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To rest or Not to Rest

Posted by wendyn on 11/14/00 at 17:41 (032739)

How much rest is enough, and how much rest is too much? This always seems to be a topic of debate. Some folks favor rest as long as necessary in an extreme form - others think resting means cutting down from 10 miles of running uphill to 8 miles of running uphill. I'm somewhere in the middle, but although I think rest (especially in the initial stages of an injury) is important - I also think there is a tendency for some to over-rest. I also think that over-resting may be just as detrimental to recovery (and to mental health) as not resting at all. Then again - I'm not a doctor, I'm just basing this still-forming opinion on my own experience and research.

I was reading an article on osteoporosis - and one comment caught my attention...'We know that if you lie in bed for even a few days, there is a profound loss of bone mass. We also know that a mechanical load applied to bone results in increased bone formation. We use these mechanical principles in the treatment of broken bones. For example we allow people to bear weight on broken legs once satisfactory mechanical stability has been achieved through surgery or early healing'. (IMPACT Septmeber/October 2000 sport medicine The Forum Dr Nick Mohtadi).

If people with broken bones need some weight bearing to retain bone mass and muscle mass- what does that mean for people with chronic foot pain who try to avoid weight bearing whenever possible? Is it okay to stop running for 6 weeks, but not okay to stop standing up to make dinnner? Does the amount you can safely rest change depending on whether you are dealing with an acute or chronic injury?

Does anyone have any valuable research or insight into just how much inactivity a person can get away with - without causing muscle atrophy or bone loss?

Re: To rest or Not to Rest

Bob G. on 11/15/00 at 00:08 (032765)

>
Hi Wendyn,

From my experience I have found that one must find a course of recovery and continually monitor one's progress. This probably would include alot of rest, especially at first.

I also found it wise to have a long-range goal and plan so as to not overdo it when one is feeling good. This takes patience and persistence.

When I first came down with PF I was 40. I recovered within a few weeks of rest, wall stretching and arch supports. I was back to jogging in a couple months.

Last time I came down with PF I was 50. I needed ten months of serious rest just to get back to walking with no pain. I found that I was too eager at times and overdid stretching and trying to run too soon. Now I am more patient and it has been six months past the ten months of serious rest and I am almost there.

No two people are alike, so one must set one's own course, be patient and not too eager. Oh, and by the way, I did not stay in bed for ten months! LOL I just gave up running, dancing, and bare feet.

Best of luck to you! BG

Re: To rest or Not to Rest

PaulS on 11/15/00 at 03:19 (032767)

Wendyn, I think your question is the most important one confronting us PF sufferers. After 6 months lurking on this site following the various posts on the topic, I still have no idea what amount and kind of rest is right for the physical condition of PF, but I do know that almost total rest, as I tried for the first few months, has a terrible effect on your mental condition - especially if you have previously been very active. I'm not sure whether the gentle cycling I'm now doing is prolonging the PF problem, but I am certain that it is helping to relieve the enormous stress that PF causes - and I intend to continue with it.

Re: To rest or Not to Rest

Rick R on 11/15/00 at 07:07 (032768)

Wendy,

After surgery for my left heel I was obviously in a major rest mode, I also focused on stretching the left side as I became ready. When I felt I was ready to start running after a full year of inactivity, not to mention about 20 lbs, wouldn't you know it the right heel went on me. I hadn't had right heel problems for over a decade. Also, as you may recall, I started running again, many years after the initial onset in order to bring things to a head. Much to my surprise I got better. After a few years of running again I got checked out for the heck of it and finaly my Dr. decided it was time to slice and dice. So I was a victim of too much rest, no doubt in my feeble mind. I firmly believe I could have avoided many years of restricted lifestyle had I abandoned the doctors rest perscription earlier. Of course I could have spent less time with my small children (at the time) and I may not have gone back to school so who knows for what reason things happen.

