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“I rested and it’s still not better!”

Tissue Healing & Acute Injury Management

What’s the one thing you probably always did without even questioning it when you got an acute injury? Probably RICE – rest, ice, compression and elevation. Everyone’s favourite go to first aid treatments.

It’s easy to underestimate the importance of those early days following an injury. As physiotherapists we often hear people say, “I rested it and it’s still not better”. It’s no surprise really when you understand a little bit about tissue healing.


When you tear tissue fibres, whether it’s ligament, muscle or bone your body leaps into action. Alongside the pain response, on a cellular level a big clear out occurs along with an influx of cells arriving on the scene to fight infections and do damage limitation. These cells are doing an incredibly important job and they travel from the blood to your injury site within fluid. What you’re seeing when you look down at your puffy swollen ankle is these processes in action.



What follows next, is a rebuilding phase. A temporary scaffold is formed which forms the basis for rebuilding the injured tissue. It starts to get stronger but it’s at this point where if you push it too hard too fast, you’re likely to end up back where you started, as it’s not as strong as the final result. Over time the gaps are filled in and your strength and performance is improved. If rehab is performed correctly, full recovery is much more achievable.

Use it or lose it

One important thing you should remember during this process is that your body and it’s tissues are constantly reacting to the stresses they’re being placed under. It’s like supply and demand; as you use a muscle, it gets stronger. This is also true for bones and ligaments, constantly changing according to the stresses you place upon them. This is what is meant by the saying, “use it or lose it”.  Your body will adapt to either get stronger if it’s being used or weaker if is not.

The Problem with Prolonged Rest 

Bearing this in mind, what does this mean when you get injured and completely rest for 3, 6, 12 weeks? As your tissue is healing, it’s not being subjected to the kind of stresses it was accustomed to before. You could heal with less range and strength than you had before. This may explain why after a period of prolonged rest,  a return to sport often results in reinjury, or injury in a different area. After not being used for so long, your tissue simply isn’t strong enough to cope with the demands being placing upon it when you expected to be able to run as you did before the injury after 6 weeks off.


It’s important to realise there’s so much more to managing an acute injury than “rest then call the physio if I’m still hobbling in 6 weeks”. This has given rise to the term “optimal loading” instead of rest (making it POLICE, not RICE). “Optimal loading” can sound vague, but that’s where early intervention with physiotherapy can really help. Physiotherapists are able to help navigate this question of “what is OPTIMAL loading? How do I go from a sprained ankle to being back on track for my race?” The earlier we can get started with putting the right amount and types of loads through these injured tissues to restore their function, the better your chances are of recovering to your fullest potential.


Kannus P., Parkkari J., Jarvinen T.L.N., Jarvinen T.A.H. and Jarvinen M. 2003. Basic science and clinical studies coincide: Active treatment is needed after a sports injury. Scand J Med Sci Sports13 pp. 150-154. (TISSUE HEALING STAGES)

Glasgow P., Phillips N. and Bleakley C. 2015. Optimal loading: key variables and mechanisms. Br J Sports Med 49 pp. 278-279.

Rebekah Knight Physiotherapist at Agile TherapyWritten by Rebekah Knight, Physiotherapist.
Rebekah graduated from Cardiff University with a BSc Physiotherapy in 2013.

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