Healthy Solutions—Back in Action

You’re cruising along, enjoying a beautiful ride on a sunny day and—wham!—you hit a patch of gravel, and your bike slides out from under you. Or maybe you’re on fire at the weekly Ultimate Frisbee game when pain suddenly shoots up your back, seemingly out of nowhere. Another weekend warrior bites the dust. But does that mean you’re destined to spend the rest of the summer watching from the sidelines? Probably not—if you’re lucky enough to have a minor injury.

“The majority of sports injuries are muscles strains or joint sprains,” says Larry Frieder, DC, CCSP, a Boulder, Colorado-based chiropractor, and they can heal relatively easily. “In general, these are either acute or chronic injuries.” The immediate onset of pain—like what you experienced when you and your bike hit the pavement or when that searing jolt of pain ran up your back—signals an acute injury. The pain of chronic injuries, such as tendonitis, tends to build more slowly, linger longer, and sometimes come back after a rest period. Chronic injuries also tend to follow a recurring pattern that will most likely require deeper assessment. But in that first painful moment, here’s how to gauge the damage you’ve incurred and to decide what you can do to speed up your recovery time

Judgment days
Take a deep breath and assess the situation calmly—if you can. Do you have any scrapes or abrasions? Are you cut and bleeding? Can you walk, and if so, do you feel any pain in the affected joints or any tension? After you decide that you won’t need emergency medical attention, you can immediately start specific treatments to help yourself heal.

“You’ll usually get swelling within an hour or two if you’ve sprained the joint,” Frieder says. “That will give you an idea of where you want to ice.” If you’ve injured a weight-bearing area, such as a leg or ankle, Frieder suggests elevating the body part to keep any load off it.

The next 48 hours is the key period for mending and assessing the damage, according to Jason Brumitt, a Portland, Oregon-based physical therapist and National Strength and Conditioning Association–certified strength and conditioning specialist. “Listen to your body and to what you are experiencing,” he says. After a few days of icing and avoiding activity, you can clearly evaluate the extent of harm.

The swelling will most likely subside within two days if you’ve incurred a minor injury—a strain or minor ligament damage. “Longer than that might indicate something more serious, such as a cartilage injury like a meniscus tear [in the knee],” Frieder says. “Numbness and tingling are important to notice and could indicate injury to a nerve.” These longer-lasting symptoms spell the need for immediate medical attention.

Be a cool patient
During the first 48 hours, the old standby prescription, RICE—rest, ice, compression, elevation—almost always helps calm down inflammation, says Pali Cooper, DC, CCSP, of Corte Madera, California. “[Inflammation] is the body’s normal response,” Cooper says. But it also damages tissues in the injured area. To keep the inflammation in check, Cooper recommends icing the injury for 15 to 20 minutes every two hours. “Sometimes I have a patient do an ice massage,” she says. Freeze a Dixie cup full of water, peel away the cup, and use the ice to massage the area gently.

According to Frieder, acupuncture, too, can help reduce swelling during that first day or two. Brummit also recommends self-massage and light, cautious stretching to make sure you maintain flexibility without making the symptoms worse. If the stretching becomes painful, stop.

Physically, you needn’t do much more than the above for the first 48 hours. “Just help reduce inflammation for faster healing and less damage to tissues,” says Frieder. That said, you do have other options. “Use homeopathic arnica cream, especially in the initial phase,” recommends Cooper. The herb Arnica montana has potent anti-inflammatory properties. “For acute injury, I recommend both topical and oral arnica.”

Diet can also support healing. “[Vitamin C] cuts the inflammatory response,” Cooper says. She also suggests eliminating inflammation-causing foods such as sugar and white-flour products. And make sure you eat a little more protein than usual, Frieder says, because muscle repair depends on an adequate supply.

The heat is on
After that initial 48-hour anti-inflammatory and assessment period, you can incorporate heat as well as ice into your recovery program, says Brumitt. “Now, you want to get blood flow to the area to help the repair process—bring the good stuff in to eat up the bad stuff.” The hot-cold method—known as contrast therapy—keeps the “bad” inflammation by-products down while increasing blood flow to stimulate healing. The heat helps that process by warming up the area where you have been suppressing circulation with cold. “Lots of chemicals, nutrients, and amino acids circulate in the blood, so after a few days of RICE, you need to bring those nutrients back to the area,” Frieder says. Experiment with an alternating pattern of heat and ice—for example, apply ice for 15 minutes one hour and heat for 15 minutes the next hour.

