Sports Injury Treatment and Rehabilitation
A guide to cutting your recovery time by days, if not weeks!
I get a lot of questions from people asking about specific sports injury prevention and treatment, like running injuries and other common pulled muscle complaints. The unfortunate thing about most of these requests is that the injuries might have occurred some time ago. This time lapse between the injury occurring, and treatment sort, is the biggest stumbling block to a full and complete recovery.
As always, before I sit down to write this newsletter, I like to spend a few hours surfing the net for information that relates to the topic I'm going to write about. In most cases, I find a great deal of useful information that relates to what I'm looking for; but not this time.
What I did find, was a lot of information which related to treating specific sports injuries long after they'd occurred. However, I found very little information relating to the immediate treatment of sports injuries. This was quite disappointing, because if people are only treating injuries long after they've occurred, they're really putting themselves at a great disadvantage.
What follows is a look at the most appropriate initial treatments for all soft tissue, sports injuries. This information will definitely cut your recover time by days, if not weeks.
Before We Start!
Lets have a quick look at the type of injuries I'm talking about. The type of sports injuries I'm referring to here are the soft tissue injuries, which are very common in most, if not all sports. These injuries include sprains, strain, tears and bruises which affect muscles, tendons, ligaments and joints. The soft tissues of the body.
Examples of common soft tissue injuries would include things like hamstring tears, sprained ankles, pulled calf muscles, strained shoulder ligaments, corked thigh, etc. Remember a sprain refers to a tear or rupture of the ligaments, while a strain refers to a tear or rupture of the muscles or tendons.
The sort of injuries I'm NOT talking about here are injuries which affect the head, neck, face or spinal cord. Injuries which involve shock, excessive bleeding, or bone fractures and breaks. The treatment of these type of injuries goes way beyond the relatively simple soft tissue injuries that I'm discussing here.
Priority Number 1
The first priority when treating any sports injury is, "Do No Further Damage." So before we get into the treatment of soft tissue injuries, there's one important point that I should discuss first.
Before you start treating any injury, whether to yourself or someone else, first STOP and take account of what has occurred. Consider things like; ..is the area safe from other dangers? ..is there a threat to life? ..is the injury serious enough to seek emergency help? Then, using the word STOP as an acronym;
Stop the injured person from moving. Consider stopping the sport or game if necessary.
T: (talk) Ask questions like; ..what happened? ..how did it happen? ..what did it feel like? ..where does it hurt? ..have you injured this part before?
O: (observe) Look for things like swelling, bruising, deformity and tenderness.
P: (prevent) Remember, do no further damage. Prevent further injury.
Once you've taken a few moments to make sure the injury isn't life threatening, it's then time to start treating the injury. Remember, the sooner you start treating a sports injury, the more chance you have of a full and complete recovery. The longer you wait, the worse it's going to be.
Without a doubt, the most effective, initial treatment for soft tissue injuries is the R.I.C.E.R. regime. This involves the application of (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment.
Where the R.I.C.E.R. regime has been used immediately after the occurrence of an injury, it has been shown to significantly reduce recovery time. R.I.C.E.R. forms the first, and perhaps most important stage of injury rehabilitation, providing the early base for the complete recovery of injury.
When a soft tissue injury occurs there is a large amount of uncontrolled bleeding around the injury site. This excessive bleeding causes swelling, which puts pressure on nerve endings and results in increased pain. It is exactly this process of bleeding, swelling and pain which the R.I.C.E.R. regime will help to alleviate. This will also limit tissue damage and help the healing process.
The "How To"
R: (rest) It is important that the injured area be kept as still as possible. If necessary support the injured area with a sling or brace. This will help to slow down blood flow to the injured area and prevent any further damage.
I: (ice) By far the most important part. The application of ice will have the greatest effect on reducing bleeding, swelling and pain. Apply ice as soon as possible after the injury has occurred.
How do you apply ice? Crushed ice in a plastic bag is usually best. However, blocks of ice, commercial cold packs and bags of frozen peas will all do fine. Even cold water from a tap is better than nothing at all.
