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The IFPA is pleased to announce the release of the newly
revised IFPA Post-Secondary Rehabilitation Specialist
Certification Course and the new, Second Edition of “Anybody’s
Sports Medicine Book” (The Complete Guide to Quick
Recovery From Injuries), by James G. Garrick, M.D.,
Peter Radetsky, Ph.D. and James T. Bell, Ph.D.,
copyright 2008.
The following is an excerpt from the
Introduction of “Anybody’s Sports Medicine Book”:
CHAPTER ONE
Some Do’s, Don’ts, Truths, and Misconceptions
THERE ARE THREE LEVELS of athletic injuries. The
first involves getting in shape. Almost all the
problems at this level come under the category of muscle
soreness. Usually these problems are magnified beyond
their real significance because at this level you’ve
probably never hurt anything before and don’t know how
to interpret the pain you may be feeling. Part of
becoming an athlete is learning to put up with being
injured. But if you’ve never been hurt, probably because
you’ve never stressed anything hard enough to injure it,
you won’t know what to be worried about and what to
ignore. It’s easy to make the wrong decisions. You may
go to the doctor for a problem that means nothing and
ignore something that a doctor really should see. You
may wake up in the morning, not be able to get out of
bed, and think you’re in real trouble; but it may be
nothing more than the result of doing too much
stretching the day before. Or you may walk around for
days with a ligament tear that needs attention. People
at level one simply have no good frame of reference.
Stick with your athletic activity long enough, and
you’ll find yourself at level two: learning the
activity. Once you get in shape, once you learn to
handle muscle soreness, and shinsplints, tendinitis, and
the rest of the common initial injuries in sports,
you’ll find yourself facing a second constellation of
injuries that occur while you’re learning your activity.
Each activity makes its own particular demands on the
body, and, once you’ve gained a general sense of what
your body can and cannot do, you must learn how to
handle these specific demands. That process takes time.
For example, 60 percent of all football injuries occur
before the first game, while the players are
trying to adapt to the particular needs of the sport. In
time you’ll learn how to do the things that work and not
do the ones that hurt. Figure skaters, for example,
learn how to fall. Instead of stretching out their arms
to break a fall and ending up with a broken wrist,
skaters learn to crumple onto the ice and take the shock
on their rear ends, where they’re well padded.
The third level involves the risks of actually
performing the activity. Some injuries are simply
more likely to occur from performing particular
movements. Baseball pitchers, for example, often
develop arthritis and lose motion in their elbow joint
from throwing so much. So the question is, as you pass
through the various levels of injury, what can you do
about them? Most people go to the doctor. If you do,
you’ll want to find a doctor who knows your activity
almost as well as you do. If not, many of these injuries
can be puzzling to someone trying to treat you. If
you’re a right-handed person who throws things—a
quarterback or a pitcher, for example—and you have a
sore right knee, you’ll probably begin to deliver the
ball differently because you won’t want to hurt the knee
even more. You may release more quickly, start depending
more on your arm, so you don’t have to come down on the
knee with any force. That can lead to other problems—a
sore elbow, say, or an injured shoulder. And the new
injury most likely won’t go away until you return to
your old delivery. Unless your doctor understands the
dynamics of your sport, and so can see that treating the
elbow injury involves clearing up the knee problem
first, little will change. Sports medicine is a world
unto itself.
INJURY TIP-OFFS
There are some general tip-offs that are common to all
these chapters, things to be aware of while you’re doing
whatever it is you like to do. The helpful thing about
sports injuries is that, with the exception of back
problems, you always have the uninjured side for
comparison. So for all the symptoms we’re about to
discuss, use your uninjured side as a barometer. If your
ankle just doesn’t feel right, but there’s nothing
obviously wrong that you can point to, compare it with
the other side. Is it swollen? Does it feel weaker? Are
you less able to bend it? If the answer to these
questions is “yes,” then you may have a problem.
Some injuries are immediately evident. You know when
you’ve hurt yourself; you know what the consequences
are. Other injuries—most of them, really— sneak up on
you. They may be even more serious in the long run, but
they can be harder to identify in the beginning. The
subsequent chapters deal with both kinds of injuries in
detail. In general, though, there are six general signs
of injury that you shouldn’t ignore, no matter where
they appear:
1. Joint pain. Don’t ignore joint pain,
especially in those joints not covered by muscles—the
knee, ankle, elbow, and wrist. Muscle pain may not be a
significant problem. If muscle pain doesn’t come on
rapidly, it may be no more than a bit of soreness from
overdoing your activity. But joint pain can be another
story. If it lasts more than a couple of days, you’d
better see a doctor.
