What's
the difference between a strain and a sprain?
When you strain or "pull" a muscle, you've stretched the muscle tissue or the tendon that connects it to a nearby bone. Strains usually happen in your neck, back, thigh, or calf muscles. Sprains, on the other hand, happen to joints. When you sprain your ankle, knee, wrist, or elbow, you've stretched or torn a ligament, the tough elastic tissue that connects the bones of the joint. Both kinds of injury will cause sharp, immediate pain. You may hear a pop or snap when you sprain a joint, which will be followed by swelling and sometimes bruising caused by ruptured blood vessels. The faster the swelling, the more severe the injury. You should be able to manage minor strains and sprains but more serious injuries should be seen by your family doctor. If you feel intense pain or if you're unable to put any weight on an injured joint, you may have severed the ligament and should see a doctor.
Most people pull muscles in their back or neck when they try to pick up something heavy without bending their knees and keeping their back straight. You can pull muscles in your legs when you push them too hard by breaking into a sprint, for instance, or squatting under a heavy barbell without warming up first. Ankle sprains usually occur when your ankle rolls outward and the ligament connecting the knobby part of the bone to the foot's outer surface gets stretched or torn. This happens most often when you're playing a sport that requires you to move quickly from side to side, such as tennis or basketball, but you can also turn your ankle while stepping off a footpath or hiking on a rough trail. You're most likely to sprain your knee by landing badly after a jump in a sport like volleyball, gymnastics or basketball, or by wrenching it out of alignment during a fall on the ski slope. You might stretch or tear ligaments in your wrist or elbow if you try to break a fall with an outstretched arm, forcing those joints to absorb your full weight.
How
can I avoid strains and sprains?
The simplest thing you can do is wear the right shoes and protective gear for any sport you play. Running shoes, for example, aren't good for hiking or tennis because their extra cushioning makes the base slightly more elevated and less stable. When you hike, be sure to wear boots that lace up over the ankles and support them, especially if you're carrying a pack that weighs more than 10 kilograms (around 20 pounds). And remember that you're destined to take a few spills while learning a sport like in-line skating or snowboarding, so wear protective wrist and elbow pads (along with knee pads and a helmet) to protect those joints when you do.
It's also crucial to warm up before a workout, by, say, jogging or riding an exercise bike at a moderate pace for at least five minutes. Light aerobic activity will literally heat up your muscles and ligaments, making them more pliable and less prone to tearing. You may also want to spend a few minutes stretching after a workout; this will improve the flexibility of your joints and muscles, which can get stiff from exertion. Over the long run, regular exercise and weight lifting can help you avoid strains and sprains by strengthening your muscles, keeping your joints limber, and improving your balance and coordination so that you're less likely to roll your ankle or take a fall. If you're just beginning an exercise programme, start out slowly and increase the intensity as you build strength and endurance.
How
should I treat a strain or sprain?
Unless the tissue is severed, you can usually treat strains and sprains at home. For hints on how to reduce the pain and swelling, remember the acronym RICE, for "rest, ice, compression, and elevation." Rest the injured area as much as possible for 24 to 48 hours. Use crutches to take the weight off a hurt knee or ankle; support a sprained elbow or shoulder for a few days with a sling. Apply a cold pack (or a bag of frozen peas) for ten to 15 minutes at a time, but wrap it in a damp towel first to avoid giving yourself frostbite. Do this as soon as possible after you get hurt, and repeat at least three times a day for a day or two. Keep excess fluid from accumulating around a sprained joint by compressing and elevating it. Starting below the joint, wrap an elastic bandage loosely, so that your circulation isn't cut off. Elevate the injured area above the level of your heart by propping it up on pillows when you're sitting or lying down. Take anti-inflammatory pain relievers like ibuprofen, too. However, be cautious with these if you are elderly or if you have a history of dyspepsia or ulcers.
After the pain and swelling are gone, which may take a week or more, you can slowly start resuming normal activity. First try moving the joint around (stop if it hurts). Once you can move it without pain, start strengthening the muscles around it. A physiotherapist can tell you which exercises are best for this. When you're ready to get moving again, choose an activity that doesn't put any stress on the injured area, such as swimming.
How
can I protect myself from sports injuries?
You faithfully wear your goggles on the racquetball court, you never go in-line skating without your pads and helmet, and you stretch like a fanatic, yet you still get sidelined by injuries. What's going on?
Although safety precautions are indispensable, there's more to staying injury-free than avoiding flying projectiles, cushioning your falls, and keeping your muscles limber. Athletes often overlook measures that can protect them from problems like sore knees and sprained ankles. There's no sure way to take the ouch out of sports, but the following advice can definitely help you stay in the game. Here are some tips for preventing the most common aches and pains.
Overuse injuries. Many people associate sports injuries with suddenly snapped bones and ripped tendons, but in non-contact sports, the vast majority of injuries come on gradually. Stress that builds over weeks or months can cause aching kneecaps, stress fractures, shinsplints, pulled muscles, strained hamstrings, tenderness in the Achilles tendon, or burning pain in the heel. These problems strike most athletes at one time or another. Doctors call them "overuse injuries," but you don't necessarily have to work out extra hard or long to get them. Worn-out shoes, uneven running surfaces, and quirks of body structure can contribute to pushing your muscles, tendons, and bones past their limits.
