Sport Dimensions

Initial Injury Management

It’s fair to say that anybody who has participated in sporting activity for long enough will most likely have picked up an injury or two along the way. Often sporting activity isn’t even nessescary for an injury to occur… accidents happen.

As a population we’re not all Physiotherapists, Rehabilitation Specialists or First Aiders, however it is of upmost importance to know how to effectively manage these injuries from the moment they occur to the point when you reach professional assistance.

This knowledge of initial injury management is important, as the better managed the injury is in the early stages often directly effects the rate and quality of recovery and repair – in other words the better you manage your injury in the first place, often the quicker you will get better!

So what do we all need to know?

PRICE
Protection, Rest, Ice, Compression, Elevation

Protection: The clue’s in the title for this one. The objective here is to protect the injured part – to reduce the risk of further injury or undue pain. Protection can be accomplished in various ways depending on the body part to be protected. A supportive wrap for an ankle or wrist, crutches for an unknown leg injury, splint for a suspected fracture of the wrist, a sling for an arm, or simply a clean gauze dressing to cover a cut or abrasion.

Rest: In many cases, injuries will require rest they heal, or receives additional assessment. For example if an ankle is sprained in a game, and the player is unable to run, jump and perform skills required for the game, then a period of rest from the sport is required as part of the healing, rehab and recovery process. Rest qualifies as time away from a particular activity to permit recovery. However “rest” DOES NOT mean doing nothing, the term active rest is perhaps more appropriae, in many cases the sooner you get an injury moving (limited by pain) the sooner you can begin an effective rehabilitation program.

Ice: Ice is the body’s friend when dealing with soft tissue injuries like sprains, strains and contusions. When the body sustains an injury to the soft tissue, capillaries are damaged, tissues are stretched or torn, and the the body releases fluids (blood, tissue fluid) into the injured area as the initial response. In many cases the body overreacts and significant swelling and bleeding occur. Excessive swelling can actually delay the recovery and slow the healing process. The goal here is to minimize the swelling, and reduce the pain that follows injury. Cooling of the tissues slows the body’s reaction to the injury. Normally Ice is applied to the area with a thin layer of protection to prevent skin from freezing, for a time period of 10-20 minutes every 2 hours or so. It can be secured with elastic wraps or rolls of thin cellophane wrap. The are many forms of ice or cold applications. I always believed that crushed ice is best, as it conforms well to the body part, is easy to apply. Frozen “blue gel” packs from the freezer at home are very cold, and hold sub zero temperatures longer, creating a greater risk for freezing the skin. Be aware also that Ice directly from your freezer is much colder than ice from your cooler at the field.

Some guidelines to follow when applying ice:

• Time of application can range from 10-15 minutes for thin tissues (ankles), to 20-25 minutes for thicker tissues (quadriceps, hams). Can be applied every 2 hours.
• Use a thin layer of protection between the ice and the skin. Do not overprotect the skin with a thick dry towel, as this insulates the cold too much from the area and no benefit is achieved. A thin damp towel is best.
• Inspect the skin before and after icing.
• Extra protection may be used of bony prominences….areas where bones are just under the skin.
• Special caution should be taken with chemical cold packs from the freezer.
• Ice can be effective for several days after the initial injury, not just the old “24 hrs” that we used to believe.

Compression: Another way to reduce swelling is to apply some form of compression to the injured part. This applies primarily to sprains and strains of the extremities. Remember, reducing swelling means a quicker return to activity. Elastic wraps are normally the most effective way to achieve this compression. The sooner the compression is applied, the more effective it will be. Caution needs to be given to avoid excessive compression which might compromise normal blood flow to an area.

Elevation: This goes hand in hand with compression, and also applies to the extremities. Here we use gravity to slow the flow of fluids to an injured area and therefore reduce the resultant swelling. Elevation, slows the flow of fluids to the injury site, and permits fluids to drain back into the primary circulation of the limb and into the body core.

Following the simple PRICE principal will,  in most cases of soft tissue injury, be the most appropriate immediate injury management strategy to employ until such time the injury is assessed by a professional.

“You want me to do what?!”

As rehab specialists and physiotherapists we often find ourselves with rather bemused looking clients when, during one of their early rehab sessions, we explain that they are going to be walking backwards on the treadmill - uphill. At some point they invariably come up with two common questions… “How?” and “Why?”.

Backpedal (Retrograde Ambulation to use the technical term) is a technique we employ in the rehabilitation of many injuries at Sport Dimensions, as a rehab tool we use it frequently and see great results.

Here we answer the two common questions:

The how?
At Sport Dimensions, we use the Super Treadmill with safety being the paramount concern – a specially designed spotting mechanism, handle bar and mirror are all used for safety; clients are always closely spotted by a Rehabilitation Specialist or physiotherapist. The mirror and Rehabilitation Specialist or physiotherapist also havs an important role in learning correct technique, which can take time to master – especially under fatigue!

Backpedal sessions are structured in sets of 3 repetitions, each repetition normally lasting between 10-15 seconds in duration. Often strength and stability exercises are performed in between sets.

To begin with clients hold on to the handle bar for the entire duration of all backpedal sessions, progressing on to letting go and using their arms in a similar way to that of running.