2. Tenderness at a specific point. Does it hurt
when you push your finger against a particular spot? If
you push against a bone, a joint, or a muscle, and it
really hurts, but the corresponding area on the other
side doesn’t, you may have a problem that requires
medical attention.
3. Swelling. Sometimes swelling is obvious—your
ankle looks like a softball, or your wrist is twice as
fat as the other one—but sometimes
swelling is not obvious at all. Sometimes you feel
swollen long before any thing seems to show up. The
knee can be that way. Often people have a tough time
noticing swelling in the knee, even though the joint may
feel funny. Here’s where comparing it with the other
side can be invaluable.
If the swelling is obvious, often other things will
start to go wrong as well. Body parts don’t slide over
one another as well as they should. Your knee, for
example, may develop a clicking sound, as the tendons
start snapping over each other because they’ve been
pushed into different places by the swelling.
4. Reduced range of motion. If you can’t see or
hear any signs of swelling even after comparing the
injured area with your other side, check for reduced
range of motion. If there’s any significant swelling, in
all likelihood you’ll lose the extremes of motion. Can
you straighten out your knee as far as on the other
side? Can you bend it as far? Or if you can, does it
feel odd at the extreme of motion? And is there pain
that keeps you from straightening or bending it all
the way, or is there a definite block? If the
latter, something (a piece of cartilage, for example)
may be in the way.
5. Comparative weakness. Look for weakness
compared to the other
side. Sometimes weakness is hard to notice, a little
more subtle than
swelling or reduced range of motion. One way to identify
weakness in the legs is by going up and down stairs. Is
this harder on one leg than the other? And, of course,
if you have access to a weight facility, you can test
your strength by comparing your lifting on one side to
that of the other.
6. Numbness and tingling. Never ignore these
sensations. They’re the kind you get when you hit your
crazy bone, or when you sleep on your arm and wake up
with it feeling dead. If you can’t readily explain such
a sensation, it’s usually an indication that you have a
problem that requires your doctor’s attention.
With all these signs of possible injury, first look for
an obvious external cause. A crease in a figure skater’s
boot can cause pain in the front of the ankle. Tying
toe-shoe ribbons too tightly can give a ballerina all
the symptoms of Achilles tendinitis. Clothing that’s too
tight, a wrinkle in your sock, something in your ski
boot, an ill-fitting handball glove—sometimes what seems
like the knottiest problem can have a simple cause and
solution. But if there’s no obvious cause for any of
your symptoms, you need to find out why they’re there.
It may be that a day or two of swelling or pain or
weakness or reduced motion is no cause for
alarm—sometimes things, unexplainable things, go on in
our bodies and soon disappear just as mysteriously. But
if you’re no better in the next couple of days, or if
things get worse, then you should see your doctor.
What to do about injuries
At first it’s simple: don’t injure yourself any more
seriously than you have already and minimize the
secondary symptoms. In other words, don’t let
whatever it is get worse, and don’t let it get any more
swollen. The goal of first aid, of any initial
treatment of any problem no matter what it is, is
precisely that. So, to begin with, if it hurts, don’t
use it. That’s really a matter of listening to your
body and acting accordingly. More often than not you
know if you’ve been hurt badly; there’s an innate sense
that warns us when real damage has been done. (For
example, a quick indication of whether you’ve broken or
sprained an ankle is whether you’re willing to put
weight on it. If you are, you’ve probably sprained it;
if you’re not, you may be faced with a fracture.) But
sometimes people go against their best judgment and
continue to use the injured part—the supposed virtue of
gutting it out, playing even though hurt, and all that
business.
So, listen to your body and do what it tells you. It
doesn’t lie.
The rest of your self-care involves keeping any
swelling down. Swelling is the enemy because it
causes pain and loss of motion, which in turn makes you
lose the ability to use your muscles. When you don’t use
your muscles, they waste away, and, once gone, muscles
resist returning. Anyone who works out knows how much
longer it takes to build strength than it does to lose
it. Miss working out a few days and it’s almost as
though you never worked out before—a process that
accelerates with age. It’s important to keep muscles
strong, especially after an injury.
