Harvard Men's Health Watch

Treating sports injuries

In a perfect world, medications would never produce side effects, operations would always be successful, and the best movie would win the Oscar. In that world, Harvard Men's Health Watch would be in every mailbox, and exercise would continue to prevent disease and prolong life without causing any aches and pains. For better or worse, perfection can never be achieved in the real world. It's a wonderful world, and exercise is wonderful for health, but people who exercise do run a risk of injury.

Although exercise rarely triggers serious heart problems, they must be the first concern for everyone who works out. To protect yourself, get a check-up before you start a serious exercise program. Listen to your body for warning symptoms such as chest pain, a racing or erratic pulse, undue shortness of breath, and light-headedness, and get help if you experience any of these symptoms.

Although cardiac problems are infrequent, musculoskeletal woes are relatively common. A study of 6,313 adults who exercised regularly found that 21 percent developed an exercise-related injury during the course of a year. Two-thirds involved the legs; the knee was the most frequently injured joint.

It sounds grim, but it's not. For one thing, injuries are much more common with intense exercise and competitive sports than with moderate exercise done for health. For another, people who exercise actually have a lower long-term risk of disability than sedentary people. A 13-year study of 370 exercisers age 50 to 72, for example, found that exercise was linked to a reduced risk of disability and a lower death rate, even among elderly folks who engaged in running, a high-impact activity.

Injuries do occur, but many are preventable, most are mild, and the majority will respond nicely to simple treatment at home. An old runner's adage boasts, "I have two fine doctors, my right leg and my left." It's true for disease prevention, but for injury treatment you'll also need your head and your hands. And you should know when to consult a health care professional.

General principles

Prevention. It's always the best treatment. Here are a few key tips:

  • Work yourself into shape slowly. It's the most important element of prevention, particularly for "weekend warriors" who may be tempted to go all out without preparing themselves properly. It's a growing problem, particularly for the baby boom generation; in fact, doctors have coined a new diagnosis, "boomeritis," for the phenomenon. Use a graded exercise program to get into shape gradually, and then stay in shape the year round.

  • Warm up before each exercise session and cool down afterwards.

  • Stretch regularly; exercise makes muscles strong, but they also get tight and short — stretching preserves flexibility and reduces the risk of injury.

  • Use good equipment; it's particularly important to have supportive, well-fitting shoes for weight-bearing activities.

  • Use good technique; a few lessons or a little coaching can improve your mechanics as well as your performance.

  • Don't overdo it. Fatigue and dehydration impair concentration, often leading to a misstep or fall. Overuse is the major cause of injuries; give your body a chance to rest and recover after workouts, particularly when you're first getting into shape. Alternate hard sessions with easier ones. Vary your routine so that you use different parts of your body; some people, for example, might walk one day, play tennis the next, and garden the third. A day off now and then doesn't hurt, either.

Recognition. If prevention fails, early detection is the next line of defense. Be alert for symptoms. A bit of soreness and stiffness is normal, but pain, swelling, diminished strength or mobility, and discoloration of the skin is not. Spot small problems before they become big ones. If your problem seems small, treat it yourself. But if you don't improve — or if you have a major injury — get expert help.

Common injuries: An exerciser's guide

Many sports injuries feel the same, but there are important differences among them. Here is a glossary of some common problems:

Sprains. Injuries to ligaments, the fibrous connective tissues that connect one bone to another. In first-degree sprains, the ligament is stretched; in second-degree sprains, some fibers are torn; in third-degree sprains, most or all of the fibers are torn. In general, first-degree sprains produce only pain and swelling, second-degree injuries are often accompanied by weakness and bluish discoloration due to bleeding, and third-degree sprains produce severe weakness and decreased mobility.

Strains. Injuries to muscles or tendons, the fibrous tissues that connect muscles to bones. Commonly known as muscle pulls, strains also come in first-, second-, and third-degree varieties. Like sprains, strains are usually caused by a misstep or fall that places excessive force on a tendon or muscle, so that fibers are stretched or torn.

Tendinitis. Inflammation of a tendon, often caused by overuse or poor body mechanics. Pain is the major symptom, but warmth, swelling, and redness may occur. The pain is typically most severe at the start of exercise; it eases up during exercise, only to return with a vengeance afterward.

Fasciitis. Inflammation of the layer of fibrous tissue that covers many muscles and tendons. Overuse is often to blame. A common example is plantar fasciitis, inflammation of the sole of the foot, which plagues many walkers and runners.

Bursitis. Inflammation of the small, fluid-like sacs that cushion joints, muscles, or bones like miniature shock absorbers.

Arthritis and synovitis. Inflammation of a joint (arthritis) or the membrane that surrounds it (synovitis). Like bursitis, joint inflammation often occurs without being triggered by exercise, but both problems can also result from overuse or trauma. Pain and swelling ("water on the knee," for example) are common symptoms.

Dislocations. Often very painful and disabling, dislocations occur when bones slip out of their proper alignment in a joint. A deformity is often visible, and the joint is unable to move properly. Although some athletes attempt to realign (reduce) a dislocation themselves, it should be done by a physician or highly experienced trainer or therapist.

Fractures. A disruption in the continuity and integrity of a bone. Except for broken toes and stress (hairline) fractures, nearly all fractures require skilled medical management.

Contusions. Bleeding into tissues caused by direct trauma — the "black and blue."

Muscle cramps and spasms. Unduly strong and sustained muscle contractions that can be very painful (the "charley horse"). Gentle stretching will help relieve cramps; hydration and good conditioning help prevent them.

