Strength Training Programs: When Did “Just Rest” Become a Viable Recommendation?
Written on September 2, 2010 at 7:14 am, by Eric Cressey
I suppose this blog title is more of a rhetorical statement than an actual question, but I’m going to write it anyway.
Just about every week, I get someone who comes to Cressey Sports Performance – either as a new client, or as a one-time consultation from out of town – and they have some issue that is bugging them to the point that they opted to see a doctor about it. This doctor may have been a general practitioner or an actual sports orthopedist. In many cases, the response from this medical professional is the same “Just rest.”
“It hurts when you lift? Then stop lifting.”
Huh? When did COMPLETE rest because a viable recommendation?
In case folks haven’t noticed, a scary number of Americans are overweight or obese. Even if rest was the absolute key to getting healthy, telling them to not move is like not seeing the forest through the trees. Your bum knee will feel better, but you’ll have a heart attack at age 43 because you’re 379 pounds.
Oh, and nevermind the fact that exercise generally improves sleep quality, mooed, and immune, endocrine, and digestive function. I’m not going to lie: I would rather have an achy lower back than be fat, chronically ill, sleep-deprived, impotent, angry, and constipated.
But you know what? The good news is that you can still exercise and avoid all these issues – regardless of symptoms. I can honestly say that in my entire career, I’ve never come across a single case who couldn’t find some way to stay active.
I’ve trained clients in back braces.
I’ve trained clients on crutches.
I’ve trained clients with poison ivy.
I’ve trained clients less than a week post-surgery (good read on that one here).
I’ve trained a client with a punctured lung.
And, when I did an internship in clinical exercise physiology, we trained pulmonary rehab patients in spite of the fact that they often had interruptions during their sessions to cough up phlegm for 2-3 minutes at a time.
All over the world, people are using exercise to rehabilitate themselves from strokes, heart attacks, spinal cord injuries – you name it.
However, Joe Average who sleeps on his shoulder funny and wakes up with a little stiffness needs complete rest and enough NSAIDs to make a liver cringe.
Sorry, but you’re going to need to be on crutches, in a back brace, with poison ivy and a punctured lung to get my sympathy. And, you’re sure as heck not going to get it if you’re just “really sore” from your workout routine. Seriously, dude?
I don’t care what your issue is: “just rest” is almost never the answer (a concussion would be an exception, FYI). When a health care practitioner says it, it’s because he/she either a) doesn’t have the time, intelligence, or network to be able to set you up for a situation where you can benefit from exercise or b) doesn’t think you have enough self control to approach exercise in a fashion that doesn’t make it more harm than good.
There is almost always something you can do to get better and maintain a training effect. While adequate rest for injured tissues is certainly part of the equation, it is just one piece in a more complex puzzle that almost always still affords people the benefits of exercise.
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September 2nd, 2010 at 7:21 am
How does this apply to someone doing a training program when it’s completed. I finished P90X then immediatly began Insanity, I’ve read in a lot of places after that I should take a week off from training. I’m not broken or anything (maybe a bit sore/worn out, but it’s expected) so I probably don’t need it, but I’m just curious what you think in relation to that instead resting after an injury?
This may be a noob-ish question, but I’m brand new to the world of physical fitness, thanks.
September 2nd, 2010 at 7:27 am
Nick, great question. There’s a difference between complete rest and a temporary deloading period – where volume, intensity, or frequency may be reduced. I wrote about a bunch of different options on this front in my e-book, The Art of the Deload. It’s very affordable; check it out:
http://ericcressey.com/artofthedeload.html
September 2nd, 2010 at 7:58 am
I contacted EC back in May after a broken scaphoid. EC gave me good advice and while conditioning slipped some I am back at it and glad I didn’t take the docs advice of taking the summer off from lifting… to think he advertises himself as a sports ortho.
September 2nd, 2010 at 8:03 am
What is the best way to convince the client of this truth when they are afraid they may hurt themselves and scared to not follow the “doctor’s orders”?
-Katy Ingvalson
September 2nd, 2010 at 8:08 am
I agree completely. Taking time off can be useful for recharging mentally, but physically it’s almost never the answer.