Applying compression to the injured part,
icing it, and elevating it are anti-swelling
tools available to just about everyone. All of these
fight swelling—elevation by keeping blood from pooling
at a low point, ice by causing blood vessels to contract
and thereby decreasing circulation, and compression by
physically maintaining the normal contour of the injured
area. Applying compression to the injured part,
icing it, and elevating it are
anti-swelling tools available to just about everyone.
All of these fight swelling—elevation by keeping blood
from pooling at a low point, ice by causing blood
vessels to contract and thereby decreasing circulation,
and compression by physically maintaining the normal
contour of the injured area. For acute injuries, the
ones that happen suddenly and tend to swell quickly,
compression is the most important of these tools.
Applied correctly (and we’ll suggest how in the chapters
to come), it can do more than anything to keep swelling
to a minimum. Ice certainly won’t hurt, but people can
more readily carry around a couple of Ace compression
bandages in their tote bags than they can a bag of
crushed ice. (And you should always use crushed
ice, rather than cubes or chemical ice, because crushed
ice, or even a bag of frozen vegetables (corn works best
if you plan to refreeze & use again) or fruit, will mold
itself to the contour of your body, is less likely to
cause frost-bite, and is cheap.)
Above all, don’t apply heat to injuries.
Stretching in a hot shower, Jacuzzi, or sauna before you
exercise can promote circulation and help you warm up,
as stretching applies internal heat. Likewise, a hot
shower can feel mighty good after exercise, but, in
either situation, don’t stick your injured part in the
hot water. Increasing circulation is the last thing you
want to do for an injury—not at first anyway. Stay away
from heat because it promotes swelling and prohibits
healing. Again, if you hurt, don’t make things worse by
continuing to use the injured part. Wrap the injured
area with a compression dressing, keep it cold with a
bag of crushed ice, and elevate it. That’s about all you
or anyone else can do at first.
SOME GENERAL TRUTHS ABOUT SPORTS INJURIES
Occasional exercise is not as beneficial as regular
exercise. A person who exercises just once a week
does not reap the conditioning benefits of regular
exercise. You have to stick with exercise for it to do
you some good. And the occasional exerciser has a
greater likelihood of being injured than someone who
exercises at least three days a week. You tax your
muscles but do not strengthen and condition them if you exercise only infrequently.
Deconditioning occurs faster than conditioning.
You lose conditioning faster than you gain it—at least
twice as fast. Twice as fast, that is, if you simply
stop working out. If you’re sick with the flu, say, or
otherwise indisposed, the rate can increase to perhaps
five times as fast. The moral of the story is: to stay
in shape you have to keep up with your activity. And if
you hurt yourself, find a healthy way of continuing to
exercise and strengthen the injured part. The longer
you’re out of the habit of regular exercise, the harder
it is to get back in shape.
If you don’t use it, you lose it. And that’s not
just true for strength and endurance, it’s true for
range of motion, cardiovascular health, your muscles’
ability to contract, and just about anything else you
can think of. For example, if you have tennis elbow and
somebody puts you in a sling for ten days, when you get
back to using the arm you’ll find that you’ve lost range
of motion in your shoulder even though there’s nothing
wrong with the joint. The same goes with the knee,
ankle, toes, and so on. It’s important to stay active.
Misuse is worse than disuse. When you misuse
something, you have to use other parts of your body
inappropriately. If you can’t walk normally after an
ankle sprain, for example, it’s better to go on crutches
until you can than it is to hobble around with your
ankle stiff and foot turned out. That awkward motion
puts unaccustomed strain on the knee, the hip, even the
back, and sometimes the resulting problems are more
difficult to deal with than the initial ankle sprain.
Our bodies are designed to function in specific ways.
They rebel against inappropriate demands.
Strength and motion coexist. You can’t have one
without the other. The body is so smart that it won’t
allow a range of motion that it can’t control. Take
shoulder injuries, for example. If, after an injury, you
don’t use your shoulder for a long time, it will lose
much of its range of motion. Sometimes the loss is so
severe it leads to a condition called “frozen shoulder.”
