Preventing Injuries
Preventing Injuries By now, most of us know it''s a mistake to think that striving for power and stamina means gasping and grunting during workouts and suffering with throbbing muscle aches later. "No pain, no gain" has become such a thoroughly discredited piffle of an axiom, it hurts just to mention it.
And yet, there''s no escaping the fact that gains make pain more likely, if not from overexertion, then from injuries that all too often accompany sports and exercise. It''s not that we''re willfully trashing ourselves, it''s that stuff, you know, happens. But injuries aren''t just happenstance: Most of the time, we set ourselves up for them. "A vast number of injuries are completely preventable," says David Janda, M.D., director of the Institute for Preventative Sports Medicine in Ann Arbor, Michigan.
Most injuries involve damage to what we think of as hard muscles, but what doctors refer to as soft tissue—namely pulls and strains. "Soft" refers to the fact that muscles are pliable, stretchable and bendable, which overall makes them pretty forgiving. Still, you have to respect their limits, not only to avoid short-term pain and inconvenience but also unforeseen trouble down the road. "Many injuries can have long-term ramifications physically and economically," Dr. Janda says. "I see people all the time who complain about injuries they got 25 years ago." If you avoid injuring muscles, you''ll likely avoid damaging tougher parts of the body as well, such as bones, tendons and ligaments.
Becoming Injury-Resistant
If you''ve read most of the other chapters in this book, you realize that respect for the body''s limits drives a lot of the concepts and principles we''ve discussed throughout. Here''s a roundup of the most crucial ways to keep your body in action and your program on track.
Progress gradually. None of us likes being told to take things easy, but you simply can''t rush your gains. Pushing your body harder than it''s ready to be pushed results in damage, whether it''s tiny tears that make your muscles sore, or larger traumas like lower-back spasms. This is a critical point to remember for anyone beginning a new routine or sport. "For example, on a long-distance, multi-day bicycle tour, we found that people with the least amount of training had the most injuries," says Andrew Dannenberg, M.D., assistant professor at the Injury Prevention Center of Johns Hopkins University School of Hygiene and Public Health in Baltimore.
Warm up. "Without question, inadequate warm-up is the major cause of injury," 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. Muscle fibers are like rubber bands: When they''re cold, they''re stiff and liable to tear. Warm muscles up, and they''re not only more pliable but they also contract faster and, in effect, become stronger. Higher body temperature also lubricates joints better and improves muscle cells'' ability to convert oxygen and glucose to energy. You just need to raise your body temperature about two degrees—enough to break into a light sweat—by doing light calisthenics, jogging, riding an exercise bike, walking briskly or whatever it takes.
Then stretch. Warming up and stretching go hand-in-hand, Dr. Levy says, and should be considered two parts of a single process. Once muscles are warmed, stretching them increases flexibility, further reducing risk of injury. (For more on stretching, see Flexibility on page 32.)
Use safety gear. A lot of injuries come from a lapse of common sense, Dr. Janda says: not wearing a helmet, for example, when doing sports in which it''s common to crack your head. It''s an obvious point, but one that''s often lost in the interests of feeling the wind in your hair, avoiding hassles, not looking dorky or what have you. The sheer number of headbangers dragged into hospitals every year shows that such temptations take far too great a toll on basic safety measures.
Learn the right moves. Dr. Janda believes that if we all possessed the fundamental skills and understood the basic forms and techniques of our sports, the vast majority of sports injuries would vanish overnight. True, you have to learn by doing, but you can also learn by watching more seasoned participants or reading books and magazines.
When muscles talk, listen. "Don''t work through a pain," Dr. Levy says. "If it''s persistent, something''s wrong and you need rest or treatment." Underline persistent for those times when a little discomfort is part of the deal. "If you''re running and feel lousy for the first mile, you can stick it out if you feel better in the second mile," Dr. Levy says. "If you feel worse in the second mile, go home."
Training Pain-Free
The fact that different sports require specific forms of training means that each also involves particular types of injuries—and particular ways to avoid them. Here''s how to protect yourself when doing three popular forms of exercise in which speed, balance, high impact or a combination of the three results in an unusually steep rate of injury.
Running
Take a freeze-frame of a runner in midstride and what do you have? A guy who''s airborne. A guy who''s about to land on one foot with all his body weight, multiplied two to three times by the forces of gravity and forward momentum. With this kind of hammering, it''s no surprise that when a study followed participants in an Atlanta 10-K race for ten years, 53 percent reported being injured. Here are some things you can do to improve your odds.
