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Back in the Game

A muscle strain, joint sprain or contusion suffered just before a competition could put you on the shelf. Here are some quick-fix options.

By Matt Fitzgerald

April 2008

Four Steps to a Quick Recovery
Step 1 - Heed your pain
Step 2 - Facilitate healing
Step 3 - Train around your injury
Step 4 - Rehabilitate
Preventing Joint Sprains
Preventing Muscles Strains
Natural Relief
Resources

Less than two weeks before the 2007 World Championships, Australian track-and-field runner Craig Mottram strained his right hamstrings during a workout. Determined to compete in the 5,000-meter run anyway, he flew to Ireland for an aggressive course of treatment from renowned physiotherapist Gerard Hartmann. Thanks to the cross-friction massage-therapy treatments Hartmann applied, as well as icing, compression and stretching, Mottram not only raced, but he ran well enough in the preliminary round to qualify for the final.

Because their livelihoods depend on maintaining peak fitness, elite athletes like Mottram do whatever it takes to bounce back quickly from acute injuries such as muscle strains (a rip or tear in a muscle, caused by overstretching), joint sprains (damage to ligaments or a joint capsule), and contusions or bruises (broken blood vessels caused by a blow to the skin).

Sprains and strains often take weeks, or even months, to fully heal. By properly treating and rehabilitating these injuries, however, you can return to full participation in your normal activities much more quickly — within a couple of weeks, in most instances. With contusions, it’s just a matter of flushing blood from the area, and with proper treatment, you can often resume full activity within a week.

As a general rule, you should proceed as quickly as you can to treat these injuries without experiencing excessive discomfort. “If it doesn’t hurt, it’s not hurting you,” says James Garrick, MD, coauthor of Anybody’s Sports Medicine Book: The Complete Guide to Quick Recovery from Injuries (Ten Speed, 2000). Athletes who try to push through pain usually make the injury worse. But it’s a fine line, because those who aren’t aggressive enough in their rehabilitation efforts are slower to regain normal function and put themselves at risk of repeating the injury when they resume normal training and competition.

Your plan for treating and rehabilitating your injury should come from a sports medicine specialist or physical therapist, as it does for professional athletes who are determined to quickly get back in the game. Thankfully, this doesn’t require flying overseas; you can get the necessary help from medical professionals in your area.

Four Steps to a Quick Recovery
If your goal is to return to your normal training schedule as quickly as possible following an injury, experts recommend you follow these four steps:

Step 1 - Heed your pain
Stop exercising the moment you experience an injury. “The surest way to make any injury worse is to try and continue doing whatever activity you were doing when the injury occurred,” says Garrick. Do not resume the activity as long as pain persists, and for that matter, he adds, avoid doing any activity that you cannot perform with more than mild discomfort.

Step 2 - Facilitate healing
Your body heals itself, and this process takes time. But you can accelerate the process with these proven measures:

Elevation — You can reduce inflammation at the injury site by reducing blood flow to that area. If there is swelling in the injured area, elevate it above the level of your heart for 10 minutes, three to five times a day, suggests Christine Springer, PT, director of physical therapy at the Sports Center in Austin, Texas.

Useful for:

Muscle strains — Muscle strains always come with inflammation, which elevation can help manage.
Joint sprains — Inflammation also accompanies joint sprains, so elevation is useful.

Not for:

Contusions — Elevation is not a standard treatment for bruises, which involve little or no tissue swelling.

Compression — Compressing the injured area with a compression wrap or garment can also help manage inflammation by reducing blood flow to the injured area. Effective compression requires proper technique that you may need to learn from a doctor or physical therapist. Take a sprained ankle, for example. “It’s important to fill the hollows in the ankle area with some type of padding before wrapping it,” explains Garrick. “Otherwise, you’ll squeeze blood into the areas you’re trying to compress it out of.”

Useful for:

Muscle strains — Compression can help manage the inflammation of a muscle strain.
Joint sprains — Compression is a useful technique for decreasing the inflammation of a sprain.
Contusions — “Compressing the area of a contusion as soon as possible after the injury occurs may limit the bruising effect by reducing the pooling of blood,” says Garrick.

Icing — Icing is the most commonly practiced way of treating the pain and inflammation associated with acute sports injuries. Apply bagged ice or a cold pack to the injured area several times a day until your symptoms improve. “Don’t apply it for more than 20 minutes at a time,” cautions Springer. “People do occasionally get frostbite from applying it too long.”

