Updated: Sep 16, 2022
In 1981 The Clash released the song “Should I stay, or should I go?” and the same is often asked of me at work when managing tendinopathies - Should I stay in and rest or should I go out and exercise?
I wish the answer was simple but sadly nothing is ever easy with management of foot pain. The goal is actually to achieve relative rest.
Why Do Injuries Happen?
Injuries occur when we exceed the capacity of the body in one way or another. Similarly, injuries become chronic (long-term) when they are not allowed to heal properly. I really like the example that occurs in physics with “Hooke’s Law”.
Hooke’s law, when slightly oversimplified says: A ‘stretchy thing’ will stretch a consistent amount according to the amount of weight applied… until a point. After that ‘point’ it then will stretch more than it was for the same amount of weight applied and then the stretchy thing gives up, at which point Mr W. E. Coyote summarises it nicely.
So, in terms of human tissue (muscles, bones, tendons, ligaments etc), they will respond in the same way as the ‘stretchy thing’ above to increases in 'load':
Stage A: They deform a bit, but then they will spring back to their original shape.
Stage B: They deform a bit, and don’t go back to normal (early / mid / late stages of tendon problems)
Stage C: They are forced to work too hard and break.
DESPITE THE SIMPLE NATURE OF THE 3 STAGES, TENDON RUPTURES ARE INCREDIBLY RARE!
Mostly because the tendon normally hurts enough that you stop doing silly things, so you rest it and it then heals back to the Part A of the diagram.
The problem that we come up against (yep! We're in this together!) is that if we allow bits of the body to heal fully before we use them, say by, putting an injured body part in a cast: we then become weaker and lose our fitness. This ultimately means that there is a trade-off in healing:
· You can maintain your activity levels - but you continue with pain
· You can reduce your activity levels - but you lose your endurance
· You maintain as much of your activity levels as possible whilst doing not so much that you develop pain but enough that you maintain your sanity.
The magic happens when you maintain as much of your normal activity levels as possible so that you maintain your sanity, whilst not doing so much that you cause yourself pain!
Let me give you an example:
Your normal day involves
1. Walking the kids to school *
2. Taking the dogs for a walk *
3. 10k run with or without a friend §
4. Clean the house §
5. Pick the kids up *
6. Make dinner *
Then one day you go for a run with a friend and they have a quicker pace and challenge you to go a bit further. The next day, you wake up and your heels or your Achilles (etc) hurt a bit but you continue with your normal activities. This is where the problem starts.
You have exceeded your body tissues' capacity (Gone from stage A to stage B) and are not allowing it to heal.
What you need to do:
Ideally, you need to split your activities up into the essentials (1, 2, 5 and 6) and then exclude or modify the non-essentials such as 3 and 4.
Yep: Cleaning the house is non-essential! [To my mother: "Yep! That's right, you heard me!"]
Jokes aside, identifying the essential and necessary tasks like doing the dishes and washing clothes versus cleaning the windows and skirting boards!
By reducing your 10k run down to a 5k or even having the day off can also pay dividends.
You can also do other things to ‘rest’:
Wearing more supportive shoes, orthotics, braces or taping can protect the injured body part so it doesn’t work as hard.
Choosing to only run on flat ground rather than doing hill runs is a type of rest.
Choosing a bike ride rather than a walk.
It’s all relative and a bit of patience can be the difference between a problem that quickly passes and a problem that spans weeks, months or even years.
Whilst you are ‘resting’ you can also work on increasing your strength with exercises specific to the body part that is injured. By exercising you are increasing blood flow and stimulating growth hormones that encourage healing.
This then means that that site is getting stronger and is then going to be more protected when you do exercise on it. That’s the purpose of rehabilitation and slowly guiding your return to sports.
What happens if you hurt yourself while increasing your activity?
It’s also ok if you accidentally overdo it whilst you are resting.
Increasing your activity levels to see if you have rested enough is helpful as sometimes your body will react positively (it won’t hurt) and other times it will react negatively (tells you that you shouldn’t have done that) with a pain response.
Don’t be scared of these moments when they come as you will need them in order to progress out of your injury.
Ultimately, activity pacing is like the transition from a goodie-two-shoes kid up to being a slightly rebellious teen:
Push it to be the best it can be (work out and do the things that help you enjoy life)
Let it be grumpy when it wants to be
Manipulate it slightly into doing things that it doesn't want to do (exercise it a bit to make it better, even though it'll tell you that you're the worst person in the world)
Now and again, be delighted by how willingly it does what you asked of it
Occasionally despair when it goes back to being stubborn and causing you grief
Repeat Step 3, 4 and 5
Wait for it to stop being horrible!
Check out my pain diary that you can use to track what you have been up to and what it was that upset you, that might also be useful!
Thanks for reading.