Injury Management

 

In the previous blog, we looked at what you can do to reduce your risk of injury however, if you're unlucky enough to sustain an injury, don't despair. There are lots of things you can do to recover and we'll look at general injury management below. Sure, an injury may dash your hopes of completing in the event you’re currently training for, but it’s very likely that with proper management, you would be able to compete during the next season/event.

There are two types of injury: Acute and Chronic (or Overuse). An acute injury is one that results from a sudden insult to a specific tissue and as such there is instant failure of that tissue. Examples would include fractures, dislocations, tears of menisci, and ruptures of muscles, ligaments or tendons, etc. Overuse injuries arise from repetitive insult to a specific tissue, leading to a sub-catastrophic failure. Examples include stress fractures, arthritis, tendinopathies, shin splints etc. A simpler way to look at the mechanism of these injuries is low volume/high force for acute injuries and low force/high volume for overuse injuries.

An acute injury is usually easier to diagnose and the management more definitive, though they usually require a longer convalescent period. Overuse injuries tend to be harder to diagnose, especially as the athlete may often be able to continue exercising; albeit with pain and at a lower intensity. Overuse injuries are usually less localised, examination findings may be negative and even imaging findings (X-ray, MRI etc) can be more elusive. Management and recovery will also vary significantly depending on the extent of the injury and patient concordance. For example if you fracture your tibia, it hurts; it hurts a lot and you cannot weight-bear. A stress fracture of the tibia however is less painful and not only can you weight-bear, but you may even be able to train with it. Often it's much harder to convince those with overuse injuries that absolute rest is needed, so the recovery period is extended.

(To clear any confusion as I get asked this a lot: Fracture is the medical term for breaking a bone - it has nothing to do with the severity of the break. Fractures can be sub-classified into types, a stress fracture being one of them).

Do not ignore pain that is out of proportion to activity. Your body is trying to tell you something and you should listen. In the first instance, reduce your intensity or alter it. For example; if you’re getting foot pain when sprinting, stop sprinting for a short while, alter your training and re-test. If the pain is still there, consult your doctor. As I mentioned in my pre-training blog, most GP’s will advise you to stop exercising and this is not always the right approach. It is vital that when you see your doctor, you explain your level of activity and how important it is for you to continue where possible. The management for a 50-year old couch potato who refuses to do any exercise is very different to the management of a 50 year-old triathlete (yes there are lots of them out there). If you’re not happy, seek the advice of a sports physician or a good physio.

The general principle of most musculoskeletal injury management is PRICE.

Protect the injury - Braces, taping (See Injury Prevention in my previous blog regarding bracing and taping)

Rest - This can be complete or relative depending on the injury

Ice – To reduce swelling

Compression – To reduce swelling

Elevation – To reduce swellingPRICE

The acronym above used to have an N at the end, which represented Non-Steroidal Anti-Inflammatory Drugs – NSAIDs. Example of these are Ibuprofen, Naproxen, Diclofenac etc. This has been removed, as these drugs are not as beneficial as we once thought. NSAIDs relieve pain by reducing inflammation and I would say for the first 24-48hrs this is ok. However, we do actually need inflammation. We do? Yes! The body does things for a reason, millions of years of evolution have ensured that. The inflammatory process is a vital part of the healing process and if we suppress it, we suppress the capacity for repair. This isn’t the only disadvantage to NSAIDs; they can cause stomach problems, exacerbate asthma, can cause kidney damage and even cardiac problems. If you have to take them, make sure you take them with food and never during training when you’re dehydrated and breaking down muscle. If you have to take any painkillers, try and stick to simple Paracetamol and if this isn’t strong enough, it means that there’s a more serious problem.

If you’re concerned you may have an injury that you haven’t been managing, make sure to see your GP as soon as possible. 

Pain isn't always weakness leaving the body!

 

This blog is written by friend of Neat, Dr Nick Ambatzis MB BS, MSc (SEM), MRCGP.

Nick is a General Practitioner specialising in Sports and Exercise Medicine. He completed his medical degree at University College London Medical School in 2002. Nick worked for almost ten years as a junior surgeon and spent three years in Trauma & Orthopaedics. He attained a Masters in Sports and Exercise Medicine and subsequently trained as a GP practising in Paddington.

From an early age, Nick has been both a keen cross-country runner and water-polo player, having competed at college level. Nick is also an accomplished ultra-marathon runner, having competed in many cross-country and cross-alpine races, ranging from 50-100 miles. He has also been a Crossfit and Crossfit Endurance coach.