Lacerations and abrasions. Cuts and scrapes; small ones can be managed with soap and water and Band-Aids, but larger ones may require special dressings or sutures. Tetanus shots are not necessary if immunizations have been kept up to date with boosters every 10 years.

Self-treatment: The price is right

Use a five-point program to handle your injuries; the key is PRICE: Protection, Rest, Ice, Compression, and Elevation.

Protection. Injured tissues must be protected against further injury. Protect your small injuries by applying bandages, elastic wraps, or simple splints. Something as easy as taping an injured toe to its healthy neighbor can do the job. See your doctor for problems that require precision splints or casts.

Rest. Injured tissues need time to heal. It's an obvious principle, but once you're hooked on exercise you may be tempted to ignore it. Don't give in to temptation — you'll shortchange yourself with shortcuts. But you can rest selectively; you may have to give up tennis while your serving shoulder recovers from tendinitis, but you can still walk, jog, or hike. In a curious way, an injury is often a blessing in disguise, forcing you to diversify your workouts and acquire new skills.

Ice. It's the cheapest, simplest, yet most effective way to manage many injuries. Ice is an excellent anti-inflammatory, reducing swelling and pain. For best results, apply an ice pack for 10 to 15 minutes as soon as possible after an injury. Repeat the ice treatment each hour for the first four hours, then four times a day for the next two to three days. Protect your skin with a thin cloth, and don't allow your skin to become red, blistered, or numb. After 48 to 72 hours, switch to heat treatments, using the same schedule and principles.

Compression. Pressure will help reduce swelling and inflammation. In most cases, a simple elastic bandage will suffice; it should be snug but not too tight. Remember that swelling may develop slowly hours after your injury, so you may have to loosen your wrap. Another trick is to place a small piece of foam rubber directly on the injured area before you wrap it; this will allow you to put gentle pressure where it's needed without constricting an entire joint or limb.

Elevation. It's a simple strategy that enlists the force of gravity to drain fluid away from injured tissues, reducing swelling, inflammation, and pain. Keep your sore foot or other limb up on a hassock or put a pillow under it in bed; elevating an injured area will help you get back to Earth faster.

Medication

PRICE is the key to the early management of most kinds of injuries, but you may also need medication for pain or inflammation. Acetaminophen (Tylenol, other brands) may be the best choice for the first day, since it will reduce pain without increasing bleeding. After the first day or two, consider aspirin or another nonsteroidal anti-inflammatory (NSAID) such as ibuprofen (Advil, other brands) or naproxen (Aleve) to fight inflammation as well as pain. NSAIDs can irritate the stomach and cause bleeding; for safety's sake, take them with milk or food. Prolonged NSAID use can lead to other complications, so use the lowest dose that works and always follow directions.

The PRICE program relies on applications of cold and then heat, often supplemented by anti-inflammatory medications or pain relievers. Instead of an ice pack or warm pack, you can rub in an ointment that will make your tissues feel cool or warm. And you can also buy liniments, gels, and ointments that contain anti-inflammatory medications. Topical anti-inflammatories are available without a prescription, and they are much safer than oral anti-inflammatory medications. Anti-inflammatory ointments are very popular with patients, but doctors have been skeptical. However, a British meta-analysis of 86 trials involving 10,160 patients concluded that these ointments can reduce pain in acute injuries (such as sprains and strains) and chronic conditions (such as arthritis) — about a third of patients improved, but their relief was only modest to moderate.

Liniments can be messy or irritating. Some have an unpleasant odor and many are expensive. If you want to use a liniment, start with one that contains an NSAID. But no matter what brand you select, be prepared for one side effect not measured by the British scientists: disappointment. Liniments are not cure-alls. Even if they reduce pain, they won't help heal injured tissues. For that, you'll need time, rest, and conventional medical therapy. So if a liniment helps, use it, but only as part of a complete program of protection, rest, and physical therapy.

The next step: Rehabilitation

Your pain is gone and your swelling is down — but your treatment is not yet over. Instead, plan your rehabilitation and return to exercise with the same care that you used to treat your injury. As a rule of thumb, give yourself two days of rehab for each day of inactivity due to injury. Start with gentle range-of-motion exercises, and then gradually increase your weight-bearing activities. When you are comfortable, consider building up your tissues with graded resistance training using calisthenics, light weights, or resistance equipment such as Cybex or Nautilus. If all goes well, you can be stronger than before your injury, thus reducing your risk of reinjury.

Don't neglect stretching exercises to improve your flexibility. Use heat or massage to warm up your injured tissues before you start your rehab exercises; afterward, apply ice to the area to reduce inflammation. The judicious use of aspirin or other NSAIDs may also facilitate your rehabilitation program.

Get help

You can manage many injuries yourself, but don't be stubborn. If you have a major injury — or if your nagging woes don't clear up — get help. An experienced exercise buddy who's been there and done that may be all the help you need. Primary care physicians can handle many exercise-induced problems, but more difficult issues require orthopedists, physical therapists, and sports podiatrists. In many centers, these specialists come together in sports medicine clinics.

Get going

The most dangerous thing about exercise is not doing it. True, injuries do happen — but don't let the threat of problems become an excuse for taking to your couch. Instead, take the simple steps that will reduce your risk of exercise-induced injuries, become able to spot problems early, learn how to handle minor injuries on your own, and be prepared to get help when you need it. It's easy to overcome simple injuries — but very hard to treat the major illnesses that stem from lack of exercise.