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Injury Management [EDITED]

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Injury Management [EDITED]

Post by MF! on Fri Dec 14, 2012 11:34 pm

** NOTE **: Re-posting this from when I originally wrote this in BWC. I have full intentions of re-writing/editing this. I was young and a lot has changed in my opinions and advice in regards to injury management in the last 3ish years (I first wrote this 2009). Read, and perhaps maybe get a giggle out of it. I may post a new one sometime soon if time permits. If anyone has any questions regarding injury management please let me know. I'm in the process of completing my education in Athletic Therapy. I don't have all the answers, but I can definitely help to put you in the right direction with regards to your health and all that fun stuff.

*******************************

Some general advice on injuries. I've decided that it was best to break it down into acute, chronic/several days post-injury. In all cases, if you're unsure about the nature or the extent of your injury, its always best to seek advice from a health professional IN PERSON. They would be able to make a good judgement of what may be causing the problem and will be able to direct you to the appropriate method of care.

ACUTE (Injury onset - 72 hours after injury)

A simple thing to remember any time you are injured is the principle of rest, ice, compression, elevation, or RICE. Remember this acronym!

- Rest -
Literally as it states. Stopping the activity as soon as you are injured or you feel any symptoms an injury (severe sharp pain, deformity, visible bruising, numbness and tingling, etc). Continued activity is likely to aggravate it and lead to making an injury worse. Obviously degrees of pain, and specific scenarios may allow you to continue your activity until the appropriate care can be given. Out of concern for the safety of the injured body part, its best to restrict the amount of activity that specific region is getting. Another option, if absolute rest is out of the question, is to make sure that it is well supported. This may mean using a brace of some kind, or in worse scenarios may mean casting of the part in question. The idea with rest is to make sure that you allow the body an opportunity to heal from injury using the natural process of inflammation.

- Ice -
Cool it down. This is done to help reduce pain and to CONTROL (not reduce) inflammation. Inflammation needs to happen for tissue to heal, however in some cases the body may respond to injury in excess. If left on its own, inflammation can cause death of otherwise healthy surrounding tissue, and with swelling can create hypoxia of the involved tissue. Icing will help with reducing some of these effects. Something like a bag of crushed ice, a bag of frozen peas, or gel cold packs are ideal since they wrap closely with the contours of your body (a bag of ice cubes won't do this). Make sure that if you use any of these options that you have a wet towel/cloth between the ice and the skin to avoid irritation. Other options are of cooling are cold water immersion, or ice cup massage (take a Styrofoam cup filled close to the brim with water, freeze it overnight, and then tear the edge of the cup off so that you have a layer of ice popping up above the cup. Use that to massage over the injury). The general advice when icing is alternating 15-20 min on (or until numb) and then 15-20 min off (or until sensation returns). Do this as often as you can throughout the day but allow for the tissue to re-warm to reduce the risk of frost bite or other similar cold irritations.

Some people they may be sensitive to ice. I don't mean that its uncomfortable or that they don't like cold, but that they actually have reduced circulation that is sustained for long periods of time after icing (google Raynaud's Phenomenon). For people like this, icing obviously is not recommended, but you can still continue with the other suggestions for injury care.

- Compress -
With regards to swelling, this is probably the most important factor to consider. Compression will assist with lymphatic drainage from the injury site so that you don't have "stuff" pooling into one area. You'll need to be sure that you keep it snug enough that you are supporting and assisting with that drainage, but not so tight that you reduce blood to flow through the injury site (circulation is needed in order to help with lymphatic drainage). Compression can be achieved by using a compression wrap, or if you have a friend nice enough to do it, you can have them help with massaging out the injured site. Foam rolling does not count, and in some cases may actually be detrimental to the injury.

- Elevate -
Keep it above heart level. Use a pillow or some sort of physical support so as not to cause unnecessary strain. Elevating will help to reduce swelling (and in essence will help to reduce pain). You also get the perks relaxation. Take time to read a book ;).


CHRONIC (72 hrs and beyond)

I'm going to steal a concept I got from Mobility WOD and briefly elaborate on it. The analogy being pushed is MCE: Move, Compression, Elevate. At this point, it's usually pointless to ice unless you find that there is still heat and pain from the initial injury. If that's the case then it's likely still in an inflamed state. If those symptoms are not there, then this protocol is something that may be of use to you.

