Should you rest or move with an injury?

Why the advice has changed

For a long time, the standard advice for injuries was rest, ice, compression and elevation. Rest was often taken to mean doing as little as possible until the pain disappeared. The thinking has shifted. Current approaches still include a short period of protection, but they emphasise getting back to movement and gradual loading as early as the injury allows.

The reason is simple: tissues heal and strengthen in response to load. Muscles, tendons, ligaments and bone all need some stress to remodel properly. Too much too soon can aggravate an injury, but too little for too long leaves tissues weaker, joints stiffer and the nervous system more protective, which can make pain last longer.

The problems with too much rest

• Muscle strength and size drop surprisingly quickly with disuse
• Joints stiffen and range of movement is lost
• Tendons and ligaments lose some of their capacity to handle load
• General fitness declines, making the return to activity harder
• Fear of movement can grow, which is linked with longer-lasting pain
• Mood and sleep often suffer, which also increases pain sensitivity

For back pain in particular, bed rest is no longer recommended. Research consistently shows people recover faster when they stay as active as possible within their pain.

What to do in the first few days

For a fresh injury, such as a sprained ankle, a strained calf or a tweaked back, the first 1 to 3 days are about protection without complete immobility. Avoid the activities that clearly aggravate it, use supports or crutches if you need them, and manage pain and swelling with compression, raising the limb above heart level and ice or heat if they help. Our guide to heat or ice for an injury explains the options.

Even in this phase, gentle movement within comfort is usually helpful: moving nearby joints, walking short distances, and keeping the rest of your body active. Then, as pain allows, start gradually loading the injured area.

How much movement is right?

A simple pain scale is one of the most useful tools. Rate the injured area from 0 (no pain) to 10 (worst imaginable) during activity and the next morning.

• Green (0 to 3): generally fine, carry on and progress gradually.
• Amber (4 to 5): acceptable for many injuries if it settles within 24 hours and does not build over the week.
• Red (above 5, or worse the next day): too much, so reduce the load, range or duration next time.

The next-day check is important. Many injuries, especially tendons, feel fine during activity and react the following morning. If you wake up no worse, the previous day's activity was probably about right.

Our guides to training with a niggle and active recovery have practical examples of keeping training going while an injury settles.

If you are unsure, start smaller than you think and build up. It is easier to add a little more next time than to recover from a flare-up.

Examples of relative rest

Relative rest looks different for every injury, but the principle is the same: keep doing everything that does not aggravate the problem, and scale back only what does. A few common examples:

• Sprained ankle: walk within comfort in a supportive shoe, do seated upper-body training and core work, and add cycling once it is comfortable.
• Tweaked lower back: keep walking, use lighter hinges or skip deadlifts for a week or two, and carry on with upper-body and conditioning work that feels fine.
• Sore Achilles: swap some runs for cycling or rowing, keep calf strengthening going, and avoid jumping for a while.
• Sore shoulder: keep lower-body training and pulling work, reduce overhead pressing, and add rotator cuff exercises.
• Hamstring strain: walk, cycle gently, train the upper body, and start early isometric hamstring work within a few days.

In each case, you stay active, maintain fitness and give the injured tissue the right amount of stress to recover. That is very different from sitting on the sofa waiting for it to stop hurting, and it usually gets people back to full activity sooner.

When rest really is the right call

There are situations where more rest or strict protection is needed. In these cases, follow the advice of your physio, GP or surgeon.

• Suspected or confirmed fractures, including stress fractures
• Bone stress injuries in runners, which need a period of reduced impact
• Specific restrictions after surgery, such as weight-bearing limits
• Severe acute injuries, such as a suspected tendon rupture or major ligament tear, until assessed
• Feeling unwell with a fever, where training should wait until you recover

If you are ill, our guide to training when ill explains when it is sensible to rest completely.

Building back up

After the first few days, most injuries benefit from a structured, progressive plan: restore movement, rebuild strength, then add speed and sport-specific work. Our guide to exercise rehabilitation explains the stages. If you are not sure how much to do, or the injury is not settling after a week or two, get it assessed.

The on-site physio at Lycan Strength can help you find the right balance between protection and movement, with 20% off for members. You can book a physio appointment online.

• Go to A&E if you cannot bear weight, have a deformity, or a limb becomes cold, pale or numb.
• Call 999 or go to A&E for numbness around the genitals or buttocks, new bladder or bowel problems, or weakness in both legs.
• Call NHS 111 or see a GP urgently for a hot, red, swollen joint, fever, or a swollen, painful calf.

Questions