Caring for Injuries
Caring for Injuries Even the man who takes to heart all the reasonable precautions outlined in the last chapter will at some point find himself wincing with pain. It''s the nature of athletics. You''re moving your body, exerting force, building speed, pushing your limits. When things are at their best, conscious thought melts away and the intuitive intelligence of muscles and nerves takes the controls. When you''re lost in the flow of movement, a conscious thought like, "Be more careful!" is not only unwelcome, it''s often counterproductive.
Then something goes wrong, the world blurs sideways, flow spatters into chaos and suddenly you''re looking up at what seems a strangely peaceful sky. Your intellect barges in on your subconscious neural party and asks what the hell is going on. "You''ve done enough harm," the brain tells the body. "Let me handle this."
What happens next is important. The brain has to know what to do, and the body has to go along with the plan—not just because you want the pain to stop but also because you want to repair whatever is damaged as soon as possible. To not deal with injuries actively is to risk not being able to do anything actively. "Most men who stop running permanently do so because of injuries," says Susan Kalish, executive director of the American Running and Fitness Association in Bethesda, Maryland.
The Big Picture
The two most common sports-injury categories are muscle injuries and tendon and ligament injuries, says four-time Mr. Universe Bill Pearl, trainer of ten Mr. Universes and eight Mr. Americas and co-author of Getting Stronger.
We''ll remind you of the basics.
* Muscles are groups of fibers that contract to cause movement. Muscles are attached to bones, other muscles or skin (contracting muscles is what makes you smile) and are responsible for all bodily movements and force. When abused, misused, overused or put to use without first being warmed up, muscles can tear, go into spasms or do any number of painful things.
A lot of blood flows through muscles to supply them with sufficient oxygen and nutrients to do their jobs, and also to sweep away waste products. This blood flow helps muscles heal quickly—in minutes, hours, days, weeks—depending upon the extent of the strain they were under.
* Tendons are among the body''s toughest materials. They are connective bands and cords that attach muscles to bones. Connective tissue doesn''t have much give, isn''t very rubbery, doesn''t care to stretch. So, when overly stressed, tendons rip loose from bone, or they tear.
* Ligaments—also made of tough connective tissue—envelop joint sockets, lashing opposing bones together firmly. As with tendons, ligaments can tear or separate from bone.
Tendons and ligaments have weak blood supplies, so they take much longer to heal when badly injured—as long as six months in some cases. Severe tears might take surgery to fix.
If you suffer a serious tendon or ligament injury, you must quit exercising the injured area. And you must be particularly careful when you resume exercising. And you can''t even think about restarting early, if you want to rebound quickly. "Injured ligaments and tendons often are pain-free long before they are completely healed," says E. Davis Ryan, P.T., owner of Community Physical Therapists in Fort Lee, New Jersey, and co-author of The Lazy Person''s Guide to Fitness. They need to be babied for at least six weeks, he says.
The Core Healing Routine
All injuries are unique and deserve lots of individual attention, but they''re also much the same. Because the body''s response to insult is fairly consistent, the steps a wounded warrior should take are similar from one injury site to another, notes David Janda, M.D., director of the Institute for Preventative Sports Medicine in Ann Arbor, Michigan. Even when a doctor''s attention is called for, you''ll usually want to first try these forms of aid to get some immediate relief.
Use the RICE stuff. It''s a classic, familiar formula for reducing swelling and pain, this acronym for Rest, Ice, Compression and Elevation (RICE). What''s less appreciated is that these four courses of action are grouped together because each takes a different approach to counteracting a single problem: the spilling of blood and fluids into the injured body part. This bloat-provoking leakage and the pressure it exerts—especially when it''s in a joint—can severely limit mobility and curtail your return to active life long after the pain has subsided, says Allan M. Levy, M.D., team physician for the New York Giants, partner at the Sports Medicine Center in Fort Lee, New Jersey, and co-author of the Sports Injury Handbook. Keep swelling down, and you''ll be back in action faster, with less pain and aggravation. According to Dr. Levy, the reason RICE works is that:
* Rest of the injured area keeps circulation to a minimum so that less fluid trickles out of broken or damaged blood vessels. It also reduces wear and tear on vessels, allowing them to heal and seal more quickly. "Rest" doesn''t mean just avoiding exercise, it means keeping the injured area as still as possible at all times, since even small movements will boost blood circulation.
