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We have all experienced some type of pain in our lives, and how we respond to that pain dictates how well we recover. With immediate acute injuries, the most common response is to stop painful activities, rest the area, possible ice/heat the area and/or take OTC medication. However, if this rest period becomes too prolonged, you can be detrimentally affecting your body and your recovery. So, how much rest is too much rest?

 Understanding Tissue Healing

To understand healing and your recovery, it’s first important to understand the phases of healing that each tissue goes through after injury. These phases can help dictate when you should return to activities, and what type of activities you should be performing.

Phase One – “Acute Inflammation”: Within the first 1-7 days post injury, the tissue responds to injury with acute inflammation, causing an increase in pain, temperature, swelling, and/or loss of motion. These responses are the initial steps of healing, and work by bringing repairing mechanisms towards the area of injury. This phase can last from 2-4 day in minor injuries, and can be up to 7 days with more severe trauma. In this acute phase it’s important to rest the injured area, apply ice often, and avoid aggravating activities. This rest allows the repair mechanisms to come into the cell in preparation for the laying down of new tissue. Performing intensive movement and aggravating activities during this time can damage the new forming tissue, and create weaker tissue once healed.

Phase Two – “Proliferative Phase”: This next phase involves the creation of new cells, and the tissue experiences an increase in collagen formation as damaged tissue is removed. As more tissue is formed to replace injured tissue, it’s important that the tissue heals in the way that the tissue is used, and that motion be initiated to ensure correct tissue structure is created. Aggravating activities should still be avoided, however, beginning to return to daily activities and movement of the injured tissue should begin. This is also the perfect time to begin Physical Therapy, to ensure a controlled and supervised progression of mobility and exercise that is tailored and unique to your injury.

Phase Three – “ Maturation and Remodelling”: Approximately 3 weeks after the initial injury the maturation phase. This phase consists of the maturation of collagen, and the production of the final scar tissue. Here, it is imperative to begin more intensive movement of the tissues, although still trying to limit aggravating activities. About 6 weeks after injury acute healing is complete, however continued healing happen as you stress/strain the new tissue. As you apply new stress to the area your body detects any inherent weakness in the new scar and tissue, and remodeling and creation of new tissue is constantly occurring to ensure the area is strong enough.

Benefits of Early Motion

Now that the phases have been presented, it’s easy to see why initiating early motion has been proven in the literature to produce the best results for recovery. In the early phases after acute inflammation, motion is vital to enhance the production of new tissue, ensuring it forms in the appropriate direction. This will help maintain full motion of that tissue and associated joints, making sure the scar tissue isn’t restricting motion. Early motion is also important to ensure cartilage health, making sure the joints are moving and lubricating the joint and associated cartilage. Early motion will also help begin to strengthen the affected area, decreasing the risk of re-injury and muscle wasting.

Negative Effects of Immobility

If activity is not initiated, a myriad of negative effects can follow. Firstly, the new tissues being created is forming in a patchwork pattern, and without stressing that tissue it will not form in the appropriate direction. This disorganized tissue will stiffen the area and restrict the mobility of that tissue, and may even lead to more chronic issues with motion such as joint contractures (a permanent shortening of muscle/joint). Lack of activity and motion will also promote continued and prolonged loss of muscle strength, which has multiple negative effects on the body. Initially, as the injured tissue heals, the other muscles surrounding the injured area will be forced to pick up the slack, causing them to be overworked and possibly lead to another injury as they fatigue. Along with that, the new repaired tissue won’t strengthen either, leaving it more susceptible to re-injury and delaying your recovery.

Besides the negative physiologic effects, it’s also important for mental health to begin a more active approach to. Studies have shown that immobility and passive approaches to recovery can often create fear and anxiety of movement, teaching the false idea that passive strategies are good for recovery. This will exacerbate fears of re-injury and further decrease activity levels, prolonging recovery. Some studies have even suggested that passive approaches increase the tendency of people to look towards passive strategies such as surgeries or injections, instead of trying to actively control their recovery with physical therapy and exercise.

How PT Can Help

If you didn’t seek Physical Therapy after your initial injury, it’s never too late to begin. In the initial phases PT can help if you are unable to move your muscles, such as after surgery, by passively moving the area to avoid joint contractures and maintaining the health of your cartilage. Some studies suggest this passive movement can even help maintain your body’s ability to sense it’s position (balance). Along with early movement, manual breaking up of scar tissue can be helpful early in recovery, as well as with more chronic type injuries. Dense scar tissue forming can actually prevent muscle fibre regeneration from happening, prolonging injury and recovery. This scar tissue can restrict motion of the area which can predispose the area to another injury. PT also helps ensure correct progression of your activity level, ensuring proper timing based on your individual injury. Your therapist can help alleviate the pain, and advise you on how much is too much, as well as help alleviate fear and anxiety about returning to potentially injurious activities.

Multiple studies have shown more optimal recovery with early movement in ligament, tendon, muscle and bone injuries. More recent literature reviews have even promoted early movement and walking in hospital based PT settings such as the Intensive Care Unit (ICU) for critically ill patients, as well as immediately post-operatively with many other Orthopaedic surgeries such as knee and hip replacements. All these studies have proven multiple times that early motion leads a quicker recovery time, and a quicker and fuller return to full activities. If these people can be up and walking around, so can you!

Take an active approach to your recovery! Balance is the key, knowing how much is too much, but not being fearful of movement. The initial protection and immobility is good for healing, however the earlier you can get back to usual activities, the better the injury responds physiologically and the better you heal mentally.

In health,

Lauren Carleton, PT, DPT