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Feeling the Pressure – The Importance of a Little R&R

Read More About the Author Here: Samantha Pittsford, PT, DPT, OCS – Director of Physical Therapy


Credit: Kyle Terada-USA TODAY SportsIf you’ve taken anything away from the NBA final, hopefully, it is how devastating not getting proper recovery can be, especially when dealing with an injury. Seeing Kevin Durant go down with an Achilles tendon rupture in his first 12 minutes back to play after dealing with a calf strain, solidifies the importance of rest and recovery. Not to mention, it probably has a lot of Kawhi Leonard nay-sayers thinking twice about his absence from play during the latter part of his time with the Spurs. The difference? Kawhi gave a stubborn quadriceps tendinosis proper time and attention before returning to play, despite feeling the heat from fans and his own organization. Unfortunately for Durant, feeling the pressure to return to the court lead to an injury that will more than likely take him out of play for all of next season.

The time it takes to recover from an injury is often much greater than the time it would have been to include proper recovery during training. We give our cars tune-ups and oil changes and calibrate equipment knowing that without routine maintenance, we cannot expect things to keep running smoothly. Somehow, this concept gets lost when we think of our bodies and physical performance. Whether it is a runner training for marathon after marathon without any recovery time built into their weekly training regimen, a cross-fitter lifting heavy loads 5 days a week, or someone initiating a new exercise routine after several years of being sedentary, injuries due to inadequate tissue recovery span the spectrum of physical performance and fitness.

My fellow physical therapists and I spent the day after the finals relating Durant’s injury to many of the issues we deal with in the clinic. While our bread and butter as clinicians is finding and improving muscle imbalances and movement disorders, the bottom line is injuries usually occur from overload: doing too much too soon and without proper rest and recovery. PTs often end up being providers of guidance for how long to hold off on a particular activity and how to safely return back to it. The education we offer to patients includes the basic physiology of tissue break down and adaption, the limiting factor of time for healing and repair, and how these basic concepts should be utilized with training and exercise.

The mechanism for building more muscle strength is via the actual break down of muscle tissue. This break down leads to the production of lactic acid, which is a signal for the production of growth hormone. Growth hormone’s job is to repair this breakdown and build up more muscle so the next time your body performs in this way, it is not as strenuous. This process is evolutionary genius, and while it allowed for improved survival at one point in our history, it is what allows us to make improvements in muscle mass, strength, and speed. Unfortunately, we now tend to exploit our body’s ability to repair and improve itself for the modern need of awesome abs and sport performance, and we neglect the fact that the body’s natural process for repair and growth takes time. If the body is continually put in states of break down and not given adequate time for growth hormone to do its job, it is just a matter of time before tissue break down turns into injury.

Not enough emphasis can be placed on time for allowing tissue repair to take place. It takes time for tissues to adapt because it takes time for growth hormone to repair the tissues that are broken down during training. If adequate time is given after heavy stress, gains in performance will occur. However, if load and frequency exceed adequate recovery time, injury occurs, or in Durant’s case, complete tissue rupture. Time in a lot of cases is the limiting factor in tissue adaptation and progression. Click the picture below to check out a video for a simple explanation of loading and tissue capacity and how balancing the two over time leads to improved performance:

While it is true that in order to make physical gains with training, you have to have tissue break down, smart training will include recovery as a necessary step for building more muscle mass, strength, speed, and overall performance. If you notice increased pain with your training or workouts, the answer is not always to do it more. It most likely means you are doing too much and your body may need more rest and recovery in order to make these necessary improvements. And the bottom line is your body’s need for recovery should never be sacrificed due to the pressures of training and performance.