Lots of luck,

Rick

Re: To rest or Not to Rest

Julie F on 11/15/00 at 17:10 (032795)

>

Hi Wendy

How long is a piece of string? I'm not being frivolous. The more I learn about PF and all the other foot problems that it is possible to have, the more I realize how different people's requirements are, and how widely our options vary. I don't think it's possible to answer the question you put in your first sentence. I really don't. For some people, whose pain is so intense they can scarcely walk, there is no alternative to almost complete rest. For others, with milder cases, rest can mean giving up running uphill for a while and running on the level, or substituting lots of walking. It's a very individual matter.

Like you, I'm somewhere in the middle. Knowing what little I do about foot mechanics, and about the plantar fascia and how it can tear at its insertion in the calcaneus, I try to visualize what that tear looks like and how, as my foot rolls forward, there is a 'pull' on the fascia which could increase the tear. For me, a certain amount of walking seems to be ok now. I overdid it today and came home very sore this afternoon after all day on my feet shopping and carrying heavy stuff all the way home, but I'll probably be ok tomorrow morning, judging by recent experience. For others, my shopping trip wouldn't be possible.

Dealing with these foot problems IS difficult emotionally. I've not been depressed, but I've certainly felt worried, limited, boxed in, stymied, frustrated. I've asked myself many times 'how long am I going to have to think about every step I take?' I was feeling I almost didn't want to do the trip to Berlin, convinced I'd have a major setback. But going, and discovering that my foot could take more punishment than I'd thought it could, has been a turning point. I feel much more optimistic now. It was a perfect example of what you said to Nancy a couple of weeks ago - and I had that much in mind before, during, and since my trip.

Muscle atrophy can more or less be held at bay by non-weight-bearing exercise, but the osteoporosis question is very serious. Every woman over 40 is at risk of it; knowing this, I've always tried to work a good bit of weight-bearing exercise into my life, especially walking and standing yoga postures. Now, with PF, there's a conflict, and I've had to make a decision about it. The decision is to lay off the weight-bearing as much as possible so that I heal as quickly as possible. The sooner I heal, the sooner I can go back to recreational walking and more standing yoga postures. I don't like it, but there it is, and it seems reasonable to me.

I do think that as someone else (I'm off line writing this so don't remember who) your question is the major one facing us. I'm glad you've raised it, and it has certainly made me think. But I feel pretty sure there is no one answer to it.

All the best, Julie

Re: To rest or Not to Rest

wendyn on 11/15/00 at 23:25 (032826)

You've all made very good points - and I think proved the argument that there certainly isn't a clear limit of what's okay for everyone.

We know that there isn't a certain amount that someone can do before they aggrevate their pain - that could be different for everyone.

But, is there a certain amount of rest that will be detrimental? For example - is it okay to have almost complete rest for up to a week - but not beyond? (I just picked an amount of time out of the air). When does osteoporosis become a factor? I was unaware that too much rest could even be a contributing factor until I read that article - but Julie, it sounds like you've hear this before. What do you know about this?

Osteoporosis is always something I have to be somewhat aware of - I'm a little female with little bones, and I really have to push to get enough calcium in my diet (the supplements just upset my stomach too much).

Re: To rest or Not to Rest

Julie F on 11/16/00 at 04:16 (032833)

>
Hi Wendy

I'm certainly no expert on osteoporosis, but I do know that bone loss begins very quickly (I believe within a couple of days) with complete bed rest, which is why it's never recommended unless absolutely unavoidable, and why people who have to stay in bed for whatever reason are now encouraged to get up and about as quickly as possible (even, apaparently, with leg fractures, which I didn't know before reading your post). There is no doubt in my mind that complete bed rest is a recipe for disaster.

Women are particularly prone to osteoporosis (perhaps because our bones are smaller?) and women over 40 need to take avoiding action - especially plenty of weight-bearing exercise. Walking is considered to be the best weight-bearing exercise - suitable for most people, which running isn't, and without the risks of running.

But when PF and the other problems rear their ugly heads, what to do? If the pain is really severe (as for Beverly and Barbara) we may have no choice. For those suffering less, as I said in my earlier post, it's got to be a trade-off. My personal view, and I'm applying it only to myself, not to anyone else, is that if I had continued walking as much as I'd like to, as much as I used to, my pf would be much worse by now. The worse it gets, the longer it takes to heal. So I reckon I'm better off cutting back on weight-bearing, and healing as quickly as possible.

