To all the endurance athletes out there, REST MAY NOT BE THE BEST ANSWER!

One of the niches of our clinic is the endurance athlete. We treat runners, cyclists, swimmers, and triathletes. Treating the endurance athlete is something that we enjoy and something we do rather well. Endurance athletes are by nature highly motivated people that genuinely enjoy their sport. When injured, a big part of their life is missing.  It’s kind of like losing your dog!

Can't imagine what life would be like without my dogs? Kinda like an endurance athlete that can't compete.

Can’t imagine how empty my life would be if our dogs ran away…Kind of like an endurance athlete that can’t compete.

We hear all the time about endurance athletes that either voluntarily choose to rest or are told by their doctors/rehab professionals (sports medicine physicians, athletic trainers, physical therapists, coaches, etc.) to rest when injured. Most athletes will accept this recommendation without question, but should you accept the rest recommendation? Pause for a moment and let it sink in. Now reassess and continue reading. We are challenging a huge stereotype here. We know it. We know there will be backlash when challenging a huge stereotype, but please hear our argument first.

REST NEVER FIXES BAD MECHANICS!

Many of the injuries that we treat in endurance athletes are due to repetitive “bad” mechanics. When you rest, you NEVER  fix the mechanics that led to the injury. You essentially “mask” the problem. When you continue with your sport as most endurance athletes do, the pain may be gone as the overload to the tissue has been temporarily reduced, but the bad mechanics are still there. These mechanics can again lead to future problems.   Would you rather fix the problem right the first time or have it recur?  

This is analogous to having the check engine light pop up on the dashboard of your car. You can either find the reason why the the light turned on or just turn the light off without fixing the problem and hope for the best.

Finding out why this turned on is much better than turning off and hoping everything will work out

Finding out why this turned on is much better than turning it off and hoping everything will work out.

Many doctors and rehab professionals (sports medicine physicians, athletic trainers, physical therapists, coaches, etc.) don’t understand this concept either. Routinely, we get consulted as a second opinion for local endurance athletes. We hear the rest recommendation far too much. We prefer to fix the bad mechanics and have you modify the training temporarily, but not completely cease the activity (unless imminent harm could be caused). This allows us to test whether the improved mechanics are reducing the insult to the tissues. Besides, you’ve worked way too long, way too hard, and invested way too much of your time and resources to simply stop what you are doing altogether.

Getting to the bottom of the problem & the solution with the scientific method

Getting to the bottom of the problem & the solution with the scientific method

Let’s back up for a second and discuss our thought process using the scientific method. First, formulate a hypothesis.  Our hypothesis is that the repetitive motion injury you are suffering from (plantar fasciitis, tennis elbow, shin splints, carpal tunnel syndrome, swimmer’s shoulder,  rotator cuff tendinitis, biceps tendinitis, triceps tendinitis, jumper’s knee, patellar tendinitis, posterior tibial tendinitis, peroneal tendinitis, etc.)  occurred due to repetitive “bad” mechanics that causes overload to the affected & painful tissues. The injuries that we are referring to aren’t from major trauma. They are from “micro trauma” meaning small insults from “bad” mechanics over time contributing to the injury.

Second, test the hypothesis. Let’s try some form of mechanical treatment (manipulations, soft tissue mobilization, joint mobilization, massage, therapeutic exercise, acupuncture, dry needling, etc.) while having the athlete continue a modified training program and see what the result is.

Third, analyze the effect of the treatment on the given activity. Did the mechanics in question improve to observation? Did the athlete’s tolerance to their sport increase? Can they run, bike or swim faster or further with less pain and better efficiency?

Fourth, reassess whether you keep the current hypothesis or is there need to modify it. Did we get the expected and anticipated result? Do we need to change something up in our evaluation process or with treatment? The scientific method helps the doctor and patient eliminate the guess work.

We can save you weeks to months of time away from training by methodically using this process. We can logically find the problem and help you fix it by using this process. We can save you months to years of suffering from the same recurring injury by doing it right the first time.

4 Problems With the Rest Recommendation in Endurance Athletes

Often, it seems like the rest recommendation is a knee jerk reaction from a physician or rehab professional. If it hurts, then don’t do it seems to be the logic.

The 4 problems with this sentiment is that:

1. The athlete has “lost their dog”: They can’t perform something that they enjoy which significantly improves the quality of their life. Part of their identity is missing. Sounds like they’ve “lost their dog.” If you get this recommendation for rest, it shows that the rehab professional doesn’t understand the mindset of the endurance athlete. Understanding the mindset of the athlete  is critical in treating and managing athletes in endurance sports.

2). Re-injury is likely: Rest never fixed the mechanics that led to injury leaving open a window for re-aggravation once the activity is resumed.

3). It’s a knee jerk reaction: The rehab professional went through years of school and training to come to the conclusion that rest is the only answer. If this is the case, then why go to a doctor or rehab professional in the first place and what good is their years of training? So much for the “sports medicine” training too right?

Many doctors or rehab professionals then send the athletes out the door one after the other while charging a $50 copay and $200+ evaluation fee. Don’t you want a better answer, better advice and a sound treatment plan with copays going up, deductibles going up, co-insurances owed going up and premiums going up?  Since you are investing more, don’t you want more from the doctor’s appointment? Kind of sounds like a knee jerk reaction when athlete after athlete visiting local sports medicine physicians offices all get the same recommendations without a comprehensive exam performed and without sports specific movement screening. All athletes and all patients should get individualized assessment and treatment plans.

