Returning to Exercise After an Injury: Why Patience Pays Off
An injury can be frustrating at any age.
After 50, it can sometimes feel even more frustrating because you may worry that you're losing fitness or that you'll never return to the activities you enjoy.
The good news is that rehabilitation doesn't have to mean doing nothing.
Rehabilitation is a process
Recovery commonly involves several stages.
You may begin with:
Reducing irritation Allowing symptoms to settle while maintaining appropriate movement.
Restoring movement Gradually improving mobility and confidence.
Building strength Introducing progressively more resistance.
Developing capacity Increasing the amount of work your body can tolerate.
Returning to activity Practising the movements and demands of your chosen sport or hobby.
The exact process depends heavily on the injury.
Don't rush the final stage
One of the most common mistakes is feeling better and immediately returning to the previous level of activity.
Pain may have reduced, but capacity may not yet have fully returned.
For example, someone might be able to walk comfortably but not yet be ready for a six-hour mountain hike.
The missing ingredient isn't necessarily fitness.
It may be load tolerance.
Gradual progression matters
Research examining training-load changes and running injuries has found some evidence that sudden increases in training can be associated with injury, although the researchers emphasised that the evidence is limited and that there isn't a universal threshold for a "safe" increase.
This is why rehabilitation should usually progress in stages rather than jumping straight from "rest" to "full activity".
Rehabilitation should have a destination
Your final rehabilitation exercise shouldn't necessarily be the same as your starting exercise.
If your goal is to return to hiking, eventually your rehabilitation should resemble hiking.
If you want to run again, you eventually need to prepare for running.
If you want to return to tennis, you need to rebuild the acceleration, deceleration and directional demands involved.
This is sometimes called specificity.
The closer you get to your goal, the more your training should resemble the activity you want to return to.
Don't measure recovery only by pain
Pain is one piece of information.
Strength, mobility, confidence, endurance, balance and functional capacity matter too.
A good rehabilitation programme aims to rebuild the whole picture.
The objective isn't simply to become pain-free.
It's to become capable again.
References
Gabbett TJ. The training-injury prevention paradox: should athletes be training smarter and harder? British Journal of Sports Medicine. 2016.
Windt J, Gabbett TJ. How do training and competition workloads relate to injury? The workload-injury relationship and its application to injury prevention. British Journal of Sports Medicine.
NICE. Osteoarthritis in over 16s: diagnosis and management (NG226). 2022. NICE NG226
World Health Organization. WHO Guidelines on Physical Activity and Sedentary Behaviour. WHO Guidelines
Comments