ACUTE INJURIES —MUSCLE TEARS AND STRAINS

These affect the thigh, primarily, and are some of the best-known injuries in sports. Who has not heard of, orexperienced, a hamstring strain or pull (the most common), or a torn quadriceps muscle? These injuries areendemic to running sports. And except for contusions—the result of direct blows—they are pretty much theonly serious problems to affect the thigh and hip area. (People don’t break their femurs very often, and ittakes a lot to dislocate a hip. These are such awesome injuries that you’re not going to run home and lookthem up in a book. Rather you’ll be writhing on the ground awaiting an ambulance. Suffice it to say thatthere’s no question about fractures and dislocations in the hip and thigh area—they don’t happen often, butyou’ll know it when they do. Go quickly to anemergency room.)

A muscle tear might occur in a sprinter who’s trying to accelerate harder than usual, or a football player whoneeds a couple of extra long strides to get under a pass that’s overthrown. Whether it’s because the muscleitself tightens and can’t tolerate the increased demands made upon it, or because the opposite muscle tight-ens and forces the first muscle to work harder to accomplish the same task, you suddenly feel somethingpop. Other times it may feel as though someone has thrown a rock at your thigh. Either way, the next thingyou know, you’re on the ground. There’s no doubt that something serious has happened.

Overstretching can cause tears. This can occur if you miss your footing, say, presenting your bodywith a situation it doesn’t anticipate. (The body does anticipate movement.) Everyone has had the experi-ence of going down a flight of stairs and encountering one more (or less) stair than expected. In theseinstances, it takes a real effort to overcome the body’s inertia and not land flat on your face. Why? Notbecause one more stair is inherently so dangerous, but because you just didn’t expect it. The same thinghappens in sports. A runner coming out of the blocks anticipates a certain kind of surface, a certain degreeof traction. But if she slips, all bets are off. A slip of no more than an inch can fool the muscles. They’re goingto go ahead and contract powerfully because they expect the resistance of the surface to slow them down,but if that resistance isn’t there, the muscles can’t readjust in time. The contraction continues, becomesmonumental, and something’s got to give. The result, a muscle tear.

Not being warmed up can also cause tears. Track meets early in the spring are a problem becauseit can still be cold outside and thus difficult to stay warmed up. When a muscle gets cold, it gets tight. And juststretching it out isn’t going to help—you have to keep it warm, working, and flowing well.

Another source of thingh tears is, of all things, stretching for exercise. Stretching has becomesomething of a cult activity, as though being well stretched in and of itself is good for you. It may be, butprobably stretching is more useful in combination with something else-before and after another activity, toprepare the muscles for action and relax them afterwards. As with any cult activity, some people don’t do itproperly. They throw themselves into stretching, start by doing bouncing toe touches and quick torso twistsrather than long, slow stretches. Sometimes the result is a torn muscle.

Sports medicine doctors usually separate these injuries into three categories: Grade Three indicatesthe worst ones-in which the muscle actually pulls apart. It feels like there’s a hole in there (reminiscent ofruptures of the calf muscles-see chapter 4, “The Lower Leg”).

Grade Two strains are not as bad. You may feel a pulling sensation, you know something’s wrong,but it really isn’t dreadful, and, rather than causing you to collapse, these strains allow you to slow down andthen get off your feet.

Grade One strains involve the least pain, the least discomfort. It’s as though your thigh just tightensup over a few strides. You know something’s happened, but it doesn’t seem like much. Rather than stoppingtheir activity, people often go ahead and try to keep doing what they’re doing.

+ What to do about it + For the worst of these, if you feel something pop and you’re immediately unable tomove, you should see a doctor. And that doctor should know how to treat athletes. If you go to a doctor whoisn’t used to treating athletic injuries, the likelihood is that you’re not going to get proper care. You might betold to rest for too long, be put on crutches, or be put in a splint. These injuries must be treated aggressively-rest is not the answer here-or it’ll take you forever to recover. The milder ones you may want to try and takecare of yourself. Here’s a way to go about it:

All muscle tears and strains, no matter how severe, probably involve at least some tearing of themuscle fibers. (A tear is no more than an extreme strain, or pull. In a tear the fibers completely separate, leaving behind a gap. In a strain, the tearing is more subtle-some fibers hold together, others separate, but thefabric of the muscle remains whole.) And since muscles are generously supplied with blood, the tearingmeans that many blood vessels tear as well. As a result, the severed vessels bleed into the muscles. With bigtears, there can be a lot of bleeding. A pint of blood can flood into the muscles just like that. Bruising maynot show up until a few days later, and usually not at the site of the injury. The blood migrates where gravitytakes it, and you won’t see it until it gets close enough to the surface to show up. A hamstring tear today maymean a discolored calf next week.

