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For this week’s Wellness Wednesday we’re featuring a guest post from our good friend Bill Lockton. This post is the first in a series of three from Bill to help you deal with sports injuries.
HOW TO CARE FOR SPORTS INJURIES by Bill Lockton
Part 1: Treating the Symptoms
As a running coach and mentor, I am often asked how to deal with injuries. I’m kind of known as the King of Achilles issues, and yet, even with chronic Achilles tendonitis diagnosed in both ankles, I still have managed national rankings in some stupidly long runs and run the Badwater Ultramarathon in its hottest year.
I have more experience than most because I’ve been constantly dealing with my own issues for well over a decade, and have found that what works for me works for my coaching clients as well. Here are some of my most productive tips.
When dealing with injuries, I look at 3 things:
1.Treating the symptoms,
2.Managing the condition, and
3.Uncovering the cause and trying to fix it.
So that this doesn’t become too long, I’m going to treat each of these individually in separate posts. That will also allow me to go into each area more fully. Doing that, I just might hit the one point that works for you that I might not have been able to get to in an abbreviated version. The overall shape of this discussion, however, will be that you’ve got to reduce the symptoms so you can function in Life, then see if there is some way you can manage the condition so that you can continue to do what you want to do, and then figure out what caused the problem in the first place to see if that is something you can correct, otherwise the condition will probably return again and again. Make sense? Good! Let’s start with treating the symptoms.
Part 1: TREATING THE SYMPTOMS
Rice is nice, but we’re not talking about a food here. R.I.C.E. is an acronym for Rest, Ice, Compression, and Elevation.
The R.I.C.E. Diet: REST, ICE, COMPRESSION, ELEVATION
“Rest” means simply not using the body part that’s in question. If it’s your foot, knee, or leg, stay off your feet. If it’s your back or arm, don’t lift anything. Don’t use the affected body part. Rather than exercise it, rest it. But, “Don’t use the affected body part” has different meanings according to the degree of injury. If you twisted you ankle badly, you might have to be on crutches or wear a boot. If it’s not that bad, it may be enough to simply limit your walking and skip all the running and jumping you might do. The point is that you do not want to aggravate the injury and make it worse, so cut it out! One of the things that athletes often want to do is stretch out whatever the area is. That’s not necessarily a good thing. In the case of Achilles tendonitis, that’s one of the worst things you can do. The problem is that the tendon was injured because it was stretched beyond what it could accommodate. You don’t stretch Achilles tendonitis until the discomfort has gone away, or else you’ll be continually recreating the problem. Resist that impulse. I know you want to “do” something to try to heal it more quickly, but there are other things you can do to help that we will talk about.
“Ice” refers to applying cold to the injured area to reduce the swelling and help manage pain. Swelling and pain are great tools because they let you know there is a problem that needs attention. They also cause you to want to rest so that you don’t experience more pain. That’s helpful. The body is clever like that. But you already know there’s a problem. Swelling and pain also have a downside in that they reduce mobility, cause your body to misalign to compensate for the injury, and just cause all sorts of ancillary problems. In a very real way, pain and swelling slow down recovery. So, reduce them. Cold reduces swelling and numbs pain. Ice is a great way to apply cold to an injured area, and ice works great … sort of. Actual, real ice isn’t always the best thing to apply because it tends to be lumpy and so doesn’t conform to the shape of the injured body part so well. A few years ago, frozen peas or frozen corn were the items of choice because they are like tiny little ice cubes and wrap around the body part more closely. They still work and are cheaper than some other alternatives. These days, there are myriad items referred to as “ice packs” that come in 1-time use products as well are reusable products that can be stored in your freezer until needed. My freezer has several of them in there at all times.
In addition to the … what should we call it? The “ice” medium? …, you also need a way to apply it to the injured area. Ace bandages work. In a pinch, I’ve used towels and bandanas. There are several wraps designed to hold ice packs that have Velcro closures and are very handy. I use them all. There now are also clothing items that have pouches built in to hold the ice packs.
If we’re talking about needing to ice a large area, you could also take an ice bath. When CBS filmed me racing Badwater, they showed a clip of me lowering myself into a bathtub as someone was throwing in a bag of ice. I had just run 42 miles at that point (only 93 more to go!), going through a stretch that reportedly hit 133 degrees, and I was taking an ice bath to reduce my core temperature (a different issue we might talk about in a future post). What you didn’t know was that 3 bags of ice had already been put in the bath, and 2 more were put in as I got it to make a 5 bag total! So many bags of ice would hardly ever be necessary; it probably wasn’t necessary then. In fact, most days, the water in my tub is cold enough to work all by itself.
There are other ways to do the same thing. I live near the Pacific Ocean, and in the winter it’s cold enough that after a particularly grueling training run, we’ll often go down to the beach and wade as deep into the ocean as we can stand it. It works, too, but not as well in the summer when the water just isn’t cold enough.
Whatever your choice, apply the ice for around 15-20 minutes at a time. Longer might actually encourage more swelling (for a lot of reasons, but let’s not get into a talk about homeostasis and all of that here!), so limit it to 20 minutes.
