When injury strikes, rest is commonly the first thing that you may be told to do.
What if, instead of rest, we called it activity modification?
Let’s say I go to the gym, lift a heavy weight and feel an odd sensation in my back. Nothing is neurological, it’s only muscular and nothing is broken.
Pathway one is for me to stop training immediately, get my stuff and go home and take the rest of the day lying on the sofa and in bed. For the next few days, I will only move when necessary, I will try to stay lying down and try not to move my body and instead stay very rigid and start compensating to avoid any pain. Sounds pretty standard and like medical advice from the early 2000s. That is fine, it’s okay, and surely the pain from your back injury will ‘naturally’ get better and heal itself. We can all put it to rest.
Pathway two is for me to stop lifting heavy and spend a few minutes doing gentle stretching and mobilising. I might do a bit of walking and some very basic low-level exercise like hip circles, pelvic tilts and small hip hinges. I’ll start to make a note of what movements and exercises are painful and pain-free. When I get home I will try heat (e.g hot water bottle) and see how that feels. I will also try to move every 30-60 minutes and avoid being still for long periods of time. I will also multitask and stretch while the kettle is on, or food is in the microwave. I will also sleep with a pillow between my legs for the first few nights. If needed, I would also take paracetamol. Over the next few days, I will try to move more and challenge myself gently by progressing exercises and stretching a bit further as long as pain is under 3/10. I might try and go to the gym, mostly to see friends but also to do a gentle bike ride and do some mobility and stretching in the gym.
This sounds more productive and like you are actually taking control of the situation. Let’s break it down and I will tell you why pathway two is the better option.
Stop lifting heavy and spend a few minutes doing gentle stretching and mobilising
The muscles and body will likely have tensed as a response so doing some gentle movement helps loosen them up and limits the amount they can become tense and rigid.
First, walking and some very basic low-level exercise like hip circles, pelvic tilts, and small hip hinges can also really help here. Walking is always a good idea for back pain and most injuries, as long as you can walk barefoot without pain. Not only does it boost some endorphins which can help reduce pain, it also stimulates the production of serotonin and dopamine, which improve your mood and improve your circulation, and lowers your cortisol (stress hormone). The gentle mobility exercises encourage movement and remind us that we can move and we want to move through a full range ideally.
Then, I’ll start to make a note of what movements and exercises are painful and pain-free. This is useful to help identify patterns and also to identify a baseline at the beginning of rehab. We can use it in an informal way to measure progress.
Beyond this, when I get home I will try heat (e.g hot water bottle) and see how that feels. Heat helps increase blood flow and relax muscles. I will also try to move every 30-60 minutes and avoid being still for long periods of time. If possible, you want to avoid becoming stiff and scared of moving because of the pain, as it will only make rehab later harder for you. I will also try to multitask and stretch while the kettle is on, or food is in the microwave. I think this is the easiest way to disguise rehab and to be proactive. I tell myself that it is free movement because I am multitasking and doing something else.
Over the forthcoming days, I will try to move more and challenge myself gently by progressing exercises and stretching a bit further, as long as my pain remains under a 3/10. I might try and go to the gym, mostly to see friends but also to do a gentle bike ride and do some mobility and stretching in the gym. All in all, it is good to keep challenging yourself to try and get back into a routine. It will be slow and probably nice for you to move your body. As always, be sensible.
Of course, the type, nature, and severity of injury all determines a different management plan, but by making sure you’re still capitalising on your downtime, your rehab process will feel more like a gradual progression than a complete shock to the system.