Useful for:

Muscle strains — Icing can help manage the inflammation of a strain.
Joint sprains — Icing is useful for bringing down the inflammation of a sprain.
Contusions — Icing a contusion may provide temporary relief from the pain associated with the injury.

Stretching — While you shouldn’t stretch within the first 72 hours after an injury occurs, since this will only aggravate your condition, there are some types of stretching that can help with your recovery.

Useful for:

Muscle strains — “Gentle stretching helps muscle strains heal by realigning damaged muscle fibers,” says Lisa Bartoli, DO, an osteopathic physician at the Continuum Center for Health and Healing in New York City. Regular, gentle stretching will help you minimize the loss of muscle function resulting from a muscle strain and return to normal activity sooner.
Joint sprains — Regular, gentle stretching will help you retain range of motion and return to normal activity sooner.
Contusions — According to Scott Woodward, PT, assistant physical therapist and athletic trainer for the Colorado Avalanche hockey team, a special type of stretching is now considered to be the most effective treatment for bruises. “As soon as possible after the injury occurs, we have the athlete stretch the bruised muscle as far as possible and then we wrap it so that position is maintained for at least the next 12 hours,” he says. This treatment drastically reduces the stiffness and loss of mobility that athletes normally experience the day after suffering a severe contusion.

Light activity — “Injured ligaments and muscles heal stronger than they would otherwise when they are actively used during the healing process,” says Garrick.

Useful for:

Muscle strains — Progressively increasing use of your strained muscle will minimize strength loss during recovery and accelerate regaining of full function, as long as you avoid crossing the pain threshold. “Sometimes it isn’t possible to do much of anything with a strained muscle initially,” says Woodward. In these cases, he suggests doing strengthening exercises for neighboring muscle groups to prevent these muscles from also weakening during the recovery process. For example, if your strained hamstrings are too painful to use, do strengthening exercises for your glutes, hips and abs.
Joint sprains — Light, progressive use of your sprained joint will minimize strength loss during recovery and accelerate the regaining of full function, as long as you avoid crossing the pain threshold. If you have a sprained ankle, for example, you might sit in a chair, elevate your foot and trace the letters of the alphabet in the air. “Your pain should not increase while you’re doing the movement,” says Garrick. “Ideally, it will decrease.” Start with only five minutes of gentle movement every other hour.
Contusions — According to Springer, activity tends to be less inhibited by contusions than it is by strains and sprains. “Except when it’s an especially deep or concentrated bruise, you can usually work through a little more discomfort without setting back the healing process,” she says.

Massage — While more useful for relaxing than healing, sports massage can help with muscle strains. As with stretching, wait at least 72 hours after suffering a strain to get a massage.

Useful for:

Muscle strains — According to Woodward, muscle strains respond especially well to special forms of sports massage therapy known as cross-friction and Active Release Techniques (ART). “Sports massage can activate muscle receptors that trigger relaxation or lengthening, thereby alleviating the stiffness and loss of mobility that follow a muscle strain,” says Springer.

Not for:

Joint sprains — Sports massage is not used to treat joint sprains, since ligaments (the tissues that are most often damaged in a sprain) lie too deep to be accessed in this way.
Contusions — Sports massage is not used to treat bruises. It tends to be very painful and has no therapeutic effect.

Acupuncture — Recent studies have shown that this ancient Chinese medical treatment alleviates pain associated with a variety of conditions, from lower-back pain to osteoarthritis. And according to Bartoli, it works well for many sports injuries, too. “The sooner you get needles into the site of the injury, the better,” she says, “because the sooner you can reduce pain, the faster you can return to normal activity.” Some experts believe that acupuncture achieves its therapeutic effects by altering nervous system activity, but the specific mechanisms are still unknown.

Useful for:

Muscle strains — Several studies have found that acupuncture is effective in treating muscle pain caused by strains.
Joint sprains — According to the American Academy of Medical Acupuncture (AMAA), acupuncture may be considered a complementary therapy for joint sprains.
Contusions — The AAMA also considers acupuncture an effective complementary therapy for contusions.

Step 3 - Train around your injury
While a sprain, strain or contusion may prevent you from engaging in your normal sports activity for a short time, you can still keep in shape by doing an alternative form of exercise that is not affected by the injury. Bartoli favors running in a swimming pool. “If you have a severe hamstrings strain, you might have to start very gently,” she says. “With most other injuries, you can do very intense running intervals in the pool that will enable you to maintain a high level of fitness while your injury heals.”

