R.I.C.E.

For years we have been taught that with any injury we should follow the simple list that has given us that acronym.

Rest, Ice, Compress, Elevate.

While a fresh ankle sprain will benefit from these steps, after 2-3 days of time from the injury you might be slowing your progress.

In my experience working with swimmers for the past 20 years, I have found that resting usually prevented the swimmer from returning to the sport successfully. Don’t get me wrong, if a swimmer had an acute injury to his/her shoulder, the athlete would rest for several days to allow the injured tissue to calm down. But after that, more rest is actually more of a problem.

Our bodies are always adapting to the loads that we place on them. Always adapting…the body never takes a break.

We often think about adaptation as a good response, usually to something beneficial, like exercise. We make sure that we get our daily steps in using our activity tracker, and the activity tracker “adjusts” the steps to another slightly higher goal for the next day. The activity tracker assumes that your body will adapt to be able to gradually handle more steps.

In that case, you are making a positive adaptation, one where you can do more in response to a challenge that you placed on your body. But what if you did less? What if you got knocked out of your rhythm of doing daily exercises, say because you sprained an ankle, or because your shoulder hurt while swimming? What happens then?

Remember, the body doesn’t take a break. It continues to adapt. Only this time in the opposite direction. Your body would adjust to doing less.

It takes 3-4 weeks of rest to start seeing losses in muscle strength, and an even shorter time to see loss in aerobic capacities. The strength losses are mostly attributable to losses in neuro-muscular control rather than loss of muscle mass…at least initially.

If you rest for more than a month, things can get much tougher. Especially for endurance athletes, like runners and swimmers.

While most athletes will regain the muscular coordination quite readily when returning to the training, the aerobic ability takes a little longer to rebuild. And with fatigue comes changes in neuro-muscular coordination that cause motions to become less efficient. Less efficiency of movement leads to more fatigue, which can lead to pain and more poor motion, and the spiral begins going downward.

So what can we do if we sustain an injury or have a pain or problem that prevents us from doing our training?

First things first, rather than focus on what you cannot do, look for what you can do. If your shoulder is limiting you from swimming, then you can bike, run, use an elliptical, etc. to at least prevent a further loss of your aerobic fitness. If your ankle prevents you from running, then look at biking, swimming, rowing to keep the aerobic fitness levels.

Switching to a new activity for a short time while allowing the problematic area a bit of relative rest will mitigate some of the losses. It will still be tough when you return to the activity you have avoided. In my experience, nothing outside of the swimming will keep the aerobic fitness level a swimmer needs when s/he returns to the water. So we also need to limit the time we rest.

In fact, some injuries will not get better with longer rest. The rest causes the negative adaptation spiral, making it more difficult to get back to previous activity levels.

Tendon injuries are at the forefront of that list.

A tendon is the structure that connects a muscle to a bone. It is an energy storing, transferring, and releasing tissue that responds to load. Specifically, tendons respond to tensile loads. That means they must have tension put across them in order to have any impetus to heal. Without tension, tendons weaken. And guess what a weaker tendon handles…LESS LOAD.

So resting a tendon injury gives us a negative adaptive response if we want the tendon to be able to handle more load in the near future, like when we return to activity, we need to judiciously put some load across the tendon.

But who would think of resting for a month?

This is a common scenario:

A swimmer presents to me after having shoulder pain when switching from short course training to long course training. She has been to the doctor who diagnoses the shoulder pain as “swimmer’s shoulder” and tells her to take 2-weeks off from swimming.

The swimmer takes 2-weeks off, as instructed, and the shoulder feels better…until she returns to the water for practice. After performing warm-ups, the shoulder begins to hurt, again. So what is she to do? Well since resting made it feel better, maybe she just needs more rest.

So she rests, again, for another 2-weeks. On returning to the water, she has the same response. Only now, she has lost some of her aerobic capacity and some of her strength because of the time out of the water.

Another rest period, maybe a little longer this time, should do the trick, right?

Not at all.

Remember that the swimmer’s body is adapting the entire time she is resting…only she is adapting to doing no activity. Her body adapts to doing less activity. So when she returns to the swimming practices, her body is unable to do what it could just a few short weeks ago.

This only serves to confuse the swimmer as she returns to the water. Now she gets sore, but is it because she hasn’t been swimming in 4-6 weeks, or is it because she has a “real shoulder problem?” How can the swimmer tell the difference?

The best way to “fix” this problem is to never allow the body to begin to negatively adapt. Whenever possible, the swimmer/ athlete should remain active. Modifications to activity must be implemented in a way to prevent further irritation, but also modified wisely to prevent loss of fitness and strength. Those losses only make it harder to return to the activity that the athlete loves.

The key is to know when to stay training and when to stop.

That is where a physical therapist knowledgeable in your sporting activity can help guide you to continue healing while still training.

I’m not encouraging blindly pushing through pain and injury. Quite the opposite, in fact. Training must continue to prevent the deleterious effects of inactivity, but it must be tempered with the knowledge of the injury cycle, biomechanics of the sporting activity, and the physiologic changes associated with injury and healing.

Remember, more rest is not the key to healing and to returning to the level of activity you want. Keep moving, work to move well, then move well more often!