A claim you hear on longevity podcasts

Does loading an injury work better than complete rest?

Leaning for. Of 9 studies that test it, 9 partly agree.

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Anyone deciding on exercise after injury
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The claim checked: An injury is not a reason to rest completely: loading the tissue helps it recover Hear it at 1:00:11

What do the studies say?

Leaning for

All nine studies partly agree, and none settles it. Exercise or early loading often helped, but the gains could be small or fade with time. Graded exercise eased tennis elbow pain at 3 months. With a torn Achilles tendon, early weight bearing helped at 8 weeks, with no difference at 3, 6, and 9 months. For acute low back pain, advice to stay active brought small benefits over bed rest. Almost none compared loading with complete rest, the thing said on the episode, because the other group was still allowed to move.

Computed from 9 studies that test this point, each judged by two readers, in full. 10 more studies are waiting for a full read and do not count yet.

What was said on the podcast?

“because resting in and of itself actually contributes to more of the dysfunction. Time is one part of recovery but the loading of the tissues themselves is another promoter of recovery. So when you remove that load entirely things start to go wrong and at an accelerated pace.”
Jeff Cavaliere, a guest on The Drive · 414 ‒ Resistance training as we age: exercise selection, training intensity, and much more · 1:00:11 on YouTube
Episode check Lift fewer, harder sets as you age, the episode says. Of four studies, none backs it and two favor more volume. 5 claims checked against 34 studies · 25 chapters not checked yet See the whole episode →
The point checked Leaning for

After a muscle, tendon or joint injury, keeping the tissue loaded with suitable, progressed exercise gives better recovery than complete rest

Agree 0· none of the studies we read

Partly agree 9

controlled trial · 2009

“We therefore conclude that, although exercise therapy is effective for improving pain and function, these benefits are not clearly reflected in patients’ self reported recovery.”

Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial. BMJ
Who: 131 patients aged 14-40, mean 24, with patellofemoral pain syndrome for 2 months to 2 years, from Dutch GP and sports medicine practices
PMID 19843565

pooled analysis · 2015

“The results remained in favour of the same group but lost their statistical significance, indicating insufficient power to demonstrate effectiveness if only high quality studies are used (Table 1).”

Weight-bearing and mobilization in the postoperative care of ankle fractures: a systematic review and meta-analysis of randomized controlled trials and cohort studies. PLoS One
Who: Adults after open reduction and internal fixation of ankle fractures, in randomized trials and cohort studies; age and comorbidities not described by outcome
PMID 25695796

controlled trial · 2020

“Unprotected weight-bearing and mobilization as tolerated as postoperative care regimen improved short-term functional outcomes and led to earlier return to work and sports, yet did not result in an increase of complications.”

Weight-bearing or non-weight-bearing after surgical treatment of ankle fractures: a multicenter randomized controlled trial. Eur J Trauma Emerg Surg
Who: Adults aged 18-65 without severe comorbidities after surgical fixation of Lauge-Hansen supination external rotation stage 2-4 ankle fractures at four Dutch teaching hospitals; mean age 39.0, 53.0% men
PMID 30251154

controlled trial · 2018

“Given that measures of muscle strength did not differ between groups at eight weeks, the mechanism underpinning the benefits of education plus exercise might well be more in the education aspect of the programme.”

Education plus exercise versus corticosteroid injection use versus a wait and see approach on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. BMJ
Who: 204 community adults aged 35-70 (167 women; mean age 54.8) with lateral hip pain for more than 3 months, pain at least 4/10, and MRI-confirmed gluteal tendinopathy
PMID 29720374

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controlled trial · 2017

“When comparing functional outcome of the injured side, the FWB group demonstrated better outcome only at the early time point.”

Functional weight-bearing mobilization after Achilles tendon rupture enhances early healing response: a single-blinded randomized controlled trial. Knee Surg Sports Traumatol Arthrosc
Who: Patients aged 18-75 with surgically repaired acute Achilles tendon rupture; 50 men, 6 women, mean age 40.1 years
PMID 27539402

trial or observed group · 2020

“Any benefit to functional bracing at 8 weeks was not evident later in recovery, with similar scores between groups at 3, 6, and 9 months.”

Plaster cast versus functional brace for non-surgical treatment of Achilles tendon rupture (UKSTAR): a multicentre randomised controlled trial and economic evaluation. Lancet
Who: Patients aged 16 or older with primary Achilles tendon rupture treated non-surgically at 39 UK hospitals; mean age 48.7 years, 79% male
PMID 32035553

controlled trial · 2011

“In conclusion, the results of this study show that a specific graded exercise regime is more effective in reducing pain in chronic TE than a wait-and-see regime in a 3-month perspective.”

A randomized controlled trial of exercise versus wait-list in chronic tennis elbow (lateral epicondylosis). Ups J Med Sci
Who: 81 adults aged 20-75, mean age 48, with tennis elbow for more than 3 months in Uppsala primary care
PMID 22066975

other primary study · 2022

“Although passive therapy was equally effective in improving the VISA-A score, tendon stiffness decreased significantly post-intervention in this group, indicating tissue deterioration and potentially increasing the risk for future strain-induced tendon injuries.”

Evidence-Based High-Loading Tendon Exercise for 12 Weeks Leads to Increased Tendon Stiffness and Cross-Sectional Area in Achilles Tendinopathy: A Controlled Clinical Trial. Sports Med Open
Who: Men aged 20-55 with chronic Achilles tendinopathy (over 3 months, VISA-A below 80), Berlin; sequentially allocated, not randomised
PMID 36538166

pooled analysis · 2010

“Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches.”

Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica. Cochrane Database Syst Rev
Who: Men and women aged 16-80 years with acute (up to six weeks) low-back pain or sciatica
PMID 20556780

Disagree 0· none of the studies we read

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