When using ice, be careful not to apply it directly to the skin. This can cause "ice burns" and further skin damage. Wrapping the ice in a damp towel generally provides the best protection for the skin.
How long? How often? This is the point where few people agree. Let me give you some figures to use as a rough guide, and then I'll give you some advice from personal experience. The most common recommendation is to apply ice for 20 minutes every 2 hours for the first 48 to 72 hours.
These figures are a good starting point, but remember they're only a guide. You must take into account that some people are more sensitive to cold than others. Also be aware that children and elderly people have a lower tolerance to ice and cold. Finally, people with circulatory problems are also more sensitive to ice. Remember to keep these things in mind when treating yourself or someone else with ice.
Personally, I recommend that people use their own judgement when applying ice to themselves. For some people, 20 minutes is way too much. For others, especially well conditioned athletes, they can leave ice on for up to an hour at a time. The individual should make the decision as to how long the ice should stay on.
My personal recommendation is that people should apply ice for as long as it is comfortable. Obviously, there will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it's time to remove the ice. It's much better to apply ice for 3 to 5 minutes a couple of time an hour, than not at all.
C: (compression) Compression actually achieves two things. Firstly, it helps to reduce both the bleeding and swelling around the injured area, and secondly, it provides support for the injured area. Simply use a wide, firm, elastic, compression bandage to cover the injured part. Make sure you bandage both above and below the injured area.
E: (elevation) Simply raise the injured area above the level of the heart at all possible times. This will further help to reduce the bleeding and swelling.
R: (referral) If the injury is severe enough, it is important that you consult a professional physical therapist or a qualified sports doctor for an accurate diagnosis of the injury. With an accurate diagnosis, you can then move onto a specific rehabilitation program to further reduce your injury time.
Before we finish up, there are a few things which you must avoid during the first 24 to 72 hours after an injury. Be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spa's, Jacuzzi's and sauna's.
Avoid all movement and massage of the injured area. Also avoid excessive alcohol. All these things will increase the bleeding, swelling and pain of your injury. Avoid them at all costs.
The above information takes care of the first 48 to 72 hours. Follow the above advice and you'll cut your recovery time by days, if not weeks. But what happens after R.I.C.E.R.? There's still a little way to go before you're completely over that injury.
After 48 to 72 Hours
Lets take a quick look at how your soft tissue (muscle, tendon, ligament, etc.) repairs itself.
When any sort of damage occurs to the soft tissues, like a strain or sprain, the body immediately goes into a process of repair. Where the individual fibres have been ruptures, or torn, the body begins to bind the damaged fibres together using a fibrous protein called collagen. Or, as it's more commonly known, scar tissue!
You see, when a muscle is torn, you would expect that the body would repair that tear with new muscle. In reality, this doesn't happen. The tear, or rupture, is repaired with scar tissue.
Now this might not sound like a big deal, but if you have ever suffered a soft tissue injury, you'll know how annoying it is to keep re-injuring that same old injury, over and over again. Untreated scar tissue is the major cause to re-injury, usually months after you thought that injury had fully healed.
Scar tissue is made from a very brittle, inflexible fibrous material. This fibrous material binds itself to the damaged soft tissue fibres in an effort to draw the damaged fibres back together. What results is a bulky mass of fibrous scar tissue completely surrounding the injury site. In some cases it's even possible to see and feel this bulky mass under the skin.
When scar tissue forms around an injury site, it is never as strong as the tissue it replaces. It also has a tendency to contract and deform the surrounding tissues, so not only is the strength of the tissue diminished, but flexibility of the tissue is also compromised.
So what does this mean for the athlete? Firstly, it means a shortening of the soft tissues which results in a loss of flexibility. Secondly, it means a weak spot has formed within the soft tissues, which could easily result in further damage.
Lastly, the formation of scar tissue will result in a loss of strength and power. For a muscle to attain full power it must be fully stretched before contraction. Both the shortening effect and weakening of the tissues means that a full stretch and optimum contraction is not possible.