Step 4 - Rehabilitate
Your injury is not fully healed when the pain goes away. The healing process is truly complete only when the affected muscle or joint is back to full strength, but this may never happen if you don’t actively work on strengthening it. “Most people don’t do enough to get full function back,” says Garrick. Failure to regain full strength will increase your chances of repeating the same injury. Your physical therapist can recommend appropriate exercises to strengthen your recovering muscle or joint.

None of these proven-effective treatment and rehabilitation measures for acute sports injuries will happen unless you make them happen. “The everyday athlete doesn’t have the luxury of being able to spend two or three hours a day with a physical therapist,” says James Garrick. “If you want to recover from an injury as fast as possible, you need to sit down with a doctor or physical therapist and lay out a plan that you can follow on your own — and then follow it.”

Matt Fitzgerald is the author of several books, including Brain Training for Runners (NAL, 2007), and he is the editor of www.poweringmuscles.com, a sports-nutrition Web site.

Preventing Joint Sprains
Joint sprains are not simply cases of bad luck. By taking certain preventive measures, you can drastically reduce the likelihood that you will suffer such an injury. “Athletes with poor proprioception have a greater risk of ankle and knee sprains,” says Lisa Bartoli, DO, an osteopathic physician at the Continuum Center for Health and Healing in New York City. Proprioception is the sense of one’s body position and movements in space, and is closely related to balance. According to Bartoli, incorporating a balance challenge into some of your strength exercises will improve your proprioception and help prevent sprains. One example is the BOSU Squat.

To do the BOSU squat: Stand with both feet on a BOSU Balance Trainer, your arms hanging at your sides. Lower your butt toward the floor as though you’re going to sit down on a chair. Avoid arching or rounding your lower back and keep most of your weight on your heels. Squat down as far as you can go without feeling any strain in your knees or lower back (but go no farther than the point where your thighs are parallel to the floor). Now contract the muscles of your thighs and buttocks and stand fully upright. Complete 10 to 12 repetitions.

Preventing Muscle Strains
Research has shown that proper conditioning can help prevent muscle strains. “Muscle strains tend to occur when a muscle tries to contract from a stretched position,” says Christine Springer, PT, director of physical therapy at the Sports Center in Austin, Texas. You can build resistance to muscle strains by doing strength exercises that mimic this type of action in a controlled way. The hamstrings are the most commonly strained muscle group. A great strengthening exercise for the hamstrings is the Double-Leg Buck.

To do the Double-Leg Buck: Lie face-up on the floor with your heels on an elevated platform such as an exercise bench, legs bent at 90 degrees. (If you don’t have an exercise bench you can use a chair.) Set your core. Contract your hamstrings, drive your heels into the platform, and lift your butt and torso upward until your body forms a straight line from knees to neck. Pause briefly and then return to the starting position. To make this exercise more challenging, perform a single leg buck, with only one foot in contact with the platform and the other foot elevated above it.

Natural Relief
Many injured athletes instinctively reach for non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen for pain relief, but Christine Springer, PT, director of physical therapy at the Sports Center in Austin, Texas, says you should not depend too heavily on such products. “The purpose of inflammation is healing,” she says. Specifically, inflammation delivers to the site of injury immune system materials that clear away cellular debris and initiate cellular repair, she explains. “When you squash that inflammatory response with medicine, you weaken the repair of the injured tissue.”

As an alternative, Springer suggests that you try a gentler, natural anti-inflammatory, either in the form of a cream, such as arnica, or in the form of a pill, like bromelain. NSAIDs have a much stronger anti-inflammatory effect because they prevent the formation of compounds that are critical to the inflammatory process. Bromelain has a narrower effect, preventing the synthesis of specific pro-inflammatory compounds. Arnica is believed to affect the inflammatory response at an early stage, but instead of completely interrupting the inflammatory response, arnica gently suppresses it.

Resources
www.sportsinjuryclinic.net — Virtual Sports Injury Clinic’s Web site provides information on how to identify and treat a wide range of sports injuries; offers products to treat, prevent, and rehabilitate injuries; and also includes a handy sports-injury clinic locator.

The Sports Medicine Bible by Lyle J. Micheli, MD (Collins, 1995) — Everything an athlete or exerciser needs to know about activity-related injuries is contained in this 352-page manual.