I was on crutches from Nov-May this year and only missed 4 training sessions (immediately post-op when I couldn’t be on my feet for more than 5 minutes without being in total agony). There is always SOMETHING you can do if you’re willing.
September 2nd, 2010 at 8:12 am
Eric, Thanks for that blog! Working with Division I premadonnas, oops, I mean athletes, it is always good to hear professionals believe in keeping the body moving even when there is an injury. Nothing I hate more when an athlete comes back in the fall and said they took a month or 2 off because they were “hurt.” And nothing bothers me more than an over cautious doctor.
Your optimal shoulder performance DVD is awesome!
September 2nd, 2010 at 8:24 am
There is always a way to train through (and at last resort, around) any kind of problem someone can have. I ripped up my ankle playing basketball, and the next day I was at the gym doing bench press and chinups while hobbling around on crutches. Passive rest is rarely the answer, unless the person is insanely overtrained!!
September 2nd, 2010 at 8:59 am
Love the site and all the great information. I’m working through the ACE materials to become a trainer and I learn so much practical advice here, possibly more than from the manual.
My mother recently had her kidney removed (renal cancer) and her surgeon did not want her to exercise for at least 4 weeks. She is 67, in very good health, exercising at least three times a week. She didn’t accept that and is walking every day. The surgeon was adamant about not lifting anything heavier than a gallon of milk so she followed his advice on that.
I was shocked at how the medical profession handles recovery. The most amazing thing was that most of the medical staff, doctors included, were overweight. You would think they would know better.
After that experience, I can see where the rest recommendation is common.
September 2nd, 2010 at 9:04 am
Dick Hartzell from jumpstretch bands recommends the same thing. When a person sprains their ankle, he takes immediate action to get back to work. Instead of RICE, where you freeze all the crap and blood in that area, he gets it moving. He uses his bands and pulls, tugs, moves, stretches, ect… all to get blood flow, fresh oxygen, fresh nutrients to the swollen ankle…not just freeze it and rest it. He’s gotten people up and jogging again on a completely sprained ankle inside of 20 minutes from not resting it, but going after it!
September 2nd, 2010 at 9:42 am
Jeremy: That’s a very good point. I experienced something similar this summer when mountain-hiking in the mountains of the Sogne-fjord in Norway (where I come from).
One of the days I decided to push myself a little extra, so I walked quite fast up the mountain (1100 meters above sea level) and sprinted down it. This is a very steep mountain, and at one point I slipped on the trail and sprained my ankle, not severe, but enough that it hurt quite much. At this point however, I was determined not to stop or slow down, so I continued at the same speed the rest of the way down. When I had finished my hike I felt a little more throbbing than usual in my hurt ankle, but it didn’t hurt. And the next day it felt as normal.
Now, I think that if I had stopped and walked slowly down and then put ice on it, I wouldn’t have recovered as fast as I did, because I have sprained my ankles enough times throughout my life and treated them with ice, and this has never helped much. So I beleive that Dick Hartzell’s method is the better option when it comes to ankle sprains and muscle/tendon injuries in general.
September 2nd, 2010 at 10:10 am
Five months ago I broke my ankle, and the orthopedist wanted me to lie around and do nothing for at least a month!
No way…I was back in the gym the next day in my compression boot. I wasn’t sure whether I should be amused or appalled at how impressed people were that I was still working out; you’d have thought that both my legs had been ripped off.
September 2nd, 2010 at 10:37 am
EC
What’s your take on adhesive capsulitis? See/work with it much? Recommendations?
September 2nd, 2010 at 10:41 am
Another way to look at it is, as Rippetoe points out in his books, applying Selye’s General Adaptation theory to injury shows that the injury won’t heal if you don’t give it a reason to. The ‘reason’ is stress, appropriately scaled to the injury.
September 2nd, 2010 at 11:16 am
Strange! i met someone (a movie star) in the gym where i offer a few group exercises classes & he said he was taking bed rest for 2 months after having a slipped disc! i thought that was the heights. does it also mean some people have very low threshold for pain tolerance & that makes doctors jump up & say rest & don’t do anything!
