When is Rest best for running injuries?
When I was 16 and had my first running injury, I remember googling on the internet what my symptoms could possibly be and what I should be doing for it. This was back in the 2000’s when it seemed like the solution to everything was orthotics and RICE (rest, ice, compression, elevation). Also, flat feet seemed to be the blame for everything. Boy, do we know a hell of a lot more now than we did back then. We also know, you don’t need to completely rest every new ache or pain.
Current research now suggests that rest isn’t always the answer for treating running injuries and that RICE isn’t always applicable. Even Dr. Gabe Mirkin who came up with the RICE protocol in 1978 recanted his own protocol. Read Here
Running overuse injuries are as they sound: repeated micro trauma in the tendons, muscles, and bones that happen gradually overtime. In an ideal, injury free world, we balance this micro trauma/ training load with enough rest and recovery. You expose an organism to a new stimulus (speed, jumping, vert), and give it enough time and it will adapt to those changes. The human body is extremely adaptable. The most common reason for running overuse injuries is overloading this system too often and too soon that things start to breakdown. On TOP of that, if the individual doesn’t have enough stability in their core/hips/ foot & ankle, it will be more susceptible to repetitive strain to specific areas and cannot withstand impact forces as well.
My top reasons for when complete rest (meaning no running & some form of cross training is necessary):
Bone Stress Injuries (BSI): Absolute rest is required, nonnegotiable. BSI’s are bone stress reactions and fractures. A stress reaction is typically the precursor to a fracture. No hairline fracture is observed, but pain/inflammation/edema around the bone periosteum is observed. A stress fracture is a visible hairline fracture detected on imaging. The best way to diagnose a bone stress injury is through an MRI or CT scan. Unfortunately, bones need completely rest for 8-12 weeks for remodeling and healing to occur.
Pain > 5/10 during running, after, and day after that does not improve with activity modification. This means you’ve tried reducing speed and volume and pain is still beyond >3/10.
Running gives you more anxiety than joy. This one is a BIG one. If running through an injury is stressing you out because you aren’t sure if running is making it worse- take a few days off to see if it helps while you seek professional help.
You’re limping or changing the way you run even when running easy.
Impaired activities of daily living (ADLS): if your running injury is making it difficult for you to walk up/down the stairs, get on and off the floor, get dressed - it’s time to let this injury heal with rest.
For most overuse injuries I treat that are soft issue related (tendons, muscles), taking 1-7 days off early on can be beneficial to decrease pain and inflammation, then return to modified running can stimulate healing along with rehab exercises specific to the injury. Remember, a certain degree of movement is good for healing because it helps maintain range of motion, strength, and promotes blood flow to the site of injury. It’s when you overload tissues that are still healing with excessive running early on & intensity that it becomes counterproductive! This is where speaking with a running physical therapist can be extremely helpful in helping manage loads when returning to running to promote injury healing.