So, you may not see it, but the muscles know all that blood is there. The problem is that they don’tknow what to do with it. They’re used to blood that’s contained in vessels. Now it’s as though somethingforeign has been injected into the body, and the muscle is capable of only one reaction to any foreign invasion:go into spasm. It’s a protective reaction, just as a turtle retreats into its shell or a snake winds tightly into acoil. Scrunch! The muscle tightens violently, as though you have a cramp. Once the muscle goes into spasm,it tends to stay in spasm. And the longer it stays in spasm— days, weeks, months—the longer it’ll take tostraighten out. Meanwhile, as the muscle is starting to heal, the likelihood is that it will heal in spasm as well.That means you end up with a shortened muscle.

So one thing you can do immediately is try to limit the amount of bleeding into the muscle. Ice andcompression are good for that, but compared to the ankle where compression is very effective after sprains,it’s hard to apply ice or compression to the thigh. There’s too much fat and muscle, making it difficult to applyenough pressure to do any good. If you’ve suffered a hamstring tear, sitting on a bag of ice is a pretty goodway to achieve icing and compression at the same time, but for injuries in other muscles it’s tough to do.(How do you sit on a torn quadriceps?) If the tear is in a place you can reach, pressing your hand against thespot that hurts for ten or fifteen minutes can help. But there’s another thing you can do to treat a tear thatmay be even more effective but is certainly less obvious: stretch it.

All the time the muscle spends shortened in spasm is lost recovery time. Even though the muscleremains tight, it really doesn’t do anything. It gets weak. It gets smaller. It gets flabbier. And when you finallyget around to stretching it out, it won’t stay that way-it just isn’t strong enough to stay stretched out. Youstretch it, you get back to your activity, the weakened muscle gets tired much too easily, and it goes right backinto spasm. That old adage about recurring hamstring injuries—”once a hamstring tear, always a hamstringtear”—is often true, simply because people don’t realize that the muscle has withered during the time itwasn’t used. So a tight muscle is not only an uncomfortable muscle, one that will tolerate only limited motion,it’s a muscle that’s weakening right before your eyes.

The best way to deal with these injuries is, never let the affected muscle get weak in the first place.As soon as you can, begin gentle stretching (immediately, if possible; within 24 hours or so if not) even thoughit may be uncomfortable to do so. Pain is your guide. Keep the stretching just on the edge of being reallypainful. The more stretched-out you can make the muscle sooner, the better off you’ll be later.

And the better off you’ll be sooner, too. Muscles are contained in tough, gristly tubes called fascia.Even though a muscle may tear, it’s likely that its fascia will not. When you stretch, you stretch the fascia aswell as the muscle, making the tube longer and narrower, tightening it around the injured muscle and reducingbleeding. You internally compress the muscle, curtailing bleeding, which is good, while stretching the muscle,which is also good. A neat trick.

So, it’s important to do something soon. If you suffer only a mild strain and get up the next morningto find the muscle is tight and hurts when you move it, and you decide that you’re not going to use it until it’sreally well, then what should be a minor injury can become as devastating as a really severe tear. With muscle injuries in athletes at least, the way you treat the injury determines disability much more than themagnitude of the injury. A small tear that you coddle, babying it while it heals on its own, can be a lot moredisabling than a substantial tear that’s dealt with effectively.