September 2nd, 2010 at 11:18 am
also can anyone kindly suggest how they have come out of hamstring issues? you know the funny pain appearing out of nowhere in certain movements, responds well to a physio’s kneading but keeps bothering time & again! thanks.
September 2nd, 2010 at 11:42 am
Imagine an animal in the wild taking complete rest??? If they did that, they’d be someone else’s dinner!
September 2nd, 2010 at 11:43 am
Sham- Repeated hamstring injuries are often are a result of weak glutes. Do you know if your glutes are activating properly? Over the long term- getting your glutes ( and hams, once healed) stronger will really help. Short term, make sure warm-up is proper- foam roll then dynamic warm-up,no long held static stretches pre exercise- and that you are stretching well post exercise(if your ham flexibility is inadequate).
You could have scar tissue from repeated hamstring tears, so muscle tissue may not be 100% healthy. Massage has to be DEEP enough to break up scar tissue. I find ART to be super helpful- if not super painful, but it works. However, if you don’t fix this weakness with proper training, you will keep having the same issue.
September 2nd, 2010 at 12:19 pm
Ami,
The medical community is not the health and fitness community, Big Pharma makes sure of that with direct ties to all medical schools. Very few brave souls will venture outside the status quo to make much more than a ripple in a pond, too much invested in time and loans they are paying back, not to mention insurance (thank attorneys for that). Then it’s you against the system, where today as a hospital worker if you injury your back lifting a patient you have to actually sue the hospital to collect worker’s comp (yes, this is true), then of course you are blackballed forever at your place of inequity!
September 2nd, 2010 at 1:20 pm
Warning! Controversy alert! If you are over 60 and have been training for 40 years then that tearing sound is the trainer-in-the-sky saying you are strong enough. No 400 lb squats for you! It’s single leg stuff, push-up variations, and mobility drills for the rest of your life. Around age 53 I began to notice I was the oldest guy in the gym and now I’m not there either. Time for my weight-vest Tai Chi on a Bosu ball in traffic. I’d rather be power cleaning and sumo wrestling but this is good too.
September 2nd, 2010 at 2:16 pm
Eric,
This sort of recommendation had a majorly damaging effect on a buddy of mine. He started working with an ART practitioner / Chiropractor to clear up a few movement quality deficits, and the guy advised him to cut out his training while they tried to “iron things out.” Not only did he remove one of the most critical pieces from the puzzle, but he ended up falling apart completely (and setting himself back years) on account of removing the buffer that attempting to maintain some sort of trainin effect provided. In fact, it further drove home that is was (as you have noted many times) the other 23 hours of the day that had been holding him back, not the training he was performing in the gym (which had actually been quite sound, all things considered).
This who ordeal left him extremely weak, far more broken down tha he had ever gotten from all his years being active, bitter, and frustrated that instead of having lucked into working with a professional who understands the importance of focusing on what can be done, as opposed to what may need to go on the back burner for a period of time.
Targeted rest and working around issues are important at times, but it’s amazing how many people dole out garbage advice to “just rest,” which ends up creating larger issues than whatever the recommendation was initially given out for addressing.
September 2nd, 2010 at 6:22 pm
I’m going to disagree, sometimes complete rest is a very viable option.
Yes, there are lazy, fearful or ignorant medical professionals who prescribe total rest as a cop out but sometimes rest is the best path. Thinking over the course a lifespan, what is 4-6 weeks out of 80 years? For the average person a few weeks rest shouldn’t be a big deal. An elite athlete may need to be handled differently due to limited window of opportunity or playable years so work-arounds may be the only choice.
Some of the previous comments reek of compulsiveness. Fear of losing fitness or strength or getting fat over a temporary break is an unfortunate burden many athletes place on themselves. Often it’s what lead to injury in the first place. And back in the weight room a week after surgery? Surgery is one of the most traumatic things you can do to your body and rather than rest and let it repair you cause more microtrauma thus spreading thin competing resources being used to repair the original injury. Plus the whole “animals don’t rest” argument is weak. Animals that are treated by a vet and forced to rest often recovery to full function, animals that work through injury usually end up disabled and dramatically shorten their lifespan.