Here are some tips for preventing overuse injuries:
• Don't push through pain. Real discomfort is a signal that something's wrong or that you're asking more from a part of your body than it can provide at the moment.
• Increase your workouts gradually. If you're a runner, don't bump up your mileage by more than 10 percent per week.
• Don't run more than 45 miles per week. Running farther than that doesn't pay off: It probably won't improve your stamina, and it definitely increases your risk of injury.
• Run on soft, flat surfaces.
• Alternate hard training days with easy days.
• Get new running shoes every 500 miles. With use, shoes lose their ability to absorb shock.
• If you pronate (the inside of your foot leans in) or have another alignment problem, you may be able to prevent injury by wearing an over-the-counter shoe insert. Ask your doctor if such inserts might work for you.
• Women and adolescent girls should make sure they're getting enough calcium, whether from their diet or from supplements. Stress fractures are 10 times more common in women than in men. Improve your odds of avoiding them by making sure you get enough of the minerals and vitamins crucial to building bone.
• Women who have irregular periods should be especially concerned about stress fractures. If this applies to you, talk to your doctor about whether you might need estrogen supplements to protect your bones.
Ankle
sprains. Ankle sprains may be the most common sports injury not caused
by overuse. Although there may be an element of bad luck behind most sprains,
you can take some steps to keep luck on your side. If ankle sprains are a common
problem for you, check with your physician. She may recommend some ankle strengthening
or lace-up stabilizers or semirigid braces. (Studies have shown that the Sports
Stirrup, manufactured by Aircast, is effective at preventing sprains.) These devices
are particularly important if you lack strength, flexibility, or good balance,
all of which can help you avoid injury (see below). By the way, a recent study
at the
Can
certain stretches or other exercises lower the odds of an overuse injury?
Many people stretch before and after working out. Stretching helps you to increase range-of-motion and prepare for activity, but according to recent reports in Sports Medicine and the American Journal of Sports Medicine, there's no clear evidence that it will prevent overuse injuries. To ward off these injuries and help existing injuries heal, exercises that actually strengthen your muscles will be far more effective than those that simply stretch them.
Here are some strengthening moves that can help prevent common overuse injuries.
• Pain around the kneecap. Check with your physician if you routinely have pain around the kneecap. If the front of your knee hurts when you climb stairs and stiffens up during long periods of rest, your kneecap is probably being tugged out of its groove during your workouts. Your doctor may recommend strengthening your inner thigh muscles, which tend to be weak in relation to the outer ones. If your physician approves, try this exercise: Stand with your back against a wall and your feet 6 to 8 inches from the wall. Hold the position for about 10 seconds, or until the tops of your thighs become tired. Stand up straight to let your muscles recover for a moment. Try doing ten repetitions each day.
• Sore shoulder. Swimmers, tennis players, weight lifters, and others who repeatedly raise their arms over their heads often feel pain in the front or side of a shoulder. To prevent that problem, work on strengthening the muscles in your rotator cuff, the muscles in the shoulder that connect to the arm bone. Here's a simple exercise you can try: Do a simple shoulder shrug: Lift both shoulders as high as you can, squeeze them together, and relax. Work up to 25 shrugs twice a day. (See your doctor, of course, if you suffer from regular shoulder pain.)
• Hamstring pull. To help prevent hamstring injuries, try this exercise: To strengthen the hamstring, lie on your stomach, pull in your abdominals to protect your lower back, engage your thigh muscles, and slowly lift one leg. Keep it in the air for two seconds, then carefully lower it and relax your thigh muscles. Try three sets of 10 repetitions each day with each leg.
• Strained Achilles tendon. The Achilles takes a pounding during running and aerobics classes, especially if your calves are too weak to carry their share of the load. To strengthen your calves, stand up straight, raise yourself onto the balls of your feet, then slowly lower. Keep it up until your calves tire. Repeat this routine twice a day.
Are
there exercises that can help prevent ankle sprains?
Strength, flexibility, and good balance make an ankle sprain less likely, and you can enhance all of these qualities through stretches and exercises.
• Calf stretch. Experts say performing this stretch on each leg before and after a workout session can reduce the severity of any future ankle sprain. Face a wall with one leg slightly forward and one slightly back. With your front leg bent at the knee and your back leg straight, put your hands on the wall and lean forward, keeping your back heel on the floor. Keep leaning until you feel the calf in your back leg extend slightly. Hold the position for 15 to 30 seconds. Then, with both heels planted on the floor, slightly bend your back leg, and hold the position for another 15 to 30 seconds. This shifts the focus within your calf, so you stretch the entire area.
• Ankle exercises. Completing three sets of these exercises every other day -- 10 to 15 repetitions per set -- can make your ankles stronger and more stable. Don't forget to do both ankles.