* Ice constricts blood vessels, curtailing the flow of blood to the injury (and also deadening pain). Dr. Levy recommends filling a zip-lock storage bag with a mixture of ice and water: The ice keeps the injury cold, but the water keeps the temperature above 32 degrees, reducing risk of frostbite. Strap it on with an Ace bandage and leave it there no longer than a half-hour: Research at the University of Chicago finds that the healing effect of ice peaks after 25 minutes; after 30 minutes, there''s danger of damaging tissue and nerves. Avoid applying heat: "The current feeling is that you should only use heat when loosening something up immediately before going back into action after the injury has healed," Dr. Levy says.
* Compression squeezes the area, keeps blood from moving outside of the vein walls and also stanches the flow of fluid to keep swelling down. A snug bandage does the trick.
* Elevation makes it more difficult for blood to reach the damaged area. It also allows fluid that has accumulated at the injury site to flow down and away. Elevating the injury doesn''t just mean raising it higher than normal, but to a level higher than your heart.
Stretch for the future. Stretching is a foundation of prevention and treatment alike, for similar reasons: Tight muscles curtail movement, effectively reduce strength and, significantly, leave themselves vulnerable to becoming injured again, says Dr. Levy. The problem here is that when you damage muscles, they react involuntarily by contracting, or shortening. It''s a protective mechanism short-term, but long-term, muscles that aren''t gradually lengthened again will heal in their shortened state. When you resume activity, these shortened muscles will more easily tear than when you first got injured—that is, unless you stretch. As a rule of thumb, you''ll know you''re ready to resume activity when you can stretch the injured muscle as far as you can the same, uninjured muscle on the other side of your body without pain, says Levy.
Pop the right pill. You''re in pain, you want relief, you open the medicine cabinet. What to choose? For injuries, the pain reliever of choice is ibuprofen, the main ingredient of familiar brands such as Advil, Nuprin and Motrin IB, says Dr. Janda. Ibuprofen is an anti-inflammatory, which means it reduces swelling and with it, pain. If you don''t have any on hand, try aspirin, because it also has anti-inflammatory properties, suggests Dr. Janda. Aspirin interferes with blood clotting, however, so it shouldn''t be taken in large doses during contact sports, Dr. Levy notes. The last choice is acetaminophen medications such as Tylenol, which kill pain, but do little to reduce inflammation. (They do, however, provoke less stomach irritation, if that''s an issue for you.)
Serious or Minor
Some injuries sideline you for a day, a week. But with smart care, you''re back in business fast enough that you''ve lost hardly a step.
And then there are injuries. Broken bones, ligament tears, repetitive stress injuries that threaten to sideline you long enough to degrade your overall fitness level, not to mention your mental state, says Dr. Levy.
The strategy for dealing with small and big injuries is the same. You use the same first-aid method in the moments after the injury: RICE. Applied quickly, RICE greatly lessens the damage and recovery time required in most cases, says Dr. Levy.
You also use the same recuperation strategy: Do everything you can to let the injury heal as quickly as possible, then do everything you can to get the injured part back to where it was, or even better, in terms of flexibility and strength, says Dr. Janda.
Other truisms exist for injuries, no matter where they occur: For example, a pulled muscle needs to be worked—stretched—as it heals; torn ligaments or tendons need to be left alone, advises Dr. Janda.
The final truism is that while each injury should be treated uniquely, the same dozen or so happen over and over and over. "Most of the injuries I see are in just a handful of areas," says Dr. Janda. We bet you know right where they are. Here are some specific healing techniques for those places that typically take the most punishment.
