Treatment Table Podcast

Mini Consult | Should You Train When You're Sick? The Above-the-Neck Rule

• Mathew Ah Chow • Season 1 • Episode 25

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0:00 | 11:23

Should you train when you're sick? Can you exercise with a cold, or should you rest?

It's one of the most common questions we get during winter, and the answer isn't always straightforward.

In this Mini Consult, Dr Mathew Ah Chow explains the simple Above-the-Neck Rule, a practical guideline used to help determine when it's generally safe to exercise and when your body needs complete rest. You'll also learn how illness affects your immune system, why returning to training too quickly can increase your injury risk, and what you can do to recover faster and get back to doing what you love.

In this episode you'll learn:

  • The Above-the-Neck Rule for exercising when you're sick.
  • When it's generally safe to train with a cold.
  • The symptoms that mean you should avoid exercise completely.
  • How to return to exercise safely after illness.
  • Why sleep is one of the most powerful tools for recovery and immune health.
  • How regular exercise supports your immune system.
  • Why marathon runners and endurance athletes are more susceptible to illness after major events.
  • The truth behind the myth that cold weather causes colds.

Key Takeaway

If your symptoms are above the neck, such as a runny nose, nasal congestion or a mild sore throat, light to moderate exercise may be appropriate if you otherwise feel well. If your symptoms are below the neck, including fever, chest congestion, shortness of breath, vomiting or diarrhoea, it's time to stop training, prioritise recovery and let your immune system do its job.

Knowing when to rest is just as important as knowing when to train.

Have a question you'd like answered on a future Mini Consult?

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SPEAKER_01

Welcome to the Treatment Table Podcast. This is your mini consult. This is where I'm going to take one question or one topic and break it down into one easy takeaway. I'm your host, Dr. Physiotherapy Matthew Archow. So today I thought I'd break down a topic and a question that I get quite often, and it is quite timely as we're in the middle of winter, and it seems like everyone around me is getting sick. Kids are coming home from daycare and school, bringing bugs back. We've got some of our team members sick at the moment. And some of the questions I'm getting at the moment are: Can I train with a cold? Should I be resting? How do I know when to best restart my exercise program? And how do I prevent myself from getting sick? And how do I recover faster so I can get back to training as quickly as possible? So I thought I'd kind of break that down today and give you a bit of a rundown, a bit of guidelines of how to train when you're sick, when to stop and rest, and how to rebuild your immune system. Let's dive into it. So let's cover basically what tends to happen. Most people will either get a virus, a common cold. That's generally what we call rhinovirus. And that's more of an upper respiratory infection. That's kind of like your runny nose, your cough, your sore throat, a bit of a headache. The other thing that we would just want to flag is more of your flu. And that's been a little bit more serious. That can be more in terms of a lower chest infection, and that's more like your pneumonia. So the first kind of guideline I want you to think about is above or below the neck. This is just a really easy concept to kind of get through. If you've got cold symptoms, it's kind of think of your runny nose, sore throat. That's kind of okay where you can do some light exercise, some light recovery. Um, you don't want to be pushing yourself too hard. Anything below the neckline, thinking about, you know, if you're having fevers, if you've got a really heavy chesty cough, if you've got shortness of breath, any kind of like stomach type symptoms, nausea, vomiting, diarrhea, that's a definite stop. And that's where you need to rest. So that's your body telling you like signals you need to stop, you need to rest, do not exercise. If it's above the neck and you've just got a little bit of sniffly nose, you're still feeling okay, your energy is still good, you're not feeling really lethargic or fatigued, then you can still do some light training. But again, that's light to moderate, you're not doing any high-intensity training. So that's your above and below the neck guidelines. So use that as your guide. Just be conscious as well, though. If you are coughing, sneezing, you don't really want to be going to the gym, you know, go for a walk, get outside, um, but ideally not spreading your germs. So, everyone, please, that'd be lovely. Okay, so say you've got your cold, three, four days, you're feeling better, you may still have a little bit of a sniffle, a little bit of a cough. How do you then restart back into your exercise program? Now, a lot of the times people will go back to what they were doing the week before. What we're gonna think about is our body is still recovering and it's still repairing itself. So being sick is an added stress on our body and it takes energy to recover, our immune system has to work to rebuild. Exercise as well is a stress. So we think about exercise as a good stress because it provides us with the ability to adapt to that stress. But what we don't want to do is when you're in a recovering state, is add additional stress. So the intensity should be low to moderate. Anything below 45 minutes is a good gauge. We kind of don't want to push past 60 minutes. Again, it's just an extended period of stress. So stick to shorter workouts. Think about where you can still have that conversation. You're maybe a little bit out of breath, but we're not going into high-intensity sprints just yet. You want to give that a good week of just easing back into it for a few sessions before you start building. Same with weight training. Again, keep the repetitions at a higher level and the weights at a lower, just so you can get your body moving. You may have been resting, you may be in a bit of bed, or you know, sitting a little bit more. We just want to avoid those injuries, particularly winter, it's been a bit colder, you're not moving as much as you would during summer. So give your body that chance to get moving again, get warm, ease back into it, and that way you're less likely to have that injury. The other really important thing, and I feel like we talk about this every week, but it still comes back to our three-legged stools. You need to make sure you're sleeping well, you get that recovery. So, a little bit of backstory. It's quite ironic. But when we recorded the sleep episode, I had like I think four hours sleep that night because I got woken up by my daughter and I couldn't get back to sleep. So I was trying my best to uh caffeine my way through that day of work and then recording the next day. I got sick. And that took me three days to recover. So what's really important is maintaining your sleep. We do know that even if you get like 50% or less of your normal sleep, your immune system isn't functioning as well as possible. So you want to make sure get good sleep, go to bed early, set your alarm if you need to to remind yourself to start winding down. So I have on my phone, I have triggers as well. And um, Renel and I were talking about this before. Is if you need that reminder, put on your phone. Because sometimes, you know, you're watching TV or you're watching Netflix, time just kind of, you know, runs away. But you want to have that reminder to start to wind down, to get off your phone, get off the screens, and prepare yourself for a good night's sleep. We spoke about how important that is in the episode. So sleep, very, very important for our immune system. The other thing that's really important is regular exercise. So, touched on this a bit before. Exercise is a stress, but it's a good stress. And what we know through moderate and even to high-intensity exercises, it does trigger our immune system because it is a stress. Not to the point where it's bad, but it's a good thing. So it keeps our body on alert that if we do come across colds or viruses, we're in a better prime state to react to those.