+ Recurrent Hamstring + (or Quadriceps) Strains
Almost without exception, hamstring strainsrecur because the muscle has never gottenstrong enough. It may be flexible, but it’snot strong. So it keeps getting injured.
The reason is that people think they canexercise themselves back into shape afterthese injuries by doing the same things theyalways did. If they run, they run again. Ifthey play tennis, it’s back to the courts. Orback to the studio, or the gym, or the healthclub. That’s all well and good, but onceone of these muscles gets weak, it nolonger starts at the same level as your othermuscles. As you exercise, all the musclesget stronger, but you never erase the dis-crepancy between the injured muscle andthe others. So even though your injuredhamstring may be stronger than it was whenyou began, compared to the rest of yourbody, it’s still weak.
You must do specific exercises for thespecific muscle that was injured. Thatdoesn’t mean more exercise, necessarily;it means different exercises. And that’s whyit’s vitally important to discover just whatit was that went wrong in the first place. Ifyou don’t know what muscle was injured—precisely what muscle—you won’t knowwhat muscle to exercise.

As a general rule, muscle injuries won’t heal asquickly if you just leave them alone. “You have to work toget well.”

That work can be easier than you think. One no-table by-product of being injured is that you soon come torealize the many ways in which that injury connects witheverything else that’s going on in your body. You neverdreamed that moving that would make it hurt here. Well, ifyou do something that makes the injured area hurt, youmust be doing something right. More likely than not, thatsomething involves stretching the injured part. Simply keepit up. You don’t have to know any anatomy, don’t evenhave to know just what it was you injured. If getting out ofa chair or out of bed, or into a shower or the car, hurts,you’ll know what you need to do to stretch the muscle.Don’t shy away from your activity. Find the motion thatgives the most discomfort and gently repeat it, stoppingjust short of real pain. That way your rehabilitation canbecome part of your daily activity, rather than somethingyou do specially. You just naturally keep the musclestretched and active, in contrast to avoiding activities thathurt. If it doesn’t hurt, you’ll know that you’re not exercis-ing the muscle at all. You’ll pay for that later.

Restrengthening the muscle involves executing theopposite motion. If you stretch out your injured hamstringby extending your leg when you step into the shower, youcan strengthen it by bending the leg. If it’s a torn quadri-ceps and bending your leg to get into your car stretchesthe muscle (again, you’ll know because it will hurt), thenextending your leg out straight after you close the door willstrengthen it. It involves listening to your body. Don’t worry,it’ll tell you the truth.

If you prefer a more formal rehab program, here’sone: To stretch the hamstrings, do a hurdler’s stretch. Whilestanding, straighten your leg out in front of you and rest iton a chair, a coffee table, or the hood of your car. Youdon’t want your leg out to the side, so keep your hipssquare—at right angles to your extended leg—and slowly lower your chest to your thigh far enough so thatthe back of your thigh starts to hurt. Hold that position for fifteen or twenty seconds, then lean forward a littlemore, again until it starts to hurt, and hold the stretch for about the same amount of time. (Just make sure the appropriate muscles are hurting. Stretching your quadriceps and feeling your knee hurt indicates you’re doingthe stretch wrong. Likewise with stretching your hamstrings and feeling the front of your hip hurt.) You mayfind, soon after the injury especially, that you can’t bend over the leg much at all without pain. That’s okay—simply do as much as you can. In time the muscles will stretch and your flexibility will increase. Do thisstretching in the morning, during the day, and before you go to bed—if you stretch at night, you won’t be sostiff in the morning. And as the muscle stretches and heals, bend farther and stretch more often.

To strengthen the muscle, bend the leg against resistance. That resistance can be your other leg, achair, the floor, an inner tube. Work to the point of fatigue, when the muscle starts to burn, and then back off.As with stretching, three series of ten contractions is a reasonable schedule. Combine the two when it’scomfortable to do so. Stretch, strengthen, and then, because the muscle will tend to tighten after beingcontracted, stretch again.

Do all this through a comfortable arc of motion. It’s not necessary to go from a straight knee to yourheel pressing up against your buttock. If you’re able to accomplish half that range of motion, or even 10percent of it, that’s fine. Your leg may hurt so much at first that you can’t bend it at all, and you may have todo the exercises isometrically, by simply tightening the muscle. It’ll still do some good.