- Move -
After the initial phase of injury, begin moving the injured site. Staying still for too long is bad for several reasons (2 that I can think of off the top of my head). First, it's demotivating. It's the worst feeling in the world to be extremely active, and then be forced to sit out for weeks. You begin to get comfortable with inactivity, may start compensating your movements, and overall just don't like the idea of having to start from scratch again. What's worse is that the longer you wait, the harder it becomes to get back into the groove of moving. Second, atrophy starts to set in with time. Not just muscles, but EVERYTHING (ligaments, tendons, bone, nervous system). You get weaker and less coordinated with time from just sitting around.

The idea with movement is not to be harsh with it. Start with basic range of motion work and slowly progress with the types and strength of movement. If you still feel weary or unsure about the injury site while in full functional movement, then complete the movement in the safest way possible. Let's take the example of someone hurting their shoulder. It hurts too much or feels unstable to lift overhead or to throw a ball, so the basic movements to do might include internal and external rotation, with perhaps forward and lateral raises to 90 degrees without weight in order to encourage full ROM.

Movement also has the added benefit of active lymphatic drainage, with the surrounding muscles assisting in driving fluid out of the vessels at the injury site.

- Compress -
Going with the concept of supporting the injured site and encouraging any left over swelling to GTFO. Once again, I'd encourage using a brace of some kind, or a tensor wrap can be used if the area is too big or a brace is unavailable.

- Elevate -
Once again for the sake of left over swelling. Elevate when rested, but if you can try to do some basic movements while in that position.


OTHER NOTES

- Just to re-iterate what I said above, if you aren't sure about your injury, it's important to see a health professional. For those paying for healthcare, your health is worth your money. You are better off having a sports doctor tell you its a simple muscle strain than to find out years later that you permanently scarred a nerve root from a disc herniation while doing deadlifts (an exaggeration, but you get my point)

- The use of RICE is debatable and its use will vary from person to person, but I've found that with the patients I've worked with that it works well for minor injuries such as bad bruises, muscle strains, ligament sprains.. etc. Any symptoms outside of this such as a broken bone, chest pain, problems breathing or random blackouts etc, get immediate care. RICE isn't the be-all and end-all of injury management.

- Do not let your injury discourage you. As i said before, you want to rest as soon as you think you are injured, and this can be a bit depressing (I'm speaking from experience). While you recover, find alternative activities/ workouts that you can do that wont aggravate your injury. If you've injured your lower body, start focusing on upper body work for a little while. Find books and videos that are related to your training and use those things to help set new goals for once you've recovered. One thing I've been putting into practice lately is using quiet time (or meditation if you will) to reflect on the circumstance. Use the time to think about the injury, what caused it, and how you can prevent it from happening again (see the next point). The main thing I'm getting at is to find things that keep you motivated in your activity.

- Look for ways of possibly PREVENTING THE INJURY in the future. This may mean contacting a health profession (personal trainer, athletic therapist/trainer, strength or sports coach, etc). Think back to what caused your injury. Were you practicing the sport safely? Were you wearing appropriate equipment? I mentioned bracing several times, because it is a good tool for supporting the injury until its fully healed. Be sure that you're doing whatever you can to avoid a dependency on the brace. Overuse of of bracing (such as with ankles) without an appropriate rehab protocol can actually cause you to be weaker in the joint of question.

- Go back into activity gradually. If the injury was serious enough to take you out of sport/training, then take your time to get back in. Don't rush healing. Its fine to use a brace if you are just returning to training, but eventually you want to be able to stop using it.

Any of those last 3 points (in my opinion) would be good reason to post in the injury area for questions...etc. but really, (you're gonna hear it from me again) if you are not sure then see a physiotherapist, sports doctor, or even a general practitioner if that's all you have access to. Keep posting your experiences and questions... keep the above advice in mind.

and that's it...

MF!


Last edited by MF! on Tue Dec 25, 2012 1:28 am; edited 4 times in total
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Re: Injury Management [EDITED]

Post by Dave on Fri Dec 14, 2012 11:49 pm

I have said in the past that I do not fully believe in RICE and I say it again. Rice is specifically designed to reduce blood flow to injured areas and while there are times when this is important, such as immediately following serious trauma (to prevent or minimize inflammation), I believe that many injuries require constant, even increased, blood flow in order to heal properly, especially after the danger of inflammation has passed.