Cooper also recommends having a movement-based, soft-tissue massage known as Active Release Technique (ART). “ART helps break down scar tissues and make them more resilient,” she says. “You’re going to have scar tissue, but you want that scar tissue to have oxygen and blood supply to heal with elasticity.”

During this phase you can also start experimenting with other forms of bodywork, such physical therapy and chiropractic care. Remember to describe your injury as precisely as possible to your therapists, so they can customize their treatment to your unique situation. You might also consider asking your chiropractor or physical therapist about ultrasound and electronic stimulation, or E-Stim, to help relieve pain, reduce swelling, and increase circulation.

Getting back on the horse
Before you ramp right up to mach speed, make sure you can move the joint or muscle through its full range of motion without pain, Frieder says. “After daily, active, and pain-free use, you can go into isometric and open-chain activity,” he explains. Isometric exercise uses resistance without joint movement. In open-chain exercises, the body has an easier time adapting to and accommodating the injury. Walking, swimming, and stretching are open-chain options. Cycling and weight lifting on machines are examples of closed-chain activities. “If these [rehab] activities are pain-free,” Frieder says, “you can go into your regular routine at a low intensity and see how that goes.”

Find a pain-free range of motion that doesn’t contribute to the injury, says Cooper. “Within that range of motion, find four or five things that don’t hurt at all.” For instance, a runner might turn to hiking or water “running” with the aid of flotation. Once you feel comfortable with that activity, you can begin adding resistance or intensity. And now that you’re on the road to recovery, you may also want to look into what may have landed you in the penalty box in the first place. “This is a good time to go to a practitioner and have him or her evaluate you and discover any asymmetries that predisposed you to injury,” Frieder says.

Bryce Edmonds is a Boulder, Colorado-based freelance writer. He has intimate knowledge of acute and chronic pain through a snowboarding-induced broken wrist and a hip injury two weeks before his last half Ironman.

How to Protect Yourself
You may not be able to avoid accidents, but you can avoid sports injuries. “Most injuries stem from not recognizing that as you get older, you have to increase your initial warm-up period,” says Larry Frieder, a Boulder, Colorado-based chiropractor. “You might not necessarily have to alter your activity, but you have to get the body to warm up to it.”

But don’t count an old-fashioned runner’s stretch as a good warm-up. “There’s a lot of research coming out lately that stretching is not as effective for injury prevention as we thought,” Frieder says. In a 2000 Medicine and Science in Sports and Exercise study, for example, researchers found that muscle stretching did not reduce exercise-related injury in army recruits.

Instead, pick a warm-up that mimics the actions you will perform in your sport or activity. For instance, try an elliptical machine if you’re a runner. Once warmed up, don’t thrust yourself beyond your experience level, says Jason Brumitt, a Portland, Oregon-based physical therapist “Ease into it, and progressively challenge your body without breaking it down too much.”
Brumitt suggests this simple warm-up routine for low-impact activities. Do each exercise for 30 seconds to one minute:

• Walking on tiptoes
• Walking on heels
• Walking forward lunge
• Walking backward lunge
• High-knee step with circular hip rotation
• Extended-leg walk with same side toe touches (keeping back straight)

Mindful Healing
Are you fretting over lost training time? Don’t. Distress extends healing time, says Edmund O’Connor, PhD, a clinical sports psychologist and clinical consultant for the Association of Applied Sports Psychology. “If you can lower someone’s intensity and anxiety they heal quicker.”
To speed up recovery, think positively. Yes, it sounds like a cliché, but the practice can make a difference if done correctly. “Think about goal setting,” says O’Connor. “What is your goal? What’s your timeline? What do you need to do every single day to get there?

“Focus on the outcome and have a narrow dedication to that.”
If you only feel sane when you exercise, think about how you can use your recovery activities for the same purpose, O’Connor says. If you run, try the pool or elliptical trainer as a stress-busting substitute.
Of course, you will likely fear reinjuring yourself, O’Connor says, but that line of thinking actually increases your risk of getting hurt again. “Performance psychology says you have to be in the moment,” O’Connor explains. “That’s the only thing if you want to perform your best and be safe.” He recommends acknowledging your fear but not dwelling constantly on your injury. Even thinking consistently about your rehab goals causes undue stress. As he says, “Wherever your mind is, that’s where you’ll go.”