THERE ARE THREE LEVELS of athletic injuries. The first involves getting inshape. 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 maybe 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, 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. In general, though, there are six general signs of injury that you shouldn’t ignore, no matter where they appear:
- 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.
- 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.
- 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 anything 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.
- 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.
- 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.
- 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, 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) 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. 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. Inaddition 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. –This is an excerpt from our Sports Medicine Trainer. If this introduction made an impact and you want to dive into the world of sports medicine, this course was designed for you!