On the operating table, however, under anesthesia the
same shoulder can be completely flexible. With the
muscles deactivated, a surgeon can turn the shoulder
through a full 360 degrees of motion. After the patient
wakes up and the muscles return to action, the shoulder
goes right back to where it was—frozen. It’s not that
there’s anything wrong with the shoulder, it’s just that
the muscles need to be stronger to control its motion.
If you’re not strong enough to handle a full range of
motion, your body just won’t let you have it. So
regaining strength is as important to rehabilitating an
injury as regaining range of motion—they go together.
Don’t live on anti-inflammatory medications.
Taking “pain pills” day after day in order to carry on
in athletics is not a good idea—unless you’re being paid
to sacrifice your body. Most nonsteroidal
anti-inflammatory drugs (NSAIDs; see sidebar, p. 15)
both combat inflammation and are potent pain
relievers (analgesics), (Indeed, in some cases, readily
available medications such as ibuprofen can be as
effective as narcotic-type drugs in combating
postoperative pain.) After seven to ten days the
anti-inflammatory component of an NSAID will have done
its job; after that the drug’s effects are due to its
pain-relieving function. That pain relief can create a
dangerous situation. You can actually make some
conditions worse by not receiving pain signals warning
you that you’re doing something wrong.
SOME COMMON MISCONCEPTIONS
Tight- or loose-jointed people suffer more injuries.
Not so. Just because you happen to have loose joints
doesn’t mean that you’ll be more prone to ligament
injuries. Just having tight joints doesn’t mean you
should look out for more muscle injuries. You run no
greater or lesser chance of these types of injuries than
anybody else.
If you have tightness or looseness because of
injury, however, that’s a different story. That kind of
situation usually means that you’ve never completely
rehabilitated the injury, and unrehabilitated injuries
often lead to more injuries. Make sure you completely
recover from any injury.
And there’s one other time when tightness can cause
problems: when we age. Aging usually means tightening,
and anyone who continues to be involved in activities
that require a great deal of flexibility may be in for
problems. It’s hard to be a competing gymnast at 45
years of age, say, or a professional dancer. Aging is
the great equalizer; just to remain as flexible as you
are now requires more and more effort.
Muscle pulls are forever. It can seem that way if
you’re a runner and you’ve pulled your hamstring every
year for the last ten years. But recurrent muscle pulls
are usually the result of never having quite completely
rehabilitated the original injury. It’s the old
story—flexibility won’t come back without strength, and
tight muscles, muscles that aren’t flexible, are likely
to be reinjured. No, muscle pulls aren’t forever, but
you must thoroughly rehabilitate them.
+Pulled Muscles+
A muscle pull, also called a strain, is really a partial
tear of the muscle. In a full-fledged tear, muscle
fibers completely separate, leaving a gap. In a pull,
some fibers hold together, others separate, but mostly
the muscle remains intact.
The biggest problem with muscle pulls is that they tend
to come back, usually as the result of inadequate
rehabilitation. Stretching the pulled muscle is the
remedy most people think of for this type of
injury—because pulled muscles feel tight— but the need
to build up strength is not so apparent. Yet it’s
probably more important. Unless the injured muscle is
strong, the beneficial results of stretching will not
become permanent, which means the tightness will simply
recur. You have to stretch and strengthen pulled
muscles. (See more on how to rehab muscle pulls in
chapter 6, “The Thigh and Hip.”)
Older Athletes
For the most part, sports injuries are equal opportunity
afflicters: they plague anyone, regardless of age (or
gender, for that matter). But older athletes do have the
following special problems: Number one—you pay for
old sins. Previous injuries can come back to haunt
you as you age. For example, joint injuries suffered in
youth are among the most common causes of arthritis
later on. Number two—it takes more effort to sustain
the status quo. As you age, you lose conditioning
more rapidly, and it takes longer to build it back up.
(It also takes longer to recover from injuries.) Yet
older athletes often try to continue their high level of
activity (“I did it when I was thirty, and, by gum, I
can still do it”) without additional training.
Cross-training or weight training becomes increasingly
important to compensate for the strength loss that
accompanies aging. And engaging in a variety of athletic
endeavors—helping to spread the conditioning, and the
stress, around— may even be more important to older
athletes.