Rehab Programs for Weight Lifters At age 65, four-time Mr. Universe Bill Pearl, trainer of ten Mr. Universes and eight Mr. Americas, still gets up at 3 a.m. and begins a 2 1/2-hour workout. "I only train six days a week; I don''t want to get fanatical about it," he jokes. Training six days a week, Pearl knows that injuries are inevitable. And he knows how to use weight training to speed rehabilitation from injuries. Below are two programs: one for injured muscles, one for injured tendons or ligaments. Muscle injuries take less time to heal than injuries of connective tissues. Plan accordingly. Rebounding from Muscle Injuries Don''t do any strenuous exercise until the swelling has gone down. The amount of time this takes will vary based on the extent of the muscle pull or tear. Once the swelling and pain have diminished, Pearl advises full-range-of-motion exercises, mimicking the weight-lifting movements of a well-rounded lifting program, like our Core Routine, but without any weights. Only when you can do that without pain should you begin weight lifting again. Of course, begin with lighter than usual weights, lifted a few days a week. Select a weight in the light to medium range for your training level. This program, he says, causes injured muscles to flush with fresh blood, rebuild tissue and clear away wastes. The intention in this training program, he says, is to rebuild strength first, then endurance. * First week. Do one to three sets of 15 reps with lighter than usual weights. When this is comfortable, increase weight to rebuild the strength you lost during the time the injury had you sidelined. * Second to fourth weeks. Increase weight again until you''re above your former strength level. Just getting back to the former level is not the goal. "You weren''t strong enough then to prevent the injury, so now you must make the muscles stronger to prevent further injuries," Pearl says. For serious weight lifters, move up to six sets—the first three sets at ten, eight and six reps, the next three at eight, six and four. After a month, you can work back into your regular program. Rebounding from Tendon/Ligament Injuries You must listen closely to your body in this program, so that what you do is healing and not hurting. Tendon and ligament injuries are easily irritated. The key in this training is to avoid straining and to do only a few reps, says Pearl. As with the muscle program, only begin working with weights when the swelling has subsided and you can go through the full range of motion without pain. This is a six-week program, three days a week, of a well-rounded program like our Core Routine. * First two weeks. Do one to three sets of eight to ten reps with medium weights. Don''t overdo it and don''t strain. You need to quit while feeling you could do at least two or three more reps. You may experience some tenderness and swelling after this workout. If it doesn''t ease up before the next workout, lay off until it does. Then reduce the weight and number of sets and try again. * Third and fourth weeks. Slowly up the weight and number of sets. Do three to six sets of reps in this order: ten, eight, six, ten, eight, six. Stay with these until you have nearly no injury-related swelling or soreness after the exercise. * Fifth and sixth weeks. Build strength. Increase weight and effort to the point where it is difficult to reach the targeted number of reps for each set. Do three to six sets of reps in this order: ten, eight, six, ten, eight, four. At the end of the program, return to your regular routine. A couple more general pointers from a weight-lifting pro who not once, but four times, ruled the body-building universe: * Always warm up, get the blood circulating, raise the body temperature, work through range of motion before tackling the heavy weights. * Always start small. Begin with a light weight and add resistance with each set. The world champions do. They don''t head for the big weights on their first set. |
Wrist
Let''s see, how could you possibly injure your wrist? Does the alphabet start with A? There''s aerobics, baseball, basketball, boxing, carrying, discus throwing, egg tossing, football, golf . . . you get the point.
Wrists are particularly prone to overuse injuries and repetitive-motion injuries, says Dr. Levy, as well as sprains and even fractures from sticking your hand out to break an unexpected fall.
Sprains are the most common wrist injury, says Dr. Levy. He x-rays all but the mildest wrist sprains because a sprained ligament sometimes pulls loose a bit of bone, causing a fracture. A fractured wrist needs to be encased in a cast. A sprained wrist usually heals well in a soft splint.
Primary treatment of a sprained wrist is the standard RICE prescription. A wrist-support splint available in drugstores helps immobilize it during the rest phase. Then, as it heals, begin building strength and flexibility with these range-of-motion exercises. Dr. Levy recommends taking an anti-inflammatory medication through the first ten days of physical therapy. Among the exercises he advises:
Grip Strengtheners
Squeeze a small, soft rubber ball, putty or a not-too-resistant grip strengthener until your hand is fatigued, suggests Dr. Levy.
Wrist Rolls
This exercise was also described in Arm Joints on page 56. Tie a light dumbbell to a three-foot long rope or chain. Firmly tie the other end of the rope to the center of a broom handle or hefty dowel. Stand upright with your feet shoulder-width apart. Hold the handle at shoulder height, with your hands shoulder-width apart, palms down, and roll the rope up on the handle, using the handle as a spool. When the weight has reached the top, lower it back down again. Continue until fatigued.
Tennis elbow doesn''t sound like a wrist injury, does it? But actually it is an inflammation of muscles in the forearm—the muscles involved in moving the wrist—and an inflammation of the tendon tying the muscles to the elbow, says Dr. Levy. When you have a serious case of tennis elbow, you can''t open a jar, turn a faucet, lift a cup of coffee, clench anything or squeeze with your hand without hot pain shooting up the inside of your arm or radiating around your wrist and elbow.
Baseball pitchers get something similar to tennis elbow from snapping the ball. But in this case, it''s on the inside of the elbow. (Sometimes they get much more serious pitcher''s elbow—a bone injury—which requires arthroscopic surgery and takes up to a year to heal.) Golfers get tennis elbow, too, but on their nondominant side. A right-handed golfer will find his left side affected.
The treatment for tennis elbow is exactly the same as that used for a wrist sprain, which is described above.