“Compression” can be applied through wrapping something like an ace bandage around the area. There are compression items of clothing that can be worn, like compression sleeves for arms and/or legs, compression socks, pants, shorts, and shirts made out of compression material, and even OTC medical devices that are designed to similarly suppress swelling. They can all work. You want something that will be tight enough to limit further swelling and gently encourage the body to reabsorb the retained fluids that are there for a very good reason. It might help if you think of it this way: The retained fluids that make up the swelling are actually your body’s attempt to cushion the area so there is no further injury; if they aren’t needed, then the body is free to reabsorb them. There are lots of very intelligent systems in the body that work that way. (Explaining and defending that concept is beyond the scope of this article and yes, I know it’s an oversimplification so we don’t have to discuss exactly how accurate it is, but I think for many it’s a useful way for many to think about what’s going on – and it’s close enough.)
“Elevation” is pretty simple. Keep the swollen, injured body part up, preferably above the heart. You are trying to keep the blood from pooling in the injured area. Elevating the body part actually helps drain blood from the area.
So, this is good news! You now have an excuse to kick back with your legs up and veg out reading or watching TV. I’d lay off the junk food, though. With less exercise, you don’t want to be adding more pounds.
You can also take NSAIDS like aspirin, some version of naproxen sodium, acetaminophen, or ibuprofen. Just remember that while Tylenol does help reduce pain, it does not reduce inflammation.
Then there are the anti-inflammatory medicines your doctor might prescribe.
For those who prefer to not take drugs, OTC or prescriptive, there are natural substances you can take instead. MSM (short for methylsulfonylmethane, the biological form of sulfur found plants) has the reputation of dissipating retained liquids, which would reduce swelling. People say it also reduces pain and discomfort. I am a big fan of it. Any good book on prescription alternatives will give you a list of substances and even products you can take for this purpose. There are enzyme products that when taken on an empty stomach will work on the affected area (taken with food, they’ll just be used to digest the food). There are herbs and spices that help reduce swelling, including boswellia serrata, bromelain, curcumin from turmeric, and quercetin. A Google search will turn up lots of alternatives. If we’re talking about joint health, then I always start with the classics: glucosamine sulfate (with or without chondroitin sulfate) and MSM, then add other things to it. They’ve supported me for years! (And MSM is perfectly safe to take, being one of the least toxic substances on the planet, and presents no problem for anyone allergic to sulfa drugs or sulfites – a common misunderstanding.)
I also strongly recommend hands-on body work. For me, the right kind of massage works best for treating the symptoms. I don’t personally have much use for the “spa” kind of massage, which may make you feel blissfully relaxed for a few minutes but don’t really do very much that lasts beyond the office door. Sports massage, however, is a completely different thing. LA Sports Massage’s Dennis Lisaius can explain the technical reasons for why it’s so effective – and more effective than other kinds of massage; I’ll just testify to the fact that it is. I often go for a sports massage session with an Achilles so stressed that I can barely walk, and after the session have regained a lot of my range of motion and have significantly reduced discomfort. After a big bike crash last year, several sessions of sports massage reduced the pain in my shoulder and one session practically eliminated my knee pain. I’ll go more into that in the Cure post coming up later.
You don’t have to stop with what I’ve recommended so far. Check out other modalities. I find TENS machines can help reduce the symptoms; it seems to scramble the neurological signals in such a way that you don’t feel quite as much pain for a while. I have friends who swear by acupuncture.
Realize that there are lots of people you could visit for treatment and lots of modalities you could investigate. We all have different desires and expectations, so you should think a bit about what choices you want to make. Remember that each specialist you might see will recommend what they specialize in. I’m sure you’ve heard the expression, “To a man with a hammer, everything looks like a nail.” If you want orthotics, go see a podiatrist, because that’s what the podiatrist is likely to recommend. Alternatively, if you want surgery, go see a surgeon because that’s what a surgeon will recommend. If you don’t want surgery, don’t go to a surgeon for advice. See how that works? The chiropractor will recommend back adjustments, the acupuncturist, sticking needles in you for energy realignment, etc. The type of specialist you choose determines the treatment you’ll receive. Choose wisely.
The whole point of all of this is that we want to be able to start living our lives again, whether we’re athletes who can’t stand sitting still, or the vast majority of people who simply want to be able to go about their lives without pain and discomfort. If you’re on this site, we already know that you are the type of person who doesn’t really have the time, patience, or inclination to be laid up or hobbled by injury. However, before you can start exercising or doing much of anything again, the affected area has to feel better, and the first way to do that is to deal with the symptoms. The main things I and my athlete friends and clients recommend are R.I.C.E., anti-inflammatories (I prefer non-drug types but will take an OTC substance on occasion), and sports massage.
Next time, I’ll talk about how to manage the situation so that you might not have to stop your activity entirely while you’re trying to fix it.
About Bill Lockton:
Bill Lockton is a running coach and ultramarathoner whose career has been the design and manufacture of additive-free nutritional supplements and skincare for health food stores. A 2-time Boston Marathon qualifier, he came in 6th in the 2003 Badwater Ultramarathon, the world’s toughest footrace, in its hottest year, and came in 8th American Male at the 2006 24 Hour National Championships. He is a fixture in the LA athletic community, active in the LA Leggers Marathon Club, LA Triathlon Club, and Nike’s Club Run LA. To contact Bill for coaching or nutritional supplements go to www.Lockedonhealth.com.
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