Rehabilitation programs come to an end. If you’ve
had a major injury, then, no, your rehab program
probably will never end—especially if you demand a lot
from the injured part. It may be that you can eventually
discard some specific rehab exercises, but the
likelihood is that while you were injured you developed
habits that compensated for the injury and so misused
other parts of your body. It can be a good idea to
continue to do general rehab exercise a few days a week.
That’s not a huge commitment, and it may compensate for
those subtle misuses that you do all the time.
We can always become stronger, faster, more flexible.
What we’re about to say may not be popular, but
there are limits. Work though we may, sweat and
suffer as we can, there’s a point beyond which we won’t
be able to go. So much for the bad news. The good news
is that as a practical matter, most of us will be
able to better our own lowly performances, at least at
first. But the better we get, the harder we work, the
more nearly we approach our limits, the more difficult
it is to reach them—and the more we get hurt.
Injuries increase as we approach our limits. Top-level
athletes live constantly on the edge. Push too hard and
you fall off into injury. The trick is to walk the line
without falling off—find a level that strikes the
balance between performance and injury and stay there.
The element that constantly destroys the balance is, of
course, aging. It’s the melancholy serenade of
athletics, the unknown variable that throws every
equation out of whack and makes life interesting. The
good news here is that getting older does not
necessarily mean getting worse. Our bodies grow smarter
as we grow older, and even if we can’t maintain strength
and speed through the years, we can rely on increasingly
rich experience and so, in some activities, actually
better our performance. Even though the clock may say
that our abilities are decreasing, our minds and hearts
can experience increased pleasure in the doing. Such
can be the enduring joy of athletics.
NSAIDs
Over-the-counter Nonsteroidal Anti-Inflammatory Drugs
NSAIDs have been around for most of our lifetimes.
Aspirin, the granddaddy of them all, is still an
excellent medication for bone, joint, and muscle
problems. The newer preparations, ibuprofen, naproxen,
and the rest, are better only in that they may have
fewer side effects (mainly gastrointestinal effects such
as stomach upsets, ulcers, etc.) and require less
frequent doses—once or twice a day rather than every
four hours. In addition to their anti-inflammatory
properties (important because with sports injuries,
inflammation is often the root of pain), all NSAIDs are
powerful pain relievers (analgesics). They can make you
feel better just because of their pain-relieving
properties. For most conditions inflammation will be
decreased by taking NSAIDs for a week or ten days; after
that these drugs function primarily as pain relievers.
Taking these medications regularly in order to
participate in a sport or activity may not be in your
best interests—especially if you haven’t first tried
other means of dealing with the underlying problem, such
as working to regain strength, endurance, and
flexibility. While the medication may mask any pain
you’re feeling, whatever is causing the pain might
actually be getting worse.
There are some conditions, however, for which people
take these medications regularly, even after they’ve
exhausted the benefits of exercises and other measures.
Rheumatoid arthritis and degenerative arthritis are two.
With these conditions, the only alternative to pain
relief from NSAIDs may be total joint replacements.
When used appropriately, NSAIDs be effective anti-inflammatories
and pain relievers. But in most cases regular use is not
appropriate. As with most drugs, you should take NSAIDs
sparingly and only when absolutely needed.
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
______ IFPA NEWS ______
Dr. Bell will be Presenting at the First Annual
Iberian Congress on Anti-Aging Medicine June 2009, ESTORIL, Portugal.
For more info:
www.a4miberia.com
Dr. Bell will be Presenting an IFPA Personal Fitness
Trainer Certification in Portugal, June, 2009.
For more info, email:
info@a4miberia.com web:
www.a4miberia.com/IFPA.h.
Dr. Jim Bell will be presenting at
the 5th Malaysian Conference and Exhibition
for Anti-Aging and Aesthetic Medicine.
Date: May 17th-19th,
2009
Venue: Shangri-La Hotel
Kuala Lumpur, Malaysia
For more info:
Web:
www.saaamm.org
Email:
info@saaamm.org
••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••
For more information on Indonesian
events, email:
Indonesia@ifpa-fitness.com
or call +62 21 780 2778
(International).
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James
T. Bell, PhD. is the
founder and CEO of the International Fitness
Professionals Association, IFPA.
 More
Books from Jim Bell, PhD.
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