Five things you should NOT do when injured
- Maryke Louw
- Mar 20
- 6 min read
Updated: Apr 3
I am often asked on social media “I’ve injured my *insert injury*. What should I do to recover?” However, by the time you seek help on Facebook, you might have already done some things that will prolong your recovery. Five things that newly injured people do wrong can easily be remembered with the phrase “Do no HARMS”: Heat, Alcohol, Running (or other sport), Massage, and Stretching.
Remember, if you need help with an injury, you're welcome to consult our team of sports physios online via video call.
In this article:
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The aim of avoiding HARMS
You've likely heard several mantras over the years of things you should do directly after getting injured: PRICE (Protect, Rest, Ice, Compression, Elevation) or more recently PEACE & LOVE (find the explanation here).
The one thing these regimes have in common is that they aim to protect the first (primary) injury and limit further (secondary) injury by preventing further irritation and trauma, while reducing bleeding and swelling.
HARMS is about things you should NOT do, and the aim is the same – avoiding making the injury worse than it already is.
Heat
Do not apply heat to a fresh injury – one that you've sustained fewer than seven days ago.
💡 Ice should be your weapon of choice for an acute injury, and you can read more about how to safely apply ice here.
Why avoid heat for sprains and strains?
When you pull or tear a muscle or ligament, you usually also tear several blood vessels in that area. If you’re lucky, you tear only a few small ones. If the area swells up quickly, it is likely that you’ve torn a rather large one.
Your aim should be to stop the bleeding as quickly as possible. Heat leads to an increase in blood circulation in that area and will obviously have the opposite effect – causing your injury to worsen, as explained above.
Damaged blood vessels can continue to be weak and leak for a few days after injury, so it is best to avoid heat for at least a week (this might vary according to the extent of your injury).
Why avoid heat for tendinopathy or tendonitis
When your tendon first becomes injured, there might be some inflammation. This is not a problem and actually plays an important role in healing. However, heat can increase the inflammation and cause it to become excessive, which can be counterproductive. So, it's best to avoid heat treatments during the early stages of a tendon injury.
It is absolutely fine to use heat for older tendon injuries – the research shows that there isn't really any inflammation present after a few weeks of tendon pain.x
Here's our article with more detail about using ice and heat for tendon injuries.
And here are some ice pack options:
Alcohol
Alcohol decreases your blood’s ability to form clots. This is especially problematic for sprains and strains. The longer it takes for your blood to clot, the more you will bleed into the injured area and the worse your injury will get.
💡 My advice would be to stay away from alcohol for at least 24 hours after injuring yourself. Consider abstaining for 72 hours if your injury swelled up quickly (which might indicate damage to a slightly larger blood vessel).
Alcohol is less problematic for injuries like tendinopathy or tendonitis, since those do not bleed. However, large quantities of alcohol can increase general levels of inflammation in the body, which might be counterproductive for healing.
The pain-dulling effect of alcohol can also be problematic – it may cause you to move more briskly or overdo things because you forget about the injury.
Running (or other sports)
Ignoring your injury and trying to train through it is not a good idea. If you've injured a structure, it is now not as strong as before, and you will likely worsen the injury if you try to train at the same intensity.
💡 This doesn't have to mean that you can't do anything, but you will have to adapt your sport or activity to match your injured body part's current strength and symptoms.
With some injuries (like calf tears), complete rest for a few days is necessary, while with others (like a tendinopathy), you often have to just reduce the intensity of your activity to a level that doesn't irritate your injury.
A physiotherapist can help you to figure out what the right level of sport or activity is for the type and severity of injury you have.
Massage
Massage can be a very useful tool, but if you do it too strongly or too early after an injury, it can make things worse:
Sprains, strains and tears: The new cells that form after you strain or tear something are not very strong during the early days (first 7 to 14 days), and massaging that area during the first week or two can be counterproductive. You can read a more detailed description of how healing takes place here.
Bursitis or other inflammatory conditions: An injury where inflammation is the main driver behind the injury process is usually made worse by massage, since it further increases the irritation.
Tendinopathies/tendonitis: Tendon injuries that are only a few weeks old or cases where the tendon is very easily irritated often also flare up after strong massage over the injured tendon (similar to what happens when you repeatedly press a bruise).
💡 It is absolutely fine to apply massage in other areas that are not directly related to the injury. And of course you can also massage the injured area once the injury has settled, if you find it useful.
Stretching
Hopefully coaches know better these days, but I still remember being told as a child to stretch a muscle when I've just torn it ... and of course that never worked.
Now, as with the other elements discussed in this article, stretching is not a bad thing as such, and it can be a useful tool in recovery. But it creates problems if you do it too soon after an injury.
Stretching a newly torn or pulled muscle is one of the worst things you can do – you're essentially pulling the torn and already over-stretched muscle fibres even further apart.
But don't worry if you, like the younger me, have already stretched yours by the time you read this. You're unlikely to stretch strongly enough to do any real damage – you've likely just made it a lot more angry than what it would have been.
Stretching an irritated tendon (tendinopathy) or inflamed structure (bursitis) can also make your symptoms feel worse. In this case, stretching doesn't necessarily cause any damage but it just irritates the tissue even further.
💡 This is why it might be a good idea to initially perform rehab exercises in positions that don't stretch the injured tendon or muscle and only ease into the stretch positions later in the rehab process. Your physiotherapist is the best person to guide you through this process.
How we can help
Need help with an injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine or at least 10 years' experience in the field. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Master’s Degree in Sports Injury Management. Follow her on LinkedIn and ResearchGate.