Before I had PF, I'd never heard of it. Now I've met and talked to two people who have had it for months without knowing what it was, who started with the classic FTITM pain as I did, thought it was unimportant and ignored it, 'carried on as normal', and are now in much worse, constant pain. So I've concluded that my strategy has been right for me, because I am definitely improving.

Right now I'm aiming for being able to walk as much as I want to - or nearly - in India when I go at the end of next month. But I've already figured out a strategy for limiting myself if that turns out to be too soon. My next goal is to be completely healed by Easter (this may be unrealistic but I pray not) when I'm going to southwest Crete - THAT'S where I do what I call my 'serious' walking. Not mammoth all-day hikes, but a couple of hours a day up and down rough goat paths. I go a couple of times a year. It's everything to me, and with that goal in front of me I can cope with cutting out my recreational walking for now.

I didn't mean to get so personal, but your questions always make me think further than I thought I was going to, if that makes sense! Thanks!

Re calcium - it is hard to get enough without taking supplements. Have you ever tried a calcium and magnesium combination? The magnesium helps the absorption of the calcium, and might suit your tummy better than straight calcium.

All the best, Julie

Re: To rest or Not to Rest

Julie F on 11/17/00 at 02:48 (032903)

Hi Bob - you made an interesting point that I missed when I first read your post the other day, regarding age, and how much longer it took you at 50 to heal than it did at 40. I have a feeling that this is something we should all be aware of: that - all other things being equal - younger people are probably likely to heal faster than older people.

I was talking to a 30-year old student the other day who had had PF (from running) several years ago. I asked him how long it had taken him to get over it and he said 'a month'. My similar mild case is now three months old, and improving but not gone. According to my pod, it is 'lingering' - I've decided not to accept or be depressed by that, because it seems obvious to me that at 65 my tissues have lost elasticity and are not going to heal as quickly as he over-optimistically told me they would when I first saw him.

So - age is a factor to be borne in mind.

All the best, Julie

Re: To rest or Not to Rest

JudyS on 11/17/00 at 20:58 (032977)

Hi Julie - I was just thinking about your post regarding age and healing. Seems like I've read similar things before but here's a slightly different experience - the first time I had PF I was 47 - it was cured quickly in barely a month with, I think, a cortisone shot. Then it started up again a year later but I know now that I did two things wrong. One, even after the first bout at age 47, I FAILED to follow proper stretching and conditioning procedures when I was running or playing ball. Also, when it started the second time a year later, I FAILED to pay attention to it because it had evaporated so quickly the first time. I kept running, I kept playing ball, I kept staying on my feet for 12-hour days while rehabing my mother-in-law's house. I ignored the pain and all it did was get worse. So, in my case at least, even at age 47 it healed rather quickly and at age 48 got worse and worse because I ignored it.

Re: To rest or Not to Rest

Bob G. on 11/15/00 at 00:08 (032765)

>
Hi Wendyn,

From my experience I have found that one must find a course of recovery and continually monitor one's progress. This probably would include alot of rest, especially at first.

I also found it wise to have a long-range goal and plan so as to not overdo it when one is feeling good. This takes patience and persistence.

When I first came down with PF I was 40. I recovered within a few weeks of rest, wall stretching and arch supports. I was back to jogging in a couple months.

Last time I came down with PF I was 50. I needed ten months of serious rest just to get back to walking with no pain. I found that I was too eager at times and overdid stretching and trying to run too soon. Now I am more patient and it has been six months past the ten months of serious rest and I am almost there.

No two people are alike, so one must set one's own course, be patient and not too eager. Oh, and by the way, I did not stay in bed for ten months! LOL I just gave up running, dancing, and bare feet.

Best of luck to you! BG

Re: To rest or Not to Rest

PaulS on 11/15/00 at 03:19 (032767)

Wendyn, I think your question is the most important one confronting us PF sufferers. After 6 months lurking on this site following the various posts on the topic, I still have no idea what amount and kind of rest is right for the physical condition of PF, but I do know that almost total rest, as I tried for the first few months, has a terrible effect on your mental condition - especially if you have previously been very active. I'm not sure whether the gentle cycling I'm now doing is prolonging the PF problem, but I am certain that it is helping to relieve the enormous stress that PF causes - and I intend to continue with it.

