. Stage 2: Walk 4 mins, jog 2 min
      3. Stage 3: Walk 3 mins, jog 3 mins
      4. Stage 4: Walk 2 mins, jog 4 mins
      5. Stage 5: Walk 1 min, jog 5 mins.

 

• Step 4: Proceed cautiously and progressively with a day of rest in between your runs, starting at 30 minutes initially.