American Physical Therapy Association — To find a licensed physical therapist in your area, log onto the American Physical Therapy Association Web site at www.apta.org and click on “Find a PT.”

Back in the Game

A muscle strain, joint sprain or contusion suffered just before a competition could put you on the shelf. Here are some quick-fix options.

By Matt Fitzgerald

Full Speed Department,
April 2008

Four Steps to a Quick Recovery (Back to Top)
If your goal is to return to your normal training schedule as quickly as possible following an injury, experts recommend you follow these four steps:

Step 1 - Heed your pain (Back to Top)
Stop exercising the moment you experience an injury. “The surest way to make any injury worse is to try and continue doing whatever activity you were doing when the injury occurred,” says Garrick. Do not resume the activity as long as pain persists, and for that matter, he adds, avoid doing any activity that you cannot perform with more than mild discomfort.

Step 2 - Facilitate healing (Back to Top)
Your body heals itself, and this process takes time. But you can accelerate the process with these proven measures:

Useful for:

Muscle strains — Muscle strains always come with inflammation, which elevation can help manage.
Joint sprains — Inflammation also accompanies joint sprains, so elevation is useful.

Not for:

Contusions — Elevation is not a standard treatment for bruises, which involve little or no tissue swelling.

Useful for:

Muscle strains — Compression can help manage the inflammation of a muscle strain.
Joint sprains — Compression is a useful technique for decreasing the inflammation of a sprain.
Contusions — “Compressing the area of a contusion as soon as possible after the injury occurs may limit the bruising effect by reducing the pooling of blood,” says Garrick.

Useful for:

Muscle strains — Icing can help manage the inflammation of a strain.
Joint sprains — Icing is useful for bringing down the inflammation of a sprain.
Contusions — Icing a contusion may provide temporary relief from the pain associated with the injury.

Useful for:

Muscle strains — “Gentle stretching helps muscle strains heal by realigning damaged muscle fibers,” says Lisa Bartoli, DO, an osteopathic physician at the Continuum Center for Health and Healing in New York City. Regular, gentle stretching will help you minimize the loss of muscle function resulting from a muscle strain and return to normal activity sooner.
Joint sprains — Regular, gentle stretching will help you retain range of motion and return to normal activity sooner.
Contusions — According to Scott Woodward, PT, assistant physical therapist and athletic trainer for the Colorado Avalanche hockey team, a special type of stretching is now considered to be the most effective treatment for bruises. “As soon as possible after the injury occurs, we have the athlete stretch the bruised muscle as far as possible and then we wrap it so that position is maintained for at least the next 12 hours,” he says. This treatment drastically reduces the stiffness and loss of mobility that athletes normally experience the day after suffering a severe contusion.

Light activity — “Injured ligaments and muscles heal stronger than they would otherwise when they are actively used during the healing process,” says Garrick.

Useful for:

Muscle strains — Progressively increasing use of your strained muscle will minimize strength loss during recovery and accelerate regaining of full function, as long as you avoid crossing the pain threshold. “Sometimes it isn’t possible to do much of anything with a strained muscle initially,” says Woodward. In these cases, he suggests doing strengthening exercises for neighboring muscle groups to prevent these muscles from also weakening during the recovery process. For example, if your strained hamstrings are too painful to use, do strengthening exercises for your glutes, hips and abs.
Joint sprains — Light, progressive use of your sprained joint will minimize strength loss during recovery and accelerate the regaining of full function, as long as you avoid crossing the pain threshold. If you have a sprained ankle, for example, you might sit in a chair, elevate your foot and trace the letters of the alphabet in the air. “Your pain should not increase while you’re doing the movement,” says Garrick. “Ideally, it will decrease.” Start with only five minutes of gentle movement every other hour.
Contusions — According to Springer, activity tends to be less inhibited by contusions than it is by strains and sprains. “Except when it’s an especially deep or concentrated bruise, you can usually work through a little more discomfort without setting back the healing process,” she says.

Massage — While more useful for relaxing than healing, sports massage can help with muscle strains. As with stretching, wait at least 72 hours after suffering a strain to get a massage.

Useful for:

Muscle strains — According to Woodward, muscle strains respond especially well to special forms of sports massage therapy known as cross-friction and Active Release Techniques (ART). “Sports massage can activate muscle receptors that trigger relaxation or lengthening, thereby alleviating the stiffness and loss of mobility that follow a muscle strain,” says Springer.