Re: To rest or Not to Rest

Rick R on 11/15/00 at 07:07 (032768)

Wendy,

After surgery for my left heel I was obviously in a major rest mode, I also focused on stretching the left side as I became ready. When I felt I was ready to start running after a full year of inactivity, not to mention about 20 lbs, wouldn't you know it the right heel went on me. I hadn't had right heel problems for over a decade. Also, as you may recall, I started running again, many years after the initial onset in order to bring things to a head. Much to my surprise I got better. After a few years of running again I got checked out for the heck of it and finaly my Dr. decided it was time to slice and dice. So I was a victim of too much rest, no doubt in my feeble mind. I firmly believe I could have avoided many years of restricted lifestyle had I abandoned the doctors rest perscription earlier. Of course I could have spent less time with my small children (at the time) and I may not have gone back to school so who knows for what reason things happen.

Lots of luck,

Rick

Re: To rest or Not to Rest

Julie F on 11/15/00 at 17:10 (032795)

>

Hi Wendy

How long is a piece of string? I'm not being frivolous. The more I learn about PF and all the other foot problems that it is possible to have, the more I realize how different people's requirements are, and how widely our options vary. I don't think it's possible to answer the question you put in your first sentence. I really don't. For some people, whose pain is so intense they can scarcely walk, there is no alternative to almost complete rest. For others, with milder cases, rest can mean giving up running uphill for a while and running on the level, or substituting lots of walking. It's a very individual matter.

Like you, I'm somewhere in the middle. Knowing what little I do about foot mechanics, and about the plantar fascia and how it can tear at its insertion in the calcaneus, I try to visualize what that tear looks like and how, as my foot rolls forward, there is a 'pull' on the fascia which could increase the tear. For me, a certain amount of walking seems to be ok now. I overdid it today and came home very sore this afternoon after all day on my feet shopping and carrying heavy stuff all the way home, but I'll probably be ok tomorrow morning, judging by recent experience. For others, my shopping trip wouldn't be possible.

Dealing with these foot problems IS difficult emotionally. I've not been depressed, but I've certainly felt worried, limited, boxed in, stymied, frustrated. I've asked myself many times 'how long am I going to have to think about every step I take?' I was feeling I almost didn't want to do the trip to Berlin, convinced I'd have a major setback. But going, and discovering that my foot could take more punishment than I'd thought it could, has been a turning point. I feel much more optimistic now. It was a perfect example of what you said to Nancy a couple of weeks ago - and I had that much in mind before, during, and since my trip.

Muscle atrophy can more or less be held at bay by non-weight-bearing exercise, but the osteoporosis question is very serious. Every woman over 40 is at risk of it; knowing this, I've always tried to work a good bit of weight-bearing exercise into my life, especially walking and standing yoga postures. Now, with PF, there's a conflict, and I've had to make a decision about it. The decision is to lay off the weight-bearing as much as possible so that I heal as quickly as possible. The sooner I heal, the sooner I can go back to recreational walking and more standing yoga postures. I don't like it, but there it is, and it seems reasonable to me.

I do think that as someone else (I'm off line writing this so don't remember who) your question is the major one facing us. I'm glad you've raised it, and it has certainly made me think. But I feel pretty sure there is no one answer to it.

All the best, Julie

Re: To rest or Not to Rest

wendyn on 11/15/00 at 23:25 (032826)

You've all made very good points - and I think proved the argument that there certainly isn't a clear limit of what's okay for everyone.

We know that there isn't a certain amount that someone can do before they aggrevate their pain - that could be different for everyone.

But, is there a certain amount of rest that will be detrimental? For example - is it okay to have almost complete rest for up to a week - but not beyond? (I just picked an amount of time out of the air). When does osteoporosis become a factor? I was unaware that too much rest could even be a contributing factor until I read that article - but Julie, it sounds like you've hear this before. What do you know about this?

