You’ve finally been consistent with your exercise routine. Lifting two times a week and jogging three days a week – your couch to 5k plan is well underway. But one morning, a sharp ache hits the front of your knee while jogging. It’s manageable, until the next day when squats bring that same pain strikes roaring back. Not wanting to “do any more damage,” you schedule an appointment with your doctor who diagnoses you with tendinitis and prescribes rest and take an anti-inflammatory.
It’s a familiar story, and this advice to “rest and let it heal” isn’t entirely wrong. But its also not the whole story. What if there is more to healing than this? Is it time we update our approach to “resting an injury?”
From RICE to Reality
The idea of RICE – rest, ice, compress, elevate – has shaped injury management for decades. It originated from a sports medicine book by a doctor in the late 70s and quickly became the standard. In theory, RICE seemed logical: injuries lead to inflammation, inflammation is bad, rest removes the stimulus, and ice reduces swelling.
But as research evolved gaps to “resting your injury away” began to show. While icing may temporarily reduce pain, it may also delay repair by blunting the natural inflammatory response essential for healing. And while total rest prevents further irritation, it can also impair recovery by reducing circulation, tissue remodeling and neuromuscular readiness. In fact, inflammation itself isn’t the villain – it’s the first responder. The “pro-inflammatory soup” your body supplies after an acute injury is what “washes out” the bad stuff and calls the good stuff in to start doing its work. While healing may appear to be passive in that it is happening at all hours of the day, including in our sleep, the process is an active biological effort. Cells are triggered, metabolism is often increased on a local level, and the body is quite literally working to bring itself back to homeostasis.
In 2015, the same doctor who first published on RICE in the late 70s redacted his claims in a separate publication, acknowledging that total rest and routine icing might not be the best way to recovery. Today, the consensus has shifting towards the concept of “PEACE and LOVE”- a more movement-based healing approach that views recovery as an extension of training, not its opposite.
Healing is Active, Not Passive
So, does that mean we should “work away” an injury? Not exactly. Healing an injury requires balance – protecting what’s injured while maintaining what’s healthy to maintain the level of fitness we have developed
We can support that goal through two means:
- Giving your body the space it needs to heal itself.
- Avoid interrupting the tissues that are healing and placing demands on tissues that cannot tolerate loading at this time. Continuing to load tissues beyond what they can tolerate or “picking at the scab” will slow down our ability to return to prior activities.
- Stay as active as possible – safely.
- Modify, don’t abandon your training. If your knee hurts, you can still train upper body. If running is out consider swimming, cycling, or other options that don’t aggravate the site of injury. Lying in bed all day, will cause detraining, which can make the return to full activity harder and risk re-injury. The goal is not to push through the injury; its respecting limits without surrendering momentum.
Moving Forward: A Practical Framework
When an injury occurs, start here:
- Accept: Be okay with the fact that you may have a setback and know that your body will work with you if you’re willing to give it what it needs. Know that changes will be needed in this time. Accept this and make the necessary changes (or get with someone who can aid you in making these changes). Accept that you may have some “red lights” in your training at this time. Don’t blow through the stop signs. “Relative rest” is going to be the name of the game here, but there is still much that can be done.
- Stay Active: Know that there are plenty of things that you can reasonably do. Can’t run or train legs right now? Keep going to the gym and smash upper body. Find the upper and lower body movements that are appropriate for you and, again, get with someone if you need aid in figuring out what is and is not appropriate for you at this time.
- Rebuild: Keep in mind what you want to return to and build your way back up to it. Odds are, you will be back to some part of that activity much sooner than you would have expected if you had taken the antiquated view of “take two weeks off to rest and then see how it goes”.
The Takeaway
Healing is not a timeout – it’s a continuum. The body is built to repair, remodel and return to performance when given the right environment. As future practitioners, coaches and clinicians, it’s on us to move beyond outdated protocols and apply what the evidence tells us:
Movement heals.
Let’s challenge the “rest to recover” mindset and start training for resilience – even when recovery is the goal.
Sources:
Mirkin G, Hoffman M. The Sports Medicine Book. Little Brown Company, Canada, Limited.
Bleakley CM, Davison G. Management of Acute Soft Tissue Injury Using Protection Rest Ice Compression and Elevation: Recommendations from the Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSM). Executive Summary. Association
Merrick MA, McBrier NM. Progression of secondary injury after musculoskeletal trauma—a window of opportunity? J Sport Rehabil. 2010;19(4):380-388. doi:10.1123/jsr.19.4.380
Vieira Ramos G, Pinheiro CM, Messa SP, et al. Cryotherapy reduces inflammatory response without altering muscle regeneration process and extracellular matrix remodeling of rat muscle. Sci Rep. 2016;4(6):18525. doi:10.1038/srep18525
Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116. PMID: 34141774;
Miyazaki A, Kawashima M, Nagata I, et al. Icing after skeletal muscle injury decreases M1 macrophage accumulation and TNF-α expression during the early phase of muscle regeneration in rats. Histochem Cell Biol. 2023;159(1):77-89. doi:10.1007/s00418-022-02
Miyakawa M, Kawashima M, Haba D, Sugiyama M, Taniguchi K, Arakawa T. Inhibition of the migration of MCP-1 positive cells by icing applied soon after crush injury to rat skeletal muscle. Acta Histochem. 2020;122(3):151511. doi:10.1016/j.acthis.2020.151511
Mirkin G. Why ice delays recovery. Dr. Gabe Mirkin on Fitness, Health and Nutrition.
Dubois B, Esculier JF. Soft-tissue injuries simply need PEACE and LOVE. Br J Sports Med. 2020 Jan;54(2):72-73. doi: 10.1136/bjsports-2019-101253. Epub 2019 Aug 3. PMID: 31377722.
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