Should I Rest When Something Hurts, or Keep Moving?
Pain can make it difficult to know what you’re supposed to do.
Do you rest it completely? Keep exercising as normal? Stretch it? Avoid anything that hurts?
The answer depends on what has happened, but for most musculoskeletal pain, complete rest isn’t usually the goal.
Is rest actually bad for an injury?
Not necessarily.
If you’ve just injured something, temporarily reducing or modifying the activity that aggravates it can be useful. If you’ve rolled your ankle playing netball, for example, I’m probably not going to suggest you test it out with another game that night.
But there’s a difference between relative rest and avoiding movement altogether.
For many musculoskeletal injuries, current rehabilitation approaches encourage gradually returning to movement and activity rather than prolonged immobilisation or complete rest (Dubois & Esculier, 2020).
That might mean walking instead of running, reducing your weights at the gym, changing an exercise temporarily, or simply doing less of whatever has aggravated it.
The aim is to give the area an opportunity to settle without unnecessarily stopping everything.
What if movement hurts?
This is where people often get stuck.
We tend to interpret pain during movement as a sign that we’re causing more damage. Sometimes pain does tell us to stop; particularly after an acute injury or when there are other concerning symptoms.
But pain and tissue damage aren’t always directly proportional.
Pain is a protective experience influenced by what is happening in the tissues, but also by the nervous system and the wider context in which the pain occurs (Raja et al., 2020).
This means some discomfort during rehabilitation doesn’t automatically mean you’re harming yourself.
In fact, research looking at exercise for persistent musculoskeletal pain has found that allowing some pain during exercise can still lead to good outcomes. It doesn’t appear that every exercise needs to be completely pain-free to be beneficial (Smith et al., 2017).
That doesn’t mean you should be gritting your teeth through significant pain either.
There’s a middle ground.
How much pain is okay when I exercise?
Unfortunately, there isn’t a universal number I can give you.
A 3/10 might be completely acceptable in one situation and something I’d want to investigate further in another.
Instead, I’m interested in how the pain behaves.
Does it settle when you stop?
Does it continue getting worse as you exercise?
How does it feel later that day?
What about the following morning?
Are you able to do more over time, or is your tolerance gradually decreasing?
That response gives us useful information about whether the current amount of activity is appropriate.
What does “modify your activity” actually mean?
It doesn’t necessarily mean stopping the activity.
If squatting is aggravating your knee, for example, we might temporarily change the depth, weight, number of repetitions or type of squat.
If running is aggravating something, we might change your distance, pace, frequency or introduce some walking intervals.
If an exercise at Pilates is uncomfortable, there may be another variation that allows you to keep training while we work on the thing that’s bothering you.
This is one of the reasons I prefer “modify” over simply telling someone to rest.
We’re trying to find what you can do.
What about back pain?
Back pain is a particularly good example of why prolonged rest isn’t generally recommended.
Contemporary clinical guidelines encourage people with low back pain to remain active and continue normal activities where possible. Exercise is also recommended as part of the management of persistent low back pain (George et al., 2021).
That doesn’t mean ignoring severe pain.
It means that for uncomplicated back pain, spending days in bed waiting for the pain to disappear usually isn’t the best way forward.
Sometimes movement needs to start very gently. Sometimes someone can continue almost everything they were already doing.
Again, it depends on the presentation.
When should I actually stop?
There are situations where I do want someone to stop an activity and have the problem assessed.
A significant traumatic injury, inability to bear weight, obvious deformity, rapidly increasing swelling, progressive weakness or neurological symptoms are very different from a familiar ache that settles once you stop exercising.
Symptoms involving changes to bladder or bowel control, numbness around the saddle/genital area, or significant progressive weakness also need urgent medical assessment.
You also don’t need to wait for something to become severe before asking for help.
If you keep trying to return to an activity and the same problem comes back every time, that’s useful information too.
So... should I rest or keep moving?
For most musculoskeletal problems, I think a better question is:
“What can I safely keep doing while this settles?”
Sometimes the answer will involve temporarily doing less.
Sometimes it will involve changing how you exercise.
And sometimes, after assessing it, there may be no reason you can’t continue what you’re already doing.
My aim is rarely to take movement away from someone unnecessarily. I’d rather work out how we can keep you active while giving the painful area an appropriate chance to recover.
Not sure whether you should be resting or moving?
If pain is stopping you from exercising or doing your normal activities, or you keep trying to return to something and the pain comes straight back, it may be worth having it assessed.
If you’re in the area, you’re welcome to book an osteopathy appointment with me in Burleigh Waters.
References
Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253
George, S. Z., Fritz, J. M., Silfies, S. P., et al. (2021). Interventions for the management of acute and chronic low back pain: Revision 2021. Journal of Orthopaedic & Sports Physical Therapy, 51(11), CPG1–CPG60. https://doi.org/10.2519/jospt.2021.0304
Raja, S. N., Carr, D. B., Cohen, M., et al. (2020). The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain, 161(9), 1976–1982. https://doi.org/10.1097/j.pain.0000000000001939
Smith, B. E., Hendrick, P., Smith, T. O., et al. (2017). Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. British Journal of Sports Medicine, 51(23), 1679–1687. https://doi.org/10.1136/bjsports-2016-097383
