THE THERAPY CORNER

Rest – Revisited

Ten years ago, I wrote about the most offensive four-letter word in the runner's glossary: rest. [Therapy Corner #33]. No runner ever wants to be told an injury requires that he/she must take even a few days off.

At that time, I offered the following general principles to help decide if rest is necessary:

· When the pain is consistent over two or more consecutive runs.

· When the pain starts at a fixed point after beginning a run, with the intensity increasing as the run continues.

· When symptoms are even slightly noticeable when not running.

· When the area is also moderately to severely sensitive to touch or pressure.

Over the past decade, however, and especially the past couple of years, new information has surfaced that leads me to reconsider these "rules."

Much of the initial evidence on this topic comes from clinical research on the effects of early and relatively aggressive exercise and return to normal activities following low back injury. Multiple investigations have confirmed what many physical therapists had intuitively believed for years; prolonged rest is, in most cases, the worst strategy you could employ to aide in the recovery from even the most feared (disc herniation) spine conditions. The advice given by most orthopedic experts these days is, get moving as soon as you are able and do not stop!

It has taken considerably longer to reach the same conclusion when talking about typical running injuries – tendinitis, ligament sprains, muscle strains – but the most recent research out of the University of Pittsburgh and other institutions appears to support the theory that moderate, active movement of these injured structures actually enhances the healing environment. Rather than cause further injury, gentle exercise appears to boost the body's repair mechanisms and strengthens the connective tissue elements that have become inflamed as a result of overuse or trauma.

Naturally, in the early stages of healing, such movement may likely cause some discomfort, but researchers now believe that, as long as the pain is no more severe than when walking and does not significantly worsen following the exercise, there is no longer a prohibition on resuming limited running after one to three days rest.

Due caution should be exercised, though, when pain is so pronounced, or weakness is so obvious, as to cause any alteration in the normal, symmetric gait pattern. Such symptoms can indicate a more severe injury such as stress fracture or ruptured tendon. Usually, these injuries are so apparent that it is unlikely anyone would want to even try to run.

So, based on this new evidence, we can propose the following "New Rules" regarding the necessity of rest when injured:

• When the pain is severe enough to cause you to limp when running
• When the area is severely tender to touch or pressure
• When there is obvious and significant swelling and/or warmth around the injured area
• When running causes a steady increase in pain over a period of time

Absent these signs, the new rules allow you to resume moderate running while suffering from most soft-tissue injuries. The problem with this rule, however, is that moderate is another word that runners often delete from their dictionary.

Gabe Yankowitz, DPT

Gabe is a physical therapist and long-time runner practicing in LaFayette and in the outpatient physical therapy clinic at St. Camillus Health and Rehabilitation Center in Syracuse. While he treats all orthopedic conditions, running injuries are his special interest.