When to see a doctor: As Dr. Levy notes, even a minor wrist sprain should be looked at, given the possibility of it developing into something worse. If you have any pain that is recurring in your wrists, you could have a repetitive stress injury. Given the delicacy of the joint and the importance of your hands to all existence as you know it, when it comes to wrists, don''t play tough—get to a doctor if you suspect anything is wrong.
Wrist Curls
This is a variation of the forearm curls described in part 2. In the Sports Injury Handbook, Dr. Levy recommends holding a comfortable weight (five pounds or less) at your side. With your elbow locked and your palm facing forward, roll your wrist as far forward as it will go comfortably and then let it back down slowly. Repeat to muscle exhaustion.
Reverse Wrist Curls
Same as above, except your palm faces backward. Flex your wrist forward as far as it will go comfortably, then let it down.
Elbows
If you''ve ever spent an afternoon on the tennis court, golf green or baseball diamond, you appreciate how susceptible this versatile joint is to overuse injury. Use the following stretches as soon as you begin to feel any soreness or pain in your elbow, says Dr. Levy. You don''t have to wait until pain strikes to do them, however. These and other exercises can pre-condition your elbow and help you avoid painful joint problems entirely. Check it out.
When to see a doctor: Severe problems are usually the result of a hard blow (or a series of traumas). Get checked out if you have a persistent "funny bone" feeling of numbness or tingling at the tip of your elbow: It may indicate a nerve injury, says Dr. Janda. Also seek attention if you develop small bumps that protrude from your elbows (Popeye had this problem): You may have fluid buildup from a form of acute bursitis.
Elbow Relief Stretches
Regardless of what side of your elbow hurts, do both of the following stretches. This will balance the muscles, says Dr. Levy. Stand alongside a wall and extend your arm straight to the side. Press the back of your hand against the wall, fingers pointing down. Keeping your hand pressed down, raise your arm higher on the wall until you feel a stretch in your forearm. Hold 20 to 30 seconds.
Next, place your palm against the wall, elbow straight, fingers pointing down. Keeping your palm pressed down, raise your arm higher on the wall until you feel a gentle stretch.
Here''s an alternative wrist stretch: Extend your arm straight out in front of you so that it''s parallel to the floor. Your elbow should be locked, your palm facing down. Use your other hand to pull your extended hand down toward the floor.
Knees
Because it''s such a complex joint that depends on bone, ligaments, tendons and fluid to work properly, the knee is one of the most frequently injured parts of the body.
The most common form of overuse injury is runner''s knee, in which the kneecap, which normally rides in a groove when the knee bends, becomes misaligned and rubs on the side of the groove. The problem is caused by overpronation of the foot, which may require orthotics to correct.
In the meantime, if you are exercising and your knee starts to hurt, immediately stop and call it quits for the day. If there''s swelling or pain, apply the RICE method. You can remedy a minor case of runner''s knee yourself by strengthening your quadriceps muscles to better support your knee and gradually pull your kneecap back into alignment. To do this, you''ll need to do modified leg extensions, says Dr. Levy.
A second common knee problem is a ligament sprain from making a too-quick pivot, landing wrong from a jump or twisting your leg in a gopher hole. Sprains take time to heal. In the short term, use the RICE method to aid the healing process. If it''s a minor sprain, it will heal on its own, but you will want to put the knee through its full range of motion and work on strengthening your leg muscles to prevent a recurrence, says Dr. Janda.
For a good stretch, use your hand to pull the foot of your injured leg up so that the heel presses your buttocks. Also, do modified leg extensions.
When to see a doctor: There are a number of knee injuries that are every bit as nasty as they sound: torn cartilage or ligament, a dislocated or broken kneecap. To separate the serious from the merely painful, Dr. Levy offers this rule of thumb: "If you receive a blow," he says, "and the pain is on the same side of the knee that was hit, it''s probably just a bruise, and the pain will go away rapidly. If the pain is on the opposite side, consider it a serious injury." That means get to a doctor.
Modified Leg Extensions
Sit in a chair and extend your injured leg straight in front of you, parallel to the floor. Next, place a footstool, box, bucket or similar object under your foot to prevent your leg from dropping any lower than six to eight inches when lowered. Why? Doing a leg extension through the knee''s full range of motion will make the problem worse, while doing just the uppermost 30 degrees of motion will make it better. If you wish to add resistance, put some ankle or free weights in a gym bag and slide your foot through the handle so you can use the bag as a weight.
Ankles
The ankle''s strengths are also its weaknesses. It provides movement in lots of different directions: up, down, back, forward, side-to-side. That allows crucial mobility for the feet and legs, but in a rare instance of seemingly careless design, it also makes a critical component of balance and stability inherently unstable.