Take a two-foot piece of tubing or rubber resistance band (available at sporting goods or medical supply stores), and tie it into a loop. While sitting in a chair, secure one end of the loop around the leg of a heavy table or another solid object, and put the other end around the top of your foot. You should be far enough from the grounded end of the loop for the tubing to be tightly stretched. With your heel on the floor, move your foot upward to the right and then upward to the left.
Now stand with one end of the loop in your hand and the other end around the ball of your foot. Keeping your heel on the floor, lift the front of your foot and then press it down as if you were stepping on the gas, using the loop to provide resistance.
Finally, stand on one foot, lightly touching a chair or table for balance. Slowly lift your heel off of the floor, then slowly lower it.
When exercise leads to a strain, sprain, or overuse injury, the pain is not only physical but also psychological. Though it's easy to start feeling down when you can't invigorate yourself with your usual walk, run, or swim, don't fall into the "Why me?" trap. Instead, consult your doctor and follow these steps. You'll be flying through the park or pool in no time.
Back in Action: A 5-Step Injury Recovery Plan
1. RICE it.
The immediate response to most common sports injuries is often called the RICE approach. (This isn't the right way to treat a broken bone or any injury that leaves you out of alignment or unable to support your weight; these problems call for emergency care.) RICE stands for rest, ice, compression, and elevation. Rest doesn't mean you take a nap; it simply means you must stop doing whatever led to the injury. As soon as possible, apply an ice pack wrapped in a thin towel (never apply ice directly to the skin) for 20 minutes; continue icing the injured area for 20-minute periods as often as you can over the next two days. At the same time, you want to put some gentle pressure on the area (that's the compression part), perhaps using a wraparound elastic bandage from the pharmacy. (This helps limit swelling, but if your circulation is impaired, you're overdoing it!) Elevate the area too, so it's above your heart; if you hurt your ankle or knee, you may find it easier to lie down.
This sounds like a lot of things to do at once, but if you take it one letter at a time and remind yourself that you're already beginning your recovery, you won't lose heart. A convenience that any athletic person may want to keep on hand is one of the widely available gel packs that fasten around a knee or elbow with Velcro. You keep it in your freezer, and it covers the "I" and "C" of RICE in one step.
2.
Take the right pills.
Unless your system doesn't tolerate over-the-counter pain relievers, it's a good idea to take a short course of one that reduces inflammation, like aspirin or ibuprofen. However, do not take either of these drugs if you have a history of peptic ulceration or even a history of significant dyspepsia/indigestion. One or two tablets every four to six hours for five to seven days (or two naproxen a day for the same duration) is recommended. You can stop sooner if the pain and swelling go away. Over-the-counter doesn't mean utterly safe, though; if you regularly take any other drugs (including alcohol), consult your doctor first.
3.
Get out the heat pack.
Once the swelling has gone down (usually about 48 hours after the injury), it's time to apply moist heat to your sore spot. That's because you've reached a point in the process where increasing circulation to the area can hasten repair. Use the type of heating pad that comes with a spongy insert that you can dampen with water; a cheaper option (though it won't stay hot for long) is to wet a washcloth and stick it in the microwave for a minute. If you're inclined to try an alternative medicine approach, sprinkle a little comfrey on your warm compress; some herbalists say it relieves inflammation, though there is no medical evidence to back this up. (Never apply it to broken skin, though.)
4.
Try gentle stretching.
You now want to carefully test out your range of motion in the injured area. Ask a physiotherapist or professional trainer to recommend a couple of simple moves, and do them slowly, never going to the point of pain. If the area feels stiff, apply moist heat before you try anything. Then let your body's reactions be your guide. Stretching will bring down inflammation of the connective tissues and actually speed the healing process.
The old wisdom was that you should stay off a pulled muscle or sprained joint until you no longer felt the slightest twinge, yet a recent study found that people who spent a week or more resting after an ankle sprain had more pain and a higher rate of re-injury than those who were up and moving sooner. So keep on doing gentle movements that feel comfortable. If you accidentally aggravate the area, look at it as a learning experience ("Okay, it hurts when I do that too much") instead of getting upset; apply an ice pack, and try again in a day or so, when it feels better.
As you ease back into being physically active, modify your workouts to avoid re-injury. This may simply mean reducing the length of your sessions or your previous level of intensity, or it may call for switching to an activity that won't stress the vulnerable area. If you're a runner with a hurt knee, for example, you could try cycling, using a rowing machine, or swimming -- whichever feels best to you. In addition, do some specific strengthening exercises for the muscles that support the area you injured. Again, if it's your knee, you want to build up the thigh muscles (inner, outer, and back) of both legs; balanced strength here can guard your knees against future harm.
Pat yourself on the back. If you're feeling no pain, you did it: you're ready to enjoy your favourite workout! Start with a shorter and less vigorous version, if you haven't already been doing that as part of your rehabilitation; gradually work up to your former time span and intensity.
Take a moment, too, to appreciate your body's remarkable healing powers. Getting over an injury isn't exactly fun, but it does renew your appreciation for the pleasures and well-being that an active lifestyle can bring.
johnbuckley@westcorkleague.com
Copyright © 2003 All rights reserved