Talking with and reading about athletes nearing the end of long careers, or master athletes still getting after it, one thing is clear, they really know how to listen to their body and manage rest. Talk to athletes that destroyed themselves and they’ll tell you they should have just taken some time off. There are a lot of athletes that work hard but not nearly as many that work hard and smart. Sometimes complete rest is smart.
September 2nd, 2010 at 8:28 pm
I tend to agree with this myself, resting for more than a few days usually just leaves me feeling stiff and weak.
In my case right now im dealing with a torn meniscus. It happened at the end of April, it was on the job. The workmans comp company is denying my claim pending investigation because my employer didnt file an incident report until about 3 weeks later, when i told them something had to be done…i was in pain. Even though i told my foreman i had done it the very next day, within 24 hours.
Ive still been hitting the gym, but i dont go nuts anymore. I pretty much just try to maintain some semblance of athletic ability. With knees especially though it is hard to do even many upper body lifts i enjoy. Such as, oly lifts, military presses, etc. Anything where you have to transfer power through your legs, whether bent or not causes enough pain that im afraid of doing more permanent damage.
What do you do in a case such as this? The only thing i do for my lower body right now is walk on the treadmill at an incline that is steep enough not to cause too much discomfort, and bodyweight (as in just me) squats. Other than that, you can only do so many pullups, bench presses and skull crushers hahaha! Even deads are out of the question.
September 2nd, 2010 at 11:28 pm
The only thing that has relieved the symptoms of my Rheumatoid Arthritis has been exercise and lots of it (5-6 times a week). Started working out with a personal trainer (kinesiologist) almost two years ago when my feet/ankles hurt so much it was difficult to walk and I was very frustrated, the amounts of NSAIDs I was taking was causing more side-effects and I needed to find new ways to move (Pilates helped, but just wasn’t enough). Within three months I was walking fast on a treadmill, taking less and less anti-inflammatory meds, and now I’m running and really pushing my body during my workouts – and generally cut down my meds by 75-80% (and quit seeing the Rheumatologist who just wanted to try more and different meds). Even though my RA still shows up in my wrists/hands now and then my daily life is far better and I’m the healthiest and fittest I’ve ever been.
Some arthritis researchers are finally doing group studies on the benefits of exercise for both rheumatoid arthritis and osteo-arthritis, but it’s going to take them a while to prove that it works. In the meantime, if you have arthritis get up and out and start moving!
September 4th, 2010 at 1:27 pm
As I always tell my sports performance training athletes… (The exceptions are a concussion or a back injury.)
You have 3 good limbs and we are going to train them! Rookies look at me like I’m nuts at first then they get it!
Eric’s post may be referring more towards the novice trainie, but the concepts hold true for all populations! In season, football players are rarely not banged up. Same goes with hockey and lacrosse and any other physical sports where there are frequent collisions. A “tweaked” shoulder that can’t rotate to hold a back squat position doesn’t mean that the athlete can’t squat that week. I have 3 safety squat bars for my athletes that can’t squat because of shoulder injuries.
No real reason why we can’t Do Work People!!!!
September 4th, 2010 at 4:01 pm
I see it all the time in PT, the general practioner will tell the athlete to rest with a prescription of “low back pain” or “shin splints”. These general diagnoses are lazy and erroneous. However, sometimes rest is a better recommendation then the exercises they prescribe…
September 6th, 2010 at 4:33 am
Great post Eric. There are always alternatives when you can’t do an exersice..
July 24th, 2011 at 11:02 am
I feel that rest is useless! Even when I don’t go to the gym I still at least take a walk. My pt tells me to take breaks and I don’t because I won’t fulfill my goals
July 24th, 2011 at 3:14 pm
I’d like to know how to keep my upper body from losing too much strength while I recover from rotator cuff surgery this week (late July). Kind of hard to workout upper body without shoulders.