Now, if you've taken the advice so far, and used the R.I.C.E.R. regime to treat the initial reaction to a soft tissue injury, you're well on your way to a complete recovery. If however, you didn't use the R.I.C.E.R. regime, you're behind the eight-ball, so to speak. Let me explain.
So far, we have learned that when an injury occurs the body responds by sending large amounts of blood to the injury site. If this isn't controlled, with the R.I.C.E.R. regime, it will result in massive bleeding, swelling and pain. More importantly, it will also result in a large formation of bulky, painful scar tissue.
As we now know, the R.I.C.E.R. regime will help to control the bleeding, swelling and pain, but more importantly, it will also control the formation of scar tissue. When the R.I.C.E.R. regime is used correctly, there will only be a minimal formation of scar tissue, which allows for optimal return of flexibility and strength.
So, how do we put the finishing touches on your recovery? How do we get rid of that annoying formation of scar tissue?
Firstly, you must keep active! Don't listen to anyone who tells you to do nothing. Now is the time to start active rehabilitation. Most of the swelling will have subsided after the first 48 to 72 hours and you are now ready to start light activity.
Light activity will not only promotes blood circulation, but it will also activates the lymphatic system. The lymphatic system is vital in clearing the body of toxins and waste products, which can accumulate in the body following a sports injury. Activity is the only way to activate the lymphatic system.
Before we move on, a quick word of warning. Never, Never, Never do any activity that hurts the injured area. Of course you may feel some discomfort, but NEVER, NEVER push yourself to the point where you're feeling pain. Listen to your body. Don't over do it at this stage of the recovery, you've come too far to blow it now.
To complete your recovery and remove most of the unwanted scar tissue, you now need to start two vital treatments. The first is commonly used by physical therapists (or physiotherapists), and it primarily involves increasing the blood supply to the injured area. The aim is to increase the amount of oxygen and nutrients to the damaged tissues.
Physical Therapists accomplish this aim by using a number of activities to stimulate the injured area. The most common methods used are ultrasound and heat.
Ultrasound, or TENS (Transcutaneous Electrical Nerve Stimulation) simply uses a light electrical pulse to stimulate the affected area. While heat, in the form of a ray lamp or hot water bottle, is very effective in stimulating blood flow to the damaged tissues.
Secondly, to remove the unwanted scar tissue it is vital that you start a course of deep tissue sports massage. While ultrasound and heat will help the injured area, they will not remove the scar tissue. Only massage will be able to do that.
Either find someone who can massage the effected area for you, or if the injury is accessible, massage the damaged tissues yourself. Doing this yourself has the advantage of knowing just how hard and deep you need to massage.
To start with, the area will be quite tender. Start with a light stroke and gradually increase the pressure until you're able to use deep, firm strokes. The more you massage the effected area the harder and deeper you will be able to push.
Use deep, firm strokes, moving in the direction of the muscle fibres. Concentrate your effort at the direct point of injury, and use your thumbs to get in as deep as possible to break down the scar tissue.
Just a few final points before we finish up. Be sure to drink plenty of fluid during your injury rehabilitation. The extra fluid will help to flush a lot of the waste products from your body.
Also, I recommend you purchase a special ointment to use for your massage called "Arnica". This special ointment is extremely effective in treating soft tissue injuries, like sprains, strains and tears. You can purchase this ointment at most health food shops and pharmacies.
Now, if you've come this far, you've done well. If you've applied all the information so far, you should be well on your way to a complete recovery. However, there is one final stage of treatment before you're back to 100%.
So far, we have looked at the initial treatment for sports injuries, like running injuries and other common pulled muscle complaints. Then we looked at specific rehabilitation techniques to help repair any damaged soft tissue. Now, we're going to put the finishing touches on your recovery and rehabilitation. We'll look at regaining the fitness components that may have been lost during your injury and recovery.
By now, you've come over 80% of the way. You may even feel that your injury is fully recovered. Your treatment so far may have stopped the swelling and bleeding, it may have reduced the amount of scar tissue at the injury site, it may have even started to heal the soft tissues which were injured. But there is still one more important thing to do.