Factor in some walking. Being much easier on muscles, joints and tendons, walking is a smart addition to a running routine, especially if you''re just starting. "Think in terms of time, not distance," Dr. Janda advises. "Alternate a fast walk for five minutes with a light run for five minutes, then walk again. The next time you go out, alternate running seven minutes and walking five, and gradually increase your intensity that way."
Wear true running shoes. Running is one of the few sports that cries out for sport-specific footwear. Running shoes cushion the impact of planting your feet and help keep you rolling smoothly from one stride to the next, Dr. Dannenberg believes. (See Buying Shoes on page 320.)
Think smooth and soft. Try to run on even surfaces; running on a pitted, pitched or gnarly path is an invitation to ankle twists and sprains. Also, when possible, run on soft surfaces such as dirt, groomed grass or packed wood chips, which cushion the stresses of running more than hard surfaces like asphalt, says Dr. Dannenberg.
Body-Temperature Injuries You don''t need to smash, twist or grind your body to get it into trouble. There''s also danger of damage that starts from the inside out. Let your body temperature swing too far to either end of the thermostat and you''ll be facing potentially deadly problems. Here''s how to keep your thermostat set in the temperate zone. * Hypothermia comes about when low internal temperature interferes with the body''s ability to regulate vital machinery like metabolism and heartbeat. One key factor is getting wet, which vastly increases heat loss in the cold. Wear clothes that wick moisture away from the body rather than holding it close to the skin. Polypropylene underwear is better than cotton in cool weather. "Avoid cotton—it''s miserable when wet," says Andrew Dannenberg, M.D., assistant professor at the Injury Prevention Center of Johns Hopkins University School of Hygiene and Public Health in Baltimore. Another key factor is loss of energy. When you''re active, body heat generally makes up for lost warmth, but you should head for shelter once intensity—and body heat—dwindles. * Heat exhaustion is a supply-and-demand problem: Muscles and skin, which compete for fluids from the blood, become understocked in the face of extreme heat and/or humidity. Obviously, not exercising in extreme heat or humidity will solve a lot of problems. Schedule hot-day activity before 10 a.m. or after 3 p.m. Wear loose-fitting clothes, drink lots of fluids and realize that muscle cramps, goose bumps, fatigue and lightheadedness are some of the first signs of trouble. |
Bicycling
"There are between 800 and 1,000 bike-related deaths a year, but these are the tip of the iceberg in terms of total injuries," says Dr. Dannenberg. Here''s how to ride safe.
Don''t flip your lid. Most of the deaths Dr. Dannenberg refers to are from head injuries sustained in crashes. Insurance against this ugly eventuality comes in two parts. The first, of course, is not to take your head for a ride while your helmet languishes in your hatchback. The second is not to crash. Keep loose items (bags, shoestrings, arms of outerwear you''ve removed) out of spokes and chain rings. If you''re riding on the pavement, watch out for unexpected obstacles such as opening car doors; if you''re off-road, keep your speed within your abilities.
Pedal fast. Common sense says straining against the resistance of a high gear could make you more susceptible to overuse injuries. Spinning at lower gears tends to reduce strain and propel you more efficiently. Save the high gears for when you have sufficient speed to keep each pedal moving at the recommended 80 to 100 revolutions per minute for non-racers and 100 to 150 for racers, says Dale Hughes, director of the Walden School of Cycling in Rochester, Michigan, and chairman of the National Off-Road Bicycling Association.
Have a fit. If you do a lot of riding, it''s common to experience knee and back pain from improper positioning on the bike. Ask a bike shop mechanic to check the position of your saddle, handlebars and pedals, says Dr. Janda.
Support your back. The leaned-over stance used when riding both road and mountain bikes can put strain on your lower back. To shore up your torso, strengthen your gut muscles (which provide most of the spine''s support) with abdominal exercises such as crunches two or three times a week, says Dr. Janda.