July 24th, 2011 at 3:23 pm
In 2006, after herniating a disk (L4-L5), I was told to “just rest” (indefinitely).
Spuriously, nothing improved, and 7 months later the pain was still unbearable. It even hurt to sneeze.
It wasn’t ’til I flipped that recommendation the bird that things started to improve. Slowly, at first, but in a positive direction nonetheless.
2 years on, I deadlifted 400 lbs. “Just rest” would’ve kept me timidly in pain to this day.
July 24th, 2011 at 5:18 pm
I completely agree that there is always “something” you can do to remain some what active. A year ago, I suffered a severe concussion that left me unable to work, be around light, read etc for 8 weeks followed by another year of no impact exercise. For the first couple of months it took all the energy in me to get up and ride a stationary bike for 15 minutes; but I did it! It is so important to keep moving.
Great post Eric!
July 24th, 2011 at 9:30 pm
My 11 year-old son agrees completely and practices what you preach:
July 24th, 2011 at 10:54 pm
Might be a bit of a stupid question but I just had ankle surgery and will be on crutches for 8 weeks. I am already feeling depressed from not exercising, so was just wondering what kind of exercises/ gym routines for my upper body people would recommend?? Thanks
July 25th, 2011 at 8:02 am
@ Cathal: Bulgarian Split Squats.
July 25th, 2011 at 8:48 am
Eric, I’ve been reading following your site for the past few months and I really enjoy reading your articles and posts!
You really hit the nail in the head on this one – chronic bed rest and complete inactivity are major contributors in why 64% of Americans are obese/overweight.
August 7th, 2011 at 8:31 am
I have a client who is an elite high school pitcher who after three showcases this summer developed an ulnar nerve problem. Ortho said no work on his throwing arm. We still train his non-throwing arm with 1 arm DB presses (bench & floor) and loads of horizontal and vertical pulling. We also continue to train his lower body with GHR, split squat varieties, and prowler pulling with a harness.
For the less elite individuals, I feel that the “just rest” approach guarantees that those in the medical community will have patients for life in that there will always be some problem that needs to be treated with NSAID’s and rest, or in some cases surgical intervention.
July 29th, 2012 at 10:22 am
I agree Eric. I’ve continued to train through 2 knee surgeries and severe shoulder pain. Not through the pain, but rarely is every joint so mashed someone can’t train.
We had a client who just a few days after an knee osteotomy was back in training in his wheelchair. We had stairs, so we dragged him self up to get to the bench press.
I was impressed.
July 29th, 2012 at 10:46 am
I’ve trained a client with 3rd degree burns over 97% of his entire body-no pores, incapable of sweating, very little use of his hands, no hair, excessively overweight…etc.
You can always workout!
July 29th, 2012 at 10:47 am
How does this apply to hamstring strains? I can lift and do plyometric workouts with little pain. Running really bothers it though and I need to be able to run. Will trying to workout and avoid doing anything that causes the hamstring too much pain still allow the hamstring to recover quickly? I kind of feel like taking one week off will help it recover quicker. I’m afraid if I continue to try to lift and do plyo workouts, it might keep the hamstring pain hanging around. What do you suggest I do?
July 29th, 2012 at 8:02 pm
Dan,
Hamstrings are really going to get irritated most by considerable hip flexion and knee extension SIMULTANEOUSLY. You’d be surprised how much you can do in a weight room without irritating a low-grade hamstrings strain. Eliminate deadlift variations and sprinting and go from there.
Also, definitely give this a read:
http://ecressey.wpengine.com/5-reasons-tight-hamstrings-strain
Some manual therapy on the area will help the cause as well.
July 30th, 2012 at 7:42 am
Thanks alot for the help Eric!
August 1st, 2012 at 9:21 am
Eric,
Great post. I sprained my ankle for the thousandth time last August (week before my wedding) and felt like I could barely walk for a few months. I went to a specialist and he told me I had arthritis in my ankle. He told me to rest it, but I’m too ADD, so I did alot of upper body workouts, riding the bike, and even played hockey. So in short, I agree with your post, there always seems to be a way to work around things in order to stay active.