The last 20% can be the most crucial to your complete recovery. If you've ever suffered from a sporting injury in the past, you'll know how annoying it is to think you're recovered, and then out-of-the-blue, you're injured again and back to where you started from. It can be one of the most frustrating and heart-breaking cycles an athlete, or anyone else for that matter, can go through.
Most people will refer to this phase of your recovery as the active rehabilitation phase. Simply because, during this phase you will be responsible for the rehabilitation process. You will be doing the exercises and activities required to speed up your full recovery.
The aim of this phase of your rehabilitation will be to regain all the fitness components that were lost during the injury process. Regaining your flexibility, strength, power, muscular endurance, balance, and co-ordination will be the primary focus.
Without this phase of your rehabilitation, there is no hope of completely and permanently making a full recovery from your injury. A quote from a great book called "Sporting injuries" by Peter Dornan & Richard Dunn will help to reinforce the value of active rehabilitation.
"The injury symptoms will permanently disappear only after the patient has undergone a very specific exercise program, deliberately designed to stretch and strengthen and regain all parameters of fitness of the damaged structure or structures. Further, it is suggested that when a specific stretching program is followed, thus more permanently reorganising the scar fibres and allowing the circulation to become normal, the painful symptoms will disappear permanently."
The first point to make clear is how important it is to keep active. Often, the advice from doctors and similar medical personnel will simply be; rest. This can be one of the worst things you can do. Without some form of activity the injured area will not receive the blood flow it requires for recovery. An active circulation will provide both the oxygen and nutrients needed for the injury to heal.
Any form of gentle activity not only promotes blood circulation, but it also activates the lymphatic system. The lymphatic system is vital in clearing the body of toxins and waste products, which can accumulate in the body following a serious injury. Activity is the only way to activate the lymphatic system.
A Word of Warning
Never, Never, Never do any activity that hurts the injured area. Of course you may feel some discomfort, but never push yourself to the point where you're feeling pain. You've come a long way from first being injured, don't take a step backwards now. Be very careful with any activity you do. Pain is the warning sign, don't ignore it.
Now it's time to make that injured area strong again. The main areas you're going to be working on are your flexibility, strength and co-ordination. Depending on your background, and what sport you're involved in, these elements should be your first priority. As you start to regain your strength, flexibility and co-ordination, you can then start to work on the more specific areas of your chosen sport. Let's start with flexibility.
When increasing the flexibility of the injured area it is important to increase the flexibility of, not only the damaged muscles and tendons, but also the muscle groups around the injured area.
The best form of stretching to use is a form of stretching called static stretching. Be sure to warm-up with some light activity, and then place the muscle group into a position where tension is felt. Hold the stretch for an extended period of time, at least 30 to 45 seconds.
Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don't make the mistake of thinking that something as simple as stretching won't be effective.
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When attempting to increase the strength of an injured area, be sure to approach this in a gradual, systematic way of lightly over-loading the muscles and tendons. Be careful not to over do this type of training. Patience is required.
The use of machine weights can be very effective here, as they provide a certain amount of stability to the joints and muscles as you perform your rehabilitation exercises.
When a soft tissue injury occurs, there is always a certain amount of damage to the nerves around the injured area. This, of course, leads to a lack of control of the muscles and tendons, and can also affect the stability of joint structures.
To compensate for this lack of co-ordination, specific exercises and drills should be done to help with balance, co-ordination and muscle control. Be sure to keep the activity as specific as possible to the sport you play.
This has been a very comprehensive account of the correct treatment for most soft tissue sports injuries. If followed correctly you will find that most minor injuries, like mild sprains and strains, will heal within a day or two. While most major soft tissue injuries will heal within a week or two.
Article by Brad Walker. Brad is a leading stretching and
sports injury consultant with nearly 20 years experience
in the health and fitness industry. For more articles on
stretching, flexibility and sports injury, please visit
The Stretching Institue
Injury Prevention from Sports Injury Prevention