Trust us, it’s much harder and takes much longer to find the problem and correct it. It takes a special skill set and mindset to identify and correct the overloading mechanics. It takes outstanding communication with the patient to convey this message and a willing patient to follow through with the recommendation that in many cases rest is not the answer. It’s much easier and lazier to tell someone to rest when they don’t need that recommendation.

4). Hurt may not equal harm:  If you give the patient a corrective exercise to fix their mechanics, they might be sore.  Their soreness could be entirely different (quality, intensity, location, etc.) than the pain from the activity. You won’t know unless you have them test the activity.  You may find that corrective exercise is working because the soreness is entirely different than the pain they came to the office with. For example, the patient comes to the office with IT Band Syndrome (pain on the outside part of the lower lateral thigh and knee) and the doctor or rehab professional gives them glut (but) strengthening exercises. The patient may be sore in the glutes following the session and sore in the glutes when attempting to run, but the pain is in a different location, the quality (ache/soreness) is different that the stabbing knee pain from the IT Band syndrome, and the intensity of pain is different. The initial problem and pain is better but a new soreness crept up. The athlete could misconceive that they are getting worse when in fact this could actually mean that progress is being made. You won’t know unless you have them continue with the activity (running) while you attempt to fix the mechanics (glut strengthening).  Take a look at a previous blog post (Simple Rules for Corrective Exercise ) for more info.

When Is Rest Actually Good?

After reading all this, you’re now thinking there must be a time when rest is good right? The answer is yes, rest is good when appropriately timed and when used to prevent imminent harm. If the athlete has a stress fracture or suspected stress fracture, please rest or perform “relative rest.”  Fore more information on stress fractures Click HERE.

Relative rest is switching the endurance exercise from one type to another to avoid overloading the affected tissues. Switch from running to swimming or biking  in the case of a tibial (shin) stress fracture. Switch from swimming to biking in the case of rotator cuff tendinitis. If the athlete is severely over trained, modify their training programs to incorporate rest so that severe fatigue, sickness and injury is avoided. These scenarios fit the category of appropriately timed rest to prevent imminent harm. These scenarios do not fit the mantra that rest never fixes bad mechanics.

Summary

In summary, we hope you’ve read and enjoyed this post. We are challenging an established stereotype. Our view may not be popular, but it has served our endurance athletes well. Telling an endurance athlete to stop can be counter intuitive and counter productive. It’s like telling them their dog ran away. Fix the problem by fixing their mechanics.  Rest never does that.

Please feel free to contact our office at 708-532-2346 or at thecfim@gmail.com if the following resonates:

  1. You’ve had the rest recommendation for way too long.
  2. You feel like it’s time for a second opinion for your sports injury.
  3. You feel like your health care provider doesn’t understand you as an endurance athlete.
  4. You need a comprehensive 45-60 minute evaluation that includes a detailed history, physical exam, orthopedic exam, neurological exam, functional movement screening (squat mechanics, lunge mechanics, overhead reach mechanics, core stability mechanics & more) and a gait analysis.
  5. You have athletic goals you wish to achieve and your injury is hampering you from reaching those goals.

We are happy to help and eager to work with you to safely and effectively help you overcome your injury. We look forward to helping you reach and surpass your goals.  Feel free to share this article with someone you know who could use seeing this information as well. “Why Put Off Feeling Good?”

*** About the Author ***

Dr. Pappas is a chiropractic physician, certified athletic trainer and certified strength and conditioning specialist. Dr.

Dr. Dino Pappas

               Dr. Dino Pappas

Pappas blends the best of physical medicine with the best of integrated medicine to help patients and athletes of all shapes and sizes. He utilizes tools such as chiropractic manipulation, soft tissue work (IASTM, Graston, myofascial release, neural mobilization and joint mobilization), biomedical acupuncture, functional movement based assessment, the McKenzie Method, strength training and conditioning, kinesiology taping, customized nutrition and specialty laboratory testing (blood, saliva, urine, and stool) when needed. Dr. Pappas’ clinical focus is sports medicine, conservative orthopedics, rehabilitation and integrated medicine. He is extremely passionate on empowering patients towards their goals. His sports medicine interests are endurance athletes, overhead athletes (pitchers, throwers, volleyball players and tennis players), contact sports athletes (football, rugby, lacrosse, field hockey, soccer and basketball) and Crossfit athletes. He has worked with athletes at all levels from professional to amateur. He reads and interprets the medical literature daily to stay abreast of cutting edge advances in his field. The doctor is currently a sports medicine volunteer for Andrew High School in Tinley Park, IL. He is an avid runner and aspiring triathlete having completed 5 marathons, 4 half marathons and numerous 5 and 10k races. The doctor is also active in the local, suburban Chicago running scene. He has goals of qualifying and competing in the Boston and New York Marathons, the Ironman in Kona, Hawaii, and climbing Mt. Kiliminjaro in Kenya, Africa. One day he hopes to serve his country as a team chiropractor for the United States Olympic teams and serve as a team chiropractor for one of the professional teams in Chicago. His mantra is “Why Put Off Feeling Good?” He can be reached by email at drdinopappas@gmail.com or at 708-532-2346. ***

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