The Perfect First-Aid Kit It''s part of the nature of accidents and mishaps that you''re not prepared for them. After all, if you knew it was going to happen, it wouldn''t have happened. That''s why it makes sense to have handy a kit of ointments, balms and patches at all times: While wincing at the stupidity (and it''s always something stupid, isn''t it?) that left you with an abrasion, contusion or unintended incision, you can draw some comfort in the fact that you were smart enough to bring tools. Here''s what to include, as recommended by Eric A. Weiss, M.D., associate professor of medicine at Stanford Medical Center and board member of the Wilderness Medical Society. For Relieving * Ibuprofen tablets (Motrin, Advil), for reducing inflammation from sprains and strains, and reducing the pain of headache and sunburn * Benadryl or other antihistamines for hay fever, poison ivy, rashes and bee stings * Pepto-Bismol or (if allergic to aspirin) Imodium for sudden stomach trouble * Aloe vera gel for minor burns and frostbite * Spenco 2nd Skin Dressings, moleskin and molefoam, for blisters For Cleaning * A ten cubic centimeter irrigation syringe with an 18-gauge catheter tip, for use as a squirt gun to flush dirt and microorganisms * Neosporin or another triple antibiotic ointment * Antiseptic towelettes with benzalkonium chloride, for swabbing For Patching * Sterile dressings (two- by two-, three- by three-, and four- by four-inch) * Sterile eye pads * Sterile gauze bandage * Assorted adhesive bandages * Elastic bandage * Wound closure strips or butterfly closures for pulling wound edges together * Tincture of benzoin for making adhesive bandages, wound closure strips and moleskin all stick better For Technical Assistance * Tweezers * Tape * Safety pins * Blunt-tip bandage scissors, for cutting cloth * Waterproof matches * A pencil and writing paper in a sealed plastic pouch * Small first-aid book * Epi-Pen, for injecting a single dose of epinephrine in case of severe allergic reaction to bee stings or food (prescription required) * Latex surgical gloves and CPR Microshield, to protect against infectious diseases like AIDS |
In-Line Skating
Before taking up in-line skating, "make sure your primary medical bills are paid," says Bob Gollwitzer, owner of the Skaters Edge shops in Philadelphia and director of the Sport and Competition Council of the International In-Line Skating Association (IISA). He''s joking, sort of. "It can be a dangerous sport, no doubt about it," he says, not laughing this time. The most recent IISA figures put the annual injury tally at 76,000. According to the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, almost 70 percent of in-line skating injuries are fractures, dislocations, sprains, strains and "avulsion," a fancy term for being torn limb from limb. Here''s how not to be.
Wear a helmet. Only about 5 percent of in-line skating injuries involve head damage, but no type of trauma poses a higher risk of lasting disability.
Be well-padded. Don''t stop with the helmet. "In-line skating is one activity where appropriate protective gear really involves a whole range of things," Dr. Dannenberg says. In fact, what really gets massacred in falls is the wrist, which accounts for a whopping 37 percent of injuries—a rate four times higher than the next-most-common injury site, the elbow. Research at the CDC finds that wearing wrist protectors cuts your odds of injuries such as lacerations, sprains and strains considerably. The other parts of the recommended ensemble are elbow and knee pads.
Take a lesson. "The backward fall is the most dangerous kind, and it''s most common in beginners," says Gollwitzer. "Braking, striding, gliding and falling are four critical things every skater needs to know how to do, and taking a lesson at the start will instantly push your skills two weeks ahead of where you''d be on your own."
Keep your head up. Looking at the horizon gives a power-assist to your sense of balance and keeps your center of gravity over your toes. "If you watch your feet, you completely throw off your balance," Gollwitzer says.
Stay off the streets. If you don''t have a local park to skate in, take to the access roads that feed corporate or industrial parks, which are largely traffic-free after-hours and are usually laid out in circular paths or loops.
The Swaddle Factor You''ve seen these guys in locker rooms, whipping out their roll of cloth tape and swathing their knees, ankles, elbows until they look like an extra from The Mummy. Looks impressive, but does it do any good? "The idea is that by restricting motion, you reduce your risk of injury," says David Janda, M.D., director of the Institute for Preventative Sports Medicine in Ann Arbor, Michigan. But wrapping is useless on knees and elbows. "There''s no indication that wrapping these joints has been of value to any athlete I''m aware of," Dr. Janda says. The only place wrapping really works is the ankle, which is particularly vulnerable to sudden, traumatic movements in a number of different directions. Still, Dr. Janda is cautious about advising anyone to wrap his own ankles, because the protection you assume you''re gaining may simply not be there. "You need to take the structure of the joint into account," he says. "Besides being difficult to do it properly on yourself, there''s a method and a technique to wrapping, and it really needs to be done by a second, trained individual." he best form of injury protection, he emphasizes, is strengthening and stretching exercises that keep muscles well-conditioned. With any luck, you''ll never need a wrap for what they can actually be useful for: treating injuries. |
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