|As more people participate in sport and exercise to stay fit and healthy and to maintain their weight, sports related injuries are on the increase. As we head into the autumn months, when training for many team sports such as hockey and rugby restarts, as do exercise classes in gyms and schools, early autumn can be a busy period for those |
Many minor injuries will get better with minimal assistance, but equally injuries that may require professional intervention will benefit from correct early self management to reduce the healing time and ensure complete functional recovery. Unfortunately if we don’t look after these small injuries correctly initially it could lead to long term problems.
All recent injuries should be initially self managed using the recognised, widely accepted, easily applied PRICE regime- Protection Rest Ice Compression & Elevation, as discussed last week. PRICE should be used for the first 72 hours after the onset of injury, i.e. during the acute inflammatory stage of healing.
However it is equally important and not always as widely known what should be avoided in the first two days after an injury to allow our natural defence mechanism kick in and get to work at healing and rebuilding the injured area.
The things to avoid have been summarised as HARM- Heat, Alcohol, Run (exercise) and Massage.
Apart from a nice hot shower to get rid of all the mud and perspiration, to relax the rest of the muscles and reduce the excess lactic acid build up in our skin, joints and muscle after playing, application of Heat should be avoided in the first 72 hours. Heat is a ‘vasodilator’, meaning its action is to increase the blood flow. However increasing blood flow to an injured area, especially torn muscle, increases the volume of bruising and swelling in the area, exacerbating rather than assisting the problem.
Instead of heat, use ice to reduce further damage e.g. ice baths, ice packs etc. Be careful when applying ice, plastic cover should not go directly onto the skin, wrap the ice bag in a thin damp towel, check the skin regularly for ice burn, don’t leave on for longer than 30 mins.
Heat is helpful and can be applied beneficially, but only 3 days after injury. A hot water bottle or deep heat cream may soothe the aches and also promotes the healing process in muscles.
We all have the image of coming off the training field to meet our injured team mate sitting at the bar pint in one hand and ice strapped around an injured leg propped up on a bar stool. Actually Alcohol should be avoided during the first day or so after an injury, for exactly the same reasons as avoiding direct application of heat, as it too is a vasodilator, increasing blood flow to the injured site. Also, after consuming alcohol general judgement and balance are affected and pain receptors are inhibited, so pain becomes less sharp. This makes it more likely that more damage can occur, on top of the original injury.
Avoiding Exercise (in the care of HARM; running) of the injured site is important in the early stages to reduce the demands of the body on that area. It is true that with some injuries early controlled and specific exercise movements may accelerate healing and restore function. For safety and best effect these need to be carried out under the guidance of an experienced Chartered Physiotherapist used to dealing with similar injuries on a regular basis.
Getting a deep tissue Massage or a rub-down to the injured site in the early days after training or a match is also not advisable. Massage is also a vasodilator. Massage must be particularly avoided in large muscle groups, especially thigh & calf muscles and should be completely avoided in the case of a ‘dead leg’, where the muscle suffered direct trauma, responding with obvious immediate bruising and swelling. Early massage in this type of injury can create serious side-effects including infiltration of the injured area with bone cells.
A gentle general massage after exercise is fine, provided the injured area is avoided. In fact it may be quite beneficial and prevent the common aches and pains.
After injury it is important to reduce the pain and discomfort of the injured area. Pain is a natural defence mechanism reminding us not to use the injured area of the body and to allow it to rest.
Simple OTC (over the counter) medications are commonly taken for pain. Here again, there is new evidence to take into account. The two main types of OTC medications are either pain killers or anti-inflammatories. Wide ranging medical research has shown that pure painkillers containing paracetamol deal with acute pain extremely effectively. For best effect in the first 24-48 hours, take in quantities as recommended on the box. In recent years research has shown that anti inflammatory tablets such as those containing ibuprofen actually slow down early natural healing, rather than assist it, immediately post injury. Anti-inflammatories interfere with the body’s own natural healing process, and so are better left until healing has become established, some 3 days post injury. At this point they are most beneficial. There is anecdotal evidence that homeopathic remedies (arnica, aloe vera) applied locally can soothe injury and may be beneficial.