24 May To rest or not to rest?
Written By Megan Hunter.
One of the most common openings to a physiotherapy appointment is “ I have had this pain for a while now and I rested it for a bit, but it’s still bothering me.” Some of you may have experienced, rest does not fix everything. As physiotherapists we understand that it can be confusing when we give mixed messages – there are times that you need to rest and there are times where you need to get going! But how can you tell which is which? The long answer is that a lot of the time it depends on the tissue that is injured. So, over the next few weeks we are going to be completing a blog series about different tissues, what happens inside your body when they are injured, how they heal and when you need to rest.
To rest or not to rest? – Acute soft tissue injuries
As with everything in this world, our knowledge and understanding of acute soft tissue injuries has evolved and changed over time. For the purposes of this post – soft tissue injury is mostly referring to muscle and ligament injuries.
We all would have heard of the acronyms RICE and maybe even PRICE. These stand for Protect, Rest, Ice, Compression and Elevation. In 2013 an editorial by the British Journal of Sports Medicine (BJSM) introduced the idea of the acronym POLICE in acute soft tissue management. This stands for Protection, Optimal Loading, Ice, Compression, and Elevation. As you may have noticed the word “rest” has been completely removed from the equation. This change reflected the development of new evidence at the time suggesting that complete rest was detrimental to healing when prolonged beyond the initial days following the soft tissue injury.
Even more recently, in 2019, the BJSM has suggested the use of the PEACE & LOVE acronym (which we know is a lot to remember). This stands for, Protection, Elevation, Avoid anti-inflammatories, Compression, Education & Load, Optimism, Vascularisation, Exercise.
We would recommend following the link to the BJSM tutorial as per the link below, as this new advice comes with further explanation. The point that we are making that it is very unlikely that your physiotherapist will prescribe complete rest following an acute soft tissue injury.
However, returning to “optimal load” does not meaning returning to sport or activity like you were before. While prolonged rest is detrimental to healing, so is doing too much too early. The key phrase here may be “complete rest beyond the initial days post-injury is likely detrimental.” This new acronym also recommends listening to your body and letting it tell you what is good for it. Not asking for much are they …..?
References/Further Reading: –
PRICE needs updating, should we call the POLICE?