As a massage therapist, I often see athletes and clients after they’ve sustained some sort of injury. This is normal, but as a strength coach I often stop seeing athletes and clients because they’ve sustained some sort of injury. What’s going on here? Could there be some sort of correlation and why does this even matter?
When seeing clients for massage therapy I’m asked two questions. Can you relieve my pain? and What do you recommend I do? The answer to the first question depends on the type of injury. As for the second question, I tell my clients to keep doing what they can and avoid things that cause pain. Simple right? But not everyone is getting this advice. Often when I stop seeing clients at the gym, I hear about some sort of biking, snowboarding, or weightlifting injury, etc, etc.
In massage therapy school the first thing we’re taught to say to an injured client is to rest and modify their activity. We’re taught to prescribe P.R.I.C.E (Protect. Rest. Ice, Compress. Elevate.) until their pain symptoms decrease, and we’re not taught how to modify activities appropriately. There are two problems here, but for today we’ll focus on rest and why it’s a problem.
Here are 5 important questions to ask when seeing an injured client or to ask yourself if you are the injured person.
- What was injured?
- How severe is the injury?
- Does it require surgery?
- Does it hurt to move?
- Does it affect you using the rest of your body?
If it doesn’t need surgery and it doesn’t affect how the rest of your body moves, you don’t need to ‘rest.’ Depending on what was injured and the severity, that particular structure should refrain from doing anything that causes it pain. If it doesn’t hurt to move and you’ve gotten the ok from your primary healthcare provider to move, then MOVE!
REST SLOWS RECOVERY
The advice to rest is too vague. When telling a client to rest without more context they may automatically assume to stop doing everything, especially going to the gym. Why do people assume this? While discussing this with my friend Drew, he brought up a great point that most people probably treat injuries like they treat a cold or flu, and he couldn’t be more right. When we’re sick, we become bedridden which forces rest.
Injuries aren’t exactly the same and unfortunately this advice is given by massage therapists even when they should know better. Yes, rest from certain activities will be required dependent again on the severity, and the limitations they may cause. However, don’t rest from everything. Resting will most likely slow your recovery and make you lose all your gym gains. How? Let’s break it down.
CONSEQUENCES OF REST
Immobilization or restricted movement of the injured structures may be required so they don’t become more damaged. Unfortunately, a side effect of immobilization is disuse atrophy. This means the muscle will ‘waste’ away and strength will diminish. If you ‘rest’ your whole body everything will start to atrophy. In addition, due to your injury you may start to compensate your movement patterns. For example, rolling an ankle will alter how you walk because you still need to get places.
Your compensated gait will overwork certain muscles and underuse others, leading to future biomechanical problems once your ankle has recovered. It’s therefore important to get back to normal movement patterns as soon as possible. Prolonged rest may make any wrong movement pattern you have picked up worse, making it difficult to reverse the new habits.
SOFT TISSUE REPAIR
The easiest way to look at how rest can slow your recovery is to look at what blood does, how it moves through your body, and how waste products are eradicated. Simply, blood transports respiratory gases, nutrients, and hormones to cells then it transports waste products away from cells. Essentially, your blood provides fuel for all the cells in your body.
The cardiovascular system is pretty simple. Think of the heart like a pump. The more times it pumps, the more nutrients your body gets. The harder it can pump, the less pumps are required to move the same amount of blood. The cardiovascular system doesn’t work alone. In fact, the lymphatic system plays an important role assisting the cardiovascular system with waste disposal.
In simple terms, the lymphatic system is a support system to the cardiovascular system. It’s a set of one-way valves which removes waste that the cardiovascular system can’t handle. Any fluid that leaks through tissue and doesn’t make it back to the cardiovascular system gets picked up by the lymphatic system.
The fluid that moves through this system can only flow by two means. The skeletal muscle lymphatic pump which squeezes and releases lymphatic vessels through muscle contraction and relaxation, and the respiratory lymphatic pump which does the same thing but is caused by pressure changes in the thorax and abdomen (a body without a head or limbs) which happens while breathing.
MOVEMENT SPEEDS RECOVERY
Now that we know that blood has healing properties and understand how blood flows through the body, how do you feel about rest? Strength training will cause more muscles in the body to contract and relax which requires more blood and helps with moving lymphatic fluid. Cardiovascular exercise increases heart rate, heart strength, and respiration which will increase the amount of blood circulating through the body and helps increase lymph fluid movement.
If you sustain an injury, ask yourself the 5 questions above so you can make better decisions about how to approach your recovery. If you require surgery, are post-op and on medication, or are completely usure where to start, ask your primary healthcare provider what you CAN do because you know what you can’t do. If you’re ok to move then move but use common sense and don’t put yourself in unsafe situations.
The worst thing you can do is become sedentary. All too many negatives come from lack of movement. If you have a personal trainer or do group fitness classes, ask your trainer or coach to modify the workouts for you. Again, make sure you’ve gotten the OK from your primary healthcare provider. Massage therapists and personal trainers absolutely cannot diagnose.
Do what you can, and move what you can.
Chris Luu, SMT(cc), RMT, SFMA, CFSC, FRCms