SPEAKER_00

So it's strengthening your immune system a bit like much like weight training. You know, the the tears in the muscle are actually what is building the strength.

SPEAKER_01

Yeah, that's right. So again, exercise and weight training is the stress, and the response that we get is the benefit, right? And same thing with the exercise and our immune system, you know, add in that little bit of a stress, and I'll cover a little bit more when that stress goes too far. But we know through light to moderate exercise, again, that 45 to 60 minute episode, if you do that daily, we know that it boosts your immune system, it keeps it on track. And again, when you come across those viruses, whether it be a cold virus or a flu, you're in a better state to attack that. And your body can respond a lot quicker to that. But again, if you're not eating well and if you're not sleeping, that immune system's already lower. And with all the bugs that are going around now during winter, you want to be in the best state to kind of react to that because it's just everywhere. We're gonna come across these bugs. You want to be in a in a good primed immune system state. Where you can go too far, and with treating a lot of runners at the moment, is the long extensive run. So anything over kind of that, I said, hour, hour and a half exercise does cause excessive stress on our body. Now, normally that would be fine, but in terms of our immune system response, it does deplete it for a few hours afterwards. So you just gotta be conscious of that. If you do do a long, long run or a very, you know, endurance-based session, that you're gonna have periods where you're gonna be a little bit more vulnerable to you know different bugs. Um, and quite often we'll see post-event of marathon runs, um, you know, clients are getting sick because their immune system is lower.

SPEAKER_00

So for those people that are into that longer form endurance style of exercise, how long does it take for them to be able to build up back to that?

SPEAKER_01

Yes. So, you know, uh if you're feeling you got you got to base it on your feeling. How's your energy feeling? And if you do get sick, you know, post-event or you've been doing that um long endurance-based running, you wanna base it on obviously, again, make sure you're sleeping well, you're eating nutritious food and you're feeling good, your energy levels are coming back up. So if you're having to really force yourself through your runs or your exercise, that's probably a good sign that you're probably pushing a little bit too hard too soon, and you need to let your body recover, rebuild. Because what will happen if you don't listen, you will either prolong the symptoms and how long it takes, and then we know you're gonna be more likely to get injuries, tendon problems because you're just not recovering very well. So listen to your body, get your energy levels up first, and then rebuild slowly into those case, right? Start less than 45 minutes and then build into those longer runs again. So please take care of yourselves out in this cold. Oh, one more thing, my quick bug here, because this was drilled to me as a kid. Cold weather does not give you a cold. So even though it is cold out there, cold weather will not get you cold. As much as my mom will say, put on more jumpers. It is the bugs. Keep your immune system strong, make sure you're sleeping well, eating well, and training regularly. That's what's gonna keep you well. Um, a bit of cold weather will not make you sick. So the main takeaway from today is if your symptoms are above the neckline, you can do some light to moderate exercise. If it is below, stop, listen to your body and rest. And as always, the three-legged stool, please make sure eat well, sleep well, and keep training. That's a wrap for today's mini console. We'll see you next week on the treatment table. Please make sure you send us through your questions. You can send us a DM at Treatment Table Podcast or send us an email at treatmenttablepodcast at gmail.com. We'll see you next week on the treatment table.