The why?
Backpedal has been used for rehabilitation of knee injuries in particular in the USA for some time now due to the claims backed up by research that it uses and strengthens lower limb musculature to a far greater extent than that of forward walking at the same speed.

A summary of the research has shown individual Gluteal (bum) muscles to be working up to 94% harder, individual Hamstring muscles to be working up to 170% harder and individual Quadriceps (thigh) muscles working up to 245% harder when walking backwards compared to walking forwards at the same speed and incline.

Backpedal has also been shown to decrease joint loading when compared to walking forwards. Put simply this means that, at a given speed and incline, when walking backwards less percentage of body weight is passed through the joints (particularly the knee) with every step compared to walking forwards. For an injured joint this is clearly of benefit.

In combination, these two factors alone show backpedal to be of great use in rehabilitation – allowing the surrounding muscles to work hard and become stronger whilst not unduly loading the joint.

Finally for anybody who is injured or has undergone surgery is how to maintain a level of fitness until they are in a position to commence normal exercise. Backpedal has an important role here also. Once again studies have shown that at a given speed and incline walking backwards proved harder work cardio-respiratory systems when compared to walking forwards. So much so that backpedal can be used to maintain a good level of fitness through injury.

Of course I love to run! Doesn’t everyone?

Actually…not everyone! I’m not just referring to the people who cant, or don’t want to run, there are an awful lot of us who find running painful and most of the time, quite unpleasant! I have to put up with people talking about the runners high and the benefits of burning fat, feeling confident, having more energy blah, blah, blah, knowing that it hurts every time I have to go out for a run. Did you get that last bit? I’ll just repeat it in case you didn’t get it the first time: “every time I have to” go out for a run. Not want to or like to, no its when my conscious mind forces me to go for a run.

Yes I do get those beneficial feelings…. sometimes, but why does the process of running have to be so damn uncomfortable and painful before I get the benefits?

The reason?

It’s pretty simple really. We don’t know how to run correctly and efficiently, and we don’t know because most of us have never been taught how to run!

We think that all we have to do is buy our sweatyBetty gear, put on the shoes and then “Watch out world the new Paula Radcliffe is on the road! Make way.”

That would be nice, but the reality is that most runners believe that they need to pay with pain for their love of running, that’s the payback for all the benefits!! Over 65% of runners get injured every year which stops them from training and a vast majority of non-runners give up after 2-3 runs because of the painful experience!

I have news for you: “It doesn’t have to be like that!!”

Most of the injuries that runners get are because of landing shock. The running style that many novice runners and many seasoned recreational athletes adopt is very inefficient biomechanically and causes stresses and strains on the body. That is understandable because they haven’t been taught how to run.

Running and running fast is a skill and just like any other skill it can be taught and through using some basic techniques you too can get enjoyment out of running.

I watch people run sometimes and it’s really painful just watching, so you can imagine what they are feeling. The amount of energy most of us put into our running technique just to get ourselves forward a few paces is not paying dividends!

There are a few common weaknesses many runners share: Too much bouncing which leads to spending longer in the air, the longer you are in the air the higher you move your body mass and the harder you hit the ground on landing. This is wasted momentum, when we need to be moving forward. The stride length is too long which means with every step we are applying the breaks to the back of the heel or onto the front of the foot, it’s a bit like riding a bike and applying the front break every rotation! The arms are rotating form side to side which puts pressure on to the lower back.

These are small inefficiencies, but when they are applied 10,000 times over a 30 minute period, it means you have a very tired runner, who wastes all their energy moving vertically rather than horizontally and more importantly it can cause many little injuries which in time can develop to more serious injuries.

Ok so how can we run better and avoid injury?

The most efficient running motion is when the body has very little up and down movement ( minimise bouncing) the arms are moving relaxed, but like mini pistons backwards and forwards and the legs are cycling with the heel coming up above knee when it is off the ground.

Feet: The feet should be landing under your body (centre of gravity) not ahead of your body, any landing further ahead and you are over striding, which causes a breaking action.

Landing: You must land lightly on your feet. The best and most efficient way is to land on the balls of your feet, not on your heel. But this is not for everyone and if you are a heel toe runner then practice landing lighter on the ground and minimise the time you are on the ground. If you want o change to running on the balls of the feet( that’s without touching the heel down first ) then you need to practice 10 minutes at a time to get used to it.

Lower Leg Cycling motion: When your foot leaves the ground bring your heel up to towards your backside to contract the hamstring (the back of your leg) and your gluteus maximus (you bum muscles). This creates a cycling motion and will mean you shorten your stride length.

Arms: The coordination of the arms with the legs is the one that will eliminate the bounce and get you moving forward rather than upwards. The arms should be bent at the elbow at about 90 degrees and the movement should be back and forward. The fingers should be closed but relaxed (like you are holding an egg) the hand should be moving to the chin and the hip.

These are not instant fixes, but you can change your running technique and run more efficiently through practice. It should take about 5 or 6 45 minute sessions to change your technique. Try incorporating one change at a time and then at the next training session make another change until it becomes fluid.

Millions of people use running to keep fit, to reduce the stresses of everyday life and to help them to achieve their sporting ambitions. Irrespective of the level you run, whether you are a recreational runner who runs to keep fit, a serious amateur who likes to participate in races, or an elite athlete, who competes at the highest level you can always improve your running technique.