Injured athletes are trying to stay as active as possible without aggravating their injuries, while also finding and fixing whatever weaknesses caused the injuries. (iStockphoto)

Given that Michael Wardian had multiple pelvic stress fractures and sports hernias, one would think that his rehab would have involved a lot of quality time on the couch.

But it was just the opposite. Although Wardian, a professional runner, didn’t run for three months, he biked, hiked, walked and aqua-jogged his way back to health.

“I wanted to maintain my fitness,” said Wardian, 41, of Arlington, a 2:17 marathoner and a veteran of 150 marathons and ultramarathons. “I asked detailed questions about what I could do instead of what I could not do. And I did those things at great length and with vigor.”

Wardian may be an elite, but his treatment regime — which involved staying as active as possible during rehab — is now routine for injured athletes of all levels of fitness.

In the past, ailments such as stress fractures, IT band syndrome, plantar fasciitis and runner’s knee were typically treated with rest, ice and over-the-counter painkillers. But this approach only compromised hard-earned fitness and deprived the injured of the emotional benefits of exercise when they needed it most. What’s more, it kept runners, triathletes and other athletes stuck in a cycle of chronic injury.

“Now, we know that in the world of injuries, true rest isn’t really helpful,” said physical therapist Kerri Kramer Webb, founder of Fast Track Sports Medicine & Performance Center in Fairfax County.

The standard approach these days is to keep ailing athletes as active as possible without aggravating their injuries, while identifying and correcting whatever biomechanical and nutrition issues, training errors, muscle imbalances or weaknesses caused the injuries.

“Before, people would get the RICE [rest, icing, compression and elevation], and then, not surprisingly, injuries tended to recur because they weren’t addressing the underlying issues,” said Adam Tenforde, a sports medicine doctor at the Spaulding National Running Center at Harvard University.

Low-impact activities such as cycling, pool running, swimming and elliptical sessions circulate blood and healing nutrients to injured muscles and tendons, promoting cell growth and repair, Webb said. Exercise removes cellular debris that accumulates from damaged tissues and hastens the flow of synovial fluids, which lubricate the joints, she said. When they’re not being used regularly, muscles begin to lose their elasticity and bones get weaker, she added.

What’s more, aerobic exercise helps release human growth factor hormones that promote healing in the tendons and connective tissues, said Stephen Pribut, a D.C. podiatrist.

The mental and emotional boosts from regular workouts are just as essential to bouncing back. Exercise has been proved to provide protection against stress, help prevent and treat depression, and boost mood. Without a daily workout to take the edge off, levels of the stress hormone cortisol can remain chronically elevated, and that can lead to tissue breakdown and hinder the healing process, Webb said. Plus, it can lead to fatigue, depression, headaches, weight gain, colds and flu, and digestive problems. What’s more, the sudden drop-off in physical activity can disrupt sleep, which is prime time for injured body tissues to recover, she added.

“You’re already in pain and feeling terrible,” Webb said. “If you’re ordered to rest, you’re likely to feel even worse. The emotional piece takes a toll. Keeping patients moving keeps their mood up throughout the rehab process.”

What’s more, staying active keeps you from losing cardiovascular fitness you worked so hard to build, said Jordan Metzl, a New York doctor of sports medicine and author of “Running Strong.”

“Your cardiovascular system doesn’t know you have a knee injury,” Metzl said. “It’s much easier to lose fitness than to gain it. Deconditioning happens quickly. It’s much more challenging to get back into shape.”

Studies have shown that if you stop working out completely, cardiovascular fitness can significantly decline in just two weeks, said Ian Klein, an exercise physiologist at Ohio University. In general, for every one week of inactivity, it can take two weeks to regain lost cardiovascular fitness, he said. Muscle strength doesn’t fade as fast and is easier to regain, he said.

When Wardian began running on the roads after four months of rigorous cross-training, he was surprised to see how quickly his fitness returned. Within two weeks, he finished a half-marathon in 1 hour 14 minutes — just eight minutes off his personal best.

“I was beyond excited,” he said. Though it took him a few weeks to regain full speed, “I had a great base.”

Staying active while injured

Here are some ways to stay active when you’re rehabbing an injury:

First, do no harm. Talk with your doctor about which activities are safe, Pribut said. You want to get the benefits of aerobic exercise without aggravating your injury or creating a new one. Swimming and pool running, for instance, are typically safe with IT band syndrome, Achilles’ tendon strains and stress fractures, as long as you’re not pushing off the pool wall with the injured area, he said. Stationary bikes are often safe with shin splints, plantar fasciitis and IT band syndrome, as long as you remain seated. But if you have Achilles’ issues, cycling can make them worse.

Let pain be your guide. If any cross-training activity hurts, stop right away. If you feel pain afterward, talk to your doctor before doing it again. Popping over-the-counter painkillers is not wise, as they may allow you to aggravate your injury without knowing it, Webb warned. “Pain is a very important thing to feel,” she said.

Find probable cause. Often injuries recur because rehab plans focus on vanquishing symptoms, not correcting the cause, Tenforde said. “Steroid injections, heat, ice and ultrasound might feel good at the time,” he said. “But they’re not going to translate to a longer-term change.” Work with a physical therapist to identify strength, flexibility, biomechanical or training issues that led to the injury, and devise a plan to correct them. See a sports dietitian to determine whether a nutrient deficiency played a role.

Mimic your regular workouts. If you get the doctor’s green light, try to replicate the workouts you’d do in your regular routine. “Think of simulating what you’re trying to accomplish,” Tenforde said. You can do intervals of vigorous running in the pool or on the elliptical, which can also help you stay focused and break up the monotony, he said.

Adjust your expectations. The more closely the activity replicates your regular routine, the easier it’s going to be to make a comeback once your injury has healed. For instance, deep-water running has traditionally been the best way to maintain fitness and performance for distance runners, Klein said. But it can’t elicit the same intensity as running, he added. Even so, you’ll retain more fitness and come back faster than if you did nothing.

Eat well. Many athletes restrict calories in an effort to avoid weight gain during their layoff. That’s not wise, Pribut said, especially if a nutrient deficiency contributed to the injury. Although you may have to cut calories a little if you drastically cut your activity, if you’re maintaining a workout routine with cross-training, you shouldn’t have to worry about weight gain. Pribut recommended that those with stress fractures get extra calcium and vitamin D, plus plenty of omega-3 fatty acids, which have been linked to lower inflammation.