The truth about rest — and why less is often more

Bone, tendon, cartilage, and muscle all respond to mechanical loading. Without load, they don't just stay the same — they weaken, lose stiffness, and lose the structural organisation needed to function.

Khan and Scott put a name to this in their 2009 paper: "mechanotherapy" — using mechanical loading to stimulate tissue repair and remodelling. The key insight is that prescribed exercise isn't just about building strength. It's a direct biological stimulus for tissue to repair itself properly.

Prolonged bed rest or immobilisation after a soft tissue injury literally works against healing.

For decades, the standard advice for acute injuries was PRICE: Protection, Rest, Ice, Compression, Elevation. Rest was front and centre.

In 2012, Bleakley and colleagues published an influential editorial arguing PRICE needed updating — and proposed POLICE: Protection, Optimal Loading, Ice, Compression, Elevation. The critical change was replacing "Rest" with "Optimal Loading."

The argument was straightforward: while some protection is warranted right after injury, prolonged rest is detrimental. Progressive loading, introduced early and scaled to what the tissue can tolerate, produces better outcomes. This is now the clinical standard.

Complete rest doesn't just slow tissue healing. It creates a secondary problem: deconditioning. Muscle begins to atrophy within 72 hours of disuse. Aerobic capacity drops measurably within days to weeks. Neuromuscular coordination and the patient's confidence in their own body both deteriorate.

That deconditioning then becomes part of the ongoing pain picture. Returning to activity feels harder, hurts more, and triggers more fear — which feeds back into the pain system. A significant number of "chronic pain" presentations I see in clinic have a major deconditioning component built up during an overly passive recovery.

Relative rest is the clinical goal: reduce load enough to protect acutely damaged tissue, while maintaining enough activity to preserve function and promote healing. In practice, that might mean modifying your training, avoiding the specific aggravating activity, but keeping up walking, swimming, or cycling.

Dosage matters enormously. Too much load too early disrupts healing. Too little for too long delays it and causes deconditioning. Finding that window is exactly what rehabilitation is for — it's not one-size-fits-all, and it shifts week by week as tissue heals.