Osteoporosis is always something I have to be somewhat aware of - I'm a little female with little bones, and I really have to push to get enough calcium in my diet (the supplements just upset my stomach too much).

Re: To rest or Not to Rest

Julie F on 11/16/00 at 04:16 (032833)

>
Hi Wendy

I'm certainly no expert on osteoporosis, but I do know that bone loss begins very quickly (I believe within a couple of days) with complete bed rest, which is why it's never recommended unless absolutely unavoidable, and why people who have to stay in bed for whatever reason are now encouraged to get up and about as quickly as possible (even, apaparently, with leg fractures, which I didn't know before reading your post). There is no doubt in my mind that complete bed rest is a recipe for disaster.

Women are particularly prone to osteoporosis (perhaps because our bones are smaller?) and women over 40 need to take avoiding action - especially plenty of weight-bearing exercise. Walking is considered to be the best weight-bearing exercise - suitable for most people, which running isn't, and without the risks of running.

But when PF and the other problems rear their ugly heads, what to do? If the pain is really severe (as for Beverly and Barbara) we may have no choice. For those suffering less, as I said in my earlier post, it's got to be a trade-off. My personal view, and I'm applying it only to myself, not to anyone else, is that if I had continued walking as much as I'd like to, as much as I used to, my pf would be much worse by now. The worse it gets, the longer it takes to heal. So I reckon I'm better off cutting back on weight-bearing, and healing as quickly as possible.

Before I had PF, I'd never heard of it. Now I've met and talked to two people who have had it for months without knowing what it was, who started with the classic FTITM pain as I did, thought it was unimportant and ignored it, 'carried on as normal', and are now in much worse, constant pain. So I've concluded that my strategy has been right for me, because I am definitely improving.

Right now I'm aiming for being able to walk as much as I want to - or nearly - in India when I go at the end of next month. But I've already figured out a strategy for limiting myself if that turns out to be too soon. My next goal is to be completely healed by Easter (this may be unrealistic but I pray not) when I'm going to southwest Crete - THAT'S where I do what I call my 'serious' walking. Not mammoth all-day hikes, but a couple of hours a day up and down rough goat paths. I go a couple of times a year. It's everything to me, and with that goal in front of me I can cope with cutting out my recreational walking for now.

I didn't mean to get so personal, but your questions always make me think further than I thought I was going to, if that makes sense! Thanks!

Re calcium - it is hard to get enough without taking supplements. Have you ever tried a calcium and magnesium combination? The magnesium helps the absorption of the calcium, and might suit your tummy better than straight calcium.

All the best, Julie

Re: To rest or Not to Rest

Julie F on 11/17/00 at 02:48 (032903)

Hi Bob - you made an interesting point that I missed when I first read your post the other day, regarding age, and how much longer it took you at 50 to heal than it did at 40. I have a feeling that this is something we should all be aware of: that - all other things being equal - younger people are probably likely to heal faster than older people.

I was talking to a 30-year old student the other day who had had PF (from running) several years ago. I asked him how long it had taken him to get over it and he said 'a month'. My similar mild case is now three months old, and improving but not gone. According to my pod, it is 'lingering' - I've decided not to accept or be depressed by that, because it seems obvious to me that at 65 my tissues have lost elasticity and are not going to heal as quickly as he over-optimistically told me they would when I first saw him.

So - age is a factor to be borne in mind.

All the best, Julie

Re: To rest or Not to Rest

JudyS on 11/17/00 at 20:58 (032977)

Hi Julie - I was just thinking about your post regarding age and healing. Seems like I've read similar things before but here's a slightly different experience - the first time I had PF I was 47 - it was cured quickly in barely a month with, I think, a cortisone shot. Then it started up again a year later but I know now that I did two things wrong. One, even after the first bout at age 47, I FAILED to follow proper stretching and conditioning procedures when I was running or playing ball. Also, when it started the second time a year later, I FAILED to pay attention to it because it had evaporated so quickly the first time. I kept running, I kept playing ball, I kept staying on my feet for 12-hour days while rehabing my mother-in-law's house. I ignored the pain and all it did was get worse. So, in my case at least, even at age 47 it healed rather quickly and at age 48 got worse and worse because I ignored it.