Last edited by Dave.cyco on Sat Dec 15, 2012 4:52 pm; edited 1 time in total
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Re: Injury Management [EDITED]

Post by MF! on Sat Dec 15, 2012 12:10 am

Dave.cyco wrote:I have said in the past that I do not fully believe in RICE and I say it again. Rice is specifically designed to reduce blood flow to injured areas and while there are times when this is important, such as immediately following serious trauma (to prevent or minimize inflammation), I believe that many injuries require constant, even increased, blood flow in order to heal properly, especially after the danger of inflammation has passed.


I agree and disagree. I feel that ice is definitely essential in initial phases of injury, simply because it helps to reduce pain and reduce severe edema/swelling. It also helps reduce excess tissue damage that occurs with inflammation. The idea with icing isn't so much to stop inflammation (it NEEDS to happen), but to control it.

However some argue against because of the decreased blood flow and that inflammation is a natural process and does not need to be controlled. I say you have to weigh out your options: preserve healthy tissue or decrease circulation slightly? With regards to un-regulated inflammation, my friend said it best like this: if someone has a high grade fever, is it right to just let them be and let the body do its thing? We've learned much about what some of these physiological processes can do to us if left unchecked, so I think in fairness that its safe to use somewhat natural means to help guide those processes. Some people do have cold sensitivities, so its granted that icing may not be ideal, but in the case of swelling, compression should at least be carried out. It's main factor that needs to be addressed with initial injury.

The main idea I want to get across with the above is that simple methods of care should be taken when you initially get injured.

Don't worry Dave, I'll get around to editing the above soon enough. What I wrote up there was really old and there's a lot that I intend to change there ;) .
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Re: Injury Management [EDITED]

Post by Dave on Sat Dec 15, 2012 1:12 am

Well I definitely appreciate your reply and I will sticky this thread because I can see there is great value here. I certainly look forward to reading your edits. :)
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Re: Injury Management [EDITED]

Post by musems on Sun Dec 16, 2012 3:26 pm

Dave.cyco wrote:I have said in the past that I do not fully believe in RICE and I say it again. Rice is specifically designed to reduce blood flow to injured areas and while there are times when this is important, such as immediately following serious trauma (to prevent or minimize inflammation), I believe that many injuries require constant, even increased, blood flow in order to heal properly, especially after the danger of inflammation has passed.

Good thread. My personal experience and working with people as a bodywork therapist is that a combination of RICE and MEAT (movement, exercise, analgesics and treatment) as some term the new paradigm work well together. Application of a cool (not ice cold) compress or cooling topical/herbal agent can be very soothing and periods of intermittent rest are essential. There also needs to be gentle mobilization and movement to keep blood flow moving. I think a big problem is people misuse ice and misunderstand rest.
Cold to the point of numbing the tissues and reducing blood flow is counterproductive as is keeping something stiffly bound for extended periods of time (unless its broken.) One of my acupuncture mentors advocated that even for breaks, people should massage and do compressions (by compressions I mean the massage technique of squeezing and releasing not binding) above and below the cast area to encourage blood flow to the cast area.

When I hurt my back I exercised it every **** day with some very gentle and effective stretches that I found in a book geared for dancers. It wasn't fun, but I really credit that with saving my back from long term disability along with the herbs, massage, and gua sha treatments.


Last edited by musems on Tue Dec 25, 2012 10:01 am; edited 1 time in total (Reason for editing : edited for clarity)

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Re: Injury Management [EDITED]

Post by Dave on Sun Dec 16, 2012 5:02 pm

Very interesting post. Thanks for dropping by!
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Re: Injury Management [EDITED]

Post by MF! on Tue Dec 25, 2012 1:12 am

Made the changes like I promised. Just in time for christmas too!! :D

Once again, if theres any questions, concerns or comments feel free to get at me.
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Re: Injury Management [EDITED]

Post by musems on Tue Dec 25, 2012 2:29 pm

What do you think about kinesio taping Flex?
I have had mixed experiences with it.

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Re: Injury Management [EDITED]

Post by MF! on Tue Dec 25, 2012 9:09 pm

musems wrote:What do you think about kinesio taping Flex?
I have had mixed experiences with it.

I'm going to answer this one in a new topic in this section. Also perhaps let other people get a chance to give any of their experiences with it.
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Re: Injury Management [EDITED]

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