The ankle injury you can do something about is the mild sprain, in which the fibers of the ligament become partially torn, usually from rolling too far off the outer part of your foot. Immediately apply the RICE method.
One method of icing involves dunking the foot in a bucket or small trash can of ice water. This isn''t necessarily a pleasant prospect, but it''s good medicine, says Dr. Levy. Another makeshift method is to use an athletic bandage to wrap and hold a bag of frozen peas around your ankle. Ice for 20 minutes on, 20 minutes off, for two days or until the swelling is gone.
Between icings, and while sleeping, keep your ankle compressed with an athletic bandage, but not so tight that you completely restrict blood flow, says Dr. Janda. Prop it up with pillows to elevate it above the level of the heart.
As with the knee, begin putting your ankle through range-of-motion and light strengthening exercises as soon as possible, says Dr. Levy.
When to see a doctor: Ankle sprains and breaks are difficult to differentiate (the more dire fractures sometimes feel less painful), so everything but the most mild sprains should be taken to a doctor for an x-ray. Clues that the injury is serious include swelling that keeps getting worse or doesn''t go away after 72 hours, or not being able to walk, says Dr. Levy.
Ankle Strengtheners
Tie a piece of rope about 1 1/2 feet long in a loop through a ten-pound weight and drape the loop over your foot (make sure you have shoes on). While sitting on a counter or stool, use your ankle to lift the weight as many times as you can. If you can, also try moving the weighted foot from side to side.
Alphabet Stretch
For improved range of motion, sit on a high chair or with your legs crossed so that the injured ankle is off the floor. Trace the letters of the alphabet with your foot, keeping your toes straight so all motion comes from the ankle.
Shoulders
Apparently, if God had meant for us to swim and play tennis, football, baseball and volleyball, he would have given us more shoulder ligaments. As it is, the few that exist are weak, so there''s little support for the shoulder when you make forceful movements with your arm over your head.
The common microtraumas that give us sore shoulders are easily remedied with some gentle stretching, icing and anti-inflammatories, says Dr. Janda.
The main overuse shoulder problem is a rotator cuff injury, an inflammation of the tendons that help hold the shoulder in place. If pain is flaring up, stop what you are doing and, if you sense an injury, apply the RICE method, advises Dr. Levy.
The main treatment for minor rotator cuff injuries is conditioning the shoulder muscles with any number of exercises, says Dr. Levy. If you do any kind of regular workout, the format of these exercises will seem comfortably familiar.
But remember: When you''re dealing with a shoulder injury, you want to use light weights—15 pounds or less—much lighter than the moderate to heavy weights you normally would use. Once you''ve repaired the damage and conditioned your shoulders, then you can slowly start adding more weight, Dr. Levy says.
When to see a doctor: You should see your doctor if it feels as if your shoulder has come out of its socket or you can''t move your shoulder or raise your arms above your head.
Gentle Shoulder Stretch
Stand in a doorway and hold onto the doorjamb at about shoulder height with both hands. Move forward through the door so that your arms are pulled behind you and your elbows are straight. When you feel a gentle stretch in your shoulders, hold for 30 seconds. This is a very versatile stretch that you can do anywhere. Plus, by slightly modifying this exercise, you can also stretch your chest muscles (see City Living on page 257).
Biceps Curls
Do a biceps curl, holding a light dumbbell at your side with your palm facing forward. Bend your elbow to bring the weight to your shoulder, then slowly lower to the starting position. Repeat 50 times or until fatigue sets in. Next, try the same move, but with your palm facing rearward at the starting position.
Straight-Arm Lifts
Hold a dumbbell at your side, your palm facing rearward. Keeping your arm straight, lift the dumbbell in front of you, raising your arm no higher than parallel to the floor. Slowly return to the starting position. Then try the same move, but with your palm facing forward at the starting position.
Side Lateral Lifts
Hold a dumbbell at your side, your palm facing your body. Keeping your arm straight, lift the weight out to your side, raising your arm no higher than parallel to the floor, then return to the starting position. Repeat 50 times or until you tire.
Back
Back problems tend to feel worse than they are. You may swear you have a blown disk and need sophisticated surgery, but actually at least 90 percent of cases are nothing more than spasms of weak or overloaded muscles. The fact that you can usually treat yourself is the somewhat tarnished silver lining in what''s otherwise a state of abject misery.
When back muscles spasm, the immediate goal is to get them to relax. Try the postures and stretches below, says Dr. Levy. RICE may also work, as might