For quadriceps tears, simply reverse these procedures. The quadriceps and hamstrings complementeach other. When you bend your knee, the hamstrings contract and the quads stretch; when you straightenyour knee, the quads contract and the hamstrings stretch. They’re always working in opposite directions. Soto stretch the quads, do the exercise that tightens the hamstrings—that is, bend your leg. Here’s a good way:while standing, bend your injured leg and grab the foot with your hand (make sure it’s the hand of the oppositearm—right foot, left hand; left foot, right hand). Then pull back on the leg. As with the hamstrings, you mayonly be able to bend a little bit at first, but greater ability to bend will come. Remember the stretch ordiscomfort should be felt in the front of the thigh, not the knee. To strengthen the quadriceps, extend the legagainst resistance, at first only as much as you can handle without hurting, then, as the muscle heals, increasethe resistance and the number of repetitions.

Perhaps the best exercise technique of all is contract-relax stretching. To exercise the hamstrings,lie on your back and have a friend extend your leg up toward your head until it begins to hurt in the injuredarea. Then push your leg back against your friend’s resistance, using the muscle, contracting it a little, but nottoo much. Hold the contraction for fifteen seconds, then relax. Then ask your friend to extend your legfarther toward your head. Surprise! You’ve picked up another fifteen degrees of flexibility. Stop when youagain feel discomfort and again push back against the pressure. Stretch again, and stop.

With this exercise you momentarily tire the muscle so that it gives up the ghost for a few seconds,then you pick up the slack and stretch it again. It may be the most effective stretching exercise you can do(it feels good, too), but its disadvantage is that it usually requires two people. However, with some ingenuityyou can do contract-relax exercises by yourself. You have to get in a position where you stretch yourselfagainst something rigid—a table leg, say, or a door jamb. Push against the table leg, then relax, move forwardto take up the slack, and push again. Contract-relax exercises are the way a physical therapist would stretchyou.

So, you’ve worked on your injury, it’s started to come around, and you’re back to the activity thatinjured you in the first place. A couple of things might happen. One is that the muscle might hurt at thebeginning of the activity, but as you exercise it loosens up and things get easier. That’s likely with anklesprains, where you milk some of the swelling away as you move and gradually your range of motion in-creases, but it’s not so common with muscle injuries. More likely with muscle injuries is the second possibility: you’ll be partway through your workout, a couple of miles into your run, say, and your hamstring will tightenup. If you try to run through it, it just gets tighter and tighter, to the point where you have to stop running orrisk hurting yourself again. A way to cope with that kind of problem is to stop running (or stop playing tennis,step away from the barre, or drop out of aerobics class), go off to the side, and do three or four good, long,slow stretches right on the spot. Then start running again. In nine out of ten instances, the leg will becomfortable once more. It may only stay comfortable for another few minutes, however, in which case yousimply stop and stretch again, then continue your activity.

If you keep up this regimen, the intervals between stretching will become longer and longer. If duringthe first couple of days you have to stop and stretch every quarter of a mile, the next week you may onlyhave to stretch every half mile, and the third week every mile and a half, to the point where you may onlyhave to stop once during your run, or not at all. It can be a bother to have to put up with all that stopping andstretching, at least at first, but it can be a very effective way of getting back to your activity.

But only if you can do the activity comfortably. If the tightness comes on and you can’t stop it bystretching, don’t continue. The muscles will just become tighter and tighter, may cause you to change yourgait, or your stroke, or your technique, and you’ll eventually either reinjure the muscle or injure somethingelse. Instead, discontinue the activity, do the home stretching and strengthening regime, and gradually tryagain. Ease back into the activity, slowly, and with patience. Don’t try and force muscle injuries. They’ll getyou in the end.

A couple of words of caution:

1.Stretch the injured side specially. This is crucial when you rehabilitate a muscle injury.Always stretch each side separately and appropriately to its level of fitness. Otherwise, thestronger and more flexible side is always limited by the lack of flexibility and strength of theinjured side.

2.See a doctor. This is your only recourse if you’re treating your injury on your own and itcontinues to get worse. That kind of situation can be ominous, nothing to trifle with. Happily,however, such is not usually the case. As long as you exercise good judgment and listen towhat your body is telling you, you’ll be okay. And you’ll be on the road back to your activitysooner than you may anticipate.

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