This is not the most technical post I’ve written, and you may not even find it useful, but to me, the point of this post is one of the most important in regards to rehab, and S&C. I recently wrote a post for http://www.toneitup.com’s community blog regarding the importance of resting within a fitness regimen. The physiological principles are very well known how the body is broken down when we work out, and is built up when we rest. As I state in this post, not all rest means sitting on your ass eating Cheetos, and one or two days of rest throughout the week will not make you gain significant weight (unless those Cheetos are close by).

In the sports med/orthopedic world, we try to follow these same principles of breaking the body down, and then building it up; however, this breakdown is usually very controlled.

Muscle cannot be completely or correctly re-built if we are constantly destroying it, and by destroying it I mean breaking it down while working out. That’s right, when we use our muscles during workouts we are breaking down our muscles [2]. Even though this destructive effect of exercise reduces over time[3], there will always be some breakdown occurring with effective exercise. We are essentially causing disruptions in the muscles fibers and cells [4]. If we continue to tear these fibers they will have no chance to fully regenerate or grow. Also, breaking down during exercise are the other connective tissues such as tendons and ligaments [4], but resting allows these tissues to recover as well. It’s all pretty simple. Workouts equal destruction, and rest equals building.

These processes do not change just because you sprained your ankle or have shoulder pain. The recovery (and usually the injury) is likely due to specific adaptations to imposed demands (SAID), but that it another post (I’m in the process of working on it). This post is about rest.

Too often while working in clinics throughout my schooling and albeit short career so far, I’ve heard, “Do these exercises every day.” I’m not saying this should never be said, especially when significant mobility restrictions are present, but this seems like too general of a direction for a home exercise program. That’s like teaching someone to drive and saying the speed limit is always 55mph.

Why do strengthening exercises in rehab have different rules than in S&C? Just because theraband external rotation is easy for you, and seems “simple” does not mean it is not the equivalent of you doing it with 35 pounds. If you were to do that for three sets a day for say a month straight, you’d be sore, probably compensating somewhere in your kinetic chain, and it would probably lead to unfavorable movement patterns. How about 10 pound straight leg raises 3 x 10-15 reps every day? Say hello hip flexor tendonitis, and back pain. Even when injured, muscles still present with specific adaptations to imposed demands.

Here’s another little excerpt from that previously mentioned post.

“These days of rest do not have to be “days off”. I usually suggest taking these days to work on mobility restrictions, or problematic areas of your body that may be causing you aches and pains. Have you been hitting the gym or spin class a little hard this week? On your rest day why not perform some stretches, and mobility drills [if needed] to make your coming week of training less likely to cause movement disorders later on. Dust off the old foam roller, or even work on some balance drills. There are many aspects of your body that need “workouts” [rehab in this case] every so often…

I always suggest my patients actually take rest days during their week from their home exercise programs. They tend to get less frustrated if they are forced to miss a day, because they can make up for it on their scheduled rest day. My patients that are compliant with their rest days, tend to recover faster, and are less likely to have set backs during their rehabilitation!”

Just because my patients aren’t working on their VMO, glute med, or RTC strength doesn’t mean they are truly taking days off. As stated above they can work on their balance, mobility, flexibility, or just do nothing if that is needed too. Rest is what truly allows the body to heal, so shouldn’t it be recommended to patients and clients? If you have any questions regarding rest within your workout or rehabilitation program shoot me an e-mail at mikescott.dpt@gmail.com.

Always Evolve,

Mike

Resources:

2. Kumar V, Atherton P, Smith K, Rennie MJ. Human muscle protein synthesis and breakdown during and after exercise. J Appl Physiol 106: 2026–2039, 2009.

3. Clarkson PM, Nosaka K, Braun B. Muscle function after exercise-induced muscle damage and rapid adaptation. Medicine & Science in Sports & Exercise. 1992 May;24(5):512-20.

4. Clarkson PM, Hubal MJ: Exercise-induced muscle damage in humans. Am J Phys Med Rehabil 2002;81(Suppl):S52-S69.