by Dave Alfano, PT, DPT

Posted in Blog.

May 14th, 2019

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

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This will be a two-part series. The first blog will address soft tissue injuries and the second will take a look at bone stress injuries.

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PART 1

The excitement is building as you continue to plug away in your training; another solid effort on your journey to your race. When all of a sudden, you begin to notice an ache or pain (as most runners experience). You spend some time foam rolling and stretching and continue with your training…

 

Now, what do you do when a few days later that ache or pain intensifies and stops you from running? It seems the only logical next step to take is to rest, but the question is for how long?

 

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? **

 

SOFT TISSUE INJURY 

Soft tissue refers to the muscles, tendons, and ligaments in your body.  This might present as”

• tendonitis (shin splints, achilles, patella),
• a muscle strain (hamstring, calf, quad)
• a ligament sprain (ankle, knee) 
• generalized inflammation (plantar fasciitis).  

 

Stage 1: Initial Rest

For the first 72 hours after this type of injury, it is important to rest from activity, alternate between ice and heat or controlled movements (see stage 2), compress and elevate the area on a daily basis.  If the injury is more chronic (>3 months) give yourself 4-6 days. Once you are able to control the inflammation and pain, this is when we can slowly move to stage 2.

 

Stage 2:  Controlled Movement

While rest is good initially with early stages of soft tissue inflammation, too much rest might actually be counterproductive as it is actually more beneficial to move the injured muscle, tendon, or ligament.  

Movement will directly stimulate soft tissue healing, will release chemical growth factors from cells which will maintain, repair, and strengthen the soft tissue, and overall will increase blood flow to the injured area. When beginning at this stage, start with controlled movements such as pain-free walking, biking with low resistance, swimming, and range of motion activities (drawing the alphabet for ankles and heel slides for knee as examples.)   When movement becomes comfortable and with little to no pain, it is time to start loading under tension.

 

Stage 3: Strengthening and Loading  

Next you must begin acclimating your injured body to the demanding loads of running.

This stage begins with isometric loading – where you hold an exercise as to not cause lengthening of muscles.

• Examples of isometric loading are holding a squat, bridge, or heel raise where you are activating the muscle for a specific period of time.

With no pain, you progress to isotonic loading – where you now introduce shortening and lengthening of the muscles while moving through your available range-of-motion.

• Examples of isotonic loading are lunges, step-ups or step-downs, or squatting activity.

Note that the number of repetitions, weights, sets, and duration are completely dependent on the injury.

 

Stage 4: Return to Running:

See the return to running protocol listed below where 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.