Not for:

Joint sprains — Sports massage is not used to treat joint sprains, since ligaments (the tissues that are most often damaged in a sprain) lie too deep to be accessed in this way.
Contusions — Sports massage is not used to treat bruises. It tends to be very painful and has no therapeutic effect.

Useful for:

Muscle strains — Several studies have found that acupuncture is effective in treating muscle pain caused by strains.
Joint sprains — According to the American Academy of Medical Acupuncture (AMAA), acupuncture may be considered a complementary therapy for joint sprains.
Contusions — The AAMA also considers acupuncture an effective complementary therapy for contusions.

Step 3 - Train around your injury (Back to Top)
While a sprain, strain or contusion may prevent you from engaging in your normal sports activity for a short time, you can still keep in shape by doing an alternative form of exercise that is not affected by the injury. Bartoli favors running in a swimming pool. “If you have a severe hamstrings strain, you might have to start very gently,” she says. “With most other injuries, you can do very intense running intervals in the pool that will enable you to maintain a high level of fitness while your injury heals.”

Step 4 - Rehabilitate (Back to Top)
Your injury is not fully healed when the pain goes away. The healing process is truly complete only when the affected muscle or joint is back to full strength, but this may never happen if you don’t actively work on strengthening it. “Most people don’t do enough to get full function back,” says Garrick. Failure to regain full strength will increase your chances of repeating the same injury. Your physical therapist can recommend appropriate exercises to strengthen your recovering muscle or joint.

Matt Fitzgerald is the author of several books, including Brain Training for Runners (NAL, 2007), and he is the editor of www.poweringmuscles.com, a sports-nutrition Web site.

Preventing Joint Sprains (Back to Top)
Joint sprains are not simply cases of bad luck. By taking certain preventive measures, you can drastically reduce the likelihood that you will suffer such an injury. “Athletes with poor proprioception have a greater risk of ankle and knee sprains,” says Lisa Bartoli, DO, an osteopathic physician at the Continuum Center for Health and Healing in New York City. Proprioception is the sense of one’s body position and movements in space, and is closely related to balance. According to Bartoli, incorporating a balance challenge into some of your strength exercises will improve your proprioception and help prevent sprains. One example is the BOSU Squat.

Preventing Muscle Strains (Back to Top)
Research has shown that proper conditioning can help prevent muscle strains. “Muscle strains tend to occur when a muscle tries to contract from a stretched position,” says Christine Springer, PT, director of physical therapy at the Sports Center in Austin, Texas. You can build resistance to muscle strains by doing strength exercises that mimic this type of action in a controlled way. The hamstrings are the most commonly strained muscle group. A great strengthening exercise for the hamstrings is the Double-Leg Buck.

Natural Relief (Back to Top)
Many injured athletes instinctively reach for non-steroidal anti-inflammatory medicines (NSAIDs) such as ibuprofen for pain relief, but Christine Springer, PT, director of physical therapy at the Sports Center in Austin, Texas, says you should not depend too heavily on such products. “The purpose of inflammation is healing,” she says. Specifically, inflammation delivers to the site of injury immune system materials that clear away cellular debris and initiate cellular repair, she explains. “When you squash that inflammatory response with medicine, you weaken the repair of the injured tissue.”

As an alternative, Springer suggests that you try a gentler, natural anti-inflammatory, either in the form of a cream, such as arnica, or in the form of a pill, like bromelain. NSAIDs have a much stronger anti-inflammatory effect because they prevent the formation of compounds that are critical to the inflammatory process. Bromelain has a narrower effect, preventing the synthesis of specific pro-inflammatory compounds. Arnica is believed to affect the inflammatory response at an early stage, but instead of completely interrupting the inflammatory response, arnica gently suppresses it.

Resources (Back to Top)
www.sportsinjuryclinic.net — Virtual Sports Injury Clinic’s Web site provides information on how to identify and treat a wide range of sports injuries; offers products to treat, prevent, and rehabilitate injuries; and also includes a handy sports-injury clinic locator.

The Sports Medicine Bible by Lyle J. Micheli, MD (Collins, 1995) — Everything an athlete or exerciser needs to know about activity-related injuries is contained in this 352-page manual.

American Physical Therapy Association — To find a licensed physical therapist in your area, log onto the American Physical Therapy Association Web site at www.apta.org and click on “Find a PT.”

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